[Lyme borreliosis--an overview]

North American Lyme disease and European borreliosis differ in many aspects: Whereas in North America infection by Borrelia burgdorferi sensu stricto almost invariably leads to erythema migrans, frequently followed by oligoarthritis in untreated individuals, most infections in Europe are caused by Borrelia garinii and Borrelia afzelii and are contracted asymptomatically. A minority of the infected individuals develop neuroborreliosis, consisting of various combinations of meningitis, radiculitis and (cranial) neuritis. Lyme carditis, presenting with second or third degree atrioventricular block, is infrequent on both continents. Diagnostic limitations and the protean manifestations of Lyme borreliosis frequently give rise to misunderstandings and overdiagnosis of Lyme disease. Targeted use of Lyme serology, judicious application of a case definition, strict adherence to established treatment options and thorough patient information may lead the narrow path between unjustified exclusion and careless assumption of the diagnosis of Lyme borreliosis.