INTRODUCTION

Lyme disease is the most common tick-borne disease in the United States and Europe [1]. It is a spirochetal infection caused by Borrelia species (B. burgdorferi in the United States, and primarily B. afzelii and B. garinii in Europe and Asia) and is transmitted by the bite of infected Ixodes ricinus complex ticks. Lyme disease can involve the skin, joints, nervous system, and heart.

The Infectious Diseases Society of America and the American Academy of Neurology published practice guidelines for the treatment of Lyme disease in the United States in 2006 and 2007, respectively [2,3]. The treatment of Lyme disease in the United States will be reviewed here and the recommendations largely reflect these guidelines. Antibiotic regimens for the treatment of B. burgdorferi infection are summarized in the following table (table 1).

The microbiology, epidemiology, clinical manifestations, and diagnosis of Lyme disease are discussed separately. (See "Epidemiology of Lyme disease" and "Clinical manifestations of Lyme disease in adults" and "Diagnosis of Lyme disease".)

The treatment of other tick-borne diseases is reviewed elsewhere. (See "Treatment of Rocky Mountain spotted fever" and "Human ehrlichiosis and anaplasmosis" and "Southern tick-associated rash illness (STARI)" and "Clinical manifestations, diagnosis, treatment, and prevention of babesiosis".)

CLINICAL STAGES

The clinical manifestations of Lyme disease can generally be divided into three phases: early localized, early disseminated, and late disease (table 2). However, the clinical features of each stage can overlap and some patients present in a later stage of Lyme disease without a history of prior signs or symptoms suggestive of earlier Lyme disease: