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The Merck Manual is continually updating the online version.
Updates of selected topics are posted about every two months. The following
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Spirochetes
Selected excerpt from topic
Lyme Disease
"B. burgdorferi enters the skin at the site of the tick bite. After 3 to 32 days, the organisms migrate locally in the skin around the bite, spread via the lymphatics to cause regional adenopathy or disseminate in blood to organs or other skin sites. Initially, an inflammatory reaction (erythema migrans) occurs before significant antibody response to infection (serologic conversion)."
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1. Fallon BA, Keilp JG, Corbera KM, et al: A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology Mar 25;70(13):992-1003, 2008. Epub 2007 Oct 10.
2. Hassett AL, Radvanski DC, Buyske S, et al: Psychiatric comorbidity and other psychological factors in patients with "chronic Lyme disease." American Journal of Medicine Sep;122(9):843-850, 2009.
3. Thompson A, Mannix R, Bachur R:
Acute pediatric monoarticular arthritis: Distinguishing Lyme arthritis from other etiologies. Pediatrics Mar;123(3):959-965, 2009.
4. Blanton L, Keith B, Brzezinski W:
Southern tick-associated rash illness: erythema migrans is not always Lyme disease. Southern Medical Journal Jul;101(7):759-760, 2008.
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