185.3 🩺 內科專科考前版

185.3.0.1 1⃣ Geographic Differences

Region Pathogen Distinct Features
N America B. burgdorferi ss Arthritis predominant
Europe B. afzelii, B. garinii ACA (afzelii), neuroborreliosis (garinii)
Russia / Asia B. garinii, B. afzelii, B. bavariensis Bannwarth syndrome (garinii)

185.3.0.2 2⃣ Lyme Carditis Acute Management

  • ECG: PR interval > 300 ms = warning
  • Hospitalize if 3° AVB, sx, structural heart disease
  • IV ceftriaxone → PO transition when stable
  • Temporary pacing if hemodynamically unstable; permanent pacemaker rarely needed
  • Resolves with antibiotics 1-2 wk

185.3.0.3 3⃣ Bilateral CN VII Palsy Workup

  • Lyme #1 cause in endemic area
  • Differential: sarcoidosis, GBS, HIV, leukemia/lymphoma, brainstem stroke
  • LP if suspicion neuroborreliosis (CSF pleocytosis)

185.3.0.4 4⃣ Antibiotic-Refractory Lyme Arthritis

  • 10% post-treatment fail
  • HLA-DR4 / HLA-DR2 association
  • Autoimmune mechanism — molecular mimicry
  • DMARD: hydroxychloroquine, methotrexate
  • Intra-articular steroid
  • Anti-TNF in some cases
  • Synovectomy rare

185.3.0.5 5⃣ PTLDS Patient Management

  • Acknowledge sx are real
  • Reassure not active infection (no benefit prolonged antibiotic + risks of long-term tx)
  • Address symptoms: pain (gabapentin, duloxetine), fatigue (CBT, graded exercise), sleep
  • Cognitive: cognitive rehab, screen depression / anxiety
  • Counseling + patient education

185.3.0.6 6⃣ Co-Infections

  • Ixodes ticks can also carry:
    • Anaplasma phagocytophilum
    • Babesia microti
    • Powassan virus
    • B. miyamotoi
  • Co-infection presentations: more severe / atypical sx
  • Tick-borne disease panel PCR

185.3.0.7 7⃣ Tick Removal Technique

  • Fine tweezers / tick remover
  • Grasp at skin level, pull straight up
  • Don’t twist (mouth parts retain)
  • Don’t burn / squeeze
  • Save tick for ID if needed

185.3.0.8 8⃣ VLA15 Vaccine Pipeline

  • Phase 3 (2023-2025)
  • 2 dose primary + boost annual
  • OspA 6 antigens across species
  • Pediatric ≥ 5 yr + adult
  • Anticipated approval 2026+
  • Will be major endemic area intervention

185.3.0.9 9⃣ 健保 / Taiwan

  • Endemic risk low Taiwan (few I. ovatus cases reported)
  • Imported cases in returning travelers
  • 健保 doxy / amox / ceftriaxone covered