scholarly journals Lyme disease: modern approaches to treatment and prevention (based on international recommendations of 2020)

2022 ◽  
Vol 66 (9-10) ◽  
pp. 57-63
Author(s):  
B. S. Belov ◽  
L. P. Ananyeva
Keyword(s):  
Lyme Disease ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
The United States ◽  
Cefuroxime Axetil ◽  
Duration Of Treatment ◽  
American College Of Rheumatology ◽  
Treatment And Prevention ◽  
Medical Importance ◽  
American Academy Of Neurology

Lyme disease (LD) or tick-borne borreliosis affects thousands of people every year in different regions of the world, primarily in the United States and Europe. Given the great social and medical importance of this problem, an updated version of the clinical guidelines for the prevention, diagnosis and treatment of PD was published in November 2020 by a committee of experts of the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR). This article discusses the main issues of the use of antibacterial drugs in LD. The most commonly used medications are doxycycline, amoxicillin, cefuroxime axetil, and ceftriaxone. Patients with erythema migrans receive appropriate antibiotics for 7–14 days, depending on the medication used. In case of other clinical manifestations of LD, the duration of treatment is extended to 14–28 days. Antibiotic prophylaxis is carried out using a single oral dose of 200 mg doxycycline for adults and 4.4 mg/kg (with a maximum of 200 mg) for children. This treatment scheme is highly efficient, easy to administer, and has a relatively low risk of adverse events.

scholarly journals Evidence-Based, Patient-Centered Treatment of Erythema Migrans in the United States

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 754
Author(s):  
Elizabeth L. Maloney
Keyword(s):  
Erythema Migrans ◽  
The United States ◽  
Therapeutic Interventions ◽  
Evidence Based ◽  
Early Disease ◽  
Patient Centered ◽  
American College Of Rheumatology ◽  
The Us ◽  
American Academy Of Neurology ◽  
Trial Evidence

Lyme disease, often characterized as a readily treatable infection, can be a debilitating and expensive illness, especially when patients remain symptomatic following therapy for early disease. Identifying and promoting highly effective therapeutic interventions for US patients with erythema migrans (EM) rashes that return them to their pre-infection health status should be a priority. The recently released treatment recommendations by the Infectious Diseases Society of America/American Academy of Neurology/American College of Rheumatology (IDSA/AAN/ACR) for the treatment of US patients fall short of that goal. This paper reviews the US trial evidence regarding EM rashes, discusses the shortcomings of the IDSA/AAN/ACR recommendations in light of that evidence and offers evidence-based, patient-centered strategies for managing patients with erythema migrans lesions.

Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19

2021 ◽  
Vol 66 (11) ◽  
pp. 689-694
Author(s):  
A. L. Shutikova ◽  
G. N. Leonova ◽  
A. F. Popov ◽  
M. Yu. Shchelkanov
Keyword(s):  
Lyme Disease ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Laboratory Diagnostics ◽  
Igg Antibodies ◽  
Serum Samples ◽  
Igm Antibodies ◽  
Chronic Encephalitis ◽  
Tbev Strain

The coexistence of various pathogens inside the patient’s body is one of the poorly studied and current issues. The aim of the study is to identify the relationship between the indicators of complex laboratory diagnostics and the clinical manifestations of a mixed disease during subsequent infection with the SARS-CoV-2 virus using the example of a case of chronic encephalitis-borreliosis infection. Seven blood serum samples were collected from the patient over the course of a year. For the etiological verification of the causative agents of TBE, Lyme disease and COVID-19, the methods of ELISA and PCR diagnostics were used. The patient was diagnosed with Lyme disease on the basis of the detection of IgG antibodies to Borrelia 5 months after the onset of the disease, since she denied the tick bite. In the clinical picture, there was an articular syndrome and erythema migrans. Later, IgG antibodies to the TBEV were found in the blood. Throughout the study, IgM antibodies to Borrelia were not detected. The exacerbation of Lyme disease could be judged by the clinical manifestations of this disease and by the growth of specific IgG antibodies. A feature of this case was that during an exacerbation of the Lyme disease, an infection with the SARS-CoV-2 virus occurred. Treatment (umifenovir, hydroxychloroquine, azithromycin, ceftriaxone) was prescribed, which improved the condition of the underlying disease, decreased joint pain, decreased IgG levels to borrelia. However, during this period, serological markers of TBEV appear: antigen, IgM antibodies, and the titer of IgG antibodies increases. Most likely, this was facilitated by the switching of the immune system to the SARS-CoV-2 virus, with the simultaneous suppression of borrelia with antibiotics and the appointment of hydroxychloroquine, which has an immunosuppressive effect. Despite the activation of the virus, clinical manifestations of TBE were not observed in the patient, which is most likely associated with infection with a weakly virulent TBEV strain. The further course of tick-borne infections revealed the dominant influence of B. burgdorferi in relation to TBEV. Laboratory studies have shown that suppression of the activity of the borreliosis process by etiotropic treatment subsequently led to the activation of the persistent TBEV.

scholarly journals Seasonality of Acute Lyme Disease in Children

2021 ◽  
Vol 6 (4) ◽  
pp. 196
Author(s):  
Kathryn M. Sundheim ◽  
Michael N. Levas ◽  
Fran Balamuth ◽  
Amy D. Thompson ◽  
Desiree N. Neville ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Regression Models ◽  
Disease Incidence ◽  
Erythema Migrans ◽  
The United States ◽  
Lyme Arthritis ◽  
Cranial Neuropathy ◽  
Acute Arthritis ◽  
Presenting Symptoms ◽  
Fourier Regression

Due to the life cycle of its vector, Lyme disease has known seasonal variation. However, investigations focused on children have been limited. Our objective was to evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States. We enrolled children presenting to one of eight Pedi Lyme Net participating emergency departments. Cases were classified based on presenting symptoms: early (single erythema migrans (EM) lesion), early-disseminated (multiple EM lesions, headache, cranial neuropathy, or carditis), or late (arthritis). We defined a case of Lyme disease by the presence of an EM lesion or a positive two-tier Lyme disease serology. To measure seasonal variability, we estimated Fourier regression models to capture cyclical patterns in Lyme disease incidence. While most children with early or early-disseminated Lyme disease presented during the summer months, children with Lyme arthritis presented throughout the year. Clinicians should consider Lyme disease when evaluating children with acute arthritis throughout the year.

scholarly journals Lyme disease: Modern approaches to prevention, diagnosis and treatment

2021 ◽  
Vol 59 (5) ◽  
pp. 547-554
Author(s):  
B. S. Belov ◽  
L. P. Ananyeva
Keyword(s):  
Lyme Disease ◽  
Laboratory Diagnosis ◽  
The United States ◽  
Cefuroxime Axetil ◽  
Diagnosis And Treatment ◽  
Common Disease ◽  
Serum Samples ◽  
Number Of Factors ◽  
Single Oral Administration

Lyme disease (LD) or tick-borne borreliosis affects thousands of people every year in different regions of the world, primarily the United States and Europe. In endemic areas, early LD is a common disease that requires high medical vigilance. Considering the extreme relevance of this problem for public health, in November 2020, the committee of experts of three American scientific societies published an updated version of the clinical guidelines for the prevention, diagnosis and treatment of LD, the main provisions of which are presented in this article. It is emphasized that in the absence of vaccines, the risk of LD and other diseases transmitted by ticks can be reduced by using personal protective equipment and repellents. Antibiotic prophylaxis is carried out by a single oral administration of doxycycline. In the laboratory diagnosis of LD, the determination of antibodies to B. burgdorfery in the blood serum is a first-line study. At the second stage, serum samples are examined using an immunoblot for IgM and IgG. The basis of treatment of LD is rational antibiotic therapy. The choice of an antibiotic depends on a number of factors, including the presence of extracutaneous manifestations of LD (neuroborreliosis, carditis, arthritis). The most commonly used are doxycycline, amoxicillin, cefuroxime-axetil and ceftriaxone.

Lyme Disease: An Overview

2000 ◽  
Vol 35 (2) ◽  
pp. 156-161 ◽  
Author(s):  
Jean G. Dib ◽  
Horatio B. Fung ◽  
Raquel M. Tiu
Keyword(s):  
United States ◽  
Nervous System ◽  
Lyme Disease ◽  
Skin Lesion ◽  
Erythema Migrans ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
The United States ◽  
Disease Treatment ◽  
Clinical Signs And Symptoms

Lyme disease is the most common tick-borne illness in the United States. It occurs most commonly in areas that foster and harbor the deer tick. The number of reported cases of Lyme disease in the United States has increased steadily since 1982. The tick transmits an infection of the spirochete Borrelia burgdorferi that typically manifests as a localized skin lesion and erythema migrans. If left untreated, infection may lead to localized arthritis, heartblock, and/or disease of the nervous system. The diagnosis of Lyme disease is made primarily from clinical signs and symptoms that are suggestive of the disease. Treatment includes 10 to 27 days of antibiotics depending on stage of the disease. Vaccines for the prevention of Lyme disease are now licensed and the trend of increasing incidence of Lyme disease will likely be reversed.

scholarly journals Patients with Erythema Migrans: Characterizing the Impact of Initiation of Antibiotic Therapy Prior to Study Enrollment

2020 ◽  
Vol 65 (1) ◽  
pp. e01895-20
Author(s):  
Gary P. Wormser ◽  
Donna McKenna ◽  
Eliana Jacobson ◽  
Elayna M. Shanker ◽  
Keith D. Shaffer ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Antibiotic Treatment ◽  
Symptom Severity ◽  
Research Study ◽  
Erythema Migrans ◽  
The United States ◽  
Subjective Symptoms ◽  
Study Enrollment ◽  
Symptom Severity Score ◽  
The Impact

ABSTRACTErythema migrans is the most common clinical manifestation of Lyme disease, with concomitant subjective symptoms occurring in ∼65% of cases in the United States. We evaluated the impact of having been started on antibiotic treatment before study enrollment on 12 particular symptoms for 38 subjects with erythema migrans versus 52 untreated subjects. There were no significant differences in the frequency of having at least one symptom or in the symptom severity score on study entry. However, the frequency of having at least one symptom was significantly greater for those who had received <7 days of antibiotic treatment than for those who had been treated for ≥7 days (23/24 [95.8%] versus 8/14 [57.1%], P = 0.006). In addition, the percentage of subjects who were males was significantly lower among the group on treatment than among the untreated study subjects (13/38 [34.2%] versus 34/52 [65.4%], P = 0.005). In conclusion, based on these findings, combining untreated and treated groups of patients with erythema migrans for research study analyses may have limitations and, depending on the study objectives, might not be preferred. Additional studies are warranted to better understand the day-to-day impact of antibiotic treatment on the presence, type, and severity of symptoms in patients with early Lyme disease.

Comparison of patient self-reported data to physician-reported data in eosinophilic granulomatosis with polyangiitis (Preprint)

2021 ◽  
Author(s):  
Irena Doubelt ◽  
Jason M. Springer ◽  
Tanaz A. Kermani ◽  
Antoine G. Sreih ◽  
Cristina Burroughs ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Clinical Manifestations ◽  
The United States ◽  
Research Network ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
American College Of Rheumatology ◽  
Organ Systems ◽  
Patient Reported ◽  
Reported Data ◽  
Eosinophilic Granulomatosis

BACKGROUND Patient-based registries can help advance research in rare diseases such as eosinophilic granulomatosis with polyangiitis (EGPA), a complex, multi-organ form of anti-cytoplasm neutrophil antibody (ANCA)-associated vasculitis. OBJECTIVE To compare patient-reported vs. physician-reported manifestations, treatments, and outcomes for patients with EGPA. METHODS Comparative analysis of patients ≥18 years with EGPA in Canada or the United States from two separate cohorts: i) The Vasculitis Patient-Powered Research Network (VPPRN), a self-enrolled, secure portal with patient-entered data updated quarterly (2013-2019), vs. ii) The Vasculitis Clinical Research Consortium (VCRC) observational studies, a physician-entered database (2003-2019) of patients who fulfilled the 1990 American College of Rheumatology classification criteria for EGPA. Studied parameters included demographics, clinical manifestations, ANCA status, treatments, and relapses. RESULTS Data from 195 patients with a validated diagnosis of EGPA in the VPPRN and 354 patients enrolled in the VCRC were analyzed. Compared to the VCRC cohort, the patients in the VPPRN cohort were more commonly female (69.2% vs. 59.0% in the VCRC cohort; P =.02), younger at diagnosis (47.3 vs. 50.0 years; P =.03), reported similar frequencies of asthma (96.2% vs 92.9% in VCRC; P =.13), cardiac manifestations (28.8% vs 21.2%; P =.06), but less frequent lung manifestations other than asthma, and more frequent disease manifestations in all other organ systems. ANCA positivity was 48.9% in the VPPRN patients vs. 38.9% (P=.05) in the VCRC cohort. Relapsing disease after study enrollment was reported in 32.3% patients in the VPPRN compared 35.7% of patients in the VCRC. Most therapies (glucocorticoids, cyclophosphamide, mepolizumab) were used at similar frequencies in both groups, except for rituximab with VPPRN patients reporting more use than VCRC cohort (24.1% vs. 10.5%; P =<.001). CONCLUSIONS Patients with EGPA generally report having more manifestations of disease than physicians report for patients with EGPA. These differences imply the need to reconsider how patient- and physician-reported data are collected for the study of EGPA, and reevaluate disease specific definitions. CLINICALTRIAL ClinicalTrials.gov: (1) VCRC Longitudinal Study (LS) NCT00315380 https://clinicaltrials.gov/ct2/show/NCT00315380 and (2) One-Time DNA (OT) study NCT01241305 https://clinicaltrials.gov/ct2/show/NCT01241305

scholarly journals The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America

2006 ◽  
Vol 43 (9) ◽  
pp. 1089-1134 ◽  
Author(s):  
Gary P. Wormser ◽  
Raymond J. Dattwyler ◽  
Eugene D. Shapiro ◽  
John J. Halperin ◽  
Allen C. Steere ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Infectious Diseases ◽  
Health Care Providers ◽  
Treatment Guidelines ◽  
Clinical Manifestations ◽  
Previous Treatment ◽  
Care Providers ◽  
Human Granulocytic Anaplasmosis ◽  
Treatment And Prevention ◽  
Granulocytic Anaplasmosis

Abstract Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1–14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post–Lyme disease syndrome is proposed.

scholarly journals Epitope Length, Genospecies Dependency, and Serum Panel Effect in the IR6 Enzyme-Linked Immunosorbent Assay for Detection of Antibodies to Borrelia burgdorferi

2007 ◽  
Vol 14 (7) ◽  
pp. 875-879 ◽  
Author(s):  
Maria J. C. Gomes-Solecki ◽  
Luciana Meirelles ◽  
John Glass ◽  
Raymond J. Dattwyler
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Immunosorbent Assay ◽  
Erythema Migrans ◽  
The United States ◽  
Enzyme Linked Immunosorbent Assay ◽  
Diagnostic Assay ◽  
Assay Sensitivity ◽  
Selection Of ◽  
Antigenic Epitopes

ABSTRACTIn the absence of erythema migrans, the basis for diagnosis of Lyme disease is the demonstration of an antibody response againstBorrelia burgdorferiin an appropriate clinical setting. The C6 enzyme-linked immunosorbent assay, based on the IR6 region of VlsE, has become widely used in both the United States and Europe. We mapped the antigenic epitopes of IR6 to a shorter sequence that is equivalent in sensitivity and specificity to the full-length IR6 25-residue peptide. In addition, we observed significant differences in sensitivity between serum panels (60 to 100%), indicating that the selection of the serum panels can shape the apparent overall sensitivity of the assay. Contrary to prior reports, the assay sensitivity is greater when the IR6 peptide is derived from the sequence of the same infectingBorreliagenospecies. Using our North American panels and the two panels obtained from European Lyme disease patients, we determined that the IR6 assay that is based on a single genospecies ofBorreliaspp. is not optimal for use as a universal diagnostic assay for Lyme disease.

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