Lyme disease, also known as borreliosis, is a controversial condition that is caused by the bacteria Borrelia burgdorferi, with infection being via a tick-borne vector.
Controversy around Lyme disease centres on chronic infection with some author doubting its existence 3. There are some terms that help differentiate these patients with non-specific symptoms of fatigue, myalgia and arthralgia, from those with acute infection 3:
- post-Lyme disease symptoms: symptoms for <6 months
- post-Lyme disease syndrome: disabling symptoms lasting for >6 months
Lyme disease is endemic in some areas of North America and Europe.
Three disease stages have been proposed manifesting after the tick bite 2:
- stage 1: flu-like illness and enlarging skin lesion (erythema migrans) (2-30 days)
- stage 2: cardiac and neurological symptoms (1-4 months)
- stage 3: arthritis and neurological symptoms (many years)
Lyme disease has nonspecific symptoms with multisystemic involvement 1,2:
Lyme disease caused by the bacteria Borrelia burgdorferi and is transmitted by the bite of the ticks Ixodes scapularis and Ixodes pacificus.
Disease manifestations can be multisystem and nonspecific includes 1,2,4,5:
- cutaneous: erythema migrans
- CNS: peripheral neuropathy, radiculoneuropathy, myelopathy, encephalitis, meningitis, facial nerve palsy
- cardiac: myopericarditis, cardiac arrhythmia
- musculoskeletal: Lyme arthritis
Treatment and prognosis
Treatment is based with antibiotics depending on the stage of the disease and its severity 1. There is no evidence that long-term antibiotic therapy is appropriate for patients with post-Lyme disease symptoms or syndrome 4.
- 1. Shapiro ED. Clinical practice. Lyme disease. N. Engl. J. Med. 2014;370 (18): 1724-31. doi:10.1056/NEJMcp1314325 - Free text at pubmed - Pubmed citation
- 2. Agarwal R, Sze G. Neuro-lyme disease: MR imaging findings. Radiology. 2009;253 (1): 167-73. doi:10.1148/radiol.2531081103 - Pubmed citation
- 3. Auwaerter P, Bakken J, Dattwyler R et-al. The Lancet Infectious Diseases. 2011;11 (9): . doi:10.1016/S1473-3099(11)70034-2
- 4. Wormser GP, Dattwyler RJ, Shapiro ED et-al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin. Infect. Dis. 2006;43 (9): 1089-134. doi:10.1086/508667 - Pubmed citation
- 5. Smouha EE, Coyle PK, Shukri S. Facial nerve palsy in Lyme disease: evaluation of clinical diagnostic criteria. Am J Otol. 1997;18 (2): 257-61. Pubmed citation