Journal of Regional Section of Serbian Medical Association in Zajecar

Year 2011     Vol 36     No 3
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      UDK 616.98:579.834

ISSN 0350-2899, 36(2011) br.3 p.170-73

Case report

Lyme disease in a school age patient - Case report
(Lajmska bolest kod pacijenta školskog uzrasta - prikaz slučaja)

Dragana Mitrović (1), Rajko Zdravković (2), Jasmina Ignjatović (1), Jovica Đorđević (1), Jasmina Stamenović(1), Vesna Milijić (1), Emilio Miletić (3)
(1) Zdravstveni centar Knjaževac, Služba za zdravstvenu zaštitu predškolske i školske dece sa medicinom sporta i savetovalištem za mlade, (2) Zavod za hitnu medicinsku pomoć Crne Gore - Jedinica Bar,
(3) Zdravstveni centar Knjaževac, Služba hitne medicinske pomoći


Lyme disease is a multisystemic disease, of subacute and chronic course, caused by the bacterium Borrelia burgdorferi. In addition to a thorough patient examination and laboratory analyses, it is first of all necessary to take good epidemiological survey to set the correct diagnosis.
This paper presents a patient and the data used in the medical records (medical records, specialist reports). The patient A.M. aged 8 in July 2010 came to see the doctor of the Children's Clinic in Knjaževac with the clinical findings of erythema on the forehead of about 20 cm in diameter. A part of the circular erythematous change spread to 1.5 cm above the eyebrows and the second part of the change was over the hairy part of the head. The change was at the level of the skin, it did not cause itching or general infectious symptoms. The doctor in Knjaževac prescribed corticosteroid ointment. The erythema and erythematous changes migrated down to the level of eyebrows after two weeks. After being reviewed by specialist dermatovenerologists in Zaječar and Niš the patient underwent serological analysis Biomedica ELISA (Enzyme-linked immunosorbent assay). Antibodies class IgG and IgM were positive for Borrelia burgdorferi.
Morbus Lyme was diagnosed in early August 2010. The epidemiologist in the Health Centre Knjaževac agreed with the diagnosis on the basis of epidemiological, clinical and serological findings.
The patient was treated with antibiotics for 21 days: amoxicillin syrup with clavulonic acid. After the therapy, the patient was proposed to continue monitoring the movement of antibodies to Borrelia burgdorferi.
It is important to promptly recognize the disease incubation period of 3-30 days when the symptoms appear (based on clinical and epidemiological surveys) and to begin timely treatment (immediately after epidemiological surveys and clinical findings of migrated erythema). The choice of antibiotics, method of administration and length of treatment depend on the form or the stage of the disease. But if there is evidence about a tick bite and after the tick bite there occurs erythema that fits the description of erythema migrans, with or without general infectious symptoms, the treatment should begin without waiting for serological results. Laboratory analysis, as a confirmation of the disease, can be done later, but the treatment with the appropriate dose and for a sufficiently long time should start immediately!
Key words: Lyme disease, infection, tick

Napomena: kompletan tekst rada na srpskom jeziku
Note: full text in Serbian

      Corresponding Address:
Dragana Mitrović
Zdravstveni centar Knjaževac
Paper received: 31.03.2011
Paper accepted: 12.04.2011
Paper Internet issues: 17.12.2011
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Timočki medicinski glasnik, Zdravstveni centar Zaječar
Journal of Regional section of Serbian medical association in Zajecar
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