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

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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