Identification of Lyme disease.
The identification of Lyme disease is an important, rewarding process. In early disease, the presence of EM, the geographic location of the patient, and the time of year are critical in assessing the likelihood of Lyme disease. Beyond this, it is important to have a high index of suspicion in early Lyme disease, because the rash may be atypical or absent, the early flu-like features can be nonspecific, and at this stage seroreactivity to B. burgdorferi may be lacking. Treatment is always with antibiotics and is highly successful. In late Lyme disease, the issues are different. Most individuals presenting with questions about late Lyme disease do not have the disorder. The clinician must recognize characteristic, objective disease manifestations such as oligoarthritis or chronic meningitis and avoid the diagnosis in individuals with "chronic fatigue" alone. Serologic testing is useful because few, if any, individuals with late Lyme disease will be seronegative. Serologic testing should not be indiscriminate, however, because false positives are common. Most patients with late Lyme disease are cured with antibiotics, but the response to successful treatment may be slow. In a minority of patients, there is a role for managing disease that cannot be cured (for example, anti-inflammatory medication, physical therapy, reassurance) as in other rheumatic diseases.
Yale University School of Medicine, New Haven, Connecticut.
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D003937:Diagnosis, Differential; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis*