Lyme Borreliosis

Abstract

Lyme borreliosis (Lyme disease) is a multisystem inflammatory disease caused by infection with species within Borrelia burgdorferi sensu lato, spread by Ixodid ticks in North America, Eurasia, and north Africa. Lyme borreliosis causes a number of cutaneous features (erythema migrans, lymphadenosis benigna cutis, lymphocytoma, acrodermatitis chronica atrophicans), various cardiac manifestations (notably variable levels of heart block), arthritis and other musculoskeletal complaints, and neurologic damage (cranial nerve palsies, lymphocytic meningitis, radiculoneuritis, encephalopathy). Other infections have been documented as being transmitted by Ixodid ticks, including Anaplasma phagocytophilum and Babesia microti, in North America and deer-tick virus in Europe. Serological tests can be useful in substantiating a diagnosis made on strict clinical grounds. Antibiotic therapy, oral and intravenous, is usually curative, although symptoms and signs may linger. In many regions of the United States, significant anxiety has arisen regarding the assertion, unsupported by any rigorous scientific evidence, that the infection may not respond to antibiotics or may become chronic – this anxiety is fed by groups with apparent self-interest in the perpetuation of this belief system.