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| __NOTOC__ | | __NOTOC__ |
| {{Lyme disease}} | | {{Lyme disease}} |
| {{CMG}};{{AE}}{{Anmol}} | | {{CMG}} |
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| ==Overview== | | ==Overview== |
| The mainstay of therapy for Lyme disease is antimicrobial therapy. Antimicrobial therapy may include either [[doxycycline]], [[amoxicillin]], [[cephalosporin]]s, or [[macrolide]]s. Individuals who remove attached ticks should be monitored closely for signs and symptoms of tick-borne diseases for up to 30 days.
| | Abnormal [[magnetic resonance imaging]] (MRI) findings are often seen in both early and late Lyme disease. Diffuse white matter pathology can disrupt these ubiquitous [[gray matter]] connections and could account for deficits in attention, memory, visuospatial ability, complex cognition, and emotional status. White matter disease may have a greater potential for recovery than gray matter disease, perhaps because neuronal loss is less common, |
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| ==Medical Therapy== | | ==MRI== |
| ===Lyme boreliosis (non-neuroborreliosis)===
| | Abnormal [[magnetic resonance imaging]] (MRI) findings are often seen in both early and late Lyme disease. MRI scans of patients with neurologic Lyme disease may demonstrate punctated [[white matter]] [[lesions]] on T2-weighted images, similar to those seen in [[demyelinating]] or inflammatory disorders such as [[multiple sclerosis]], [[systemic lupus erythematosus]] (SLE), or cerebrovascular disease.<ref>{{cite conference | last = Fallon | first = BA | title = Review of Lyme Neuroborreliosis | conference = 3th International Scientific Conference on Lyme Disease and other Tick-borne Disorders | url = http://www.medscape.com/viewarticle/412987 | year = 2000}}</ref> [[Cerebral atrophy]] and brainstem [[neoplasm]] has been indicated with Lyme infection as well.<ref>{{cite journal |author=Kalina P, Decker A, Kornel E, Halperin JJ |title=Lyme disease of the brainstem |journal=Neuroradiology |volume=47 |issue=12 |pages=903-7 |year=2005 |pmid=16158278 |doi=10.1007/s00234-005-1440-2}}</ref> |
| '''Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for treatment of Lyme disease'''<ref name="pmid17029130">{{cite journal| author=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al.| title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 9 | pages= 1089-134 | pmid=17029130 | doi=10.1086/508667 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17029130 }} </ref>
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| * '''1 Stage 1 - early localized Lyme disease'''
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| ** 1.1 '''Erythema migrans'''
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| *** 1.1.1 '''Adult'''
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| **** Preferred regimen (1): [[Doxycycline]] 100 mg PO q12h for 10-21 days '''(avoid in pregnancy)'''
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| **** Preferred regimen (2): [[Amoxicillin]] 500 mg PO q8h for 14-21 days
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| **** Preferred regimen (3): [[Cefuroxime axetil]] 500 mg q12h for 14-21 days
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| **** Alternative regimen (1): [[Azithromycin]] 500 mg PO q6h for 7–10 days
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| **** Alternative regimen (2): [[Clarithromycin]] 500 mg PO q12h for 14–21 days '''(avoid in pregnancy)'''
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| **** Alternative regimen (3): [[Erythromycin]] 500 mg PO q6h for 14–21 days
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| *** 1.1.2 '''Pediatric'''
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| **** 1.1.2.1 '''children < 8 years of age'''
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| ***** Preferred regimen (1): [[Amoxicillin]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
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| ***** Preferred regimen (2): [[Cefuroxime axetil]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
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| ***** Alternative regimen (1): [[Azithromycin]] 10 mg/kg PO q6h (maximum, 500 mg per day)
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| ***** Alternative regimen (2): [[Clarithromycin]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
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| ***** Alternative regimen (3): [[Erythromycin]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
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| ****1.1.2.2 '''children ≥ 8 years of age'''
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| ***** Preferred regimen (1): [[Doxycycline]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
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| ***** Alternative regimen (1): [[Azithromycin]] 10 mg/kg PO q6h (maximum, 500 mg per day)
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| ***** Alternative regimen (2): [[Clarithromycin]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
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| ***** Alternative regimen (3): [[Erythromycin]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
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| ** 2.1 '''When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis'''
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| *** 2.1.1 '''Adult'''
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| **** Preferred regimen (1): [[Amoxicillin-Clavulanate]] 500 mg PO q8h
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| *** 2.1.2 '''Pediatric'''
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| **** Preferred regimen (1): [[Amoxicillin-Clavulanate]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
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| * 2 '''Stage 2 - early disseminated Lyme disease'''
| | Diffuse white matter pathology can disrupt these ubiquitous [[gray matter]] connections and could account for deficits in attention, memory, visuospatial ability, complex cognition, and emotional status. White matter disease may have a greater potential for recovery than gray matter disease, perhaps because neuronal loss is less common. Spontaneous [[remission (medicine)|remission]] can occur in [[multiple sclerosis]], and resolution of MRI white matter hyper-intensities, after antibiotic treatment, has been observed in Lyme disease.<ref>{{cite journal |author=Fallon BA, Keilp J, Prohovnik I, Heertum RV, Mann JJ |title=Regional cerebral blood flow and cognitive deficits in chronic lyme disease |journal=The Journal of neuropsychiatry and clinical neurosciences |volume=15 |issue=3 |pages=326-32 |year=2003 |pmid=12928508}}</ref> |
| ** 2.1 '''Lyme carditis'''
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| **: '''Note (1):''' Parenteral regimen is recommended at the start of therapy for patients who have been hospitalized for cardiac monitoring; oral regimen may be substituted to complete a course of therapy or to treat ambulatory patients.
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| **: '''Note (2)''': A temporary pacemaker may be required for patients with advanced heart block.
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| **: '''Note (3):''' Patients treated with macrolides should be closely observed to ensure resolution of the clinical manifest
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| *** 2.1.1 '''Adult'''
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| **** Parenteral regimen
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| ***** Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 (14–21) days
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| ***** Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h for 14 (14–21) days
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| ***** Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 14 (14–21) days '''(patients with normal renal function)'''
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| **** Oral regimen
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| ***** Preferred regimen (1): [[Amoxicillin]] 500 mg PO q8h for 14 (14–21) days
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| ***** Preferred regimen (2): [[Doxycycline]] 100 mg PO q12h for 14 (14–21) days '''(avoid in pregnancy)'''
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| ***** Preferred regimen (3): [[Cefuroxime]] 500 mg PO q12h for 14 (14–21) days
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| ***** Alternative regimen (1): [[Azithromycin]] 500 mg PO q6h for 7–10 days
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| ***** Alternative regimen (2): [[Clarithromycin]] 500 mg PO q12h for 14–21 days '''(avoid in pregnancy)'''
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| ***** Alternative regimen (3): [[Erythromycin]] 500 mg PO q6h for 14–21 days
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| *** 2.1.2 '''Pediatric'''
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| **** Parenteral regimen
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| ***** Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
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| ***** Alternative regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
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| ***** Alternative regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '''(patients with normal renal function)'''
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| **** Oral regimen
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| ***** Preferred regimen (1): [[Amoxicillin]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
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| ***** Preferred regimen (2): [[Doxycycline]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
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| ***** Preferred regimen (3): [[Cefuroxime]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
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| ***** Alternative regimen (1): [[Azithromycin]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
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| ***** Alternative regimen (2): [[Clarithromycin]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
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| ***** Alternative regimen (3): [[Erythromycin]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
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| ** 2.2 '''Borrelial lymphocytoma'''
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| *** The same regimens used to treat patients with erythema migrans (see above)
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| * 3 '''Stage 3 - late disseminated Lyme Disease'''
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| ** 3.1 '''Lyme arthritis'''
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| *** 3.1.1 '''Adult'''
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| **** Preferred regimen (1): [[Doxycycline]] 100 mg PO q12h for 28 days '''(avoid in pregnancy)'''
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| **** Preferred regimen (2): [[Amoxicillin]] 500 mg PO q8h for 28 days
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| **** Preferred regimen (3): [[Cefuroxime axetil]] 500 mg PO q12h for 28 days
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| *** 3.1.2 '''Pediatric'''
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| **** Preferred regimen (1): [[Amoxicillin]] 50 mg/kg/day PO q8h for 28 days (maximum, 500 mg per dose)
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| **** Preferred regimen (1): [[Cefuroxime axetil]] 30 mg/kg/day PO q12h for 28 days (maximum, 500 mg per dose)
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| **** Preferred regimen (1): [[Doxycycline]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 28 days (maximum, 100 mg per dose)
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| **:'''Note:''' Patient with persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy are suggested re-treatment with another 4-week course of oral antibiotics or with a 2–4 weeks course of [[ceftriaxone]].
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| ** 3.2 '''Patients with arthritis and objective evidence of neurologic disease'''
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| *** 3.2.1 '''Adult'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 2–4 weeks
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| **** Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h for 2–4 weeks
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| **** Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 2-4 weeks '''(patients with normal renal function)'''
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| *** 3.2.2 '''Pediatric'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg IV q24h for 2–4 weeks (maximum, 2 g)
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| **** Preferred regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h for 2–4 weeks (maximum, 6 g per day)
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| **** Alternative regimen (1): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h for 14 for 2–4 weeks (maximum, 18–24 million U per day) '''(patients with normal renal function)'''
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| ** 3.3 '''Acrodermatitis chronica atrophicans'''
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| *** Preferred regimen (1): [[Doxycycline]] 100 mg PO q12h for 21 days '''(avoid in pregnancy)'''
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| *** Preferred regimen (2): [[Amoxicillin]] 500 mg PO q8h for 21 days
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| *** Preferred regimen (3): [[Cefuroxime axetil]] 500 mg PO q12h for 21 days
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| * 4. '''Post–Lyme Disease Syndromes'''
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| ** Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)
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| ===Lyme neuroborreliosis===
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| * 1. '''Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines'''<ref name="pmid17029130">{{cite journal| author=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al.| title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 9 | pages= 1089-134 | pmid=17029130 | doi=10.1086/508667 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17029130 }} </ref>
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| ** 1.1 '''Early neurologic disease (Stage 2 - early disseminated Lyme disease)'''
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| *** 1.1.1 '''Cranial nerve palsy'''
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| **** 1.1.1.1 '''Adult'''
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| ***** Preferred regimen (1): [[Amoxicillin]] 500 mg PO q8h for 14 (14–21) days
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| ***** Preferred regimen (2): [[Doxycycline]] 100 mg PO q12h for 14 (14–21) days '''(avoid in pregnancy)'''
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| ***** Preferred regimen (3): [[Cefuroxime]] 500 mg PO q12h for 14 (14–21) days
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| ***** Alternative regimen (1): [[Azithromycin]] 500 mg PO q6h for 7–10 days
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| ***** Alternative regimen (2): [[Clarithromycin]] 500 mg PO q12h for 14–21 days
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| ***** Alternative regimen (3): [[Erythromycin]] 500 mg PO q6h for 14–21 days
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| **** 1.1.1.2. '''Pediatric'''
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| ***** Preferred regimen (1): [[Amoxicillin]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg/dose)
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| ***** Preferred regimen (2): [[Doxycycline]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg/dose)
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| ***** Preferred regimen (3): [[Cefuroxime]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg/dose)
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| ***** Alternative regimen (1): [[Azithromycin]] 10 mg/kg/day PO q6h for 7–10 days (maximum, 500 mg/day)
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| ***** Alternative regimen (2): [[Clarithromycin]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg/dose)
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| ***** Alternative regimen (3): [[Erythromycin]] 12.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg/dose)
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| *** 1.1.2 '''Meningitis or radiculopathy'''
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| **** 1.1.2.1 '''Adult'''
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| ***** Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
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| ***** Alternative regimen (1): [[Cefotaxime]] 2 g IV q6-8h for 14 (10–28) days
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| ***** Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days '''(patients with normal renal function)'''
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| ***:'''Note:''' For adult patients intolerant of β-lactam agents, [[Doxycycline]] '''(avoid in pregnancy)''' 200–400 mg/day PO/IV q12h may be considered.
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| **** 1.1.2.2 '''Pediatric'''
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| ***** Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg IV q24h for 14 (10–28) days (maximum, 2 g/day)
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| ***** Alternative regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6-8h for 14 (10–28) days (maximum, 6 g/day)
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| ***** Alternative regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h for 14 (10–28) days (maximum, 18–24 MU/day) '''(patients with normal renal function)'''
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| ***:'''Note:''' For children intolerant of β-lactam agents, [[Doxycycline]] '''(children aged ≥ 8 years)''' 4–8 mg/kg/day PO/IV q12h (maximum, 200–400 mg/day may be considered)
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| ** 1.2 '''Late neurologic disease (Stage 3 - late disseminated Lyme disease)'''
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| *** 1.2.1 '''Central or peripheral nervous system disease'''
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| **** 1.2.1.1 '''Adult'''
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| ***** Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
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| ***** Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days
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| ***** Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days '''(patients with normal renal function)'''
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| **** 1.2.1.2 '''Pediatric'''
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| ***** Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h for 14 (10–28) days (maximum, 2 g/day)
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| ***** Alternative regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h for 14 (10–28) days (maximum, 6 g/day)
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| ***** Alternative regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h for 14 (10–28) days (maximum, 18–24 MU/day) '''(patients with normal renal function)'''
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| * 2 '''American Academy of Neurology (AAN) Practice Parameter'''<ref>{{Cite journal| doi = 10.1212/01.wnl.0000265517.66976.28| issn = 1526-632X| volume = 69| issue = 1| pages = 91–102| last1 = Halperin| first1 = J. J.| last2 = Shapiro| first2 = E. D.| last3 = Logigian| first3 = E.| last4 = Belman| first4 = A. L.| last5 = Dotevall| first5 = L.| last6 = Wormser| first6 = G. P.| last7 = Krupp| first7 = L.| last8 = Gronseth| first8 = G.| last9 = Bever| first9 = C. T.| last10 = Quality Standards Subcommittee of the American Academy of Neurology| title = Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology| journal = Neurology| date = 2007-07-03| pmid = 17522387}}</ref>
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| ** 2.1 '''Meningitis'''
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| *** 2.1.1 '''Adult'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
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| **** Preferred regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days
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| **** Preferred regimen (3): [[Penicillin G]] 18–24 MU/day q4h for 14 days '''(patients with normal renal function)'''
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| **** Alternative regimen (1): [[Doxycycline]] 100–200 mg q12h for 14 days '''(avoid in pregnancy)'''
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| *** 2.1.2 '''Pediatric'''
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| **** Preferred regimen (1): Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h (maximum, 2 g/day)
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| **** Preferred regimen (2): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h (maximum, 6 g/day)
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| **** Preferred regimen (3): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (maximum, 18–24 MU/day) '''(patients with normal renal function)'''
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| **** Alternative regimen (1): [[Doxycycline]] '''(for children aged ≥ 8 years)''' 4–8 mg/kg/day q12h (maximum 200 mg/day)
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| ** 2.2 '''Any neurologic syndrome with CSF pleocytosis'''
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| *** 2.2.1 '''Adult'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
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| **** Preferred regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days
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| **** Preferred regimen (3): [[Penicillin G]] 18–24 MU/day IV q4h for 14 days '''(patients with normal renal function)'''
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| **** Alternative regimen (1): [[Doxycycline]] 100–200 mg q12h for 14 days '''(avoid in pregnancy)'''
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| *** 2.2.2 '''Pediatric'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg/day IV q24h (maximum, 2 g/day)
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| **** Preferred regimen (2): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h (maximum, 6 g/day)
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| **** Preferred regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day q4h (maximum, 18–24 MU/day) '''(patients with normal renal function)'''
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| **** Alternative regimen (1): [[Doxycycline]] '''(for children aged ≥ 8 years)''' 4–8 mg/kg/day q12h (maximum 200 mg/day)
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| ** 2.3 '''Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)'''
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| *** 2.3.1 '''Adult'''
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| **** Preferred regimen (1): [[Doxycycline]] 100–200 mg q12h for 14 days '''(avoid in pregnancy)'''
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| **** Alternative regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
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| **** Alternative regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days
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| **** Alternative regimen (3): [[Penicillin G]] 18–24 MU/day IV q4h for 14 days '''(patients with normal renal function)'''
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| *** 2.3.2 '''Pediatric'''
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| **** Preferred regimen (1): [[Doxycycline]] '''(for children aged ≥ 8 years)''' 4–8 mg/kg/day q12h (maximum 200 mg/day)
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| **** Alternative regimen (1): [[Ceftriaxone]] 50–75 mg/kg/day IV q24h (maximum, 2 g/day)
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| **** Alternative regimen (2): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h (maximum, 6 g/day)
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| **** Alternative regimen (3): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (maximum, 18–24 MU/day) '''(patients with normal renal function)'''
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| ** 2.4 '''Encephalomyelitis'''
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| *** 2.4.1 '''Adult'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
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| **** Preferred regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days
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| **** Preferred regimen (3): [[Penicillin G]] 18–24 MU/day IV q4h for 14 days '''(patients with normal renal function)'''
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| *** 2.4.2 '''Pediatric'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg/day IV q24h (maximum, 2 g/day)
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| **** Preferred regimen (2): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h (maximum, 6 g/day)
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| **** Preferred regimen (3): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (maximum, 18–24 MU/day) '''(patients with normal renal function)'''
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| ** 2.5 '''Encephalopathy'''
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| *** 2.5.1 '''Adult'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
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| **** Preferred regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days
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| **** Preferred regimen (3): [[Penicillin G]] 18–24 MU/day IV q4h for 14 days '''(patients with normal renal function)'''
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| *** 2.5.2 '''Pediatric'''
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| **** Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg/day IV q24h (maximum, 2 g/day)
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| **** Preferred regimen (2): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h (maximum, 6 g/day)
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| **** Preferred regimen (3): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (maximum, 18–24 MU/day) '''(patients with normal renal function)'''
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| ** 2.6 '''Post-treatment Lyme syndrome'''
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| *** Preferred regimen: symptomatic management
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| **: '''Note:''' Antibiotic therapy is not indicated
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| ===Follow-up===
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| *Approximately 10 to 20% of patients treated for Lyme disease with a recommended 2-4 week course of antibiotics will develop post-treatment Lyme disease syndrome (PTLDS). Patients report lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months.
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| *The majority of patients with post-treatment Lyme disease syndrome gradually improve over months/years of the primary infection.
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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| [[Category:Infectious Disease Project]]
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| [[Category:Needs overview]] | | [[Category:Needs overview]] |
| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Intensive care medicine]] | | [[Category:Intensive care medicine]] |
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