Neurological

New tips for managing Lyme illness

The Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology have worked together to provide new guidelines for clinical practice for the prevention, diagnosis, and treatment of Lyme disease published in Neurology.

The 2020 recommendations for treating Lyme disease are based on what is available. The panel followed a systematic process using standardized methodology to assess the security of the evidence and the strength of the recommendations. To do this, they used the assessment, development and evaluation of recommendations approach.

To prevent tick bites and tick-borne infections, the Panel recommends that personal protective measures be carried out using repellents and that adherent ticks be removed immediately with clean, fine-tipped tweezers. It is not recommended to burn an attached tick or use harmful chemicals or petroleum products.

After a tick bite, it is recommended that the removed tick be submitted for species identification, but not test a removed Ixodes tick for Borrelia burgdorferi. Prophylactic oral doxycycline therapy is recommended only to adults and children within 72 hours of removal of an identified high risk tick bite that was identified as a tick bite from an identified Ixodes spp. Is defined. Vector species, one that was found in a highly endemic area and derived from a tick that had been bound for at least 36 hours. Antibiotic therapy is not recommended if the risk is ambiguous or low. The panel recommends a wait-and-watch approach if the tick bite cannot be classified with a high degree of certainty.

The diagnosis of erythema migrans should be based on clinical findings in patients with typical skin lesions, while antibody tests should be performed for atypical skin lesions. The recommended antibiotic therapies for erythema migrans include oral doxycycline for 10 days or 14 days of treatment with amoxicillin or cefuroxime axetil.

For the diagnosis of Lyme neuroborreliosis, the Panel recommends serum antibody tests instead of the polymerase chain reaction (PCR) or cerebrospinal fluid culture or serum. Testing for Lyme disease should be considered in patients with a variety of neurological symptoms. However, the panel advises against routine testing in patients with psychiatric illnesses.

Intravenous ceftriaxone, cefotaxime, penicillin G, or oral doxycycline are the recommended antibiotics for treating acute neurological manifestations of Lyme disease without parenchymal involvement of the brain or spinal cord.

Hospitalization with continuous ECG monitoring is recommended for patients with or at risk of severe cardiac complications from Lyme disease. The panel also recommends temporary pacing modalities for symptomatic bradycardia due to Lyme carditis that cannot be medically treated. In addition, oral antibiotic therapy is recommended for outpatients with Lyme carditis, while intravenous ceftriaxone is recommended initially for hospitalized patients until clinical improvement. After clinical improvement, they can be switched to oral antibiotics.

Serum antibody tests are the recommended diagnostic tests for Lyme arthritis, while PCR can be used if more information is needed to make treatment decisions. Oral antibiotic should be used for 28 days for Lyme arthritis. However, in patients with no or minimal response to this initial oral antibiotic course, the Panel suggests a 2 to 4 week intravenous ceftriaxone course.

The Panel recommends additional antibiotic therapy for persistent or recurring nonspecific symptoms after treatment for Lyme disease, if there is no objective evidence of re-infection or treatment failure.

These guidelines are intended to provide recommendations for the treatment of Lyme disease and address clinical issues related to its prevention, diagnosis, and treatment, and complications related to its neurological, cardiac, and rheumatic symptoms.

reference

Lantos PM, Rumbaugh J., Bockenstedt LK, et al. Clinical Practice Guidelines of the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Neurology. Published online November 30, 2020. doi: 10.1212 / WNL.0000000000011151

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