Skip to main content
Erschienen in: Wiener klinische Wochenschrift 15-16/2018

14.01.2016 | Lyme Borreliosis

Management approaches for suspected and established Lyme disease used at the Lyme disease diagnostic center

verfasst von: Gary P. Wormser, MD, Donna McKenna, NP, John Nowakowski, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 15-16/2018

Einloggen, um Zugang zu erhalten

Summary

2015 marks the 27th year that the Lyme Disease Diagnostic Center, located in New York State in the United States, has provided care for patients with suspected or established deer tick-transmitted infections. There are five deer tick-transmitted infectious in this geographic area of which Lyme disease is the most common.
For patients with erythema migrans, we do not obtain any laboratory testing. However, if the patient is febrile at the time of the visit or reports rigors and high-grade fevers, we consider the possibility of a co-infection and order pertinent laboratory tests.
Our preferred management for Lyme disease-related facial palsy and/or radiculopathy is a 2-week course of doxycycline. Patients who are hospitalized for Lyme meningitis are usually treated at least initially with ceftriaxone. We have not seen convincing cases of encephalitis or myelitis solely due to Borrelia burgdorferi infection in the absence of laboratory evidence of concomitant deer tick virus infection (Powassan virus). We have also never seen Lyme encephalopathy or a diffuse axonal peripheral neuropathy and suggest that these entities are either very rare or nonexistent.
We have found that Lyme disease rarely presents with fever without other objective clinical manifestations. Prior cases attributed to Lyme disease may have overlooked an asymptomatic erythema migrans skin lesion or the diagnosis may have been based on nonspecific IgM seroreactivity. More research is needed on the appropriate management and significance of IgG seropositivity in asymptomatic patients who have no history of Lyme disease.
Literatur
1.
Zurück zum Zitat Molloy PJ, Telford SR 3rd, Chowdri HR, et al. Borrelia miyamotoi disease in the Northeastern United States: a case series. Ann Intern Med. 2015;163:91–8.CrossRefPubMed Molloy PJ, Telford SR 3rd, Chowdri HR, et al. Borrelia miyamotoi disease in the Northeastern United States: a case series. Ann Intern Med. 2015;163:91–8.CrossRefPubMed
2.
3.
Zurück zum Zitat Wormser GP, McKenna D, Carlin J, et al. Brief communication: hematogenous dissemination in early Lyme disease. Ann Intern Med. 2005;142:751–5.CrossRefPubMed Wormser GP, McKenna D, Carlin J, et al. Brief communication: hematogenous dissemination in early Lyme disease. Ann Intern Med. 2005;142:751–5.CrossRefPubMed
4.
Zurück zum Zitat Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089–134.CrossRefPubMed Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089–134.CrossRefPubMed
5.
Zurück zum Zitat Goldberg WS, Forseter G, Nadelman RB, et al. Vesicular erythema migrans. Arch Dermatol. 1992;128:1495–8.CrossRefPubMed Goldberg WS, Forseter G, Nadelman RB, et al. Vesicular erythema migrans. Arch Dermatol. 1992;128:1495–8.CrossRefPubMed
6.
Zurück zum Zitat Wormser GP, Ramanathan R, Nowakowski J, et al. Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003;138:697–704.CrossRefPubMed Wormser GP, Ramanathan R, Nowakowski J, et al. Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003;138:697–704.CrossRefPubMed
7.
Zurück zum Zitat Kowalski TJ, Tata S, Berth W, Mathiason MA, Agger WA. Antibiotic treatment duration and long-term outcomes of patients with early Lyme disease from a Lyme disease-hyperendemic area. Clin Infect Dis. 2010;50:512–20.CrossRefPubMed Kowalski TJ, Tata S, Berth W, Mathiason MA, Agger WA. Antibiotic treatment duration and long-term outcomes of patients with early Lyme disease from a Lyme disease-hyperendemic area. Clin Infect Dis. 2010;50:512–20.CrossRefPubMed
8.
Zurück zum Zitat Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky mountain spotted fever, ehrlichioses, and anaplasmosis–United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep 2006;55 (RR-4):1–27.PubMed Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky mountain spotted fever, ehrlichioses, and anaplasmosis–United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep 2006;55 (RR-4):1–27.PubMed
9.
Zurück zum Zitat Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:e10–52.CrossRefPubMed Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:e10–52.CrossRefPubMed
10.
Zurück zum Zitat Bakken JS, Aguero-Rosenfeld ME, Tilden RL, et al. Serial measurements of hematologic counts during the active phase of human granulocytic ehrlichiosis. Clin Infect Dis. 2001;32:862–70.CrossRefPubMed Bakken JS, Aguero-Rosenfeld ME, Tilden RL, et al. Serial measurements of hematologic counts during the active phase of human granulocytic ehrlichiosis. Clin Infect Dis. 2001;32:862–70.CrossRefPubMed
11.
Zurück zum Zitat Wormser GP, Aguero-Rosenfeld ME, Cox ME, et al. Differences and similarities between culture-confirmed human granulocytic anaplasmosis and early Lyme disease. J Clin Microbiol. 2013;51:954–8.CrossRefPubMedPubMedCentral Wormser GP, Aguero-Rosenfeld ME, Cox ME, et al. Differences and similarities between culture-confirmed human granulocytic anaplasmosis and early Lyme disease. J Clin Microbiol. 2013;51:954–8.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Wormser GP, Villafuerte P, Nolan SM, et al. Neutropenia in congenital and adult babesiosis. Am J Clin Pathol. 2015;144:94–6.CrossRefPubMed Wormser GP, Villafuerte P, Nolan SM, et al. Neutropenia in congenital and adult babesiosis. Am J Clin Pathol. 2015;144:94–6.CrossRefPubMed
14.
Zurück zum Zitat Wang G, Wormser GP, Zhuge J, et al. Utilization of a real-time PCR assay for diagnosis of Babesia microti infection in clinical practice. Ticks Tick Borne Dis. 2015;6:376–82.CrossRefPubMed Wang G, Wormser GP, Zhuge J, et al. Utilization of a real-time PCR assay for diagnosis of Babesia microti infection in clinical practice. Ticks Tick Borne Dis. 2015;6:376–82.CrossRefPubMed
15.
Zurück zum Zitat Wang G, Villafuerte P, Zhuge J, Visintainer P, Wormser GP. Comparison of a quantitative PCR assay with peripheral blood smear examination for detection and quantitation of Babesia microti infection in humans. Diagn Microbiol Infect Dis. 2015;82:109–13.CrossRefPubMed Wang G, Villafuerte P, Zhuge J, Visintainer P, Wormser GP. Comparison of a quantitative PCR assay with peripheral blood smear examination for detection and quantitation of Babesia microti infection in humans. Diagn Microbiol Infect Dis. 2015;82:109–13.CrossRefPubMed
16.
Zurück zum Zitat Aguero-Rosenfeld ME, Kalantarpour F, Baluch M, et al. Serology of culture-confirmed cases of human granulocytic anaplasmosis. J Clin Microbiol. 2000;38:635–8.PubMedPubMedCentral Aguero-Rosenfeld ME, Kalantarpour F, Baluch M, et al. Serology of culture-confirmed cases of human granulocytic anaplasmosis. J Clin Microbiol. 2000;38:635–8.PubMedPubMedCentral
17.
Zurück zum Zitat Steere AC, Hutchinson GJ, Rahn DW, et al. Treatment of early manifestations of Lyme disease. Ann Intern Med. 1983;99:22–6.CrossRefPubMed Steere AC, Hutchinson GJ, Rahn DW, et al. Treatment of early manifestations of Lyme disease. Ann Intern Med. 1983;99:22–6.CrossRefPubMed
18.
Zurück zum Zitat Clark JR, Carlson RD, Sasaki CT, Pachies AR, Steere AC. Facial paralysis in Lyme disease. Laryngoscope. 1985;95:1341–5.PubMed Clark JR, Carlson RD, Sasaki CT, Pachies AR, Steere AC. Facial paralysis in Lyme disease. Laryngoscope. 1985;95:1341–5.PubMed
19.
Zurück zum Zitat Ljostad U, Skogvoll E, Eikeland R, et al. Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial. Lancet Neurol. 2008;7:690–5.CrossRefPubMed Ljostad U, Skogvoll E, Eikeland R, et al. Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial. Lancet Neurol. 2008;7:690–5.CrossRefPubMed
20.
Zurück zum Zitat Wormser GP, Halperin JJ. Oral doxycycline for neuroborreliosis. Lancet Neurol. 2008;7:665–6.CrossRefPubMed Wormser GP, Halperin JJ. Oral doxycycline for neuroborreliosis. Lancet Neurol. 2008;7:665–6.CrossRefPubMed
21.
Zurück zum Zitat van Dam AP, Kuiper H, Vos K, et al. Different genospecies of Borrelia burgdorferi are associated with distinct clinical manifestations of Lyme borreliosis. Clin Infect Dis. 1993;17:708–17.CrossRefPubMed van Dam AP, Kuiper H, Vos K, et al. Different genospecies of Borrelia burgdorferi are associated with distinct clinical manifestations of Lyme borreliosis. Clin Infect Dis. 1993;17:708–17.CrossRefPubMed
22.
Zurück zum Zitat Weitzner E, McKenna D, Nowakowski J, et al. Long-term assessment of post-treatment symptoms in patients with culture-confirmed early Lyme disease. Clin Infect Dis. 2015;61:1800–6.CrossRefPubMedPubMedCentral Weitzner E, McKenna D, Nowakowski J, et al. Long-term assessment of post-treatment symptoms in patients with culture-confirmed early Lyme disease. Clin Infect Dis. 2015;61:1800–6.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Personal communication from Dr. Franc Strle, 08/2015. Personal communication from Dr. Franc Strle, 08/2015.
24.
Zurück zum Zitat Kindstrand E, Nilsson BY, Hovmark A, Pirskanen R, Asbrink E. Peripheral neuropathy in acrodermatitis chronica atrophicans—a late manifestation. Acta Neurol Scand. 1997;95:338–45.CrossRefPubMed Kindstrand E, Nilsson BY, Hovmark A, Pirskanen R, Asbrink E. Peripheral neuropathy in acrodermatitis chronica atrophicans—a late manifestation. Acta Neurol Scand. 1997;95:338–45.CrossRefPubMed
26.
Zurück zum Zitat Nimmrich S, Becker I, Horneff G. Intra-articular corticosteroids in refractory childhood Lyme arthritis. Rheumatol Int. 2014;34:987–94.CrossRefPubMed Nimmrich S, Becker I, Horneff G. Intra-articular corticosteroids in refractory childhood Lyme arthritis. Rheumatol Int. 2014;34:987–94.CrossRefPubMed
27.
Zurück zum Zitat Wormser GP, Horowitz HW, Nowakowski J, et al. Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis. Am J Clin Pathol. 1997;107:142–7.CrossRefPubMed Wormser GP, Horowitz HW, Nowakowski J, et al. Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis. Am J Clin Pathol. 1997;107:142–7.CrossRefPubMed
28.
Zurück zum Zitat Steere AC, Dhar A, Hernandez J, et al. Systemic symptoms without erythema migrans as the presenting picture of early Lyme disease. Am J Med. 2003;114:58–62.CrossRefPubMed Steere AC, Dhar A, Hernandez J, et al. Systemic symptoms without erythema migrans as the presenting picture of early Lyme disease. Am J Med. 2003;114:58–62.CrossRefPubMed
29.
Zurück zum Zitat Wormser GP, Nadelman RB, Nowakowski J, Schwartz I. Asymptomatic Borrelia burgdorferi infection. Med Hypotheses. 2001;57:435–8.CrossRefPubMed Wormser GP, Nadelman RB, Nowakowski J, Schwartz I. Asymptomatic Borrelia burgdorferi infection. Med Hypotheses. 2001;57:435–8.CrossRefPubMed
Metadaten
Titel
Management approaches for suspected and established Lyme disease used at the Lyme disease diagnostic center
verfasst von
Gary P. Wormser, MD
Donna McKenna, NP
John Nowakowski, MD
Publikationsdatum
14.01.2016
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 15-16/2018
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0936-y

Weitere Artikel der Ausgabe 15-16/2018

Wiener klinische Wochenschrift 15-16/2018 Zur Ausgabe

mitteilungen der gesellschaft der ärzte in wien

Vorschau auf das Wintersemester 2018/19

MUW researcher of the month

MUW researcher of the month