A 10-year-old boy presents to the emergency department with a 3-day history of high fever (39.5°C), headache, and muscle aches. His parents report he was camping in North Carolina a week ago. On exam, you note a faint macular rash on his wrists and ankles. Question: What is the most likely causative agent of this patient’s suspected Rocky Mountain Spotted Fever?
A 45-year-old woman was treated for early-stage Lyme disease with a standard 14-day course of doxycycline. Several months later, she reports persistent fatigue, diffuse musculoskeletal pain, and cognitive difficulties, despite no evidence of active infection upon evaluation. Which of the following is the most appropriate management approach for her current condition?
A 10-year-old boy is brought to the clinic after developing a rash on his right thigh. The rash began 5 days ago and has gradually expanded. The boy reports no fever, joint pain, or other systemic symptoms. His medical history is unremarkable, but his parents mention they recently returned from a family hiking trip in the northeastern United States. Physical examination reveals a large, annular rash with central clearing and a red, advancing edge. Which of the following is the most appropriate treatment?
A 42-year-old woman presents to the clinic because she is concerned about Lyme disease. She recalls a tick bite about one month ago while working in a wooded area. Which symptom is not typically associated with early-stage Lyme disease?
A patient planning to hike in Connecticut asks which tick is the primary vector for Lyme disease in North America. Which tick should they be most concerned about?
A 32-year-old woman at 20 weeks gestation presents with a history of a recent tick bite. She reports a new onset of fatigue, intermittent fevers, and a characteristic “bullseye” rash on her left arm. Physical examination confirms the presence of erythema migrans. Which of the following antibiotics is contraindicated in pregnant women with Lyme disease?
A 35-year-old hiker presents with fever, fatigue, and an expanding rash with central clearing. She recalls removing a tick 8 days ago. What is the next best step in management?
Case: A 32-year-old woman presents to the clinic in early summer with complaints of fever, fatigue, and a rash that she noticed three days ago on her lower back. She reports that the rash started as a small red spot but has since expanded and now appears as a red ring with central clearing. She denies pain or itching associated with the rash but mentions that she feels tired, has mild headaches, and occasional muscle aches. History: Recent Activities: The patient lives in a rural area in Connecticut and enjoys hiking in wooded areas. She recalls pulling off a tick from her lower back about 10 days ago but thought nothing of it. Past Medical History: No significant past medical history. Medications: None. Family History: Unremarkable. Social History: Non-smoker, occasional alcohol use, works as a schoolteacher. Physical Examination: Vital Signs: Temperature: 99.8 °F Heart Rate: 84 bpm Blood Pressure: 120/76 mm Hg Respiratory Rate: 16 breaths/min Skin: A single erythematous, annular rash approximately 10 cm in diameter with central clearing located on the lower back. Musculoskeletal: Mild tenderness of the quadriceps bilaterally; no joint swelling or erythema. Neurologic: Cranial nerves intact, no focal deficits. Which of the following is the most common early sign of this disease? of Lyme disease?
A 42-year-old man with HIV/AIDS (CD4 count: 80 cells/μL) presents with progressive headaches, low-grade fever, and fatigue over the past two weeks. He denies neck stiffness or photophobia. A non-contrast cranial CT scan is unremarkable. A lumbar puncture is performed, and India ink staining of the cerebrospinal fluid (CSF) reveals yeast cells with a surrounding clear halo. Which of the following is the first-line induction therapy for this patient?
