Overview
Lyme borreliosis, caused by Borrelia burgdorferi, is a tick-borne disease presenting with diverse clinical manifestations including cutaneous, neurological, and rheumatological symptoms 12.Diagnosis
Clinical History: Epidemiological exposure to tick-infested areas is crucial 12.
Cutaneous Manifestations: Erythema migrans, multiple erythema migrantiae, borrelial lymphocytoma, and acrodermatitis chronica atrophicans are key clinical signs 1.
Laboratory Tests: Serological tests (ELISA, Western blot) are commonly used but have limitations in early disease detection 14.
Emerging Techniques: Direct detection methods targeting Borrelia antigens like OspC show promise for early diagnosis 3.
Interpretation Challenges: Significant variability in test results between laboratories can affect diagnosis 4.Management
Early Localized Disease: Oral doxycycline, amoxicillin, or cefuroxime axetil are first-line treatments 1.
Disseminated or Severe Cases: Intravenous ceftriaxone or penicillin may be required 1.
Duration: Typically 14-21 days depending on the severity and stage of the disease 1.
Adjunctive Therapies: No specific adjunctive therapies beyond addressing symptoms are widely recommended 1.Special Populations
Pregnancy: Doxycycline should be avoided; alternatives like amoxicillin are preferred 1.
Pediatrics: Similar treatment regimens as adults but with careful monitoring 1.
Elderly: Consider comorbidities and renal function when selecting antibiotics 1.Key Recommendations
Clinical Diagnosis: Confirm diagnosis using clinical history and characteristic skin manifestations, supplemented by serological testing 1 (Evidence: Strong).
Treatment of Early Localized Disease: Initiate treatment with oral antibiotics such as doxycycline, amoxicillin, or cefuroxime axetil 1 (Evidence: Strong).
Serological Test Interpretation: Exercise caution due to variability in test results between laboratories 4 (Evidence: Moderate).
Avoid Doxycycline in Pregnancy: Opt for alternatives like amoxicillin for pregnant patients 1 (Evidence: Expert opinion).References
1 Hofmann H, Fingerle V, Rauer S, Hunfeld KP, Huppertz HI, Krause A. Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society. German medical science : GMS e-journal 2025. link
2 Oteo JA, Corominas H, Escudero R, Fariñas-Guerrero F, García-Moncó JC, Goenaga MA et al.. Executive summary of the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Spanish Society of Neurology (SEN), Spanish Society of Immunology (SEI), Spanish Society of Pediatric Infectology (SEIP), Spanish Society of Rheumatology (SER), and Spanish Academy of Dermatology and Venereology (AEDV), on the diagnosis, treatment and prevention of Lyme borreliosis. Enfermedades infecciosas y microbiologia clinica (English ed.) 2023. link
3 Dolange V, Simon S, Morel N. Detection of Borrelia burgdorferi antigens in tissues and plasma during early infection in a mouse model. Scientific reports 2021. link
4 Hansmann Y, Leyer C, Lefebvre N, Revest M, Rabaud C, Alfandari S et al.. Feedback on difficulties raised by the interpretation of serological tests for the diagnosis of Lyme disease. Medecine et maladies infectieuses 2014. link
5 Gebbia JA, Monco JC, Degen JL, Bugge TH, Benach JL. The plasminogen activation system enhances brain and heart invasion in murine relapsing fever borreliosis. The Journal of clinical investigation 1999. link
6 Schmutzhard E. Lyme borreliosis and multiple sclerosis. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 1989. link90239-4)