Volume 28, Issue 150, August 2024

Lyme borreliosis - review of the diagnosis and management in the multidisciplinary tick-borne disease

Anna Salińska^1♦, Piotr Węgrzyn², Konstancja Węgrzyn², Agnieszka Góra³, Marcin Wasilewski⁴, Maciej Nowicki⁵, Julia Skwara⁵, Dawid Barański⁴, Natalia Dąbrowska⁶, Gustaw Laskowski²

¹Mazowiecki Szpital Bródnowski, ul. Kondratowicza 8, 03-242 Warsaw, Poland
²Central Clinical Hospital of Medical University of Warsaw, 1a Banacha Str. 02-097 Warsaw, Poland
³Medical University of Warsaw, 61 Żwirki i Wigury Str. 02-091 Warsaw, Poland
⁴Jerzy Popiełuszko Bielański Hospital – Independent Public Healthcare Centre, 80 Cegłowska Str. 01-809 Warsaw, Poland
⁵National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland
⁶Szpital Dzieciątka Jezus, 4 Lindleya Str. 02-005 Warsaw, Poland

^♦Corresponding Author
Mazowiecki Szpital Bródnowski, ul. Kondratowicza 8, 03-242 Warsaw, Poland

ABSTRACT

Background: Lyme borreliosis is a tick-borne zoonotic disease caused by Borrelia burgdorferi spirochetes transmitted by Ixodes ticks. It is prevalent worldwide and spreads within one to two weeks, potentially causing erythema migrans and other symptoms. Diagnosing and treating Lyme borreliosis is challenging due to varied clinical presentations and diagnostic test limitations. Diagnosis: Diagnosis involves clinical symptoms and serological tests. Erythema migrans alone is diagnostic without further tests. The standard two-tiered testing approach, involving an initial ELISA followed by a confirmatory Western Blot, is commonly used but has low sensitivity in early-stage disease. Modified two-tiered testing aims to improve diagnostic accuracy but requires two stages for sufficient sensitivity and specificity. New diagnostic methods include lateral flow immunoassays, EliSpot techniques, biomarker-based approaches, pathogen culture, and PCR with modifications like immune-PCR. The methods mentioned each have their limitations. The lack of a gold standard method makes exploring a valid diagnostic algorithm necessary. Treatment: Treatment primarily involves antibiotics such as doxycycline, usually for no more than 28 days. Long-term antibiotic therapy is not supported by evidence and is not recommended for nonspecific post-Lyme syndrome symptoms. Conclusions: In conclusion, advancements in Lyme borreliosis diagnostics continue, but challenges remain in developing a simple, cost-effective, and highly accurate diagnostic test. Improved diagnostics are crucial for timely treatment, preventing complications, and minimizing unnecessary antibiotic use.

Keywords: Lyme disease; Borrelia burgdorferi; tick-borne; diagnostic algorithm; antibiotic treatment

Medical Science, 2024, 28, e93ms3399

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DOI: https://doi.org/10.54905/disssi.v28i150.e93ms3399

Published: 09 August 2024