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A 25-year-old primigravida, who is 12 weeks pregnant and lives in Pennsylvania, comes to the doctor™ s office after having found a tick on her left arm 3 days ago. She is extremely anxious about acquiring Lyme's disease. She is afraid that her baby will be adversely affected. She never acquired Lyme's disease before, though she lives in an endemic area. She states that the tick was small and was walking on her lower arm when she removed it. She further recalls that she walked through the woods a few hours earlier, when she discovered the tick. She is asymptomatic and there is no rash on her arm. What is the most appropriate next step in the management of this patient?
A. Draw her blood and send it for serology
B. Observe her for possible infection
C. Giver her oral amoxicillin
D. Reassure her that that there is absolutely no risk of infection
E. Give her vaccine for Lyme's disease
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Explanation: ans ddd
Tick bite is not treated prophylactically even in high-risk patients. Risk of getting Lyme's disease is significant when the tick remains attached to the body for 40-70 hours and is engorged at the time of removal. Freely moving tick over the body means low chances of infection. Patients are sent back without any prophylaxis and reminded to call to the physician if they observe a change in their health or observe an area or redness around the site of tick bite. Transient redness at the site of tick bite is just due to reaction of saliva and should not be confused with erythema migrans. Prophylactic treatment with amoxicillin is considered when tick bite occurs in a pregnant female. Pregnant females are given prophylactic treatment just because of increased anxiety, though they carry the same risk of infection as non-pregnant patients. Drawing blood for serology at this stage is highly inappropriate as she has no clinical disease and serology will be negative. Vaccination is considered for those people who live or work in moderate to high-risk areas and are frequently exposed to tick.
Vaccine may be given in pregnancy. Vaccination may be given in the above patient but it will not address her current problem of exceptional anxiety that requires the use of prophylactic amoxicillin.
Educational Objective:
Lyme disease prophylaxis is given in pregnant patients who have history of tick bite and have anxiety about acquiring disease.
