What are the symptoms of Lyme disease and what analyses should be performed?

From the Guidelines

Lyme disease symptoms typically include a bull's-eye rash called erythema migrans, fever, lymphadenopathy, myalgias, or arthralgias, and diagnosis should be confirmed by a 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting, as recommended by current guidelines 1. The symptoms of Lyme disease can be divided into three stages: early localized, early disseminated, and late disseminated.

• Early localized infection is characterized by erythema migrans (EM), which is defined as a gradually expanding annular lesion >5 cm in diameter, accompanied by fever, lymphadenopathy, myalgias, or arthralgias 1.
• Early disseminated Lyme disease can manifest as multiple EM skin lesions, facial palsy, meningitis, or carditis 1.
• Late disseminated disease is characterized by recurrent large-joint arthritis, and late neurologic Lyme disease is uncommon in the United States, with symptoms including peripheral neuropathy, encephalopathy, or encephalomyelitis 1. For patients with a lesion consistent with EM and a history of living in or traveling to Lyme-endemic areas, diagnosis can be made without laboratory testing 1. However, for all other patients, laboratory testing is necessary to confirm the diagnosis, with a 2-tiered serologic analysis being the recommended approach, consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting, which has a high specificity (>95%) during all stages of disease 1. It is essential to note that the sensitivity of 2-tiered testing is low (30%–40%) during early infection, but increases to 70%–100% for disseminated Lyme disease 1.

From the Research

Symptoms of Lyme Disease

• The earliest symptom of Lyme borreliosis is a characteristic skin rash, erythema migrans 2
• If untreated, Lyme disease can affect the nervous system, joints, and the heart 2
• Other symptoms may include multiple erythema migrans lesions or objective evidence of organ involvement 3

Analyses to be Performed

• Initial diagnosis of Lyme borreliosis is based on symptoms, physical findings, and the history of a tick-bite 2
• Centers for Disease Control recommended two-step laboratory testing:
  • The first step is immunoserological testing with enzyme immunoassay (EIA) for the presence of specific antibodies 2, 4
  • The second step is a Western blot technique, which should be carried out only in case of positive or equivocal EIA results 2, 4, 5
• Other diagnostic methods are not recommended 2

Treatment

• In early stages of the disease, patients should receive oral antibiotics, such as amoxicillin, doxycycline, or cefuroxime axetil, with treatment lasting 14-21 days 2
• In some cases (neuroborreliosis, carditis, and chronic arthritis), patients may require intravenous treatment with ceftriaxone or penicillin for 14-28 days 2
• Oral doxycycline and parenterally administered ceftriaxone were found to be equally effective in preventing the late manifestations of disease in patients with acute disseminated Lyme disease but without meningitis 3