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In What Parts Of The United States Are Lyme Disease Seen, How Is Diagnosis Confirmed, And What Is The Appropriate Treatment?

30), though only 18 women will dress for each match. For the Australia game, the squad will be without Tyresos players (Whitney Engen, Meghan Klingenberg, Ali Krieger, Christen Press), Tobin Heath (Paris Saint-Germain), and Megan Rapinoe (Lyon). Erika Tymrak, with Bayern Munich after earning the NWSLs Rookie of the Year award, was not named to the squad. Sermannis team will undergo a second shift after the Australia match. College stars Crystal Dunn (North Carolina) and Morgan Brian (Virginia), who will miss their teams Oct. 20 ACC matchup to be in Texas, will return to their schools after the Australia match. Likewise NWSL fullbacks Leigh Ann Robinson (FC Kansas City) and Stephanie Cox (Seattle Reign FC) will leave the team before the New Zealand games. For Cox, the callup is her first since returning to the field late in the NWSL season, the 27-year-old sidelined for most of the season as she welcomed her first child. With 82 caps to her credit, the 2008 gold medalist was once a national team mainstay, though he last appearance with the U.S. was in May 2012. Now shell compete against Dunn and converted midfielder Kristie Mewis for a place on the depth chart. Stephanie Cox, pictured here with the LA Sol, returned to action late in the NWSL season after delivering her first child. Though 27-year-old defender has 82 caps with the U.S. national team, shes been called in for the first time since May 2012. (Source: JMR Photography, via Wiki Commons.) Theyre part of the 10-defender crew named to the U.S.

On average, the skin lesion lasts approximately 3 weeks. The rash is often accompanied by fever, headache, myalgia, fatigue, arthralgia, and stiff neck. Left untreated the disease may progress to more serious neurologic (meningitis, meningoencephalitis, uni- or bilateral facial palsy, etc) or cardiac (atrioventricular heart block, myocarditis) manifestations termed early disseminated (second stage). The infection may ultimately result in arthritis in half of infected individuals if not treated. The arthritis tends to involve large joints (knee, shoulder, elbow, etc) with a sudden onset. The involved joint is tender, swollen, and warm. Figure 16-2. Erythema migrans rash. ( Centers for Disease Control and Prevention http://www.cdc.gov/ticks/symptoms.htm.) The diagnosis of Lyme disease may be made clinically and confirmed serologically. If the patient presents with erythema migrans and a history of tick exposure, the diagnosis can be based solely on the clinical presentation. However, if the patient presents later in the course of illness, serologic testing is necessary. The CDC recommends a 2-phased diagnostic approach consisting of an initial enzymelinked immunosorbent assay (ELISA) followed by a specific Western blot assay. If the initial ELISA is negative, further validation is unnecessary. If the ELISA result is positive or indeterminate, additional confirmatory testing using Western blot is indicated. A Western blot assay detecting both IgM and IgG should be performed if the child is being evaluated within 4 weeks of symptom onset.