小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 游走性红斑
- 全身性症状
其他诊断因素
- 面神经麻痹
- 关节炎或者关节痛
- 局部淋巴结肿大变
- 颈强直
- 皮肤淋巴细胞瘤
- 慢性萎缩性肢皮炎
- 房室 (AV) 传导阻滞或者心肌心包炎
- 神经根神经病
- 脑脊髓膜炎、外周神经病变或脑病
危险因素
- 接触携带螺旋体的蜱虫
- 户外活动
- 蜱叮咬的持续时间
诊断性检查
首要检查
- 酶联免疫法或免疫荧光检测
需考虑的检查
- 莱姆病特异性 IgM 和 IgG（免疫印迹试验）
- 皮肤活检培养
- 聚合酶链反应 (PCR)
- 心电图 (ECG)
治疗流程
明确蜱虫叮咬史
游走性红斑
心脏受累
神经系统疾病
关节炎
复发性或持续性关节炎
撰稿人
作者
Janak Koirala, MD, MPH, FACP, FIDSA
Professor of Medicine and Infectious Diseases
Division of Infectious Diseases
Southern Illinois University School of Medicine
Springfield
IL
利益声明
JK declares that he has no competing interests.
鸣谢
Dr Janak Koirala would like to gratefully acknowledge Dr Tin Han Htwe and Dr Cristian A. Spiel, previous contributors to this topic.
利益声明
THH and CAS declare that they have no competing interests.
同行评议者
Raymond J. Dattwyler, MD
Professor of Medicine and Microbiology/Immunology
Chief of Allergy, Immunology and Rheumatology
New York Medical College
Valhalla
NY
利益声明
RJD declares that he has no competing interests.
Ionita Catalina, MD
Assistant Professor of Neurology and Neurosurgery
SUNY at Buffalo
Stroke/Neurocritical Care
Millard Fillmore Gates Hospital - Kaleida Stroke Center
Buffalo
NY
利益声明
IC declares that she has no competing interests.
Graham Fry, MB, FRCSI, DTM&H
Lecturer in Tropical Medicine
University College Dublin
Medical Director
Tropical Medical Bureau
Ireland
利益声明
GF declares that he has no competing interests.
Andras Lakos, MD, PhD
Physician
Centre for Tick-Borne Diseases
Budapest
Hungary
利益声明
AL is an author of a reference cited in this topic.
鉴别诊断
- 蜱虫叮咬后过敏反应
- 蜂窝织炎
- 多形性红斑
更多 鉴别诊断指南
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