From the Research
The most appropriate diagnostic study for this patient is a serum Lyme (Borrelia burgdorferi) antibody assay. This 19-year-old woman presents with acute unilateral facial weakness consistent with Bell's palsy, along with fatigue, joint pain, and erythematous skin lesions. Her history of outdoor activities in a rural area puts her at risk for tick exposure. The constellation of symptoms—facial palsy, fatigue, joint pain, and skin manifestations—strongly suggests Lyme disease, which is caused by the spirochete Borrelia burgdorferi transmitted through tick bites. Her previous "flu-like" illness a month ago could have been the initial manifestation of Lyme disease, as early symptoms often include fever, headache, and myalgia. Facial nerve palsy is a common neurologic manifestation of early disseminated Lyme disease. Testing for Lyme antibodies is essential to confirm the diagnosis and guide appropriate antibiotic therapy, which typically consists of doxycycline, amoxicillin, or ceftriaxone depending on the severity and stage of infection, as supported by recent studies 1. Some of the key points to consider in the diagnosis of Lyme disease include:
- The use of a modified 2-tier test strategy using 2 EIAs, which offers a faster, less expensive, and more sensitive assay compared with standard 2-tier testing 1
- The importance of early diagnosis and treatment to prevent long-term complications 2
- The need for awareness of the risk factors for Lyme disease, including outdoor activities in endemic areas and exposure to ticks 2
- The potential for new technologies to improve the diagnosis of Lyme disease, particularly in the early stages of infection 3
- The limitations of current serologic tests, including low sensitivity in early infection and the potential for false-positive results 4, 5