Joint Infection| Spirochete (lyme)

Risk Factors

  • Hx living in area endemic w/lyme→ Northeast, WI/MN, Northern Calif
  • Occurs secondary to tick bite x 24-48h
  • Walking in an endemic area wearing shorts, t-shirts and not using tick repellent (e.g. DEET containing products)

Symptoms

  • Early localized disease (within 3-30 d of bite): bull's eye type rash→ erythema migrans
  • Early disseminated disease (within 3-30d): fever, chills, adenopathy, arthralgias, brief mono-articular arthritis, bells palsy (or other CN dysfunction), headache (aseptic meningitis), peripheral neuropathy (pain, weakness), carditis (heart block)
  • Late disseminated disease (weeks-to-months-to-years after infection): occurs in < 10% of infections; joint inflammation and pain, large joints (e.g. knee), can wax/wane; peripheral neuropathy; memory loss

Physical Exam Findings

  • For late disseminated disease: large joint pain (e.g. knee), swelling, effusion

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