What is Lyme disease (Lyme borreliosis)?

From the Guidelines

Lyme disease should be treated with antibiotics as early as possible to prevent long-term complications, with doxycycline 100mg twice daily for 10-14 days being the recommended treatment for early localized disease in adults, and amoxicillin 50mg/kg/day divided into three doses for the same duration for children under 8 1.

Key Considerations

• The treatment of Lyme disease depends on the stage and severity of the disease, with oral antibiotics being the preferred treatment for early localized disease and intravenous antibiotics being reserved for more advanced disease with neurological or cardiac involvement 1.
• The diagnosis of Lyme disease is typically made based on clinical symptoms, such as the characteristic bull's-eye rash called erythema migrans, fever, fatigue, headache, and muscle and joint pain, as well as laboratory tests, including serologic testing and PCR 1.
• Prevention of Lyme disease involves avoiding exposure to vector ticks, using protective clothing and tick repellents, checking for ticks daily, and prompt removal of attached ticks 1.

Treatment Options

• For early localized disease, doxycycline 100mg twice daily for 10-14 days is the recommended treatment for adults, while amoxicillin 50mg/kg/day divided into three doses for the same duration is recommended for children under 8 1.
• For more advanced disease with neurological or cardiac involvement, intravenous ceftriaxone 2g daily for 14-28 days may be necessary 1.

Important Notes

• The bacterium Borrelia burgdorferi causes Lyme disease, and antibiotics work by killing these bacteria before they can spread throughout the body and cause more serious complications 1.
• If left untreated, Lyme disease can progress to affect the heart, joints, and nervous system, leading to long-term complications and morbidity 1.

From the Research

Overview of Lyme Disease

• Lyme disease is the most common tick-borne disease in the United States, with approximately 20,000 cases reported annually 2.
• The disease is transmitted to humans through the bite of the Ixodes tick (Ixodes scapularis and Ixodes pacificus) and can be divided into three stages: early localized infection, early disseminated infection, and late disseminated infection 2, 3.

Risk Factors and Prevention

• Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk of contracting Lyme disease 2.
• Children and those spending extended time outdoors in wooded areas are also at increased risk 2.
• Preventive measures include avoiding areas with high tick burdens, wearing protective clothing, using tick repellents, and performing frequent body checks and bathing following outdoor activities 3.

Diagnosis and Treatment

• Diagnosis is usually made clinically, with identification of an erythema migrans rash following a tick bite being the only clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation 3.
• Treatment is typically accomplished with doxycycline or amoxicillin, with cefuroxime axetil or erythromycin used as an alternative 2.
• Late or severe disease requires intravenous ceftriaxone or penicillin G 2.
• A network meta-analysis found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease, while cefuroxime and penicillin were safe for treating the disease 4.
• A recent study identified piperacillin as a potential alternative therapy for Lyme disease, which may offer clinicians another therapeutic option for the disease 5.

Clinical Manifestations

• The disease can cause a range of clinical manifestations, including erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias 2.
• Neurologic manifestations, such as neuropathy or encephalopathy, may also occur 2.
• Lyme neuroborreliosis and Lyme arthritis are also common manifestations of the disease 4, 6.