Problem
Case Study
A 41-year-old woman was referred to the Infectious Disease Clinic for recurrent symptoms beginning about 4 months after noticing a small, -painful swollen spot on her leg after removal of a tick. She had been treated with doxycycline for 14 days for presumed Lyme disease, documented by a positive IFA titer and presentation with migratory arthralgias, which were worse in the small joints of the hands. She also complained of fatigue, poor mentation, and occasional headaches. Because her symptoms recurred 2 months after treatment, she was unable to continue employment. Six months after a course of amoxicillin and later two courses of ceftriaxone, she again became symptomatic. A Western blot and PCR of her serum was ordered.
The Western blot result was equivocal, but the PCR was positive for the agent of Lyme disease.
Task
a) How did this patient acquire Lyme disease?
b) Why did the physician order further testing to diagnose Lyme disease in this patient?
c) Our patient did not respond to therapy for B. bergdorferi. Can you explain why this can happen?