Prevention, Diagnosis and Treatment of Lyme Disease

Publication Date: January 1, 2021

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

...anagemen...

I. Prevention

...tective MeasuresIndividuals at risk of expo...

...ents to Prevent Tick BitesFor the prevention of t...

...al of Attached Ticks...

...mend promptly removing attached ticks by mechan...

...mend against burning an attached tick (with a...


II. Diagnostic Tick Te...

...nostic Tick Testing...

...e recommend submitting the removed tick for sp...

...recommend against testing a removed...

...B) Diagnostic Testing of Asymptomatic Patient...


...Antibiotic Prophy...

...t prophylactic antibiotic therapy be given o...


...Antibiotic Regime...

...high-risk Ixodes spp. bites in al...


V. Erythema Migrans T...

...potential tick exposure in a Lyme dis...

...1 or more skin lesions suggestive of, b...


...hema Migrans Antibiotic Regimen...

...patients with erythema migrans, we recommen...


...rythema Migrans Antibiotic Duration...

...mmend that patients with erythema m...


...III. The Southern Tick-associated Rash Il...

...ents who develop an erythema migrans-lik...


IX. Lyme Neuroborr...

...sing patients for possible Lyme neuroborreliosis i...

...testing is performed in patients with susp...


...Neurological Presentations...

...presenting with 1 or more of the fo...

...atients with typical amyotrophic l...

...ents with neurological syndromes other...

...senting with nonspecific magnetic r...


.... Adult Psychiatric Illne...

In patients with psychiatric illness, we recom...


...hildhood Psychiatric Illnesse...

...ldren presenting with developmental, behavi...


...Neurologic Manifestations...

...atients with Lyme disease-associated m...


.... Brain or Spinal Co...

...ts with Lyme disease-associated parenchymal involv...


...ial Nerve Palsy...

...Lyme disease-associated facial nerve palsy, we m...


...e Carditis Screening...

...orming an electrocardiogram (ECG) only in pati...


...me Carditis Hospitalization...

...n patients with or at risk for seve...


...I. Lyme Carditis Pa...

...with symptomatic bradycardia due to Lyme carditis...


...Lyme Carditis Antibiotics...

...outpatients with Lyme carditis, we sugg...

...talized patient with Lyme carditis, we sugg...

...treatment of Lyme carditis, we sugges...


...e Myocarditis/Pericarditis

...tients with acute myocarditis/pericarditis of u...

...n patients with chronic cardiomyopath...


...e Arthritis Testing...

...ossible Lyme arthritis, we recommend serum...

...ive patients for whom the diagnosis of Ly...


...Lyme Arthritis Initial Antibiotics...

...nts with Lyme arthritis, we recommend us...


XXIII. Unresolved Lyme Art...

...atients with Lyme arthritis with par...

...patients with Lyme arthritis with no...


.... Post-antibiotic Arthrit...

...ients who have failed one course of oral antibioti...


XXV. Persistent Symptom...

For patients who have persistent or...


...rrelial Lymphocytoma...

...tients with borrelial lymphocytoma, we suggest...


...dermatitis Chronica Atrophican...

...ith acrodermatitis chronica atrophicans, we...


...III. Co-Infection with A. Phagocytoph...

...with Lyme disease who have a high-grade f...


Tables and Figures

...s and Figures...

...ug DosesHaving trouble viewing table? Ex...


...ent of Specific Manifestations of Lyme DiseaseH...


...Personal Prevention MeasuresHaving trou...


...4. Management of a suspected Ixodes t...


...re 2. Dorsal View of Unfed Blacklegged Tick (Ixo...


...3. Lyme Disease, Confirmed CasesBy month of...


...4. Reported Cases of Lyme Disease, Un...


...roper Tick RemovalProper removal requires...


...elative Sizes of Engorging Nymphal and Adult...


...e 7. Early Lyme Ra...