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Lyme Disease

Bulls Eye Rash orFever, Headache, Stiff Neck orFacial Palsy orA Swollen Painful Knee

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Introduction to Clinical Infectious Diseases

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Abstract

Lyme disease is an infection caused by the spirochete Borrelia burgdorferi sensu stricto in the United States, which is transmitted to humans by Ixodes scapularis and I. pacificus ticks. The hallmark of early, localized infection is the characteristic bull’s-eye-like skin rash, erythema chronicum migrans (ECM) (Latin for chronic migrating redness). Early disseminated infection is associated with fever, fatigue, and myalgias, most classically in association with carditis, aseptic meningitis, facial nerve palsy and/or multiple foci of erythema migrans. Late disease most typically presents as large joint monoarticular arthritis. The diagnosis of Lyme disease is based on the results of serologic testing, taking care to interpret the findings in the context of the patient’s clinical presentation. Two-tiered testing is the standard diagnostic approach. An enzyme-linked immunoassay (ELISA) is performed first. Results that meet or exceed the cutoff threshold undergo reflex confirmatory testing by Western blot. Treatment for Lyme disease requires the use of a correct medication, at the correct dosage, for the correct length of time based on the patient’s clinical presentation. Recommended courses of treatment range between 14 and 28 days. For most individuals and most clinical presentations, doxycycline, given orally, is the antibiotic of choice. Amoxicillin, given orally, or ceftriaxone, given intravenously or intramuscularly, is also effective. Ceftriaxone is preferred over doxycycline in specific circumstances. Although many antibiotics should effectively treat Lyme disease given the typical antibiotic susceptibility profile of the causative organism, only a small number of alternatives have a sufficiently strong clinical track record to be included as second- or third-line alternatives in clinical practice guidelines.

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Authors and Affiliations

  1. Connecticut Children’s Medical Center, Division of Infectious Diseases and Immunology, Hartford, CT, USA

    Nicholas J. Bennett

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  1. SUNY Upstate Medical University, Syracuse, NY, USA

    Joseph Domachowske

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Bennett, N.J. (2019). Lyme Disease. In: Domachowske, J. (eds) Introduction to Clinical Infectious Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-91080-2_32

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  • DOI: https://doi.org/10.1007/978-3-319-91080-2_32

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