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Lyme disease update. Current approach to early, disseminated, & late disease

  [ 31 votes ]   [ Discuss This Article ]
By Rahn DW, Felz MW • • May 10, 1998

A rational approach to diagnosis and treatment of Lyme disease
requires an understanding of the endemic range of the tick
vectors for B burgdorferi, the epidemiologic risk factors, and
the spectrum of clinical manifestations. A two-step approach
to serologic testing (ELISA followed by Western blot analysis
of positive or equivocal results) can be useful if the pretest
likelihood of Lyme disease is higher than 20%. Consideration
should be given to the possibility of (1) a noninfectious
disease with clinical features similar to those of Lyme
disease or (2) coinfection with a second tick-transmitted
organism. Late Lyme disease must be distinguished by clinical
characteristics from fibromyalgia (the commonest source of
misdiagnosis in several studies). Antibiotic therapy should be
tailored to the extent of disease and limited to 4 weeks in
most cases. Human vaccines based on an outer-surface protein
from B burgdorferi have been tested in large-scale US clinical
trials and may soon be approved for use in persons whose
occupational or recreational activities place them at risk for
B burgdorferi exposure.

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