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
Disclosures
GF declares that he has no competing interests.
Andras Lakos, MD, PhD
Physician
Centre for Tick-Borne Diseases
Budapest
Hungary
Disclosures
AL is an author of a reference cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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].Full text
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.Full text Abstract
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.Full text Abstract
National Institute for Health and Care Excellence. Lyme disease. Oct 2018 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Local inflammatory reaction to tick bite
- Tickbite allergy
- Cellulitis
More DifferentialsGuidelines
- CDC Yellow Book: health information for international travel - Lyme disease
- 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease
More GuidelinesPatient information
Lyme disease
More Patient information
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