Fast Five Quiz: Tick Bites

Michael Stuart Bronze, MD


March 11, 2022

Guidelines from the IDSA, AAN, and ACR suggest that patients with plausible exposure to ticks who present with one or more of the following acute disorders should be tested for Lyme disease:

  • Meningitis

  • Painful radiculoneuritis

  • Mononeuropathy multiplex, including confluent mononeuropathy multiplex

  • Acute cranial neuropathies (particularly VII, VIII, less commonly III, V, VI and others)

  • Evidence of spinal cord (or rarely brain) inflammation, the former particularly in association with painful radiculitis involving related spinal cord segments

Clinical diagnosis is recommended over laboratory testing for patients with potential tick exposure in a Lyme disease–endemic area who have one or more skin lesions compatible with erythema migrans. When assessing patients for possible Lyme neuroborreliosis involving either the peripheral or central nervous system, serum antibody testing is recommended over PCR or culture of either cerebrospinal fluid or serum.

The IDSA, AAN, and ACR recommend against routine testing for Lyme disease in adult patients with psychiatric illness, as well as children with developmental, behavioral, or psychiatric disorders.

Learn more about the workup of Lyme disease.


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