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Lyme Disease: Multisystem Involvement and Organ-Specific Manifestations

Stages and Organ Tropism

  1. Early localized (3–30 days): Erythema migrans (EM) at bite site – skin only.
  2. Early disseminated (weeks–months): Hematogenous spread → multiple EM, cranial nerve palsies (VII), meningitis, radiculoneuritis, carditis (AV block), migratory arthralgias.
  3. Late disseminated (months–years):
    • Joints: Lyme arthritis (large joints, especially knee) – oligoarticular, intermittent.
    • Nervous system: Encephalopathy, polyneuropathy, leukoencephalitis.
    • Skin: Acrodermatitis chronica atrophicans (ACA) – extremities, atrophy.
    • Eye: Uveitis, keratitis, optic neuritis.

Diagnosis

Two-tier serology (EIA/IFA → Western blot) + clinical correlation. PCR of CSF/synovial fluid in neuro/arthritic Lyme.

Treatment

  • Early: Doxycycline 100 mg BID × 10–14 days (amoxicillin/cefuroxime alternatives).
  • Neurologic/cardiac: IV ceftriaxone 2 g daily × 14–28 days.
  • Late arthritis: Oral × 28 days; may need repeat or IV if refractory.

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