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萊姆病 (Lyme disease)
- 病原 Borrelia burgdorferi 包氏疏螺旋體
也是一種螺旋體 (疏螺旋體), 為具雙層膜結構的細菌
- 台灣近年病例均為境外移入, 移入病例以美國最多
- TOCC 為旅行加上野外踏青 (世界地圖, 美國地圖)
- 傳染途徑為硬蜱 (Tick, 俗稱壁蝨) 叮咬, 大小肉眼約略可見
蜱會把頭鑽入皮膚吸血, 很慢且不會痛, 吸飽後會長大
- 症狀為微燒及非特異性症狀
頭痛, 發燒, 全身疲勞, 寒顫, 噁心嘔吐, 頭部僵硬, 肌肉疼痛及淋巴腫脹
Fever, chills, fatigue, myalgias, arthralgias, and lymphadenopathy
Consider Lyme disease as the causative agent in patients who have
facial palsy with erythema migrans, tick bite, or arthritis.
Some patients will have bilateral facial palsy.
Multifocal Lyme polyradiculopathy
CSF : Mononuclear pleocytosis typical of Lyme infection
第一期 :
約八成會有獨特的 慢性遊走性紅斑 (Erythema migrans)
被蜱叮咬後 3 - 30日出現 (平均 7 日)
直徑常大於5公分, 不會自行消失, 和蕁麻疹不同, 局部灼熱, 可能不痛不癢
此紅斑會逐漸擴散而成牛眼狀, 皮疹多在 3-4週 後消退
Facial palsy can also occur along with the initial rash of erythema migrans
第二期 :
Few days to months of the initial infection
Fever, adenopathy, neuropathies, cardiac abnormalities,
arthritic complaints, and skin lesions.
無菌性腦膜炎, 神經 (Bell's palsy), 心肌炎, AV block
Facial nerve palsies in Lyme disease represent the secondary stage
第三期 :
Years after the initial infection
Chronic arthritis, myocarditis, subacute encephalopathy,
axonal polyneuropathy, and leukoencephalopathy
慢性關節炎, 腦病變
Treatment of Lyme disease is with doxycycline (preferred agent) or amoxicillin.
Neurologic symptoms or persistent other manifestations require ceftriaxone therapy
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