Teachers and other school personnel. Flight attendants and pilots. May contribute to overgrowth of candida necessitating antifungal medication. If symptoms intensify on antibiotics consider the Jarisch-Herxheimer reaction and a longer antibiotic trial. Jarisch-Herxheimer reaction often within 10 days on oral antibiotics, and much more rapid and pronounced on IV antibiotics.
Symptoms are a worsening of the pretreatment ones, especially fatigue, headaches, pains and sweats.
Improvement may take weeks. Relapse is common when antibiotics are discontinued. Endemic area, improper dress. Failure to check for ticks or use repellant. SED rates 20 if arthritis Lyme antibodies may be present.