Lyme disease

John J Halperin MD (Dr. Halperin of Overlook Medical Center and Sidney Kimmel Medical College of Thomas Jefferson University has stock ownership in Merck, Abbott, and Johnson & Johnson.)
Raymond P Roos MD, editor. (Dr. Roos of the University of Chicago owns stock in Amgen, Best Doctors, Express Scripts, Ionis, and Merck.)
Originally released May 8, 1995; last updated April 23, 2017; expires April 23, 2020

This article includes discussion of Lyme disease, erythema migrans disease, Garin-Bujadoux-Bannwarth syndrome, Lyme borreliosis, neuroborreliosis, Lyme disease associated meningitis, cranial neuritis, radiculitis, and facial nerve palsy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Lyme disease, a multisystem spirochetal infection responsive to antimicrobial therapy, continues to be the source of contentious but probably artificial debate. Some patient advocacy groups argue that there are large numbers of patients with chronic neurologic symptoms requiring long-term antibiotics. Studies now clearly show that individuals with the chronic symptoms referred to as “chronic Lyme disease” have neither neurologic disease nor Lyme disease and that these individuals do not benefit from treatment with long-term antibiotics. The author discusses the manifestations, pathophysiology, diagnosis, and treatment of Lyme disease.

Key points

 

• Lyme disease, infection with the tick-borne spirochete Borrelia burgdorferi, affects the central or peripheral nervous system in up to 10% to 15% of patients.

 

• Clinical phenomena associated with neuroborreliosis typically include cranial neuropathy (most often the facial nerve), radiculopathy, and lymphocytic meningitis.

 

• Serodiagnosis after the first month of infection has high sensitivity and specificity.

 

• Treatment with 2- to 4-week courses of oral antibiotics is curative in most; parenteral treatment is recommended either if there is evidence of parenchymal brain or spinal cord involvement or if objectively demonstrable active disease persists after appropriate oral treatment.

 

• Persisting difficulties after treatment, often referred to as “post Lyme disease syndrome”, may occur, but are not associated with nervous system infection and probably are no more common than in control populations.

Historical note and terminology

The term "Lyme arthritis" was first introduced in 1977 and was subsequently broadened to "Lyme disease" when it was recognized that the disorder commonly involved multiple organ systems in addition to joints (Steere et al 1977). However, the syndrome was described much earlier in the 20th century. In 1910, Afzelius first reported the typical cutaneous lesion, erythema migrans (formerly known as erythema chronicum migrans). In 1922, Garin and Bujadoux described tick bite-associated meningoradiculitis, the most typical neurologic presentation in this disorder (Garin and Bujadoux 1922). Following a more detailed description of this syndrome by Bannwarth, the notion that bites of Ixodes ticks could lead to a syndrome of lymphocytic meningitis with painful radiculoneuritis became widely accepted by European clinicians. The first reports of Lyme arthritis described cases of apparent juvenile rheumatoid arthritis among children in the region of Lyme, Connecticut (Steere et al 1977). Detailed epidemiologic studies led to the association of this disorder with bites of Ixodes ticks. In 1979, Reik and colleagues described a neurologic syndrome in American patients with Lyme disease virtually identical to that described by Garin and Bujadoux (Reik et al 1979). In 1983, the responsible spirochete, Borrelia burgdorferi, was identified as the causative agent in American patients with Lyme disease (Benach et al 1983; Steere et al 1983). Shortly thereafter, a closely related agent was identified in European patients (Asbrink et al 1984). Subsequent work has both broadened the scope of the neurologic disorders recognized as associated with this infection (known collectively as "neuroborreliosis") and refined the microbiological understanding of the responsible organisms.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.