Treatment of Lyme borreliosis

Abstract

Borrelia burgdorferi sensu lato is the causative agent of Lyme borreliosis in humans. This inflammatory disease can affect the skin, the peripheral and central nervous system, the musculoskeletal and cardiovascular system and rarely the eyes. Early stages are directly associated with viable bacteria at the site of inflammation. The pathogen-host interaction is complex and has been elucidated only in part. B. burgdorferi is highly susceptible to antibiotic treatment and the majority of patients profit from this treatment. Some patients develop chronic persistent disease despite repeated antibiotics. Whether this is a sequel of pathogen persistence or a status of chronic auto-inflammation, auto-immunity or a form of fibromyalgia is highly debated. Since vaccination is not available, prevention of a tick bite or chemoprophylaxis is important. If the infection is manifest, then treatment strategies should target not only the pathogen by using antibiotics but also the chronic inflammation by using anti-inflammatory drugs.

Treatment of Generalized Annular Elastolytic Giant Cell Granuloma with Doxycycline which is Associated with Borrelia burgdorferi Infection

“…Similar to this situation, this concept has been argued by identification of "leukocyte function associated antigen 1 alpha" as a candidate auto-antigen, which might cross-react with an outer surface protein A peptide epitope in the patient with treatment-refrac- tory Lyme arthritis. Moreover, it has been stated that Lyme arthritis might be derived from a persistent infection of the pathogen that was suggested by the presence of borrelia DNA retained spirochetal antigens with no living bacteria present, and these DNA products might induce an autoimmunity resulting from a T-cell-receptor epitope mimicry (21). Additionally, it has been postulated that the antibodies against some immunodominant borrelia proteins such as p41, OspC (p25), p35, p37 (11) and p45 (22) might be detected more in the early stage of Lyme disease, whereas some others such as p31…”

Therapy of Lyme Disease

“…The management options for treating myopericarditis and atrioventricular heart blocks include both oral and parenteral antibiotic therapy for 14 days (range 10-28 days) [11]. In particular, hospitalized patients are treated with intravenously antibiotics, such as ceftriaxone (at the single dose of 2 g daily; pediatric dose: 50-75 mg/kg per day with a maximum of 2 g daily) [11], cefotaxime (6 g divided into 3 doses/daily; pediatric dose: 150-200 mg/kg/day with a maximum of 6 g per day) [12] or penicillin G (0.5 million U/kg/day, divided in four-six doses daily, with a maximum of 20 million U/day) [24], albeit there are no relevant clinical trials to support these therapeutic approaches. In case of advanced heart block, a temporary pacemaker may be required (at least since the advanced heart block has been resolved) [34,35].…”

“…Immunological features, genetic factors and pathogenrelated factors might all contribute to the evolution into a rheumatoid-like disease. Even though a significant portion of treatment-refractory patients with Lyme arthritis has been noted in several studies, the general consensus is that antibiotic treatment remains the cornerstone of therapy [24].…”

“…If patients respond to treatment, ocular LD is diagnosed, and no other therapy is needed [52,53]. Other authors suggest the use of doxycycline for 28 days (4 mg/kg/day in two divided doses, with a maximum of 200 mg/day; after 8 years of age) [24]. In cases of recurrences of ocular manifestations, once adequate intravenous therapy has been given, some authors advise a judicious course of topical or systemic corticosteroids [52,54].…”

Lyme borreliosis: Epidemiology, clinical manifestations and treatment

“…Kod većine pacijenata terapija lajmske borelioze je uspešna uz primenu preporučenih antibiotika (16,(44)(45)(46). U lečenju lajmske borelioze se koriste antibiotici koji su se prethodno pokazali efikasnim protiv borelija u in vitro studijama.…”