Lyme DiseaseCase StudyA 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaintsof headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’ssymptoms began shortly after a camping vacation. He recalled a bug bite and rash on histhigh immediately after the trip. The following studies were ordered:Studies ResultsLyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi(normal: low)Erythrocyte sedimentation rate(ESR),30 mm/hour (normal: ≤15 mm/hour)Aspartate aminotransferase(AST),32 units/L (normal: 8-20 units/L)Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL)Hematocrit (Hct), 36% (normal: 42%-52%)Rheumatoid factor (RF), Negative (normal: negative)Antinuclear antibodies (ANA), Negative (normal: negative)Diagnostic AnalysisBased on the patient’s history of camping in the woods and an insect bite and rash on thethigh, Lyme disease was suspected. Early in the course of this disease, testing for specificimmunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosingLyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seenearly in this disease. RF and ANA abnormalities are usually absent.Critical Thinking Questions1. What is the cardinal sign of Lyme disease? (always on the boards) 2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 3. Why was the ESR elevated? 4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.
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