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
...nagemen...
...Preventi...
...) Personal Protective MeasuresIndividual...
...llents to Prevent Tick BitesFor the...
...C) Removal of Attached Ticks...
...promptly removing attached ticks by m...
...mmend against burning an attached tick (with a m...
...I. Diagnostic Tick Test...
...A) Diagnostic Tick Tes...
We recommend submitting the removed tick for spec...
...against testing a removed Ixodes tick for...
...agnostic Testing of Asymptomatic Patients Fol...
...Antibiotic Prophylaxis...
...mend that prophylactic antibiotic therapy...
...Antibiotic Regimen...
...r high-risk Ixodes spp. bites in all age...
...rythema Migrans Tes...
...atients with potential tick exposure in a Lyme dis...
...tients with 1 or more skin lesions suggest...
.... Erythema Migrans Antibiotic...
...ts with erythema migrans, we recommend using ora...
...ythema Migrans Antibiotic Duration
...d that patients with erythema migra...
...he Southern Tick-associated Rash Illness (STARI)...
...patients who develop an erythema migr...
...me Neuroborreliosi...
...patients for possible Lyme neuroborreliosi...
...esting is performed in patients with sus...
...ological Presentation...
...ients presenting with 1 or more of the f...
...ents with typical amyotrophic lateral sclero...
...th neurological syndromes other than those l...
...n patients presenting with nonspecific ma...
...Adult Psychiatric Ill...
...patients with psychiatric illness, we recomme...
...I. Childhood Psychiatric Ill...
...children presenting with developmental, b...
...Acute Neurologic Manifestation...
...with Lyme disease-associated meningitis, cranial...
...V. Brain or Spinal...
...with Lyme disease-associated parenchymal involveme...
...Facial Nerve Pal...
In patients with Lyme disease-associated fa...
...Carditis Screening...
...rforming an electrocardiogram (ECG) onl...
...II. Lyme Carditis Hospitalizatio...
...tients with or at risk for severe c...
.... Lyme Carditis Pa...
...atients with symptomatic bradycardia due to Lyme c...
...Carditis Antibiotics...
...with Lyme carditis, we suggest oral an...
...he hospitalized patient with Lyme carditis,...
...tment of Lyme carditis, we suggest 14–21 days...
...yme Myocarditis/Pericar...
...atients with acute myocarditis/pericardit...
...n patients with chronic cardiomyopa...
...Lyme Arthritis Test...
...assessing possible Lyme arthritis, we...
...positive patients for whom the diagnosis of Lyme...
XXII. Lyme Arthritis Initial Ant...
...tients with Lyme arthritis, we recommend using or...
...Unresolved Lyme Arthritis...
...patients with Lyme arthritis with partial respo...
...with Lyme arthritis with no or minimal response...
...IV. Post-antibiotic Arth...
...have failed one course of oral antibiotics a...
...Persistent Symptoms...
...patients who have persistent or recurrin...
.... Borrelial Lymphocytoma...
...patients with borrelial lymphocytoma, we su...
XXVII. Acrodermatitis Chronica Atrophi...
...ith acrodermatitis chronica atrophicans, we sug...
...XVIII. Co-Infection with A. Phagocy...
...ith Lyme disease who have a high-grade fever o...
Tables and Figures
...s and Figures...
...ble 1. Drug DosesHaving trouble viewin...
...nt of Specific Manifestations of Lyme DiseaseHa...
...sonal Prevention MeasuresHaving tr...
Table 4. Management of a suspected Ixodes tick...
...Dorsal View of Unfed Blacklegged Tick (Ixodes sc...
...gure 3. Lyme Disease, Confirmed CasesBy month o...
Figure 4. Reported Cases of Lyme Disease,...
...oper Tick RemovalProper removal requires...
...Relative Sizes of Engorging Nymphal and Adult F...
.... Early Lyme Rash