Lyme borreliosis: current issues in diagnosis and management.

PURPOSE OF REVIEW: Lyme borreliosis is the most common vector-borne bacterial infection in temperate areas of the northern hemisphere. It has been perceived as difficult to diagnose and treat, but much is now known about its clinical presentations, which largely fall into well defined categories in both adults and children. This review features recent publications on clinical diagnosis and management. RECENT FINDINGS: The reported incidence of Lyme borreliosis has increased markedly in many countries. Many recent publications have focused on clinical and laboratory aspects of paediatric and adult neuroborreliosis, and there is now strong evidence for the efficacy of oral doxycycline for most presentations of neuroborreliosis. Serological tests have improved significantly. Several studies have confirmed that patients treated for early Lyme borreliosis have good overall long-term outcomes. Studies of patients with persistent symptoms following treatment have not shown evidence for active infection or for sustained benefit from prolonged antibiotic treatment. SUMMARY: Greater efforts are needed to provide education for prevention and early diagnosis to avoid late complications. Further improvements in diagnostic tests would be welcomed. More research is required to assess the causes and management of post-Lyme symptoms.

Perineuritis in acute lyme neuroborreliosis.

Perineuritis is an unusual cause of direct peripheral nerve injury. We describe the clinicopathologic features of a 56-year-old man with mononeuritis multiplex due to Lyme disease; sural nerve biopsy demonstrated florid perineuritis. Treatment with intravenous ceftriaxone resulted in marked neurologic improvement. This study supports the notion that perineuritis forms part of the pathogenesis in acute Lyme neuroborreliosis.