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, Volume 43, Issue 5, pp 683–699 | Cite as

Current Recommendations for the Treatment of Lyme Disease

  • Leonard H. Sigal
Practical Therapeutic

Summary

Lyme disease is a multisystem inflammatory disease caused by infection with Borrelia burgdorferi. Soon after the tick bite which transmits the infection, the pathognomonic skin rash erythema chronicum migrans occurs in 50 to 70% of patients, often with associated symptoms resembling a ‘summer cold’ or viral infection. Therapy for this stage of disease consists of 3 to 4 weeks of oral therapy. The agents currently used are: amoxicillin (500mg 3 or 4 times daily) with or without probenecid 500mg 3 times daily, doxycycline (100mg twice daily), or tetracycline (500mg 4 times daily). Longer duration therapy has never been evaluated and therefore is not currently indicated. Even patients with severe early manifestations of Lyme disease should be treated orally.

Later features of Lyme disease include carditis and neurological disease, which can occur days to approximately 9 months after the onset of illness, and arthritis and neurological disease which can occur weeks to years after the onset of the illness. Treatment at this stage is with 2 to 3 weeks of intravenous antibiotics, currently cefotaxime (3g every 12 hours), ceftriaxone (lg every 12 hours or 2g every day) and benzylpenicillin (14g in divided doses). There is no evidence that longer duration therapy is indicated or more efficacious. The exception to this suggestion is the patient with isolated facial seventh cranial nerve palsy; if such a patient has no other signs or symptoms to suggest Lyme disease and has normal spinal fluid, oral therapy is usually sufficient, although some physicians will give concomitant corticosteroids to hasten the resolution of the palsy.

Of major consequence to the practitioner and patient is the possibility that persistent symptoms (e.g. fibromyalgia) may be caused by a process which is no longer antibiotic-sensitive. Special care in the management of so-called ‘chronic Lyme disease’ is crucial lest the clinician prescribes prolonged or unending courses of antibiotics for such noninfectious problems.

Keywords

Lyme Disease Borrelia Burgdorferi Complete Heart Block Lyme Arthritis Inosine Pranobex 

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References

  1. Ackermann R, Rehse-Kupper B, Gollmer E, Schmidt R. chronic neurologic manifestations of erythema migrans Borreliosis. Annals of the New York Academy of Sciences 539: 16–23, 1988PubMedGoogle Scholar
  2. Ackley Jr A, Lupovici M. Lyme disease meningitis treated with tetracycline. Annals of Internal Medicine 105: 630–631, 1986PubMedGoogle Scholar
  3. Afzelius A. Erythema chronicum migrans. Acta Dermato-Venereologica 2: 120–125, 1921Google Scholar
  4. Alpert LI, Welch P, Fisher N. Gallium-positive Lyme disease myocarditis. Clinical Nuclear Medicine 10: 617, 1985PubMedGoogle Scholar
  5. Artigao R, Torres G, Guerrero A, Jimenez-Mena M, Paredes MB. Irreversible complete heart block in Lyme disease. American Journal of Medicine 90: 531–533, 1991PubMedGoogle Scholar
  6. Asbrink E, Hovmark A. Early and late cutaneous manifestations in Ixodes-borneBorreliosis. Annals of the New York Academy of Sciences 539: 4–15, 1988PubMedGoogle Scholar
  7. Bannwarth A. Chronische Lymphocytare Meningitis, entzuundliche Polyneuritis und ‘Rheumatismus’. Ein Beitrag zum Problem ‘Allergie und Nervensystem’. Archiv für Psychiatric und Nervenkrankheiten 113: 284–376, 1941Google Scholar
  8. Bedell SE, Pastor BM, Cohen SI. Symptomatic high grade heart block in Lyme disease. Chest 79: 236–237, 1981PubMedGoogle Scholar
  9. Benach JL, Bosler EM, Hanrahan JP, Coleman JL, Habicht GS, et al. Spirochetes isolated from the blood of two patients with Lyme disease. New England Journal of Medicine 308: 740–742, 1983PubMedGoogle Scholar
  10. Benach JL, Bosler EM (Eds) Third International Symposium on Lyme Disease and related disorders. Annals of the New York Academy of Sciences 539: 1–513, 1988Google Scholar
  11. Berger BW, Kaplan MH, Rotherberg IR, Barbour AG. Isolation and characterization of the Lyme disease spirochete from the skin of patients with erythema chronicum migrans. Journal of the American Academy of Dermatology 13: 444–449, 1989Google Scholar
  12. Berger BW, Johnson RC. Clinical and microbiologic findings in six patients with erythema migrans of Lyme disease. Journal of the American Academy of Dermatology 21: 1188–1191, 1989PubMedGoogle Scholar
  13. Bialasiewicz AA, Ruprecht KW, Naumann GOH, Blenk H. Bilateral diffuse choroiditis and exudative retinal detachments with evidence of Lyme disease. American Journal of Ophthalmology 105: 419–420, 1988PubMedGoogle Scholar
  14. Blaauw AA, van der Linden SJ, Kuiper H. Lyme carditis in the Netherlands. Annals of Internal Medicine 111: 261–262, 1989PubMedGoogle Scholar
  15. Bojar M, Hercogova J, Valesova M, Jirous J. Cefotaxime in the treatment of Lyme Borreliosis. Presented at the Fourth European Congress of Clinical Microbiology in Nice, France, April 17–20, 1989Google Scholar
  16. Buchwald A. Ein Fall von diffuser idiopathischer Haut-Atrophie. Archives of Dermatology and Syphilology 10: 553–556, 1883Google Scholar
  17. Burckhardt B. Zur Frage der Follikel und Kreinzentrenbildung in der Haut. Frankfurter Zeitschrift für Pathologie 6: 352–359, 1911Google Scholar
  18. Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldt E, et al. Lyme disease — a tick-borne spirochetosis? Science 216: 1317–1320, 1982PubMedGoogle Scholar
  19. Casans I, Villar A, Almenar V, Blanes A. Lyme myocarditis diagnosed by Indium 111 anti-myosin antibody scintigraphy. European Journal of Nuclear Medicine 15: 330–331, 1989PubMedGoogle Scholar
  20. Clarke JR, Carlson RD, Sasaki CT, Pachner AR, Steere AC. Facial paralysis in Lyme disease. Laryngoscope 95: 1341–1345, 1985Google Scholar
  21. Costello CM, Steere AC, Pinkerton RE, Feder Jr HM. A prospective study of tick bites in an endemic area for Lyme disease. Journal of Infectious Diseases 159: 136–139, 1989PubMedGoogle Scholar
  22. Dattwyler RJ, Halperin JJ. Failure of tetracycline therapy in early Lyme disease. Arthritis and Rheumatism 30: 442–448, 1987Google Scholar
  23. Dattwyler RJ, Halperin JJ, Pass H, Luft BJ. Ceftriaxone as effective therapy in refractory Lyme disease. Journal of Infectious Diseases 155: 1322–1325, 1987PubMedGoogle Scholar
  24. Dattwyler DJ, Halperin JJ, Volkman DJ, Luft BJ. Treatment of late Lyme Borreliosis — randomised comparison of ceftriaxone and penicillin. Lancet 1: 1191–1194, 1988PubMedGoogle Scholar
  25. Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ. Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet 2: 1404–1406, 1990Google Scholar
  26. de Koning J, Hoogkaamp-Korstanje JAA, van der Linde MR, Crijns HJGM. Demonstration of spirochetes in cardiac biopsies of patients with Lyme disease. Journal of Infectious Diseases 160: 150–153, 1989PubMedGoogle Scholar
  27. Dlesk A, Bjarnason D, Goldberg J, Lee M, Washington W. Lyme disease (LD) presenting as seronegative rheumatoid arthritis (SNRA). Arthritis and Rheumatism 29: S31, 1986Google Scholar
  28. Dlesk A, Broste SK, Harkins PG, McCarty PA, Mitchell PD. Lyme seropositivity (LS+) and pregnancy (PG) outcome in the absence of symptoms (Sx) of Lyme disease (LD). Arthritis and Rheumatism 32: S46, 1989Google Scholar
  29. Dotevall L, Alestig K, Hanner P, Norkrans G, Hagberg L. The use of doxycycline in nervous sytem Borrelia burgdorferiinfection. Scandinavian Journal of Infectious Diseases (Suppl. 53): 74–79, 1988Google Scholar
  30. Eichenfield AH, Goldsmith DP, Benach JL, Ross AH, Loeb FX, et al. Childhood Lyme arthritis: experience in an endemic area. Journal of Pediatrics 109: 753–760, 1986PubMedGoogle Scholar
  31. Garin-Bujadoux C. Paralysie par les tiques. Journal de Médecine de Lyons 3: 765–767, 1922Google Scholar
  32. Hansen K, Madsen JK. Myocarditis associated with tickborne Borrelia burgdorferiinfection. Lancet 2: 1323–1324, 1986Google Scholar
  33. Hassler D, Zipperle G, Ackermann R, Lembke U, Heinrich F. Kardiale Beteilung auch bei der europaischen Erythema-migrans-Borreliose? Deutsch Medizinische Wochenschrift 112: 1506–1508, 1987Google Scholar
  34. Hauser W. Zur Kenntnis der Akrodermatitis chronica atrophicans. Archives of Dermatology and Syphilology 199: 350–375, 1955Google Scholar
  35. Heimlich HJ. Should we try malariotherapy for Lyme disease? New England Journal of Medicine 322: 1234–1235, 1990PubMedGoogle Scholar
  36. Hellerstrom S. Erythema chronicum migran Afzelius with meningitis. Southern Medical Journal 43: 330–337, 1950Google Scholar
  37. Hellerstrom S. Erythema chronicum migrans Afzelius with meningitis. Acta Dermato-Venereologica 31: 227–234, 1951PubMedGoogle Scholar
  38. Hessler D, zoller L, Sonntag MG. Randomized comparative study of cefotaxime versus penicillin G for late Lyme Borreliosis. Abstract presented at the 16th International Congress on Chemotherapy in Jerusalem, June 11–16, 1989Google Scholar
  39. Horstrup P, Ackermann R. Durch zecker ubertragene Meningopolyneuritis (Garlin-Bujadoux, Bannwarth). Fortschritte der Neurologie-Psychiatrie 41: 583–606, 1973Google Scholar
  40. Johnson RC, Schmid GP, Hyde FW, Steigerwalt AG, Brenner DJ. Borrelia burgdorferisp. nov.: etiologic agent of Lyme disease. International Journal of Systematic Bacteriology 34: 496–497, 1984Google Scholar
  41. Johnson RC, Kodner C, Russel M. In vitroand in vivosusceptibility of the Lyme disease spirochete Borrelia burgdorferi, to four antimicrobial agents. Antimicrobial Agents and Chemotherapy 31: 164–167, 1987PubMedGoogle Scholar
  42. Johnson SE, Klein GC, Schmid GP, Feeley JC. Susceptibility of the Lyme disease spirochete to seven antimicrobial agents. Yale Journal of Biology and Meciine 57: 549–553, 1984Google Scholar
  43. Kauffmann DJH, Wormser G. Ocular Lyme disease: case report and review of the literature. British Journal of Ophthalmology 74: 325–327, 1990PubMedGoogle Scholar
  44. Kimball SA, Janson PA, LaRaia PJ. complete heart block as the sole presentation of Lyme disease. Archives of Internal Medicine 149: 1897–1898, 1989PubMedGoogle Scholar
  45. Kirmser R, Umbach R, Rowett D, Ross A. Complete heart block due to acute non-specific carditis. Chest 71: 682–684, 1977PubMedGoogle Scholar
  46. Kishaba RG, Weinhouse E, Chusid MJ, Nudel DB. Lyme disease presenting as heart block. Clinical Pediatrics 27: 291–293, 1988PubMedGoogle Scholar
  47. Kohler J, Kasper J, Kern U, Thoden U, Rehse-Kupper B. Borrelia encephalomyelitis. Lancet 2: 35, 1986PubMedGoogle Scholar
  48. Lange GE, Schonherr U, Naumann GOH. Retinal vasculitis with proliferative retinopathy in a patient with evidence of Borrelia burgdorferiinfection. American Journal of Ophthalmology 111: 243–244, 1991Google Scholar
  49. Lawson JP, Steere AC. Lyme arthritis: radiologic findings. Radiology 154: 37–45, 1985PubMedGoogle Scholar
  50. Lesser RL, Kornmehl EW, Pachner AR, Kattah J, et al. Neuro-ophthalmologic manifestations of Lyme disease. Ophthalmology 97: 699–706, 1990PubMedGoogle Scholar
  51. Liu NY, Dinerman H, Levin RE, Massarotti E, olloy PJ, et al. Randomized trial of doxycycline vs amoxycillin/probenecid for the treatment of Lyme arthritis: treatment of non-responders with IV penicillin or ceftriaxone. Arthritis and Rheumatism 32: S46, 1989Google Scholar
  52. Lorincz I, Lakos A, Kovacs P, Varvolgyi C, Polgar P, et al. Temporary pacing in complete heart block due to Lyme disease: a case report. PACE Pacing and Clinical Electrophysiology 12: 1433–1436, 1989Google Scholar
  53. Luger SW. Active Lyme Borreliosis in pregnancy: outcomes of six cases with Stage 1, Stage 2, and Stage 3 disease. IV International Conference on Lyme Borreliosis, Stockholm, 1990Google Scholar
  54. MacDonald AB. Human fetal Borreliosis, toxemia of pregnancy, and fetal death. Zbl Bakt Hyg A 263: 189–200, 1986Google Scholar
  55. MacDonald AB, Benach JL, Burgdorfer W. Stillbirth following maternal Lyme disease. New York State Journal of Medicine 87: 615–616, 1987PubMedGoogle Scholar
  56. Marcus LC, Steere AC, Duray PH, Anderson AE, Mahoney EB. Fatal pancarditis in a patient with coexistent Lyme disease and Babesiosis. Annals of Internal Medicine 103: 374–376, 1985PubMedGoogle Scholar
  57. Markowitz LE, Steere AC, Benach JL, Slade JD, Brrome CV. Lyme disease during pregnancy. Journal of the American Medical Association 255: 3394–3396, 1986PubMedGoogle Scholar
  58. Mayer W, Kleber FX, Wilske B. Persistent atrioventricular block in Lyme Borreliosis. Kilinishce Wochenschrift 68: 431–435, 1990Google Scholar
  59. Mayer W, Kleber FX, Wilske B, Preac-Mursic V, Doering W. Variable efficacy of antibiotic therapy in Lyme carditis. IV International Conference on Lyme Borreliosis, Stockholm, 1990Google Scholar
  60. McAlister HF, Klementowicz PT, Andrews C, Fisher JD, Field M, et al. Lyme carditis: an important cause of reversible heart block. Annals of Internal Medicine 110: 339–345 Meissner C, Szer I, Zemel L, Taylor E, Steere A. Amoxicillin or penicillin therapy for Lyme arthritis in children: results from 3 hospitals. Presented at the IV International Conference on Lyme Borreliosis at Stockholm, June 18–21, 1990Google Scholar
  61. Mertz K, Spitalny KC. Epidemiologic notes and reports: imported malaria associated with malariotherapy of Lyme disease — New Jersey. Morbidity and Mortality Weekly Report 39: 873–874, 1990Google Scholar
  62. Murray N, Kristoferitsch W, Stanek G, Steck AJ. Specificity of CSF antibodies against components of Borrelia burgdorferiin patients with meningopolyneuritis Garin-Bujadoux-Bann-warth. Journal of Neurology 233: 224–227, 1986PubMedGoogle Scholar
  63. Nadelman R, Forseter G, Horowitz H, Fish D, Welch P, et al. Single dose doxycycline as prophylaxis for Lyme Borreliosis after I damminibites in a Lyme endemic area. Presented at the IV International Conference on Lyme Borreliosis at Stockholm, June 18–21, 1990Google Scholar
  64. Nishio MJ, Liebling MR, Rodriguez A, Sigal LH, Louie JS. Identification of Borrelia burgdorferiusing interrupted polymerase chain reaction. Arthritis and Rheumatism 33: S84, 1990Google Scholar
  65. Olson LJ, OkafonEC, Clements IP. Cardiac involvement in Lyme disease: Manifestations and management. Mayo Clinic Proceedings 61: 745–749, 1986PubMedGoogle Scholar
  66. Pachner AR. Spirochetal diseases of the central nervous system. Neurologic Clinics 4: 207–222, 1986PubMedGoogle Scholar
  67. Pachner AR, Steere AC. The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology 35: 47–53, 1985PubMedGoogle Scholar
  68. Pachner AR, Steere AC. CNS manifestations of third stage Lyme disease. Zentralblatt für Bakkteriologie, Mikrobiologie und Hygiene 263: 301–306, 1986Google Scholar
  69. Pal GS, Baker JT, Wright DJM. Penicillin-resistant Borrelia encephalitis responding to cefotaxime. Lancet 1: 50–51, 1988PubMedGoogle Scholar
  70. Peeters AJ, Dijkmans BAC, Sedney MI, et al. Lyme Borreliosis: a hidden cause of heart block in pacemaker treated males. IV International Conference on Lyme Borreliosis, Stockholm, 1990Google Scholar
  71. Pfister HW, Einhaupl KM, Franz P, Garner C. Corticosteroids for radicular pain in Bannwarth’s syndrome. Annals of the New York Academy of Science 539: 485–487, 1988Google Scholar
  72. Pfister H-W, Preac-Mursic V, Wilske B, Einhaupl KM, Cefotaxime vs penicillin G for acute neurologic manifestations in Lyme Borreliosis: a prospective randomized study. Archives of Neurology 46: 1190–1194, 1989PubMedGoogle Scholar
  73. Pfister H-W, Preac-Mursic V, Wilske B, Schielke E, Sorgel F, et al. Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. Journal of Infectious Diseases 163: 311–318, 1991PubMedGoogle Scholar
  74. Pikelj F, Strle F, Mozina M. Seronegative Lyme disease and transitory atrioventricular block. Annals of Internal Medicine 111: 90, 1989PubMedGoogle Scholar
  75. Preac-Mursic V, Wilske B, Schierz G. European Borrelia burgdorferiisolated from humans and ticks; culture conditions and antibiotic susceptibility. Zentralblatt für Bakteriologie Mikrobiologie und Hygien (A) 263: 112–118, 1986Google Scholar
  76. Preac-Mursic V, Wilske B, Scherz G, Holmburger M, Suss E. In vitroand in vivosusceptibility of Borrelia burgdorferi. European Journal of Clinical Microbiology 6: 424–426, 1987Google Scholar
  77. Preac-Mursic V, Wilske B, Schierz G, Suss E, Gross B. Comparative antimicrobial activity of the new macrolides against Borrelia burgdorferi. European Journal of Clinical Microbiology 8: 651–653, 1989Google Scholar
  78. Reik Jr L, Burgdorfer W, Donaldson JO. Neurologic abnormalities in Lyme disease without erythema chronicum migrans. American Journal of Medicine 81: 73–78, 1986PubMedGoogle Scholar
  79. Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE. Neurologic abnormalities of Lyme disease. Medicine 58: 281–294, 1979PubMedGoogle Scholar
  80. Reznick JW, Braunstein DB, Walsh RL, et al. Lyme carditis: electrophysiologic and histopathologic study. American Journal of Medicine 81: 923–927, 1986PubMedGoogle Scholar
  81. Ross WH, Sutton HF. Acquired syphilitic uveitis. Archives of Ophthalmology 98: 496–498, 1980PubMedGoogle Scholar
  82. Schechter SL. Lyme disease associated with optic neuropathy. American Journal of Medicine 81: 143–145, 1986PubMedGoogle Scholar
  83. Schlesinger PA, Duray PH, Burke BA, Steere AC, Stillman T. Maternal-fetal transmission of the Lyme disease spiroochete, Borrelia burgdorferi. Annals of Internal Medicine 103: 67–68, 1985PubMedGoogle Scholar
  84. Schmid GP. The global distribution of Lyme disease. Review of Infectious Diseases 7: 41–50, 1985Google Scholar
  85. Sigal LH. Lyme disease: a worldwide Borreliosis. Clinical and Experimental Rheumatology 6: 411–421, 1988PubMedGoogle Scholar
  86. Sigal LH. Lyme disease, 1988: immunologic manifestations and possible immunopathogenetic mechanisms. Seminars in Arthritis and Rheumatism 18: 151–167, 1989PubMedGoogle Scholar
  87. Sigal LH. Experience with the first one hundred patients referred to a Lyme Disease referral center. American Journal of Medicine 88: 577–581, 1990PubMedGoogle Scholar
  88. Sigal LH. Summary of the Fourth International Symposium on Lyme Borreliosis. Arthritis and Rheumatism 34: 367–370, 1991PubMedGoogle Scholar
  89. Sigal LH. Persisting symptoms in Lyme disease. In Coyle PK (Ed.) Lyme disease, BC Decker, Inc., Philadelphia, 1992Google Scholar
  90. Sigal LH, Curran AS. Lyme disease. Annual Review of Public Health 12: 85–109, 1991PubMedGoogle Scholar
  91. Sigal LH, Tatum AH. Molecular mimicry in Lyme neurologic disease: cross-reactivity between Borrelia burgdorferiand neuronal antigens. Neurology 38: 1439–1442, 1988PubMedGoogle Scholar
  92. Stanek GL, Flamm H, Barbour AG & Burgdorfer W (Eds) Proceedings of the Second International Symposium on Lyme disease and related disorders. Zentralblatt für Bakteriologie, Microbiologie und Hygiene 263: 1–495, 1986Google Scholar
  93. Stanek G, Klein J, Bittner R, Glogar D. Isolation of Borrelia burgdorferifrom the myocardium of a patient with longstanding cardiomyopathy. New England Journal of Medicine 322: 249–252, 1990PubMedGoogle Scholar
  94. Steere AC. Lyme disease. New England Journal of Medicine 321: 586–596, 1989PubMedGoogle Scholar
  95. Steere AC, Bartenhagen NH, Craft JE, Hutchinson GJ, Newman JH, et al. The early clinical manifestations of Lyme disease. Annals of Internal Medicine 99: 76–82, 1983PubMedGoogle Scholar
  96. Steere AC, Batsford WP, Weinberg M, Alexander J, Berger HJ, et al. Lyme carditis: cardiac abnormalities of Lyme disease. Annals of Internal Medicine 93: 8–16, 1980PubMedGoogle Scholar
  97. Steere AC, Duray P, Kauffmann DJH, Wormser G. Unilateral blindness caused by infection with the Lyme disease spirochete, Borrelia burgdorferi. Annals of Internal Medicine 103: 382–384, 1PubMedGoogle Scholar
  98. Steere AC, Gibofsky A, Patarroyo ME, Winchester RJ, Hardin JA, et al. Chronic Lyme arthritis, clinical and immunogenetic differentiation from rheumatoid arthritis. Annals of Internal Medicine 90: 896–903, 1979PubMedGoogle Scholar
  99. Steere AC, Green J, Schoen RT, Taylor E, Hutchinson GJ, et al. Successful parenteral penicillin therapy of established Lyme arthritis. New England Journal of Medicine 312: 869–874, 1984Google Scholar
  100. Steere AC, Grodzicki RL, Kornblatt AN, Craft JE, Barbour AG, et al. The spirochetal etiology of Lyme Disease. New England Journal of Medicine 308: 733–740, 1983PubMedGoogle Scholar
  101. Steere AC, Hutchinson GJ, Rahn DW, Sigal LH, Craft JE, et al. Treatment of the early manifestations of Lyme disease. Annals of Internal Medicine 99: 22–26, 1983PubMedGoogle Scholar
  102. Steere AC, Malawista SE. Cases of Lyme disease in the United States: location correlated with distribution of Ixodes dammini. Annals of Internal Medicine 91: 730–735, 1979PubMedGoogle Scholar
  103. Steere AC, Malawista SE, Craft JE, Fischer DK, Garcia-Blanco M. (Eds) International Symposium on Lyme disease. Yale Journal of Biology and Medicine 57: 445–705, 1984Google Scholar
  104. Steere AC, Malawista SE, Hardin JA, Ruddy S, Askenase PW, et al. Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum. Annals lof Internal Medicine 86: 685–692, 1977Google Scholar
  105. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis and Rheumatism 20: 7–17, 1977PubMedGoogle Scholar
  106. Steere AC, Pachner AR, Malawista SE. Neurologic abnormalities of Lyme disease: successful treatment with high dose intravenous penicillin. Annals of Internal Medicine 99: 767–772, 1983PubMedGoogle Scholar
  107. Steere AC, Schoen RT, Taylor E. The clinical evolution of Lyme arthritis. Annals of Internal Medicine 107: 725–731, 1987PubMedGoogle Scholar
  108. Stiernstedt G. Tick-borne Borreliainfection in Sweden. Scandinavian Journal of Infectious Diseases 45 (Suppl.): 1–70, 1985PubMedGoogle Scholar
  109. Stiernstedt G, Eriksson G, Enfors W, Jorbeck H, Svenungsson B, et al. Erythema chronicum migrans in Sweden: clinical manifestations and antibodies to Ixodes ricinusspirochete. Scandinavian Journal of Infectious Diseases 18: 217–225, 1986PubMedGoogle Scholar
  110. Stiernstedt GT, Granstrom M, Hederstedt B, Skoldenberg B. Diagnosis of spirochetal meningitis by enzyme-linked immunosorbent assay and indirect immunofluorescence assay in serum and cerebrospinal fluid. Journal of Clinical Microbiology 21: 819–825, 1985PubMedGoogle Scholar
  111. Szczepanski A, Benach JL. Lyme Borreliosis: host response to Borrelia burgdorferi.Microbiological Review 55: 21–34, 1991Google Scholar
  112. van der Linde MR, Crijns HJGM, Lie KI. Transient complete AV block in Lyme disease: electrophysiologic observations. Chest 96: 219–221, 1989PubMedGoogle Scholar
  113. van der Linde MR, Crijns HJGM, de Koning J, Hoogkaamp-Korstanje JAA, de Graaf JJ, et al. Range of atrioventricular conduction disturbances in Lyme borreliosis: a report of four cases and review of other published reports. British Heart Journal 63: 162–168, 1990PubMedGoogle Scholar
  114. Vlay SC. Complete heart block due to Lyme disease. New England Journal of Medicine 315: 1418, 1986PubMedGoogle Scholar
  115. Weber K. Lymphocytic meningoradiculitis of Bannwarth and erythema chronicum migrans disease. Journal of Neurology 231: 281–283, 1984PubMedGoogle Scholar
  116. Weber K, Bratzke H-J, Neubert U, Wilske B, Duray PH. Borrelia burgdorferiin a newborn despite oral penicillin for Lyme borreliosis during pregnancy. Pediatric Infectious Diseases 7: 286–289, 1988Google Scholar
  117. Weber K, Neubert U. Clinical features of early erythema chronicum migrans disease and related disorders. Zentralblatt für Bakteriologie Mikrobiologie und Hygiene (A) 263: 209–228, 1986Google Scholar
  118. Williams CL, Strobino B, Weinsten A, Spierling P, Medici F. Lyme disease, pregnancy, and congenital malformations: a cordblood serosurvey. presented at IV International Conference on Lyme Borreliosis, Stockholm, 1990Google Scholar
  119. Wilske B, Schierz G, Preac-Muric V, von Busch K, Kuhbeck R, et al. Intrathecal production of specific antibodies against Borrelia burgdorferiin patients with lymphocytic meningoradiculitis (Bannwarth’s syndrome). Annals of Neurology 20: 337–345, 1986Google Scholar
  120. Winward KE, Smith JL, Culbertson WW, Paris-Hamelin A. Ocular Lyme Borreliosis. American Journal of Ophthalmology 108: 651–657, 1989PubMedGoogle Scholar
  121. Zalneraitis EL, Gerber MA. Prevalence of clinically significant neurologic disorders attributable to congenital Lyme disease. Presented at IV International Conference on Lyme Borreliosis, Stockholm, 1990Google Scholar
  122. Zoller L, Haude M, Hassler D„ Burkhard S, Sontag HG. Spontaneous and post-treatment antibody kinetics in late Lyme borreliosis. Serodiagnosis and Immunotherapy in Infectious Disease 3: 345–353, 1989Google Scholar

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© Adis International Limited 1992

Authors and Affiliations

  • Leonard H. Sigal
    • 1
  1. 1.Lyme Disease Center, Robert Wood Johnson Medical SchoolUniversity of Medicine and Dentistry of New JerseyNew BrunswickUSA

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