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Suggest treatment for lesions on lower extremities

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Posted on Tue, 10 May 2016
Question: I have lesions on my mid section and lower extremities that have not been diagnosed. Swelling and pain in wrists. bitten by deer tick in November. Treated with one dose of antibiotics at that time. Dr. does not trust Lime testing methodology.
doctor
Answered by Dr. Tushar Kanti Biswas (33 hours later)
Brief Answer:
Tick borne skin lesion

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Zoonotic infection which can spread from deer are mainly viral like Jamestown Canyon virus (JCV),Cache Valley virus (CVV),Tick-borne encephalitis virus
(TBEV).These can produce some rashes which usually subside but does not produce nodules or necrotic lesions as shown by the picture posted by you.

Lyme Borreliosis(spirochete ) transmitted by ticks of the Ixodes ricinus complex can somehow cause similar kind of lesions,as the center of skin lesion sometimes becomes intensely erythematous,and indurated, vesicular, or necrotic.
It would be appropriate to go for two-step approach in which samples are first tested by enzyme-linked immunosorbent assay (ELISA) and equivocal or positive results are then tested by western blotting. During the first weeks of infection, both IgM and IgG responses to the spirochete should be determined, preferably in both acute- and convalescent-phase serum
samples.

After 4–8 weeks of infection , the sensitivity and specificity of the IgG response to the spirochete -very high—in the range of 99%—as determined by the two-test approach of ELISA and western blot.Since you have been bitten in November 2015,it is fairly possible to have conclusive test by now.






Regards

Dr. T.K. Biswas M.D.
Mumba

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Tushar Kanti Biswas (28 hours later)
Thank you, that explains a lot, and I will strongly encourage the tests be conducted when I return. I am on vacation in Hawaii, which complicates matters. I have been trying to get a diagnosis since December.
doctor
Answered by Dr. Tushar Kanti Biswas (0 minute later)
Brief Answer:
Tick borne skin lesion

Detailed Answer:
You are most welcome.Please fell free to ask any further query.

Regards

Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1910 Questions

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Suggest treatment for lesions on lower extremities

Brief Answer: Tick borne skin lesion Detailed Answer: Hi, Thank you for your query. I can understand your concerns. Zoonotic infection which can spread from deer are mainly viral like Jamestown Canyon virus (JCV),Cache Valley virus (CVV),Tick-borne encephalitis virus (TBEV).These can produce some rashes which usually subside but does not produce nodules or necrotic lesions as shown by the picture posted by you. Lyme Borreliosis(spirochete ) transmitted by ticks of the Ixodes ricinus complex can somehow cause similar kind of lesions,as the center of skin lesion sometimes becomes intensely erythematous,and indurated, vesicular, or necrotic. It would be appropriate to go for two-step approach in which samples are first tested by enzyme-linked immunosorbent assay (ELISA) and equivocal or positive results are then tested by western blotting. During the first weeks of infection, both IgM and IgG responses to the spirochete should be determined, preferably in both acute- and convalescent-phase serum samples. After 4–8 weeks of infection , the sensitivity and specificity of the IgG response to the spirochete -very high—in the range of 99%—as determined by the two-test approach of ELISA and western blot.Since you have been bitten in November 2015,it is fairly possible to have conclusive test by now. Regards Dr. T.K. Biswas M.D. Mumba