title: Lyme disease: a rigorous review of diagnostic criteria and treatment.
abstract: Lyme disease was originally identified in Lyme, Connecticut, based upon an unusual cluster of what appeared to be patients with juvenile rheumatoid arthritis. It was subsequently identified as a new clinical entity originally called Lyme arthritis based on the observation that arthritis was a major clinical feature. However, Lyme arthritis is now called Lyme disease based upon the understanding that the clinical features include not only arthritis, but also potential cardiac, dermatologic and neurologic findings. Lyme disease typically begins with an erythematous rash called erythema migrans (EM). Approximately 4-8% of patients develop cardiac, 11% develop neurologic and 45-60% of patients manifest arthritis. The disease is transmitted following exposure to a tick bite containing a spirochete in a genetically susceptible host. There is considerable data on spirochetes, including Borrelia burgdorferi (Bb), the original bacteria identified in this disease. Lyme disease, if an organism had not been identified, would be considered as a classic autoimmune disease and indeed the effector mechanisms are similar to many human diseases manifest as loss of tolerance. The clinical diagnosis is highly likely based upon appropriate serology and clinical manifestations. However, the serologic features are often misinterpreted and may have false positives if confirmatory laboratory testing is not performed. Antibiotics are routinely and typically used to treat patients with Lyme disease, but there is no evidence that prolonged or recurrent treatment with antibiotics change the natural history of Lyme disease. Although there are animal models of Lyme disease, there is no system that faithfully recapitulates the human disease. Further research on the effector mechanisms that lead to pathology in some individuals should be further explored to develop more specific therapy.
authors.affiliation: Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA 95616, USA.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Borchers
authors.affiliation: Department of Nutrition, University of California at Davis, Davis, CA 95616, USA.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Keen
authors.affiliation: Department of Dermatology, University of California at Davis, Davis, CA 95616, USA.
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Huntley
authors.affiliation: Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA 95616, USA. Electronic address: megershwin@ucdavis.edu.
authors.forename: M Eric
authors.initials: ME
authors.lastname: Gershwin
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001898:Borrelia / Q000145:classification / Q000187:drug effects / Q000502:physiology*; D054884:Host-Pathogen Interactions / Q000187:drug effects; D006801:Humans; D007303:Insect Vectors / Q000145:classification / Q000382:microbiology; D018884:Ixodes / Q000145:classification / Q000382:microbiology; D008193:Lyme Disease / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Autoimmunity; Diagnostic criteria; Lyme disease; Spirochetes