What is Late Lyme Disease?

Lyme disease is the most common tick-borne illness in North America and Europe. It is caused by the bacterium Borrelia burgdorferi, and if you're treated with appropriate antibiotics in the early stages of the disease, you're likely to recover completely.  In later stages however, response to treatment may be slower, but the majority of people with Lyme disease recover completely with appropriate treatment.

Symptoms of Lyme can include:

·                     Rash

·                     Flu-like symptoms

·                     Migratory joint pain

·                     Neurological problems

·                     Chronic joint inflammation (Lyme arthritis), particularly of the knee

·                     Neurological symptoms, such as facial palsy and neuropathy

·                     Cognitive defects, such as impaired memory

·                     Heart rhythm irregularities

What is late Lyme disease?

Often, these symptoms don’t develop or present until months or even years after the tick bite and is often referred to as late Lyme disease.  Late Lyme disease may not be preceded by a history of early localized or disseminated Lyme disease.  Arthritis in one or a few joints is the most common feature of patients with late Lyme disease, but neurologic manifestations, such as a subtle encephalopathy or polyneuropathy can also occur.

Neurologic features of early disseminated Lyme disease may include:

o   Lymphocytic meningitis

o   Unilateral or bilateral cranial nerve palsies (especially of the facial nerve)

o   Radiculopathy

o   Peripheral neuropathy

o   Mononeuropathy multiplex

o   Cerebellar ataxia (rarely)

o   Encephalomyelitis (rarely)

Cardiac manifestations of Lyme disease include fluctuating degrees of atrioventricular heart block, sometimes with myopericarditis, which is usually mild when it occurs. Chronic cardiomyopathy with heart failure has been linked to Lyme disease in Europe, but not in the United States.

A variety of ocular manifestations have been associated with Lyme disease, including conjunctivitis, keratitis, iridocyclitis, retinal vasculitis, choroiditis, optic neuropathy, and uveitis.

How is it treated?

A 10 day to 4-week course of antibiotics is used to treat people who are diagnosed with Lyme disease, depending on the choice of drug.  OF course the choice of antibiotic depends on the stage of the disease and the symptoms, but common choices include doxycycline, amoxicillin, azithromycin, cefuroxime, and ceftriaxone.

Treatment recommendations for patients with late neurologic manifestations of Lyme disease acquired in the United States are based upon small studies. From these studies, it is not possible to determine if a 30 day course of antibiotic therapy is superior to a 14 day course for late neurologic Lyme disease. The Infectious Diseases Society of America and the American Academy of Neurology recommend a treatment duration of 14 days.