From the Guidelines
Lyme disease typically progresses through three distinct stages if left untreated, with the majority of patients developing a characteristic bull's-eye rash called erythema migrans at the site of the tick bite within 3-30 days, accompanied by flu-like symptoms, and potentially leading to more severe symptoms if not treated promptly with antibiotics such as doxycycline. The disease is caused by the bacterium Borrelia burgdorferi, transmitted through the bite of infected blacklegged ticks, which explains why symptoms affect multiple body systems as the bacteria spread through the bloodstream 1.
Key Stages of Lyme Disease
- Initially, most patients (70-80%) develop erythema migrans, which may be accompanied by fever, headache, fatigue, and muscle and joint aches.
- Without treatment, the infection can spread to other parts of the body within weeks to months, entering the early disseminated stage, characterized by multiple erythema migrans rashes, facial or Bell's palsy, severe headaches, neck stiffness, heart palpitations, and joint pain.
- The late disseminated stage occurs months to years after infection and primarily manifests as intermittent bouts of arthritis with severe joint pain and swelling, particularly in the knees, and some patients develop neurological problems including numbness, pain, and cognitive difficulties.
Treatment and Management
- Treatment typically involves antibiotics, with doxycycline (100mg twice daily for 10-21 days) being the first-line treatment for early Lyme disease, as recommended by the Infectious Diseases Society of America 1.
- More advanced cases may require intravenous antibiotics like ceftriaxone, and for patients with Lyme arthritis with no or minimal response to an initial course of oral antibiotic, a 2–4-week course of IV ceftriaxone may be suggested over a second course of oral antibiotics 1.
- Most people recover completely with prompt antibiotic treatment, but delayed treatment can lead to persistent symptoms in some individuals, and additional antibiotic therapy is not recommended for patients with persistent symptoms following standard treatment, unless there is objective evidence of reinfection or treatment failure 1.
From the Research
Typical Course of Lyme Disease
The typical course of Lyme disease can be divided into several stages, including:
- Early localized infection, characterized by erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias 2
- Early disseminated infection, occurring days to weeks later, with neurologic, musculoskeletal, or cardiovascular symptoms and multiple erythema migrans lesions 2
- Late disseminated infection, with intermittent swelling and pain of one or more joints, especially knees 2
Treatment of Lyme Disease
Treatment of Lyme disease typically involves the use of antibiotics, such as:
- Doxycycline or amoxicillin for early localized infection 2, 3
- Ceftriaxone or penicillin G for late or severe disease 2, 3
- Cefuroxime axetil or erythromycin as alternative treatments 2 The duration of treatment is usually 2-4 weeks, although some patients may require extended treatment 4
Effectiveness of Antibiotics
Studies have shown that various antibiotics are effective in treating Lyme disease, including:
- Amoxicillin, azithromycin, ceftriaxone, and cefotaxime 5
- Doxycycline and ceftriaxone are equally effective in preventing late manifestations of disease 3 However, some patients may not respond to treatment, and the use of extended courses of antibiotics is increasing 4
Prevention and Prophylaxis
Preventive measures, such as avoiding tick bites and using single-dose doxycycline as prophylaxis, can help reduce the risk of Lyme disease 2