185.4 📌 章末速蚘

  • Lyme = Ixodes (hard tick, attaches ≥ 36-48 hr)
  • EM at bite site = early sign; clinical dx (no serology needed)
  • Early disseminated: multiple EM, carditis (AVB), neuroborreliosis (CN VII!)
  • Late: knee arthritis (USA), ACA (Europe)
  • Tx: doxy 100 bid × 14d (early), ceftriaxone IV × 14-21d (carditis severe, neuro), doxy × 28d (arthritis)
  • Prophylaxis: doxy 200 PO × 1 within 72 hr (Ixodes ≥ 36 hr endemic)
  • PTLDS 5-15% — not active infection, supportive
  • VLA15 vaccine Phase 3 (Pfizer/Valneva) anticipated 2026+
  • Co-infection: Anaplasma, Babesia, Powassan, B. miyamotoi (same tick)
  • Bilateral CN VII → 考 Lyme + sarcoid + GBS