[Lyme Borreliosis: should we prepare for an epidemic?]

Lyme Borreliosis results from the persistent infection with a spirochete, Borrelia burgdorferi, transmitted by ticks of the Ixodes ricinus complex. The geographic distribution of these ticks depends on specific climatic and ecologic conditions. Lyme borreliosis is a disease with protean manifestations whose distribution is world-wide. In North America, the disease usually begins between May and August with a characteristic rash, erythema chronicum migrans, accompanied by non specific or meningitis-like symptoms. Weeks or months after the rash, the patient may develop transient cardiac, neurologic or musculo-skeletal manifestations, and usually more than a year later, some patients have chronic skin, joint, or neurologic manifestations. Antibody titers rise after four to eight weeks in most patients that did not receive antibiotics, and serologic testing then represents the most useful aid in diagnosis. Due to large numbers of false positives, serologic testing should be limited to those patients with strong clinical or epidemiological evidence of the disease. Treatment with appropriate antibiotics, and for adequate time, is usually curative but in later stages patients may need to be retreated and some may not respond.