Department of Emergency Medicine, Summa Health System, Akron, Ohio.
J Emerg Med. 2023 Jul;65(1):e23-e26. doi: 10.1016/j.jemermed.2023.04.002. Epub 2023 Apr 14.
Lyme disease is one of the most common vector-borne illnesses in the United States. It is caused by Borrelia burgdorferi infection transmitted via the Ixodes tick. Rarely, it can progress to early disseminated Lyme disease with cardiac or neurologic manifestations, or both.
A 41-year-old previously healthy man presented to the emergency department (ED) by ambulance after an episode of syncope. Electrocardiogram revealed right bundle branch block with borderline first-degree atrioventricular nodal block. During his admission he was noted to have night sweats and elevated procalcitonin. Infectious workup revealed positive Borrelia enzyme-linked immunosorbent assay. Further testing revealed positive Borrelia immunoglobulin M with negative immunoglobulin G, indicating a recent infection. Why should an emergency physician be aware of this? Lyme disease should be on the differential for patients presenting with vague, flu-like symptoms in the summer months in endemic areas. Treatment of early Lyme disease with doxycycline can prevent progression to secondary Lyme, which can present as a true cardiac or neurologic emergency.
莱姆病是美国最常见的虫媒病之一。它是由伯氏疏螺旋体感染通过伊蚊传播引起的。很少见的情况下，它会进展为早期播散性莱姆病，伴有心脏或神经系统表现，或两者兼有。
一名 41 岁的既往健康男性在晕厥发作后由救护车送往急诊科。心电图显示右束支传导阻滞伴临界一度房室结阻滞。在他住院期间，他出现夜间盗汗和降钙素原升高。感染性检查显示伯氏螺旋体酶联免疫吸附试验阳性。进一步的检查显示伯氏免疫球蛋白 M 阳性，免疫球蛋白 G 阴性，表明近期感染。为什么急诊医生应该知道这一点？对于在流行地区夏季出现模糊、流感样症状的患者，莱姆病应列入鉴别诊断。用多西环素治疗早期莱姆病可以防止进展为二级莱姆病，二级莱姆病可表现为真正的心脏或神经系统急症。
