Lyme disease update.
OBJECTIVE
Lyme disease is endemic to areas in both Europe and the United States and the incidence is increasing. Despite published guidelines, controversy persists about its diagnosis and management in patients who do not meet strict diagnostic criteria. This review summarizes important recently published studies and recommendations for the diagnosis and management of Lyme disease.


RESULTS
Recent comprehensive guidelines have been published for the diagnosis and management of pediatric Lyme disease. In addition, recent studies may help physicians differentiate between Lyme and aseptic meningitis, as well as show the poor sensitivity of cerebrospinal fluid polymerase chain reaction. Controversy continues about the diagnosis and management of "chronic Lyme disease", despite the current medical literature. Recently published studies in the US have also better described southern tick-associated rash illness, an entity that may present a similar clinical picture to Lyme disease. Guidelines have also been published on the management and diagnosis of other tick-borne illnesses often seen as co-infections with Lyme disease. Finally, case reports have been published describing new cardiac manifestations associated with Lyme disease.


CONCLUSIONS
Controversies persist about the diagnosis and management of Lyme disease. Recently published guidelines and primary research can aid clinicians in diagnosing Lyme properly.
Hoppa
Eric
E
Division of Emergency Medicine, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Eric.hoppa@childrens.harvard.edu
Bachur
Richard
R
D025065:Borrelia burgdorferi; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008587:Meningitis, Viral / Q000175:diagnosis / Q000209:etiology / Q000628:therapy