Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease

Abstract

This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of North American (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection This guideline was jointly developed by the Infectious Diseases Society of America, the American Academy of Neurology Institute, and the American College of Rheumatology. The article was peer reviewed by Arthritis & Rheumatology and simultaneously published by Clinical Infectious Diseases, Neurology, Arthritis Care & Research, and Arthritis & Rheumatology. Each editor of the 4 journals appointed 1 reviewer for peer review. The articles

Papilledema as the Sole Manifestation of Neuroborreliosis

“…Our patient was treated with a 21-day course of doxycycline therapy. This choice was based on the recommendation that “A growing body of evidence suggests that oral doxycycline is effective for the treatment of Lyme meningitis and may be used as an alternative to hospitalization and parenteral ceftriaxone therapy in children who are well enough to be treated as outpatients.” [ 12 , 13 ] Her symptoms resolved with antibiotic therapy. After the completion of therapy, a repeat fundoscopic exam demonstrated improvement in optic disc edema ( Figure 2 ).…”

To Lumbar Puncture or Not to Lumbar Puncture: A Case of Lyme Neuroborreliosis

“…The joint 2020 IDSA/AAN and ACR guidelines for the prevention, diagnosis, and treatment of Lyme disease differ significantly from the European Federation of Neurological Societies guidelines when it comes to the diagnosis of LNB. The former recommends an individualized approach for spinal fluid analysis, opting to favor serum antibody testing in the clinical scenario when a patient has a compatible presentation and risk factors, while the latter considers spinal fluid analysis as the cornerstone for diagnosing LNB in all of its forms [6,7].…”

“…Other available testing options for the diagnosis of LNB include CSF antibodies to Borrelia burgdorferi, CSF:serum antibodies index, and in certain cases, CSF B. burgdorferi polymerase chain reaction (PCR). However, the sensitivities and specificities of these tests are variable and false-positive are common [6][7][8][9][10][11]. On the other hand, in some studies, up to >90% of patients with early LNB are seropositive by the traditional 2-tier serological test, which may obviate the need for a lumbar puncture (LP) in cases where acute meningitis is not suspected and the degree of suspicion for early disseminated LNB is high [8].…”

“…The clinical manifestations of Lyme disease can vary by stage of infection. While the history of a tick bite in an endemic area between May and October along with the pathognomonic skin lesion of erythema migrans (EM) is sufficient to establish the diagnosis and warrant treatment, diagnosing multisystem involvement may prove to be challenging [3][4][5][6]. We present a rare case of early disseminated Lyme neuroborreliosis (LNB) with manifestations of facial palsy and painful radiculoneuritis as determined by clinical and serological criteria.…”

Antibiotic prophylaxis for prevention against Lyme disease following tick bite: an updated systematic review and meta-analysis

“…In 2019, guidelines from French Scientific Societies stated that initiating an antibiotic therapy is not recommended, irrespective of the patient’s age, duration of tick attachment, and the stage of development of the extracted tick [ 7 ]. In 2020, guidelines from IDSA, American Academy of Neurology (AAN), and American College of Rheumatology (ACR) recommended the administration of a single dose of oral doxycycline within 72 h of tick removal and observation in all age groups [ 17 ].…”