June 2020

The Generalist: Lyme Disease Part 1


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Saul N. -

Thank you for discussing this topic. You mention testing. If a patient presents with meningitis in a Lyme endemic area could you comment on what Lyme specific labs we should be ordering on CSF, and interpretation of CSF lab testing? On whom would you selectively perform a lumbar puncture AND test for Lyme disease if the patient presents with general symptoms of meningitis? Would you obtain CSF if a patient presents with undifferentiated encephalopathy in a Lyme endemic area? Thank you again!

Heidi J., MD -

Thanks for your question, Saul. Here's Chris Drumm's reply:

Lyme meningitis presents similarly to viral meningitis. It can be difficult to tell the difference. The presence of cranial neuropathy helps point towards Lyme as the cause. We order a serum Lyme test here for all patients with a CSF looking like viral meningitis. The CSF often has moderately elevated protein and modest pleocytosis. The CSF can be sent for antibodies for Borrelia however the sensitivity is not clear. CSF is sent for cell count, protein and glucose concentrations, gram stain and culture. But my hospital will almost always include a serum Lyme testing and correlate clinically. We do not routinely do CSF antibody testing at this time. We do often include HSV and west Nile though.
I hope you have a tick free summer.

Chris Drumm

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ROP 2020 June Full episode audio for MD edition 116:04 min - 55 MB - M4AROP 2020 06 June Individual MP3s 144 MB - ZIPROP 2020 06 June Written Summary 597 KB - PDF