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
...anagement
...Prevention
...al Protective MeasuresIndividuals at risk of expos...
...B) Repellents to Prevent Tick BitesFor the preve...
...emoval of Attached Ti...
...promptly removing attached ticks by mechan...
...ecommend against burning an attached tick (with...
.... Diagnostic Tick Te...
(A) Diagnostic Tick...
...submitting the removed tick for speci...
...ecommend against testing a removed Ix...
...nostic Testing of Asymptomatic Patients Fo...
...II. Antibiotic Prophylaxis
...nd that prophylactic antibiotic therapy...
IV. Antibiotic...
...igh-risk Ixodes spp. bites in all age groups, we...
...Erythema Migrans Testin...
...potential tick exposure in a Lyme disea...
...with 1 or more skin lesions suggestive o...
...ma Migrans Antibiotic Regimens...
...s with erythema migrans, we recommend...
...ema Migrans Antibiotic Duration...
...hat patients with erythema migrans be...
...ern Tick-associated Rash Illness (STARI)...
...develop an erythema migrans-like skin les...
.... Lyme Neuroborrelio...
...ng patients for possible Lyme neuroborrelio...
...CSF testing is performed in patients with s...
...ological Presentations...
...atients presenting with 1 or more of the...
In patients with typical amyotrophic l...
...ith neurological syndromes other than those listed...
...enting with nonspecific magnetic resona...
...Psychiatric Illnesses
...s with psychiatric illness, we recomm...
...ldhood Psychiatric Illne...
...children presenting with developmental...
...I. Acute Neurologic Manifestat...
...ith Lyme disease-associated meningitis, crania...
...in or Spinal Cord...
...ith Lyme disease-associated parenchymal involveme...
...acial Nerve Palsy...
...Lyme disease-associated facial ner...
...VI. Lyme Carditis Screenin...
...uggest performing an electrocardio...
...me Carditis Hospitalizat...
...patients with or at risk for severe cardiac co...
...Lyme Carditis Pacing...
...patients with symptomatic bradycardia due to Lyme...
...yme Carditis Antibiotics...
...nts with Lyme carditis, we suggest oral an...
...lized patient with Lyme carditis,...
...he treatment of Lyme carditis, we suggest 14–2...
...Myocarditis/Pericarditis...
...acute myocarditis/pericarditis of...
...n patients with chronic cardiomyopathy of...
...yme Arthritis Testing...
...sessing possible Lyme arthritis, we rec...
...seropositive patients for whom the diagnosis of...
...II. Lyme Arthritis Initial An...
...nts with Lyme arthritis, we recommend usin...
...resolved Lyme Arthritis...
...ients with Lyme arthritis with partial...
...patients with Lyme arthritis with...
...-antibiotic Arthritis...
...tients who have failed one course of oral...
...sistent Symptoms...
...patients who have persistent or re...
...I. Borrelial Lymphocytoma
...ents with borrelial lymphocytoma, we suggest oral...
...Acrodermatitis Chronica Atrophicans...
...n patients with acrodermatitis chronica atroph...
...ection with A. Phagocytophilum Or Microti?...
...h Lyme disease who have a high-grade fever...
Tables and Figures
...bles and Figures...
...1. Drug DosesHaving trouble viewing table? Exp...
...2. Treatment of Specific Manifestations of L...
...al Prevention MeasuresHaving trouble viewing t...
...nagement of a suspected Ixodes tick bite in the US...
...Dorsal View of Unfed Blacklegged Tick (I...
.... Lyme Disease, Confirmed CasesBy month of di...
Figure 4. Reported Cases of Lyme Di...
...oper Tick RemovalProper removal requires...
...elative Sizes of Engorging Nymphal and Adult Fe...
...igure 7. Early Lyme...