Lyme borreliosis: diagnosis and management

Area of Science:

• Infectious Diseases
• Epidemiology
• Immunology

Background:

• Lyme borreliosis is the most prevalent vector-borne disease in the Northern Hemisphere.
• Clinical manifestations range from erythema migrans and neurologic disease to arthritis and acrodermatitis chronica atrophicans (ACA).

Purpose of the Study:

• To summarize the clinical presentation, diagnosis, and management of Lyme borreliosis.
• To discuss the phenomenon of persistent symptoms following treatment, termed post-treatment Lyme disease syndrome (PTLDS).
• To review current understanding of PTLDS pathophysiology and treatment efficacy.

Main Methods:

• Review of clinical signs and symptoms for diagnosis.
• Serological confirmation of infection.
• Analysis of treatment responses and sequelae, including PTLDS.
• Evaluation of evidence regarding prolonged antibiotic treatment for PTLDS.

Main Results:

• Diagnosis relies on clinical presentation and serology.
• While antibiotic treatment is usually effective, some patients develop sequelae like PTLDS.
• PTLDS is characterized by persistent fatigue, pain, arthralgia, and neurocognitive symptoms.
• The pathophysiology of PTLDS remains unclear, and prolonged antibiotic therapy has not shown benefits in trials.
• Persistent active infection is not identified as a cause of PTLDS.

Conclusions:

• Lyme borreliosis requires timely diagnosis and appropriate antibiotic treatment.
• Post-treatment Lyme disease syndrome is a recognized entity, but its underlying mechanisms require further investigation.
• Current evidence does not support prolonged antibiotic treatment for PTLDS.
• Preventive measures, including post-exposure prophylaxis and vaccine development, are crucial.