Borrelia burgdorferi (Lyme disease)

Abstract

• On the basis of strong evidence from research, approximately 90% of children with Lyme disease have erythema migrans, which often does not have central clearing; most are either uniformly erythematous or have enhanced central erythema. • On the basis of strong evidence from research, antibody testing of patients with erythema migrans is not indicated routinely because of poor sensitivity in early Lyme disease. By contrast, sensitivity is excellent in patients with infection for 4 weeks or longer. • On the basis of strong research evidence, treatment of Lyme disease at any stage with antibiotics is safe and highly efficacious. • On the basis of strong evidence from research, a single 200-mg dose of doxycycline reduces the risk of Lyme disease in persons bitten by Ixodes scapularis but is not indicated routinely (because risk of transmission from a tick bite is low). • There is no evidence that chronic Lyme disease exists. On the basis of strong evidence from research, patients treated for Lyme disease who have persistent, nonspecific symptoms (eg, arthralgia and fatigue) do not have persistent infection; the risks of prolonged treatment with antimicrobials far outweigh benefits, if any.