Lyme disease: a rigorous review of diagnostic criteria and treatment
- PMID:25451629
- DOI: 10.1016/j.jaut.2014.09.004
Lyme disease: a rigorous review of diagnostic criteria and treatment
Abstract
Lyme disease was originally identified in Lyme, Connecticut, based upon an unusual cluster of what appeared to be patients with juvenile rheumatoid arthritis. It was subsequently identified as a new clinical entity originally called Lyme arthritis based on the observation that arthritis was a major clinical feature. However, Lyme arthritis is now called Lyme disease based upon the understanding that the clinical features include not only arthritis, but also potential cardiac, dermatologic and neurologic findings. Lyme disease typically begins with an erythematous rash called erythema migrans (EM). Approximately 4-8% of patients develop cardiac, 11% develop neurologic and 45-60% of patients manifest arthritis. The disease is transmitted following exposure to a tick bite containing a spirochete in a genetically susceptible host. There is considerable data on spirochetes, including Borrelia burgdorferi (Bb), the original bacteria identified in this disease. Lyme disease, if an organism had not been identified, would be considered as a classic autoimmune disease and indeed the effector mechanisms are similar to many human diseases manifest as loss of tolerance. The clinical diagnosis is highly likely based upon appropriate serology and clinical manifestations. However, the serologic features are often misinterpreted and may have false positives if confirmatory laboratory testing is not performed. Antibiotics are routinely and typically used to treat patients with Lyme disease, but there is no evidence that prolonged or recurrent treatment with antibiotics change the natural history of Lyme disease. Although there are animal models of Lyme disease, there is no system that faithfully recapitulates the human disease. Further research on the effector mechanisms that lead to pathology in some individuals should be further explored to develop more specific therapy.
Keywords: Autoimmunity; Diagnostic criteria; Lyme disease; Spirochetes.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Similar articles
- Orthopaedic manifestations of Lyme disease.Jouben LM, Steele RJ, Bono JV.Jouben LM, et al.Orthop Rev. 1994 May;23(5):395-400.Orthop Rev. 1994.PMID:8041573Review.
- Lyme disease.Hedayati H.Hedayati H.J Am Osteopath Assoc. 1992 Jun;92(6):755-60, 763-5.J Am Osteopath Assoc. 1992.PMID:1612941Review.
- Clinical spectrum of Lyme disease.Cardenas-de la Garza JA, De la Cruz-Valadez E, Ocampo-Candiani J, Welsh O.Cardenas-de la Garza JA, et al.Eur J Clin Microbiol Infect Dis. 2019 Feb;38(2):201-208. doi: 10.1007/s10096-018-3417-1. Epub 2018 Nov 19.Eur J Clin Microbiol Infect Dis. 2019.PMID:30456435Review.
- Dermatological manifestations of Lyme borreliosis.Mullegger RR.Mullegger RR.Eur J Dermatol. 2004 Sep-Oct;14(5):296-309.Eur J Dermatol. 2004.PMID:15358567Review.
- Lyme disease update for the general dermatologist.Godar DA, Laniosz V, Wetter DA.Godar DA, et al.Am J Clin Dermatol. 2015 Feb;16(1):5-18. doi: 10.1007/s40257-014-0108-2.Am J Clin Dermatol. 2015.PMID:25589049
Cited by
- Technical and clinical validation of three commercial real-time PCR kits for the diagnosis of neuroborreliosis in cerebrospinal fluid on three different real-time PCR platforms.Maes L, Carolus T, De Preter V, Ignoul S, Cartuyvels R, Braeken L, D'Huys PJ, Saegeman V, Kabamba B, Raymaekers M.Maes L, et al.Eur J Clin Microbiol Infect Dis. 2017 Feb;36(2):273-279. doi: 10.1007/s10096-016-2797-3. Epub 2016 Oct 6.Eur J Clin Microbiol Infect Dis. 2017.PMID:27714590
- Delineating Surface Epitopes of Lyme Disease Pathogen Targeted by Highly Protective Antibodies of New Zealand White Rabbits.Rogovskyy AS, Caoili SEC, Ionov Y, Piontkivska H, Skums P, Tsyvina V, Zelikovsky A, Waghela SD.Rogovskyy AS, et al.Infect Immun. 2019 Jul 23;87(8):e00246-19. doi: 10.1128/IAI.00246-19. Print 2019 Aug.Infect Immun. 2019.PMID:31085705Free PMC article.
- T2 Magnetic Resonance Assay-Based Direct Detection of Three Lyme Disease-Related Borrelia Species in Whole-Blood Samples.Snyder JL, Giese H, Bandoski-Gralinski C, Townsend J, Jacobson BE, Shivers R, Schotthoefer AM, Fritsche TR, Green C, Callister SM, Branda JA, Lowery TJ.Snyder JL, et al.J Clin Microbiol. 2017 Aug;55(8):2453-2461. doi: 10.1128/JCM.00510-17. Epub 2017 May 31.J Clin Microbiol. 2017.PMID:28566314Free PMC article.
- Prevalence of Function-Dependent Temporomandibular Joint and Masticatory Muscle Pain, and Predictors of Temporomandibular Disorders among Patients with Lyme Disease.Osiewicz M, Manfredini D, Biesiada G, Czepiel J, Garlicki A, Aarab G, Pytko-Polończyk J, Lobbezoo F.Osiewicz M, et al.J Clin Med. 2019 Jun 28;8(7):929. doi: 10.3390/jcm8070929.J Clin Med. 2019.PMID:31261623Free PMC article.
- NF‑κB is a key modulator in the signaling pathway of Borrelia burgdorferi BmpA‑induced inflammatory chemokines in murine microglia BV2 cells.Zhao Z, Tao L, Liu A, Ma M, Li H, Zhao H, Yang J, Wang S, Jin Y, Shao X, Bao F.Zhao Z, et al.Mol Med Rep. 2018 Apr;17(4):4953-4958. doi: 10.3892/mmr.2018.8526. Epub 2018 Jan 31.Mol Med Rep. 2018.PMID:29393443Free PMC article.
Publication types
MeSH terms
Substances
Related information
LinkOut - more resources
Full Text Sources
Medical