Lyme disease

Last reviewed: 30 May 2022
Last updated: 06 May 2021

Summary

Definition

History and exam

Key diagnostic factors

  • erythema migrans
  • constitutional symptoms
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • exposure to infected ticks
  • outdoor activities
  • tick bite duration
More risk factors

Diagnostic investigations

1st investigations to order

  • enzyme immunoassay or immunofluorescence assay
More 1st investigations to order

Investigations to consider

  • Lyme-specific IgM and IgG (immunoblot assays)
  • skin biopsy culture
  • polymerase chain reaction (PCR)
  • ECG
More investigations to consider

Treatment algorithm

INITIAL

known tick bite

ACUTE

erythema migrans

cardiac involvement

neurologic disease

arthritis

ONGOING

recurrent or persistent arthritis

Contributors

Authors

Janak Koirala, MD, MPH, FACP, FIDSA
Janak Koirala

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.

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