Question

An 18 year-old woman comes to a clinic and reports that two weeks ago she visited Cape Cod for a picnic. Now she has a large, red, circular lesion on her upper thigh. She doesn’t remember being bitten by an insect or having any injury. She also reports fatigue and has some muscle pain.

Questions:

1. Could this patient have an infectious disease?

2. What laboratory tests could be performed to support a diagnosis?

3. What laboratory tests could be performed to confirm a diagnosis?

Answer 1

1.Yes, it is suspected that the patient is infected with lyme disease caused by spirochetal infection caused by the bite of an infected deer tick. Most U. S cases occur in three endemic areas, along the northeastern coast from Maryland to Massachusetts;in the midwestern states of Wisconsin and Minnesota snd slong the North western coast of California and Oregon.

2.A diagnosis of Lyme disease is often based on clinical manifestation, in particular the erythema migrans lesion and a history of exposure in an endemic area. CBC and ESR results are usually normal.

3.Lyme serology tests for antibodies may be falsely negative in early disease but are reliable for diagnosis in later disease. CSF should be examined in individuals with neurologic involvement.