0071643192.pdf

INFECTIOUS DISEASE

DIFFERENTIAL

Enteroviral diseases, aseptic meningitis, acute rheumatic fever, encephalitis,
multiple sclerosis, rheumatoid arthritis, Reiter syndrome

DIAGNOSIS

■ Summer visit to endemic area +suggestive clinical symptoms (eg, rash,
meningitis)
■ CSF:↑Lymphs,↑protein, normal glucose
■ Definitive diagnosis: Serum/CSF serologies
■ Frequent false-positives
■ Requires two positive tests

SYMPTOMATICTREATMENT

■ For treatment regimens see Table 8.12.

FIGURE 8.2. Erythema migrans. Spreading redness with central clearing in patient with
Lyme disease.

(Reproduced, with permission, from Rudolph CD et al.Rudolph’s Pediatrics,21st ed.
New York: McGraw-Hil1, 2003: Color Plate 22.)

TABLE 8.12. Lyme Disease Treatment Regimens

STAGI NG TREATMENTa

Early localized Doxycycline ×21 days

Early disseminated (arthritis) Doxycycline ×30 days

Early disseminated (neurologic) Doxycycline ×21 days (if isolated CN palsy)

or

Ceftriaxone IV at meningitic doses (all others)

Early disseminated (cardiac) Doxycycline ×21 days (if first-degree AV block)

or

Ceftriaxone IV at meningitic doses (all others)

aSubstitute amoxicillin for doxycycline in children <8 years old.