Lyme Disease in Pregnancy… What’s the deal?
Lyme disease can become serious if left untreated, so how should I manage a pregnant woman who thinks she might have contracted it?
Step 1: Review how Lyme disease is contracted & presents
- Lyme disease is transmitted by tick bites (some ixodid ticks harbor the infective bacterium Borrelia burgdorferi) and the risk is ONLY significant when the tick remains attached to the body for 40-70 hours and is engorged (i.e. puffed up from having a tasty blood meal) at the time of removal. Freely moving tick over the body (aka, it’s crawling & not attached/feeding) means low chances of infection.
- After the blood meal and a (3-30 days post-tick bite) incubation period, Lyme disease will present with a red, expanding rash called erythema migrans (EM) in 70-80% of patients.
- The next stage is a more disseminated disease which may present as: more “EM lesions in other areas of the body, Facial or Bell’s palsy (loss of muscle tone on one or both sides of the face), Severe headaches and neck stiffness due to meningitis (inflammation of the spinal cord), Pain and swelling in the large joints (such as knees), Shooting pains that may interfere with sleep, and Heart palpitations and dizziness due to changes in heartbeat” (www.cdc.gov/lyme/signs_symptoms/index.html).
- Later stages have a more chronic presentation & can mimic other diseases like arthritis, so it’s better to catch it early! :)
Step 2: Perform a good history & physical
- Ask about exposure: did they remove a freely-moving tick, a recent bite, or an engorged tick? If they have had tick contact but it was not the 3rd type (& NO rash), then it is best to send the patient home without any prophylaxis and reminded them to return, if they observe a change in their health or observe an area or redness around the site of tick bite.
- Check for a rash (see step 1) & ask about any later-stage symptoms. (Take note that transient redness at the site of tick bite is due to reaction of saliva… Don’t confuse this with erythema migrans!!)
Step 3: If there has been exposure & the patient is pregnant
- Offer treatment with IV amoxicillin, if there is evidence of disease (see step 1 & 2)
- Offer prophylactic treatment with amoxicillin if the patient is low risk (no EM, no engorged tick removal) & the patient exhibits increased anxiety about the disease. NB (i.e. important note): I have read different sources on this issue of prophylactic treatment for pregnant women… So, at this point I would consult your doc/hospitals protocols…
- Remember: Pregnant patients have an equal infective risk as non-pregnant patients. That is, being pregnant does not make a patient more likely to be infected.
Picture: which tick do you think just had a tasty meal of blood…
Read more about Lyme disease here: (www.cdc.gov/lyme)