Borrelia burgdorferi

Group A streptococcus

Rickettsia rickettsii

Staphylococcus aureus


Characteristic rash

Erythema migrans: papule that expands to an annular lesion with a central clearing. a.k.a. "bull's eye" Usually occurs at the belt line or the axilla

Erythema marginatum: nonpruritic, erythematous papules occurring in polycyclic waves over the trunk, sparing ilie face

Rash begins on wrists anel ankles and spreads centripetally Appears on palms and soles later

Diffuse erythema involving the palms followed by desquamation after 7-10 days

Discrete lesions that become confluent as the rash proceeds from the hairline down, but spares the palms and the soles

Clinical features

• Initially viral-like syndrome

• Cardiac and neurologic manifestations if no initial treatment

• Migratory oligoartie-ular (knee) or polyarticular arthritis weeks to months later

• Streptococcal pharyngitis

• Migratory polyarthritis

• Carditis—cardiac valvular and muscle damage

• Rheumatic heart disease (10-20 years after original attack)

Headache, myalgias, abdominal pain

• 40% mortality if not treated

• Fever >102°F. hypotension, multior-gan dysfunction

• Menstruating woman with tampon placed for a long period of time

• Wound or skin infections

• Cough, conjunctivitis. cory/.a. severe prostration

1- to 2-mm bluish lesions with an erythematous halo on buccal mucosa pathognomonic for measles

• Chorea—abrupt, purposeless. nonrhyth-mic, involuntary movements

• Subcutaneous nodules


• Doxycycline (first

• Anti-inflammatory

• Doxycycline (first-

• Penicillin or oxacillin

• Supportive therapy

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