A 28-year-old woman, gravida 2 para 1, at 16 weeks gestation comes to the office for prenatal follow-up. The patient reports increased fatigue, intermittent headache, myalgia, and arthralgia for the past several days. She attributes her symptoms to physical exhaustion after her recent travel to Connecticut, where she visited her family and enjoyed outdoor activities. The patient does not recall a specific insect or tick bite during the trip. She has no significant medical history and takes prenatal vitamins daily. She does not use tobacco or illicit drugs and stopped drinking alcohol after conceiving. The patient lives with her husband and 4-year-old son. Temperature is 37.7 C (99.8 F), blood pressure is 120/70 mm Hg, and pulse is 84/min. Cardiopulmonary examination is normal. The abdomen is soft and nontender with the uterine fundus palpable halfway between the symphysis pubis and the umbilicus. Skin examination reveals a 5-cm, circular, erythematous rash with central clearing in the left popliteal area. Empiric treatment with amoxicillin is administered. The patient is concerned about risk to the fetus and her family. Which of the following is most accurate regarding this patient's current condition?

Question

A 28-year-old woman, gravida 2 para 1, at 16 weeks gestation comes to the office for prenatal follow-up.  The patient reports increased fatigue, intermittent headache, myalgia, and arthralgia for the past several days.  She attributes her symptoms to physical exhaustion after her recent travel to Connecticut, where she visited her family and enjoyed outdoor activities.  The patient does not recall a specific insect or tick bite during the trip.  She has no significant medical history and takes prenatal vitamins daily.  She does not use tobacco or illicit drugs and stopped drinking alcohol after conceiving.  The patient lives with her husband and 4-year-old son.  Temperature is 37.7 C (99.8 F), blood pressure is 120/70 mm Hg, and pulse is 84/min.  Cardiopulmonary examination is normal.  The abdomen is soft and nontender with the uterine fundus palpable halfway between the symphysis pubis and the umbilicus.  Skin examination reveals a 5-cm, circular, erythematous rash with central clearing in the left popliteal area.  Empiric treatment with amoxicillin is administered.  The patient is concerned about risk to the fetus and her family.  Which of the following is most accurate regarding this patient's current condition?

Quizplus · Accepted Answer

Explanation: This pregnant patient, who recently visited a Lyme-endemic area, has viral-like symptoms and a rash with central clearing suggesting early localized Lyme disease. Lyme disease is a spirochetal illness caused by Borrelia burgdorferi after transmission during an Ixodes scapularis tick bite. Manifestations usually begin with erythema migrans, a slowly expanding erythematous rash that often develops central clearing ("bull's-eye" appearance). Patients may also have viral-like symptoms of fatigue, headache, myalgias, and arthralgias. Only 25% of patients recall a previous tick bite. Lyme-endemic area "bull's-eye" appearance Both B burgdorferi and Treponema pallidum, the causative agent in syphilis, are spirochetal organisms. As such, there is theoretical concern that Lyme disease during pregnancy may be associated with an increased risk for severe congenital fetal abnormalities and fetal demise (as seen with syphilis). However, clinical data show no increased risk to the fetus when the mother receives adequate treatment for Lyme disease with 14-21 days of amoxicillin or cefuroxime. Doxycycline, which is used most commonly for the treatment of Lyme disease in nonpregnant patients, should be avoided during pregnancy due to adverse effects on fetal long-bone development and teeth coloration. (Choices A, B, and C) There is no evidence to suggest that Lyme disease can be transmitted from person to person; sexual contact and breast feeding do not increase transmission risk, and close contacts do not require chemoprophylaxis. (Choice E) There is no evidence to suggest that Lyme disease causes a congenital syndrome similar to syphilis when adequate treatment is administered. Educational objective: Lyme disease during pregnancy is associated with no increased risk to the fetus if the mother receives adequate treatment (eg, oral amoxicillin, oral cefuroxime).

A 28-Year-Old Woman, Gravida 2 Para 1, at 16 Weeks