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Lyme disease - Management
Basis for recommendation

These recommendations are based on guidelines from the Infectious Diseases Society of America (IDSA) [Wormser et al, 2006] which have been endorsed by the UK Health Protection Agency [HPA, 2009e], and on a clinical practice parameter from the American Academy of Neurology [Halperin et al, 2007].

  • The IDSA guidelines state that 'erythema migrans is the only manifestation of Lyme disease in the United States that is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory confirmation... (in) a patient with a compatible epidemiologic and clinical history' [Wormser et al, 2006].
    • This implies that people with any other manifestation of Lyme disease, including facial palsy, need laboratory confirmation.
    • A delay in treatment for people with isolated unilateral facial palsy is not likely to be clinically significant, as the purpose of antibiotics is to prevent late complications rather than speed up recovery of the facial palsy [Wormser et al, 2006].
  • Neurological manifestations, cardiac manifestations, and arthritis may require referral for:
    • Secondary care assessment to exclude other causes of symptoms and signs. This recommendation was supported by the majority of CKS expert reviewers.
    • Secondary care investigations, such as lumbar puncture, if deemed necessary [Wormser et al, 2006; Halperin et al, 2007].
    • Secondary care treatment, such as continuous monitoring for people with cardiac involvement, or intravenous antibiotics [Wormser et al, 2006].
  • The recommendation that isolated, unilateral facial palsy secondary to Lyme disease can usually be treated with the same antibiotic regimen as for erythema migrans is based on the IDSA guidelines [Wormser et al, 2006].
  • Acrodermatitis chronica atrophicans and Borrelia lymphocytoma are rare manifestations of Lyme disease and, as such, would be unfamiliar and difficult to diagnose for most primary healthcare professionals.
  • The treatment of people with persistent symptoms attributed to Lyme disease is controversial (see Prognosis) and requires specialist management.

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