Know that antibiotic prophylaxis of deer tick bites is not recommended. Be aware of the clinical stages of Lyme disease (LD) and the appropriate laboratory evaluation and treatment associated with each stage
Michael Clemmens MD
What to Do – Gather Appropriate Data, Interpret the Data, Make a Decision
LD is caused by the spirochete Borrelia burgdorferi, which is transmitted by the bite of the deer tick. It is endemic in the Northeast, the mid-Atlantic states, the upper Midwest, and in parts of southern California. Because interstate travel is so common, however, LD can be seen in any state. Not all deer tick bites lead to LD. The deer tick must remain attached for at least 48 hours and become engorged before it can transmit the spirochete. Because the tick falls off of its host when fully engorged, transmission of the spirochete may not occur and the tick bite often goes undetected.
The clinical course of LD is divided into three stages: early localized, early disseminated, and late. The cardinal manifestation of early localized disease is an erythema migrans (EM) rash, which classically looks like a target with concentric erythematous rings. Although constitutional symptoms occasionally occur, the presence of an EM rash is all that is required to make a diagnosis of early localized LD. Early disseminated disease manifests as multiple EM lesions, meningitis, facial nerve palsy, or heart block. Acute and chronic arthritis are the major manifestations of late disease in children. Of note, both early disseminated and late disease may occur without an antecedent history of erythema migrans.

Stay updated, free articles. Join our Telegram channel

Full access? Get Clinical Tree

