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Copyright 2016 American Medical Association. All rig hts reserved.

vomiting as well.2,3 Weeks to months after initial infection, pa-

tients with untreated Lyme disease may develop early dissemi-

nated disease thatcan include migratorymusculoskeletalpain, car-

ditis,facial nervepalsy, ocularmanifestations,or meningitis.Months

to a few years after initial infection(latedisease), arthritismay de-

velop, typically of the knee.

ProphylaxisAvoidance of ticks and use of tick repellents can reduce the risk of

being bitten.4Ticksfoundontheskinshouldberemovedpromptly;

ticks must be attached for36hourstotransmitthedisease.Within

72hours after tickremoval,antibioticprophylaxiswith a single dose

of doxycycline should be considered (Table); the strongest indica-

tion is when anI scapularistick from a highly endemic area is par-

tially engorged or attached for36 hours, but prophylaxis would

also be reasonable when the durationof tick attachmentor degree

of engorgement is uncertain.5

Erythema Migrans

In patients with early Lyme disease, treatment with oral doxycy-

cline for 10 days shortens the duration of the skin lesion and gen-

erallypreventsdevelopmentof latesequelae. Doxycyclineis notrec-

ommended for children