Diagnostik und Therapie der Lyme-Arthritis

Abstract

These guidelines summarize the current evidence for diagnosis and treatment of Lyme arthritis and the most frequent skin manifestations of Borrelia burgdorferi infections. Lyme arthritis is a monoarticular or oligoarticular form of arthritis that typically involves the knee. A positive enzyme-linked immunosorbent assay (ELISA) for IgG antibodies should be followed by an IgG immunoblot. A positive PCR test from synovial fluid adds increased diagnostic certainty. Serum positivity for antibodies to Borrelia burgdorferi without typical symptoms does not justify antibiotic treatment. Oral antibiotic treatment for erythema migrans is recommended using doxycycline, 200 mg once per day for 10-21 days, alternative choices are amoxicillin, cefuroxime and azithromycin. For children below 8 years of age, amoxicillin is recommended.Lyme arthritis can usually be successfully treated with orally administered antimicrobial agents. Doxycycline, 1 × 200 or 2 × 100 mg for 30 days is the antibiotic agent of choice. Amoxicillin (3 × 500-1000 mg) can be alternatively chosen. Patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be treated intravenously. In this situation, ceftriaxone at 2 g per day for 14-21 days is recommended. There is no evidence to recommend long-term and combined treatments.

Generality of Post-Antimicrobial Treatment Persistence of Borrelia burgdorferi Strains N40 and B31 in Genetically Susceptible and Resistant Mouse Strains

“…Persistent Lyme borreliosis infection (without antimicrobials) has been experimentally demonstrated in various animal models by culture and PCR (23)(24)(25)(26)(27)(28)(29)(30), as well as in reported confirmed spontaneous cases in humans based on culture (31)(32)(33)(34)(35)(36)(37) and PCR (38)(39)(40)(41). A prolonged treatment regimen has been evaluated in patients with chronic Lyme disease, and treatment is often less effective (15,(42)(43)(44). The general findings of some of these studies were that a small population of persistent spirochetes that survived antimicrobial treatment are noncultivable but that B. burgdorferi-specific DNA (BbDNA) can be detected by PCR.…”

Lyme-Borreliose und Lyme-Arthritis

“…Ungeeignete Testverfahren sind der Antikörpernachweis in der Synovialflüssigkeit und der Lymphozytentransformationstest. Das Gelenkpunktat zeigt im akuten Stadium einen neutrophilen Gelenkerguss, richtungsweisende histologische Befunde finden sich in der Synovialmembran nicht [24].…”

Wichtige Zoonosen: Die Lyme Borreliose

“…Die Erkrankung kann mit jeder Manifestation beginnen und gilt als effizient zu therapierende Erkrankung mitzumindest bei den frühen Manifestationenguter Prognose. Mögliche Begleitsymptome beinhalten u. a. Abgeschlagenheit, Kopfschmerzen, Gelenkschmerzen oder leichtes Fieber [2,3,4,5,6,9]. Das frühe lokalisierte Stadium -Erythema migrans (Wanderröte)kann 3-30 Tage nach dem Zeckenstich auftreten und betrifft etwa 80-90 % aller Fälle.…”

“…Späte (früher: chronische) Manifestationen können Monate bis Jahre nach dem Stich auftreten als Lyme-Arthritis, Acrodermatitis chronica atrophicans (ACA) oder chronische Neuroborreliose (u. a. Borrelienencephalomyelitis) [3,4,9]. Die Lyme Arthritis betrifft ganz überwiegend ein einzelnes oder wenige große Gelenkeüberwiegend Kniegelenkmit voluminöser, intraartikulärer, meist rezidivierender Schwellung [2,3,5].…”