title: Lyme borreliosis.
abstract: Lyme borreliosis is an infectious disease caused by spirochaetal bacteria, Borrelia burgdorferi sensu lato , which is transmitted by Ixodes spp. ticks. Several of Borrelia burgdorferi genospecies are pathogenic to humans. Endemic areas of the disease in Europe include: Scandinavia, Eastern Europe, Austria, Germany, Slovenia. In Poland the number of reported cases has increased since 1996 and large majority of all cases are diagnosed in Podlasie and Warmia-Mazuria provinces. The earliest symptom of Lyme borreliosis is characteristic skin rash, erythema migrans. If untreated, it can affect the nervous system, joints and the heart. Initial diagnosis of Lyme borreliosis is based on symptoms, physical findings, and the history of a tick-bite. Centers for Disease Control recommended two-step laboratory testing. The first step is immunoserological testing with enzyme immunoassay (EIA) for the presence of specific antibodies. Only in case of positive or equivocal EIA, the second step with western blot technique should be carried out. Other diagnostic methods are not recommended. In early stages of the disease patients should receive oral antibiotics, e.g. amoxicillin, doxycycline or cefuroxime axetil, with treatment lasting 14-21 days. In some cases (neuroborreliosis, carditis and chronic arthritis) patients require intravenous treatment usually with ceftriaxone or penicillin for 14-28 days. Superiority of longer therapy with higher doses of antibiotics, combination treatment with two or more antibiotics, or sequence therapy is not supported by any results of clinical trials, therefore it should not be applied and recommended according to the principles of evidence based medicine.
authors.affiliation: Department of Infectious Diseases and Hepatology, Medical University, 14 Żurawia Street, 15-540 Białystok, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Szulżyk
authors.affiliation: Department of Infectious Diseases and Hepatology, Medical University, 14 Żurawia Street, 15-540 Białystok, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Flisiak
keywords: Borrelia burgdorferi; Lyme borreliosis; Lyme disease; arthritis; erythema migrans; neuroborreliosis