Nadelman and Wormser listed clinical findings which can help distinguish reinfection from relapse for a patient with Lyme Disease. The authors are from New York Medical College in Valhalla.
Parameter
Finding Favoring Relapse
Finding Favoring Reinfection
antibiotic therapy of original episode
inappropriate choice, inadequate dose, poor compliance
appropriate choice, adequate dose, good compliance
recent tick bite in an endemic area
no
yes, followed by erythema migrans
timing relative to original episode
within a few weeks or months
>= 12 months afterwards
site of erythema migrans
same as original episode
different
punctum in center of erythema migrans
absent
present
where:
• A patient with a first episode of Lyme Disease may develop multiple foci of erythema migrans if there is hematogenous spread.
• A punctum is a small depressed or raised focus where the tick attached.
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Specialty: Infectious Diseases
ICD-10: ,
