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Lyme borreliosis 

Lyme borreliosis

Lyme borreliosis

Gary P. Wormser

, John Nowakowski

, and Robert B. Nadelman


July 30, 2015: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.


Further reading—updated.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 30 March 2017

Lyme borreliosis is a zoonotic bacterial infection caused by Borrelia burgdorferi sensu lato, a spirochaetal agent transmitted by certain species of Ixodes ticks. Small rodents and birds serve as reservoirs. It is the most common vector-borne infection in the United States of America and an important infection in many countries throughout the temperate regions of Europe and northern Asia, where a wider variety of borrelia species account for differences in clinical manifestations in Eurasia compared with the United States.

Clinical features—the commonest and earliest clinical manifestation is erythema migrans, a distinctive cutaneous lesion that occurs at the site of deposition of the spirochaete by the vector tick, beginning 7–14 days later as a red macule or papule, with the rash then expanding over days to weeks, with or without central clearing. This may be associated with ‘viral’ symptoms, fever and regional lymphadenopathy. Later manifestations include (1) carditis—usually manifested by fluctuating degrees of atrioventricular block; (2) neurological involvement—including cranial neuropathy (typically cranial nerve VII palsy), radiculopathy, and meningitis; (3) arthritis—typically migratory monoarthritis or asymmetric oligoarthritis; (4) acrodermatitis chronica atrophicans—a swollen, bluish-red appearing skin lesion in which the involved skin ultimately atrophies.

Diagnosis—the diagnosis of erythema migrans is purely clinical in geographical areas endemic for Lyme borreliosis: serological testing is not recommended because it is insufficiently sensitive on acute phase serum samples. In patients with suspected later clinical manifestations, serological testing is essential because clinical findings alone lack sufficient specificity. Polymerase chain reaction (PCR) testing of joint fluid and/or cerebrospinal fluid may be helpful in some cases.

Treatment—most people treated for Lyme borreliosis respond well to a 2-week course of antibiotic therapy (preferred oral regimen usually amoxicillin, doxycycline, or cefuroxime). Symptomatic treatment is recommended for patients who have or develop subjective complaints of unclear aetiology despite successful resolution of the objective manifestation of Lyme borreliosis following antibiotic therapy, since randomized double-blind placebo-controlled trials have shown that additional antibiotic treatment is not helpful.

Prevention—measures include avoiding exposure to ticks by limiting outdoor activities in tick-infested locations, using tick repellents, tucking in clothing to decrease exposed skin surfaces, and frequent inspection of the skin for early detection and removal of ticks.

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