Diagnosis and Treatment of Lyme Disease

Abstract

Lyme disease is the most common tick-borne disease in the United States. This review details the risk factors, clinical presentation, treatment, and prophylaxis for the disease. Information was obtained from a search of the PubMed and MEDLINE databases (keyword: Lyme disease) for articles published from August 31, 1997, through September 1, 2007. Approximately 20,000 cases of Lyme disease are reported annually. Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk. Children and those spending extended time outdoors in wooded areas are also at increased risk. The disease is transmitted to humans through the bite of the Ixodes tick (Ixodes scapularis and Ixodes pacificus). Typically, the tick must feed for at least 36 hours for transmission of the causative bacterium, Borrelia burgdorferi, to occur. Each of the 3 stages of the disease is associated with specific clinical features: early localized infection, with erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias; early disseminated infection (occurring days to weeks later), with neurologic, musculoskeletal, or cardiovascular symptoms and multiple erythema migrans lesions; and late disseminated infection, with intermittent swelling and pain of 1 or more joints (especially knees). Neurologic manifestations (neuropathy or encephalopathy) may occur. Diagnosis is usually made clinically. Treatment is accomplished with doxycycline or amoxicillin; cefuroxime axetil or erythromycin can be used as an alternative. Late or severe disease requires intravenous ceftriaxone or penicillin G. Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients. Preventive measures should be emphasized to patients to help reduce risk.

Undiagnosed Lyme disease in adults with schizophrenia

“…This infection is a global health concern and is associated with numerous cardiologic, dermatologic, rheumatologic neurologic, and psychiatric manifestations (Bratton et al, 2008). Only a few epidemiologic studies have evaluated the frequency of antibodies to Bb in psychiatric patients; one study found only 1/517 (0.2%) of all adult psychiatric patients had Lyme titer seropositivity (Nadelman et al, 1997) and the other larger study found that 322/926 (35%) of psychiatric inpatients had seropositivity to antibodies to Bb (Hajek et al, 2002).…”

Erythema caused by a localised skin infection with Arthrobacter mysorens

“…Mild systemic symptoms like low-grade fever and chills might be present. EM in the United States is often associated with more prominent signs of inflammation, as compared to that in Europe [1-4]. This case report illustrates that erythemas caused by other pathogens might resemble this clinical picture, thus a false diagnosis may be made which may complicate and prolong the disease process and prevent adequate therapy.…”

“…Among many clinicians, laminary spreading erythemas often lead to the diagnosis of a tick bite-associated erythema migrans (EM), a symptom of early localized infection with Borrelia burgdorferi (sensu lato) [1,2]. As the development of an immunologic response to this infection usually takes 4 to 6 weeks and the incubation period for EM is typically 7 to 14 days, early Lyme borreliosis often presents itself with a negative serology [3,4]. In addition, tick bites are not always described or remembered by the patient.…”

T2 Magnetic Resonance Assay-Based Direct Detection of Three Lyme Disease-Related Borrelia Species in Whole-Blood Samples

“…Early LD is diagnosed in the clinic by recognition of the EM rash, other associated symptoms, and a compatible exposure history (11,12). However, the diagnosis can be difficult, as 5 to 30% of patients do not present with an EM rash (10,12) and early-stage symptoms may be completely lacking or nonspecific (13).…”

“…However, the diagnosis can be difficult, as 5 to 30% of patients do not present with an EM rash (10,12) and early-stage symptoms may be completely lacking or nonspecific (13). Laboratory confirmation of clinical diagnosis is performed using serology.…”