{"product_id":"lyme-disease-and-other-tick-borne-illnesses-a-complete-patients-guide-to-diagnosis-treatment-and-persistent-symptoms","title":"Lyme Disease and Other Tick-Borne Illnesses: A Complete Patient's Guide to Diagnosis, Treatment, and Persistent Symptoms","description":"\u003cp\u003eLyme disease, transmitted by tick bites, can be challenging to diagnose and treat. This comprehensive guide, based on official French medical society recommendations, explains how doctors use blood tests and spinal fluid analysis to confirm the infection, why a two-step testing approach is essential, and which antibiotics work best for different stages of the disease. The guidelines also address a critical concern for many patients: persistent symptoms after treatment. Importantly, the research shows that in 80% of patients with ongoing symptoms after suspected Lyme disease, another condition is eventually diagnosed, and repeated or prolonged antibiotic treatment is not recommended.\u003c\/p\u003e\n\n\u003ch1\u003eLyme Disease and Other Tick-Borne Illnesses: A Complete Patient's Guide to Diagnosis, Treatment, and Persistent Symptoms\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Understanding Lyme Disease and Tick-Borne Infections\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#diagnosis\"\u003eHow Lyme Disease Is Diagnosed: The Two-Tier Testing Strategy\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#serology\"\u003eBlood Tests (Serology): What They Can and Cannot Tell You\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#pcr\"\u003ePCR Testing: Detecting Bacterial DNA\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#culture\"\u003eCulture and Tissue Examination\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#other-tests\"\u003eOther Tests: What Works, What Doesn't, and What's Still Being Studied\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#imaging\"\u003eImaging Tests: Their Limited Role\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#treatment-em\"\u003eTreating Erythema Migrans (The Classic Rash) and Borrelial Lymphocytoma\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#treatment-neuro\"\u003eTreating Neurological Lyme Disease (Neuroborreliosis)\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#treatment-articular\"\u003eTreating Joint Manifestations of Lyme Disease\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#treatment-other\"\u003eTreating Other Manifestations: Skin, Heart, and Eyes\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#persistent\"\u003ePersistent Symptoms After Treatment: What the Evidence Shows\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#other-diseases\"\u003eOther Tick-Borne Diseases: Diagnosis and Testing\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eTwo-tier testing (ELISA then Western blot) is recommended for Lyme disease diagnosis.\u003c\/li\u003e\n\u003cli\u003eSerology is negative in 60–70% of erythema migrans cases; diagnose clinically.\u003c\/li\u003e\n\u003cli\u003ePersistent symptoms after treatment: another condition is found in 80% of patients.\u003c\/li\u003e\n\u003cli\u003eRepeated or prolonged antibiotics are not recommended for persistent symptoms.\u003c\/li\u003e\n\u003cli\u003ePositive serology without symptoms usually indicates past infection, not active disease.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Understanding Lyme Disease and Tick-Borne Infections\u003c\/h2\u003e\n\n\u003cp\u003eLyme borreliosis, commonly known as Lyme disease, is caused by bacteria of the \u003cem\u003eBorrelia burgdorferi\u003c\/em\u003e sensu lato group, which are transmitted to humans through tick bites. In Europe, three main species can cause disease in humans: \u003cem\u003eBorrelia afzelii\u003c\/em\u003e, \u003cem\u003eBorrelia garinii\u003c\/em\u003e, and \u003cem\u003eBorrelia burgdorferi\u003c\/em\u003e sensu stricto. The disease can affect multiple organ systems, including the skin, nervous system, joints, heart, and eyes.\u003c\/p\u003e\n\n\u003cp\u003eThese guidelines were developed by a consortium of French scientific societies, including specialists in infectious diseases, dermatology, rheumatology, neurology, pediatrics, internal medicine, microbiology, psychiatry, cardiology, and general practice. They represent a comprehensive, evidence-based approach to diagnosing and treating Lyme disease and other tick-borne illnesses.\u003c\/p\u003e\n\n\u003cp\u003eOne of the most important messages from these guidelines is that diagnosis is not always straightforward. The accuracy of diagnostic tests depends heavily on the stage of the disease and the clinical presentation. Understanding these nuances can help patients navigate their care more effectively.\u003c\/p\u003e\n\n\u003ch2 id=\"diagnosis\"\u003eHow Lyme Disease Is Diagnosed: The Two-Tier Testing Strategy\u003c\/h2\u003e\n\n\u003cp\u003eAll national, European, and American evidence-based guidelines recommend a two-tier serology strategy for diagnosing Lyme disease. This approach involves two steps:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eFirst step (screening):\u003c\/strong\u003e An immuno-enzymatic technique called ELISA (Enzyme-Linked Immunosorbent Assay) is used as the initial screening test.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSecond step (confirmation):\u003c\/strong\u003e If the ELISA test is positive or equivocal, a confirmatory test called a Western blot (immunoblot) is performed. This test has better specificity, meaning it is less likely to produce false-positive results.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eAlmost all currently available ELISA tests include antigens from the three main European species pathogenic to humans, providing better sensitivity and specificity than first-generation ELISA tests. Several studies have demonstrated that one-tier (ELISA alone) and two-tier strategies (ELISA plus Western blot) have similar performance. However, no study has ever demonstrated the superiority of ELISA alone versus the two-tier strategy.\u003c\/p\u003e\n\n\u003cp\u003eIt is crucial to understand that no screening test is available for active \u003cem\u003eBorrelia\u003c\/em\u003e infection because asymptomatic seropositivity (having antibodies without symptoms) is common. In other words, a positive blood test alone is not sufficient to establish a diagnosis of Lyme disease. The test results must always be interpreted in the context of clinical symptoms and exposure history.\u003c\/p\u003e\n\n\u003cp\u003eDetailed information about the characteristics and performance of commercialized serological tests, including the antigens used, study populations, and disease stages, is available from the French Agency for the Safety of Health Products (ANSM) and the national reference center for \u003cem\u003eBorrelia\u003c\/em\u003e (CNR). These resources help standardize testing and maximize diagnostic performance.\u003c\/p\u003e\n\n\u003ch2 id=\"serology\"\u003eBlood Tests (Serology): What They Can and Cannot Tell You\u003c\/h2\u003e\n\n\u003cp\u003eThe performance of serological tests varies dramatically depending on the stage of the disease. This is one of the most important concepts for patients to understand.\u003c\/p\u003e\n\n\u003ch3\u003eEarly Localized Disease (Erythema Migrans)\u003c\/h3\u003e\n\n\u003cp\u003eDuring early localized manifestations of Lyme disease, specifically the characteristic rash called erythema migrans, Lyme serology has poor sensitivity of only 30–40%. This means that 60–70% of patients with the classic rash will test negative. Therefore, the guidelines clearly state that serological testing should \u003cstrong\u003enot\u003c\/strong\u003e be performed when a patient presents with erythema migrans. The diagnosis at this stage should be based purely on clinical signs and symptoms.\u003c\/p\u003e\n\n\u003cp\u003eSeroconversion (the development of detectable antibodies) occurs within approximately six weeks after symptoms onset, with IgG detection. Six weeks after symptoms begin, the serological test is associated with greater than 90% sensitivity and specificity. This means that by six weeks, the test correctly identifies more than 90% of infected patients and correctly rules out the disease in more than 90% of uninfected patients.\u003c\/p\u003e\n\n\u003ch3\u003eEarly Disseminated Disease (Neurological Symptoms Within Six Weeks)\u003c\/h3\u003e\n\n\u003cp\u003eFor early disseminated manifestations with neurological symptoms occurring within six weeks after the tick bite (early Lyme neuroborreliosis), the blood serological test may be negative. In these cases, the biological diagnosis should be based on the results of cerebrospinal fluid (CSF) analysis, which requires a lumbar puncture (spinal tap).\u003c\/p\u003e\n\n\u003cp\u003eThe sole persistence of IgM antibodies beyond six weeks should be considered a false positive result, because of the high risk of non-specific cross-reactions. This is an important point: IgM antibodies that remain positive for more than six weeks are likely not meaningful and should not be used to make a diagnosis.\u003c\/p\u003e\n\n\u003ch3\u003eLate Disseminated Disease\u003c\/h3\u003e\n\n\u003cp\u003eThe sensitivity of serological tests in late disseminated neurological, cutaneous, or joint manifestations is close to 100%, and very high IgG levels are common. Immunoblot testing almost always reveals IgG targeted against numerous \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato antigens. The ELISA serological test is rarely negative in patients presenting with late Lyme disease.\u003c\/p\u003e\n\n\u003cp\u003eHowever, a few exceptional cases have been reported: two cases of acrodermatitis chronica atrophicans (ACA, a late skin manifestation) with atypical clinical presentation, one case of Lyme arthritis, and one case of seronegative late Lyme neuroborreliosis. Thus, a negative Lyme serological test result at this late stage of the disease should lead physicians to question the diagnostic hypothesis.\u003c\/p\u003e\n\n\u003cp\u003eThe sole presence of IgG, without IgM, is common in late manifestations of Lyme disease, even if the culture is positive (for example, 15–20% of ACA cases). High levels of antibodies can be observed in treated patients several years after recovery. The treatment should in that case \u003cstrong\u003enot\u003c\/strong\u003e be resumed. Serological follow-up is therefore not recommended, and treatment success should be assessed based on clinical signs and symptoms.\u003c\/p\u003e\n\n\u003ch3\u003eKey Points About Serology\u003c\/h3\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThe sole persistence of IgM beyond six weeks should be considered a false positive result, because of the high risk of non-specific cross-reactions.\u003c\/li\u003e\n  \u003cli\u003ePerforming a serological test at four weeks in patients presenting with reinfection may help detect increased IgG levels.\u003c\/li\u003e\n  \u003cli\u003eA positive serology does not distinguish an active infection from a serological scar (evidence of past infection).\u003c\/li\u003e\n  \u003cli\u003eHigh levels of antibodies can be observed in treated patients several years after recovery. The treatment should in that case not be resumed.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch3\u003eWhat a Positive Test Really Means\u003c\/h3\u003e\n\n\u003cp\u003eA positive serology result does not distinguish an active infection from a serological scar. A positive serology result without any clinical signs and symptoms is either suggestive of a serological scar or an asymptomatic seroconversion indicating contamination but not active Lyme disease.\u003c\/p\u003e\n\n\u003cp\u003eA Swiss longitudinal study conducted from 1986 to 1993 followed 305 patients infected with \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato who had a positive Lyme serology but no initial clinical signs. The study reported that more than 95% of these patients remained asymptomatic at seven years of follow-up. This finding underscores that a positive blood test alone, without symptoms, does not warrant treatment.\u003c\/p\u003e\n\n\u003cp\u003eA prospective Scandinavian study showed that, in the absence of prophylaxis and within three months following a tick bite, 5.4% of patients (102 out of 1,886) achieved seroconversion, with clinical signs of Lyme disease developing in 39.2% of those cases (40 out of 102). This means that even after a confirmed tick bite, the vast majority of people do not develop Lyme disease.\u003c\/p\u003e\n\n\u003ch3\u003eNeurological Testing: The Intrathecal Synthesis Index\u003c\/h3\u003e\n\n\u003cp\u003eFor neurological manifestations, the guidelines recommend simultaneous quantification of specific anti-\u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato IgG and total IgG in both the blood and the cerebrospinal fluid using ELISA testing. This allows calculation of the intrathecal synthesis index, which measures whether antibodies are being produced within the central nervous system itself. This is a strong indicator of neuroborreliosis (neurological Lyme disease).\u003c\/p\u003e\n\n\u003ch2 id=\"pcr\"\u003ePCR Testing: Detecting Bacterial DNA\u003c\/h2\u003e\n\n\u003cp\u003ePolymerase chain reaction (PCR) testing detects the DNA of \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato directly. The specificity of the test should be close to 100%, though this is not always the case depending on the manufacturer, as the targets, primers, and methods are neither standardized nor assessed.\u003c\/p\u003e\n\n\u003cp\u003eA positive PCR result for \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato does not establish active infection. The PCR sensitivity varies depending on the disease stage and its localization. PCR testing is useful for difficult-to-establish diagnoses for cutaneous manifestations (PCR test on skin biopsy) or joint manifestations (PCR test on synovial fluid or synovial biopsy).\u003c\/p\u003e\n\n\u003cp\u003eHowever, PCR is pointless in patients presenting with neurological manifestations for more than six weeks, due to poor sensitivity. Looking for \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato by PCR test in urine and blood samples is \u003cstrong\u003enot recommended\u003c\/strong\u003e, as studies reported highly contradictory results.\u003c\/p\u003e\n\n\u003ch2 id=\"culture\"\u003eCulture and Tissue Examination\u003c\/h2\u003e\n\n\u003cp\u003eCulture is the reference biological diagnostic method, with 100% specificity but limited sensitivity because of the small number of bacteria at the sampling sites. There is no healthy carriage of \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato: isolation of the bacterium indicates active Lyme disease.\u003c\/p\u003e\n\n\u003cp\u003eCulture is performed in specialized laboratories. The culture medium is specific (called BSK), enriched, and it may easily be contaminated by commensal bacteria. Culture takes time, usually 2–8 weeks, and negative results are available only after three months.\u003c\/p\u003e\n\n\u003cp\u003eSpirochetes (the corkscrew-shaped bacteria) cannot be detected by Gram staining at direct microscopic examination. A dark-field or phase-contrast microscope is required, or direct immunofluorescence should be used, though these have moderate sensitivity and specificity. Official identification of the bacterium is then performed by molecular biology. Microscopy can be used to interpret culture results, but direct microscopy on samples is not recommended because of its lack of specificity.\u003c\/p\u003e\n\n\u003cp\u003eHistology (tissue examination under a microscope) is useful for the diagnosis of acrodermatitis chronica atrophicans and for differential diagnoses, but the result is not indicative of active Lyme disease.\u003c\/p\u003e\n\n\u003ch2 id=\"other-tests\"\u003eOther Tests: What Works, What Doesn't, and What's Still Being Studied\u003c\/h2\u003e\n\n\u003ch3\u003eTests Under Evaluation: CXCL13 Level in CSF\u003c\/h3\u003e\n\n\u003cp\u003eA promising test measures the level of a protein called CXCL13 in the cerebrospinal fluid. This test has 89–97% sensitivity and 92–98% specificity in Lyme neuroborreliosis. However, it is still under evaluation and not yet part of routine clinical practice.\u003c\/p\u003e\n\n\u003ch3\u003eDiagnostic Methods NOT Recommended (Lack of Sensitivity and\/or Specificity)\u003c\/h3\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThin blood film and thick blood smear\u003c\/li\u003e\n  \u003cli\u003eDark-field microscopy or phase-contrast microscopy\u003c\/li\u003e\n  \u003cli\u003eCD57+\/CD3-NK cell level testing\u003c\/li\u003e\n  \u003cli\u003eRapid diagnostic tests\u003c\/li\u003e\n  \u003cli\u003e\n\u003cem\u003eBorrelia\u003c\/em\u003e PCR in blood and\/or urine\u003c\/li\u003e\n  \u003cli\u003e\n\u003cem\u003eBorrelia\u003c\/em\u003e PCR in CSF if symptom onset is more than 6 weeks\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch3\u003eDiagnostic Methods NOT Recommended (Lack of Study or Contradictory Findings)\u003c\/h3\u003e\n\n\u003cul\u003e\n  \u003cli\u003eLymphocyte transformation tests (LTT) and searching for interferon-gamma and interferon-alpha in direct markers\u003c\/li\u003e\n  \u003cli\u003eXenodiagnosis (using ticks to try to detect the bacteria)\u003c\/li\u003e\n  \u003cli\u003eMembrane protein level testing\u003c\/li\u003e\n  \u003cli\u003eCCL19 and apolipoprotein B-100 testing\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eNew tests will need to be assessed as part of prospective studies in future reference centers. Results will be published and evaluated by the ANSM and the CNRs for the relevant pathogens.\u003c\/p\u003e\n\n\u003ch2 id=\"imaging\"\u003eImaging Tests: Their Limited Role\u003c\/h2\u003e\n\n\u003cp\u003eNo radiologic lesion is indicative of Lyme disease. Imaging tests are mainly used to investigate a differential diagnosis, meaning they help rule out other conditions that might explain the symptoms.\u003c\/p\u003e\n\n\u003ch2 id=\"treatment-em\"\u003eTreating Erythema Migrans (The Classic Rash) and Borrelial Lymphocytoma\u003c\/h2\u003e\n\n\u003ch3\u003eErythema Migrans and Multiple Erythema Migrans\u003c\/h3\u003e\n\n\u003cp\u003eErythema migrans, the characteristic \"bull's-eye\" rash, spontaneously resolves without treatment within a few weeks. However, \u003cem\u003eB. burgdorferi\u003c\/em\u003e sensu lato may persist in the skin, and new manifestations may occur later on. An antibiotic therapy is therefore required, with documented efficacy, irrespective of symptoms duration before treatment.\u003c\/p\u003e\n\n\u003cp\u003eTwenty studies compared several molecules with various treatment durations, dosing regimens, and outcomes. Antibiotics with proven efficacy include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eDoxycycline\u003c\/li\u003e\n  \u003cli\u003eAmoxicillin\u003c\/li\u003e\n  \u003cli\u003eCefuroxime-axetil\u003c\/li\u003e\n  \u003cli\u003eCeftriaxone\u003c\/li\u003e\n  \u003cli\u003eAzithromycin\u003c\/li\u003e\n  \u003cli\u003ePhenoxymethylpenicillin\u003c\/li\u003e\n  \u003cli\u003eMinocycline\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eA meta-analysis suggested the absence of difference in efficacy and tolerability between molecules, with low rates of treatment failure (4% at 2 months, 2% at 12 months). Considering the continuum between early localized and disseminated manifestations and the efficacy of doxycycline in patients presenting with Lyme neuroborreliosis, doxycycline should be favored as first-line treatment.\u003c\/p\u003e\n\n\u003cp\u003eErythema migrans is usually cured after 7 to 13 days of antibiotic therapy. The recommended regimen is doxycycline for 14 days, with amoxicillin as an alternative. The specific dosing is typically doxycycline 200 mg per day.\u003c\/p\u003e\n\n\u003ch3\u003eBorrelial Lymphocytoma\u003c\/h3\u003e\n\n\u003cp\u003eBorrelial lymphocytoma is a less common skin manifestation of Lyme disease, appearing as a bluish-red nodule or plaque, most often on the ear lobe, nipple, or scrotum. A study of 144 patients with borrelial lymphocytoma found that antibiotic therapy was required for 14 patients (9.7%) because of initial treatment failure, defined as persistence of the lesion for more than one month after treatment, new signs of Lyme disease, or persistence of clear non-specific signs and symptoms. The main risk factor for treatment failure was the presence of signs suggestive of dissemination. The outcome was favorable for all patients at one year, with disappearance of the lymphocytoma within 21 days on average (range 10–30 days).\u003c\/p\u003e\n\n\u003cp\u003eThe first-line treatment of borrelial lymphocytoma is doxycycline (alternative: amoxicillin), at the same dosage as for erythema migrans, but for 21 days. Children can alternatively be treated with azithromycin for 10 days.\u003c\/p\u003e\n\n\u003cp\u003eRecent guidelines from other countries recommend the use of amoxicillin 1 gram three times daily or doxycycline 200 mg\/day for 21 days. Only the Belgian guidelines recommend a shorter treatment with doxycycline for 10 days or amoxicillin for 14 days.\u003c\/p\u003e\n\n\u003ch2 id=\"treatment-neuro\"\u003eTreating Neurological Lyme Disease (Neuroborreliosis)\u003c\/h2\u003e\n\n\u003cp\u003eThe antibiotic therapy of Lyme neuroborreliosis has never been evaluated in placebo-controlled studies. The Cochrane Library retrieved seven European randomized studies, including one pediatric study, assessing penicillin G, cefotaxime, ceftriaxone, and doxycycline for 10 to 21 days.\u003c\/p\u003e\n\n\u003cp\u003eAn open-label randomized study did not report any difference between a 14-day regimen and a 28-day regimen with ceftriaxone. A retrospective cohort study of early Lyme disease manifestations, mainly cutaneous but also neurological, did not show any difference between treatment durations of less than 10 days and more than 16 days.\u003c\/p\u003e\n\n\u003cp\u003eA non-inferiority, multicenter, randomized, placebo-controlled, blinded study is currently ongoing to compare two weeks with six weeks of doxycycline. A study demonstrated the non-inferiority of doxycycline (200 mg\/day) versus ceftriaxone (2 g\/day) for early disseminated manifestations. The studies included few late manifestations (10%), and specific analyses were not performed.\u003c\/p\u003e\n\n\u003cp\u003eAdverse effects of ceftriaxone, mainly due to the parenteral (intravenous) route of administration or its broad spectrum, should lead physicians to favor doxycycline for the treatment of Lyme neuroborreliosis.\u003c\/p\u003e\n\n\u003cp\u003eThe evidence-based German guidelines recommend ceftriaxone or doxycycline during 14 days for early Lyme neuroborreliosis and during 14 to 21 days for late Lyme neuroborreliosis. A review of available pediatric data resulted in the same suggestions.\u003c\/p\u003e\n\n\u003cp\u003eThe British guidelines make a distinction between central and peripheral symptoms:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eOral doxycycline or amoxicillin treatments are recommended for cranial nerve palsies and\/or peripheral nervous system manifestations.\u003c\/li\u003e\n  \u003cli\u003eCeftriaxone or doxycycline are recommended in patients presenting with central nervous system manifestations.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn summary, the recommended treatment for neuroborreliosis is doxycycline for 14 days if early, and 21 days if late, with ceftriaxone as an alternative.\u003c\/p\u003e\n\n\u003ch2 id=\"treatment-articular\"\u003eTreating Joint Manifestations of Lyme Disease\u003c\/h2\u003e\n\n\u003cp\u003eLyme arthritis typically presents as a swollen, painful joint, most commonly the knee. The treatment of articular manifestations of Lyme disease is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. This longer duration reflects the need to eradicate bacteria that may be sequestered in joint tissues.\u003c\/p\u003e\n\n\u003ch2 id=\"treatment-other\"\u003eTreating Other Manifestations: Skin, Heart, and Eyes\u003c\/h2\u003e\n\n\u003cp\u003eWhile the guidelines focus primarily on erythema migrans, neuroborreliosis, and arthritis, they also acknowledge other manifestations of Lyme disease, including:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAcrodermatitis chronica atrophicans (ACA):\u003c\/strong\u003e A late skin manifestation characterized by bluish-red discoloration and thinning of the skin, typically on the extremities. PCR on skin biopsy has a sensitivity of 16–92%, and histology is useful for diagnosis.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCardiac symptoms:\u003c\/strong\u003e Lyme carditis can cause heart block and other rhythm disturbances. ELISA sensitivity is greater than 80% for cardiac manifestations.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eOcular symptoms:\u003c\/strong\u003e Eye involvement can occur in various forms. Testing may include PCR in aqueous humor and CSF, with variable sensitivity.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFor these manifestations, the same antibiotic principles apply, with treatment duration and route determined by the severity and location of the infection.\u003c\/p\u003e\n\n\u003ch2 id=\"persistent\"\u003ePersistent Symptoms After Treatment: What the Evidence Shows\u003c\/h2\u003e\n\n\u003cp\u003eThis is perhaps the most important section for many patients. Some patients present with persistent and pleomorphic (varied and changing) symptoms after documented or suspected Lyme disease. These symptoms may include fatigue, musculoskeletal pain, cognitive difficulties, and other nonspecific complaints.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines are clear and emphatic: \u003cstrong\u003ePatients with persistent symptoms after appropriate treatment of Lyme disease should not be prescribed repeated or prolonged antibacterial treatment.\u003c\/strong\u003e\u003c\/p\u003e\n\n\u003cp\u003eCritically, the research shows that \u003cstrong\u003eanother condition is eventually diagnosed in 80% of patients\u003c\/strong\u003e who present with persistent symptoms after documented or suspected Lyme disease. This means that the vast majority of patients with ongoing symptoms do not have an ongoing \u003cem\u003eBorrelia\u003c\/em\u003e infection, and their symptoms are due to something else.\u003c\/p\u003e\n\n\u003cp\u003eThis finding has profound implications for patient care. Rather than repeated courses of antibiotics, which can cause harm including antibiotic resistance, disruption of normal gut flora, and potential side effects, patients with persistent symptoms deserve a thorough evaluation for other potential causes of their symptoms.\u003c\/p\u003e\n\n\u003cp\u003eThe guidelines emphasize that treatment success should be assessed based on clinical signs and symptoms, not on laboratory values. High levels of antibodies can persist for years after successful treatment and do not indicate ongoing infection.\u003c\/p\u003e\n\n\u003ch2 id=\"other-diseases\"\u003eOther Tick-Borne Diseases: Diagnosis and Testing\u003c\/h2\u003e\n\n\u003cp\u003eTicks can transmit several other diseases besides Lyme disease. The guidelines provide diagnostic recommendations for these conditions as well.\u003c\/p\u003e\n\n\u003ch3\u003eTick-Borne Encephalitis (TBE)\u003c\/h3\u003e\n\n\u003cp\u003eTick-borne encephalitis is a viral infection that can cause meningitis and encephalitis. Diagnosis is based on serology showing IgG and IgM seroconversion or increased IgG levels. Cross-reactions can occur with other arboviruses (viruses transmitted by arthropods) and yellow fever vaccine. PCR is only useful at the initial stage (viremia). CSF examination should show monocytosis (increased monocytes) and IgM. Urine PCR should not be performed.\u003c\/p\u003e\n\n\u003ch3\u003eHuman Granulocytic Anaplasmosis (HGA)\u003c\/h3\u003e\n\n\u003cp\u003eThis bacterial infection causes fever, headache, and muscle aches. Serology for IgG, IgM, or total immunoglobulins (TIg) is used. Diagnosis requires increased TIg or seroconversion, with sensitivity of 32% for initial testing. High levels of TIg have 74% sensitivity and 100% specificity. PCR on whole blood during the viremic stage has only 20% sensitivity. A thin blood film can detect morulae (clusters of bacteria inside white blood cells).\u003c\/p\u003e\n\n\u003ch3\u003eBabesiosis\u003c\/h3\u003e\n\n\u003cp\u003eBabesiosis is a parasitic infection that affects red blood cells. Serology for IgG, IgM, or TIg is used, with diagnosis based on seroconversion or increased TIg. PCR on whole blood at the febrile stage is useful. A thin blood film can detect trophozoites (the parasitic form in red blood cells). Dark-field microscopy or phase-contrast microscopy should not be performed.\u003c\/p\u003e\n\n\u003ch3\u003eBorrelia miyamotoi Disease\u003c\/h3\u003e\n\n\u003cp\u003eThis relapsing fever-like illness is caused by a different \u003cem\u003eBorrelia\u003c\/em\u003e species. Diagnosis is made by PCR on whole blood at the febrile stage. Thin blood film and thick blood smear should not be performed.\u003c\/p\u003e\n\n\u003ch3\u003eCandidatus Neoehrlichia mikurensis Infection\u003c\/h3\u003e\n\n\u003cp\u003eThis emerging infection is diagnosed by PCR on whole blood at the febrile stage. Thin blood film and thick blood smear should not be performed.\u003c\/p\u003e\n\n\u003ch3\u003eMediterranean Spotted Fever\u003c\/h3\u003e\n\n\u003cp\u003eThis rickettsial infection causes fever, rash, and a characteristic black spot (eschar) at the tick bite site. Serology for IgG and IgM shows seroconversion or increased TIg, with 100% sensitivity after Day 30. There is a risk of cross-reactions between species. PCR on the black spot is useful.\u003c\/p\u003e\n\n\u003ch3\u003eFrancisella tularensis Infection (Tularemia)\u003c\/h3\u003e\n\n\u003cp\u003eThis bacterial infection can cause skin ulcers and swollen lymph nodes. Serology for IgG or TIg shows seroconversion or increased IgG levels, with 100% sensitivity after Day 30. IgM cross-reactions can occur. PCR on ulcer or lymph node samples has 75% sensitivity.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations\u003c\/h2\u003e\n\n\u003cp\u003eIt is important to acknowledge the limitations of the evidence underlying these guidelines. The antibiotic therapy of Lyme neuroborreliosis has never been evaluated in placebo-controlled studies, meaning we lack the highest level of evidence for this treatment. The available studies included few late manifestations (only 10%), and specific analyses were not performed for these cases.\u003c\/p\u003e\n\n\u003cp\u003eFor serological testing, the sensitivity varies widely depending on the stage of disease, and no test can distinguish between an active infection and a past infection (serological scar). The performance characteristics of commercial tests vary, and standardization remains a challenge.\u003c\/p\u003e\n\n\u003cp\u003eFor other tick-borne diseases, the evidence base is even more limited, with many diagnostic tests having unknown sensitivity or specificity. The guidelines note that new tests will need to be assessed as part of prospective studies in future reference centers.\u003c\/p\u003e\n\n\u003cp\u003eFinally, the finding that 80% of patients with persistent symptoms after suspected Lyme disease receive another diagnosis highlights the complexity of these cases and the need for thorough, multidisciplinary evaluation.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eBased on these guidelines, here are the key recommendations for patients:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you develop the characteristic bull's-eye rash (erythema migrans):\u003c\/strong\u003e See your doctor promptly. A blood test is not needed at this stage because it will be negative in 60–70% of cases. Treatment with doxycycline for 14 days (or amoxicillin as an alternative) is highly effective.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have neurological symptoms within 6 weeks of a tick bite:\u003c\/strong\u003e Your doctor may recommend both blood and spinal fluid testing. Early treatment with doxycycline for 14 days is recommended.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have joint swelling or pain:\u003c\/strong\u003e Treatment with doxycycline, ceftriaxone, or amoxicillin for 28 days is recommended.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have persistent symptoms after completing appropriate treatment:\u003c\/strong\u003e Do not seek repeated or prolonged antibiotic therapy. The evidence shows that another condition is eventually diagnosed in 80% of such patients. Work with your doctor to investigate other potential causes of your symptoms.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you have a positive blood test but no symptoms:\u003c\/strong\u003e This likely represents a serological scar or asymptomatic seroconversion. More than 95% of such patients remain asymptomatic at seven years. Treatment is not recommended.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAvoid unproven tests:\u003c\/strong\u003e Tests such as lymphocyte transformation tests, CD57+ cell levels, urine PCR, and others have not been validated and are not recommended.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIf you are bitten by a tick:\u003c\/strong\u003e The risk of developing Lyme disease is low. In a Scandinavian study, only 5.4% of people bitten by ticks developed antibodies, and only 39.2% of those (about 2% of all tick bite victims) developed clinical symptoms.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhy is a blood test not recommended when I have the classic bull's-eye rash?\u003c\/h3\u003e\n\u003cp\u003eIn early Lyme disease with erythema migrans, blood tests are negative in 60–70% of cases. Therefore, testing is not recommended at this stage. Diagnosis should be based on the rash and exposure history. Treatment with doxycycline for 14 days is highly effective.\u003c\/p\u003e\n\u003ch3\u003eWhat tests are not recommended for diagnosing Lyme disease?\u003c\/h3\u003e\n\u003cp\u003eTests lacking sensitivity or specificity include thin blood film, dark-field microscopy, CD57+ cell levels, rapid diagnostic tests, and PCR in blood or urine. Also not recommended are lymphocyte transformation tests, xenodiagnosis, and CCL19 testing. These are not validated for clinical use.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e B. Jaulhac, A. Saunier, E. Caumes, K. Bouiller, J.F. Gehanno, C. Rabaud, S. Perrot, C. Eldin, T. de Broucker, F. Roblot, J. Toubiana, F. Sella, F. Vuillemet, C. Sordet, B. Fantin, G. Lina, C. Sobas, X. Gocko, J. Figoni, C. Chirouze, Y. Hansmann, V. Hentgen, P. Cathebras, M. Dieudonné, B. Bodaghi, J.P. Gangneux, B. Degeilh, H. Partouche, C. Lenormand, A. Sotto, A. Raffetin, J.J. Monsuez, C. Michel, N. Boulanger, C. Lemogne, P. Tattevin, and the French scientific societies (SFD, SFR, FFN, SFN, CNGE, CMG, SNFMI, SFM, CNPP-CNQSP, AFPBN, SPMPLLF, SFMT, SFC, SPD, GPIP, SOFREMIP, SFO, SFMM, SFP, CMIT, CNP-FFI, CNOG, SFETD, SPILF)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e Médecine et maladies infectieuses (2019)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e https:\/\/doi.org\/10.1016\/j.medmal.2019.05.001\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication Date:\u003c\/strong\u003e Available online 2019 (Received March 30, 2019; Accepted May 7, 2019)\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eNote: This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace professional medical advice. Always consult with a qualified healthcare provider regarding diagnosis and treatment of any medical condition.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47377200775324,"sku":null,"price":0.0,"currency_code":"EUR","in_stock":true}],"url":"https:\/\/diagnosticdetectives.hk\/products\/lyme-disease-and-other-tick-borne-illnesses-a-complete-patients-guide-to-diagnosis-treatment-and-persistent-symptoms","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}