Lyme Disease – ‘tis the season!

6 Jun

Tick-borne illness caused by the spirochete Borrelia burgdorferi


3 clinical stages

–    Stage 1, early localized disease (days-weeks):

  • target lesion of erythema migrans (EM) -> occurs at the site of the tick bite. Near the axilla, inguinal region most common. 



  • nonspecific viral prodrome -> fatigue, anorexia, headache, neck stiffness, myalgias, arthralgias, regional lymphadenopathy, fever. Note: upper respiratory and GI symptoms uncommon.


–     Stage 2, early disseminated disease (weeks-months) :

  • multiple EM lesions
  • +/- cardiac -> heart block,cardiomyopathy
  • +/- neurologic -> lymphocytic meningitis, cranial nerve palsies (especially of the facial nerve), radiculopathy, peripheral neuropathy, mononeuropathy multiplex


–     Stage 3, late disease (months-years):

  • arthritis of one or few large joints
  • +/- neurologic -> different from the stage two findings such as subtle cognitive disturbance, chronic axonal polyneuropathy (spinal radicular pain or distal parasthesias)


 CDC criteria for diagnosis of Lyme Disease

–     presence of EM OR one late manifestation plus laboratory confirmation of infection (IgM or IgG antibodies to b. burgdorferi in serum or CSF)



It’s complicated, but the basic idea is doxycycline 100 mg PO bid x 10-21 days for erythema migrans (stage 1). This treatment lengthens to 21-28 days for neurologic, cardiac, or musculoskeletal involvement (stage 2-3). Second line is amoxicillin or cefuroxime.


Submitted by K. Estes.


References: Steere AC. Lyme disease. N Engl J Med 2001; 345:115.; Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Morb Mortal Recomm Rep 1997;46(RR-10):1.; 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; 43:1089.


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