185.2 📚 國考版

185.2.0.1 必背 — Vector

• Ixodes hard tick (NOT Ornithodoros soft tick — that’s TBRF Ch 184)
• Nymph stage main biter (May-July)
• Attach ≥ 36-48 hr to transmit Lyme

185.2.0.2 必背 — 3 Stages

1. Early Localized: EM at bite site
2. Early Disseminated: multiple EM, carditis (AVB), neuroborreliosis (CN VII palsy, meningitis, radiculitis)
3. Late: arthritis (knee), late neuro, ACA (Europe)

185.2.0.3 必背 — Dx

• EM = clinical dx (don’t need serology)
• 2-tier serology (EIA + Western blot or 2 EIAs)
• PCR synovial fluid / CSF / skin

185.2.0.4 必背 — Treatment

Form	Tx
Early / EM	Doxy 100 bid × 10-14d
Carditis severe	Ceftriaxone IV × 14-21d
Neuroborreliosis	Ceftriaxone IV × 14-21d (or doxy PO if mild facial palsy)
Arthritis	Doxy × 28d
Post-bite prophylaxis	Doxy 200 PO × 1 within 72 hr

185.2.0.5 必背 — Bilateral CN VII palsy → 考 Lyme + sarcoid + GBS

185.2.0.6 必背 — PTLDS

• 5-15% post-treatment persistent sx
• Not active infection — supportive care
• Prolonged antibiotic NO benefit

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