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Volume 30, Number 3—March 2024
Dispatch

Delayed Diagnosis of Locally Acquired Lyme Disease, Central North Carolina, USA

Ross M. BoyceComments to Author , Peyton Pretsch, Kay Tyrlik, Abigail Schulz, Dana A. Giandomenico, Alexis M. Barbarin, and Carl Williams
Author affiliations: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA (R.M. Boyce, P. Pretsch, K. Tyrlik, D.A. Giandomenico); University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA (A. Schulz); North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA (A.M. Barbarin, C. Williams)

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Table

Select clinical and laboratory information for a patient with Lyme disease, central North Carolina, USA*

Characteristic Range Day of illness (provider)
Day 10 (PCP) Day 28 (PCP)
 Day 43 (PCP) Day 83 (ID clinic)
Signs/symptoms
Fever >38.0°C X
Rash X
Fatigue X
Headache X
Itching X
Left-sided ear pain X X
Left sided asymmetric smile X
Inability to close left eye X
Cognitive impairment X X
Other
Laboratory testing
Complete blood count
Leukocytes, cells/mm3 4.0–11.0 6.1
Hemoglobin, mg/dL 12.9–16.0 13.3
Platelets, × 109/L 150–400 193
Metabolic panel
Sodium, mmol/L 136–145 138
Potassium, mmol/L 3.5–5.5 4.0
Creatinine, mg/dL 0.6–1.30 0.70
Liver function, U/L
Alkaline phosphatase 38–126
Aspartate aminotransferase 0–39
Alanine aminotransferase 0–52
C-reactive protein, mg/L <10 10.2 <4.0
Sedimentation rate, mm/h 0–30 42 16
Tick-borne disease testing
Lyme EIA <0.91 Positive
Lyme Western blot
IgM 0 of 3 bands p41, p39, p23
IgG 0 of 10 bands p66, p45, p41, p39, p23, p18
SFGR IgG <1:64 <1:64
Ehrlichia IgG <1:64 <1:64
α-gal IgE, kUA/L <0.35† 0.43
Other infectious diseases
HIV antigen/antibody Nonreactive Nonreactive
Syphilis antibody RPR
 Nonreactive
Nonreactive
Diagnosis
Cellulitis
Bell’s palsy
 Lyme disease
Treatment Cephalexin, bactrim
 Erythromycin Valacyclovir, prednisone Doxycycline

*EIA, enzyme immunoassay; ID, infectious disease; PCP, primary care provider; RPR, rapid plasma reagin; SFGR, spotted fever group Rickettsia; X, present. †Reference range <0.1 kUA/L (kUA/L level of allergy): <0.35 absent, 0.35–0.69 low, 0.70–3.49 moderate, 3.50–17.5 high, >17.5 very high.

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Page created: January 31, 2024
Page updated: February 22, 2024
Page reviewed: February 22, 2024
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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