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Pathophysiology
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
i – Borrelia burgdorferi is a bacterium that causes Lyme disease. It is transmitted by ticks and presents with erythema chronicum migrans (expanding ‘bullseye’ red rash) and flu-like symptoms in its initial stages. In its later stages, patients may experience a migratory polyarthritis and bilateral Bell’s palsy. Doxycycline, which is a tetracycline, is indicated for the treatment of Lyme disease.15
Infectious disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Borreliosis: Lyme disease (Borrelia burgdorferi) is spread by Ixodes ticks common in woodland areas where there are deer and sheep. Characteristic rash (erythema chronicum migrans) can be followed by a second phase with cardiac and neurological features, e.g. myocarditis, meningitis, cranial nerve palsies (e.g. seventh). Arthritis may occur late.
Answers
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Lyme disease is caused by the spirochete bacterium Borrelia burgdorferi. B. burgdorferi is transferred to humans via the hard tick Ixodes dammini, which feeds on animals infected with the bacterium. Introduction of the bacterium into the human bloodstream via tick saliva occurs during a tick bite. Patients may recall this tick bite and the resultant macular lesion that appears at the site of the bite. This lesion then expands over the course of a week and develops into the characteristic rash of Lyme disease: erythema chronicum migrans. While this is occurring the patient may suffer from a prodromal phase in which there is fever and general malaise. The appearance of the typical rash should raise suspicions and trigger appropriate investigations that may include serology (to look for antibodies against the bacterium) and culture from appropriate fluid or tissue. Untreated, there is a significant risk of developing the late manifestations of Lyme disease, which include neurological abnormalities (e.g. meningitis, cranial neuropathy, peripheral neuropathy), heart disease (e.g. myocarditis, pericarditis, atrioventricular block) and rheumatological disease such as arthritis and fatigue. Rarely, the eyes, liver, spleen and testicles may also be involved. Doxycycline is the first-choice antibiotic. Summer forest walkers should be advised to cover up well and remove attached ticks promptly. Q fever is another bacterial zoonosis caused by the bacterium Coxiella burnetii.
Breast implant causes allergic contact dermatitis or foreign body reaction?
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Hilde M. Bosker, Jorrit B. Terra, Martin M. Stenekes
Our differential diagnosis consisted of erythema chronicum migrans, morphea, allergic contact dermatitis and a granulomatous (foreign body) reaction. An ultrasound showed nothing unusual. Laboratory results showed e.g. erythrocyte sedimentation rate (ESR; 40), Hb (8.4), leukocytes (6.4) and alanine aminotransferase (ALAT; 19). The biopsy showed a superficial and deep perivascular dermatitis consisting of mainly lymphocytes and plasma cells (see Figure 2). The polymerase chain reaction (PCR) on the fresh biopsy was negative for Borrelia as was Borrelia serology. Furthermore, the safety sheets (SDS) of the permanent tissue expander were requested and patch tests were performed with our extended European Baseline series, cosmetics series, fragrance series, metal series, plastic glues series and the acrylates series. The patient only reacted positive to hydroperoxides of limonene which was considered to be irrelevant.