Prevention, Diagnosis and Treatment of Lyme Disease
Key Points
Key Points
- Lyme disease is the most common vector-borne infectious disease of humans in the temperate northern hemisphere.
- It is a complex infection, and clinical disease can manifest as early as days and as late as many months following an infectious tick bite.
- Presentations include a skin lesion at the site of the tick bite and disseminated disease resulting in skin lesions distant from the tick-bite site, neuropathy, meningitis, cardiac conduction abnormalities, and/or arthritis.
- Interpretation of diagnostic tests for Lyme disease presents certain challenges due to the dynamics of the serologic response following infection.
- Finally, treatment options, including the drug, route, and duration of treatment may differ for different disease manifestations.
Management
...agement
.... Prevention...
...) Personal Protective MeasuresIndividu...
...) Repellents to Prevent Tick BitesFor the preventi...
...al of Attached Ticks...
...mend promptly removing attached ticks...
...d against burning an attached tick (with a match...
II. Diagnostic Tick Testin...
(A) Diagnostic Tick T...
...ecommend submitting the removed tick for s...
...ommend against testing a removed Ixodes tick...
...Diagnostic Testing of Asymptomatic Pa...
.... Antibiotic Prophylax...
...that prophylactic antibiotic therapy be g...
...ibiotic Regimen...
...xodes spp. bites in all age groups, we rec...
...hema Migrans Testing...
...n patients with potential tick exposure in...
...n patients with 1 or more skin lesions sug...
...Erythema Migrans Antibiotic Regimens
...atients with erythema migrans, we recommend usin...
...a Migrans Antibiotic Duration...
...ommend that patients with erythema migrans be tr...
...ern Tick-associated Rash Illness (S...
...who develop an erythema migrans-like skin lesio...
...e Neuroborreliosis...
...ssessing patients for possible Lyme ne...
...ting is performed in patients with suspecte...
...eurological Presentations...
...patients presenting with 1 or more...
...s with typical amyotrophic lateral sclerosi...
...ients with neurological syndromes other than t...
...resenting with nonspecific magnetic reso...
...I. Adult Psychiatric I...
...ents with psychiatric illness, we recommend...
...dhood Psychiatric Illnes...
...ren presenting with developmental, behavioral or...
...Acute Neurologic Manifestations...
...n patients with Lyme disease-associated meningit...
...V. Brain or Spinal Cor...
...Lyme disease-associated parenchymal inv...
...acial Nerve Palsy...
...th Lyme disease-associated facial nerve palsy,...
...me Carditis Screening...
...gest performing an electrocardiogram (EC...
...yme Carditis Hospitalization
...or at risk for severe cardiac complications...
...I. Lyme Carditis Pacing...
...nts with symptomatic bradycardia due to Ly...
...X. Lyme Carditis Antibioti...
...ith Lyme carditis, we suggest oral antibiotics...
...spitalized patient with Lyme carditi...
...ment of Lyme carditis, we suggest 14–21...
...yocarditis/Pericarditis
...with acute myocarditis/pericarditis o...
In patients with chronic cardiomyopathy of unk...
...Arthritis Testing
...g possible Lyme arthritis, we recommen...
...e patients for whom the diagnosis of Lym...
...rthritis Initial Antibiotics...
...ith Lyme arthritis, we recommend using ora...
...esolved Lyme Arthritis...
...atients with Lyme arthritis with partial r...
...th Lyme arthritis with no or minima...
XXIV. Post-antibiotic Arth...
In patients who have failed one course of oral an...
...ersistent Symptoms
...nts who have persistent or recurring n...
XXVI. Borrelial Lymphocytom...
...s with borrelial lymphocytoma, we suggest oral an...
XXVII. Acrodermatitis Chronica Atrophicans
In patients with acrodermatitis chronica atrop...
...Co-Infection with A. Phagocytophilum Or Mic...
...tients with Lyme disease who have a high-grad...
Tables and Figures
Tables and F...
...le 1. Drug DosesHaving trouble viewin...
...2. Treatment of Specific Manifestatio...
...ersonal Prevention MeasuresHaving trouble viewing...
...le 4. Management of a suspected Ixodes tick b...
.... Dorsal View of Unfed Blacklegged Tick (Ixode...
...Lyme Disease, Confirmed CasesBy mon...
...ure 4. Reported Cases of Lyme Disease, United Stat...
...gure 5. Proper Tick RemovalProper removal requires...
...lative Sizes of Engorging Nymphal and Adult Femal...
...e 7. Early Lyme Ra...