A Rash Decision - A case study on Lyme Disease
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Canterbury Health Laboratories A RASH DECISION Rebecca Dew BSc, Grad Dip Sci Serology/Virology
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Rebecca Dew, Medical Laboratory Scientist at Canterbury Health Laboratories presented this case study on Lyme Disease at the NZIMLS South Island Seminar in Hokitika in April 2013
Transcript of A Rash Decision - A case study on Lyme Disease
Canterbury Health Laboratories
A RASH DECISION
Rebecca Dew BSc, Grad Dip SciSerology/Virology
Canterbury Health Laboratories
Presenting Complaint
• 60 year old man• Originally from Scotland• 5-6 year history of a slowly extending rash• No foreign travel
Canterbury Health Laboratories
Presenting Complaint
• Right arm• Thickening over elbow
Canterbury Health Laboratories
Early Infection
• Bluish/red discolouration with swelling• Extensor surfaces hands and feet• Unilateral
Canterbury Health Laboratories
Over the Years
• Extends over months to years• Oedema resolves as atrophy develops• Prominent underlying veins
Canterbury Health Laboratories
Late Infection
• Fibrous induration/ nodules over bony prominences• Sclerotic lesions can cause peripheral nerve or joint
damage
Canterbury Health Laboratories
Histology
• Acrodermatitis chronica atrophicans
Canterbury Health Laboratories
To Recap……
• Deer farmer in the Highlands of Scotland• What’s your answer?
Canterbury Health Laboratories
Lyme Disease
• Positive Lyme serology• Western Blot
– 3 bands to Borrelia burgdorferi– 7 bands to B. afzelii
• No identified tick bite• Known cases among
co-workers
Canterbury Health Laboratories
Castor Bean Tick
• Ixodes ricinus– B. burgdorferi– B. afzelii– B. garinii
Canterbury Health Laboratories
Symptoms and Clinical Features
• Tick bite• “Bulls-eye” rash• Multiple and chronic multisystem complications
– Arthritis
• Neuroboreliosis
Canterbury Health Laboratories
Reported Cases of Lyme Disease by Year, United States, 2002-2011
Centre for Disease Control and Prevention
Canterbury Health Laboratories
Treatment
• Antibiotics - Generally, recovery will be quicker and more complete the sooner treatment begins
• Oral antibiotics - early-stage Lyme disease
– Doxycycline for adults and children older than 8, or amoxicillin or cefuroxime for adults, younger children, and pregnant or breast-feeding women
• Intravenous antibiotics - CNS involvement.
Canterbury Health Laboratories
Prevention
• Long sleeves and long pants
• DEET
• Check, check and check again…….
• Vaccination???
Canterbury Health Laboratories
And to finish….
• Dr Richard Clinghan
• Dr Sophie Wen
