Question

Nick, a 39-year-old was in good health until mid-July when he developed myalgias and fever. These symptoms resolved. Two weeks prior to the evaluation, he developed large, erythematous, annual rashes on his left forearm, right hip, and left knee. Nick subsequently developed a left facial (cranial nerve VII) palsy. His past history is notable only for travel to the northeast United Stated (Connecticut) prior to the onset of his symptoms. On physical examination, Nick is afebrile with normal vital signs. A skin examination demonstrates the three lesions previously noted which had, according to the patient, faded considerably. A neurological examination demonstrates left facial nerve weakness. Lab studies include a normal CBC. A lumbar puncture is preformed. His CSF contains 78 nucleated cells/mm^3 with 88% lymphocytes and 12% monocytes. Nick's CSF glucose is 60 mg/dl, and the protein level is 55mg/dl. The clinical diagnosis is confirmed serologically. 18. What is the etiologic agent of Nick's infection? Which signs and symptoms were important clues? 19. What is the significance of Nick's travel history and the time of year he was infected? 20. How is this infection acquired (be specific!)?

Answer 1

What is the etiological agent of the Nick's infection? Which signs and symptoms are important clues?

• The cause of the disease is the bite of an adult deer tick.
• The disease caused due to bite of deer tick is called as Lyme disease.
• Lyme disease is caused by the species Borrelia bacteria.
• The first sign of infection is the redness rash at the site of bite known as erythema migrans.

What is the significance of the Nick's travel History and the time of year he was infected?

• Nick was infected with lyme disease after mid-July. The infection is most commonly seen during early summer and in spring. He had travelled to Connecticut of Northeast US which is highly prone to lyme disease.

How is this infection acquired?

Through deer tick bite only the disease gets acquired and it won’t get spread from a human to other human.