Abstract
Lyme disease or Lyme borreliosis is a vector-borne disease caused by the Borrelia burgdorferi spirochete. It is a systemic infectious disease which may express cardiac, neurological, dermatological and rheumatological manifestations.
Different clinical manifestations are related to the genetic diversity of the Borreliae, depending on geographical area. Skin manifestations include erythema migrans, borrelial lymphocytoma and acrodermatitis chronica atrophicans.
Systemic manifestations could be neurological, cardiovascular, rheumatic, opthalmologic etc. The course of the disease could be divided into stages, but to distinguish the early and late infection is more practical. 7-14 days after the tick bite clinical signs and symptoms develop.
Skin is affected in 80-90% patients, other organs in 10-20%. At the early stage, the nervous system is mostly affected.
Cardiac manifestations may be preceded by dermatological manifestations and they are related to conduction or rhythm problems. Borrelial DNA could be detected by PCR even a few months after therapy.
Cardiac evaluation should include an electrocardiogram or a 24-h Holter ECG. Antibiotic therapy includes doxycycline, and in allergic patients, macrolides.
The duration of therapy should be at least 2 weeks. Patients with extracutaneous symptoms are treated with ceftriaxone.