Summary
Definition
History and exam
Key diagnostic factors
- erythema migrans
- constitutional symptoms
Other diagnostic factors
- facial palsy
- arthritis or arthralgia
- regional lymphadenopathy
- stiff neck
- lymphocytoma cutis
- acrodermatitis chronica atrophicans
- atrioventricular (AV) block or myopericarditis
- radiculoneuropathy
- encephalomyelitis, peripheral neuropathy, encephalopathy
Risk factors
- exposure to infected ticks
- outdoor activities
- tick bite duration
Diagnostic tests
1st tests to order
- enzyme immunoassay or immunofluorescence assay
Tests to consider
- Lyme-specific IgM and IgG (immunoblot assays)
- skin biopsy culture
- polymerase chain reaction (PCR)
- ECG
Treatment algorithm
known high risk tick bite
erythema migrans
cardiac involvement
neurologic disease
arthritis
recurrent or persistent arthritis
Contributors
Authors
Janak Koirala, MD, MPH, FACP, FIDSA
Professor of Medicine and Infectious Diseases
Division of Infectious Diseases
Southern Illinois University School of Medicine
Springfield
IL
Disclosures
JK declares that he has no competing interests.
Acknowledgements
Dr Janak Koirala would like to gratefully acknowledge Dr Tin Han Htwe and Dr Cristian A. Spiel, previous contributors to this topic.
Disclosures
THH and CAS declare that they have no competing interests.
Peer reviewers
Raymond J. Dattwyler, MD
Professor of Medicine and Microbiology/Immunology
Chief of Allergy, Immunology and Rheumatology
New York Medical College
Valhalla
NY
Disclosures
RJD declares that he has no competing interests.
Ionita Catalina, MD
Assistant Professor of Neurology and Neurosurgery
SUNY at Buffalo
Stroke/Neurocritical Care
Millard Fillmore Gates Hospital - Kaleida Stroke Center
Buffalo
NY
Disclosures
IC declares that she has no competing interests.
Graham Fry, MB, FRCSI, DTM&H
Lecturer in Tropical Medicine
University College Dublin
Medical Director
Tropical Medical Bureau
Ireland
Declarações
GF declares that he has no competing interests.
Andras Lakos, MD, PhD
Physician
Centre for Tick-Borne Diseases
Budapest
Hungary
Declarações
AL is an author of a reference cited in this topic.
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Referências
Principais artigos
Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis. 2021 Jan 23;72(1):e1-48.Texto completo Resumo
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - Lyme disease. May 2023 [internet publication].Texto completo
Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of lyme disease. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):703.Texto completo Resumo
Mygland A, Ljøstad U, Fingerle V, et al; European Federation of Neurological Societies. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol. 2010 Jan;17(1):8-16;e1-4.Texto completo Resumo
National Institute for Health and Care Excellence. Lyme disease. Oct 2018 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Local inflammatory reaction to tick bite
- Tickbite allergy
- Cellulitis
Mais Diagnósticos diferenciaisDiretrizes
- CDC Yellow Book: health information for international travel - Lyme disease
- 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease
Mais DiretrizesFolhetos informativos para os pacientes
Lyme disease
Mais Folhetos informativos para os pacientes
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