The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America

Abstract

Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.

Molecular detection of tick-borne protozoal and ehrlichial infections in domestic dogs in South Africa

“…Currently, the two tick-transmitted Ehrlichia/Anaplasma species known to cause human disease are Ehrlichia chaffeensis (Dumler et al, 1995;Paddock et al, 1997) and Anaplasma phagocytophilum (Wormser et al, 2006). Our RLB assay had probes that could detect and differentiate between the two zoonotic species (Table 2), but our results were negative.…”

Human Granulocytic Anaplasmosis

“…11,12,14,41,56 Probable and laboratoryconfirmed HGA require a nonspecific febrile illness and laboratory confirmation by PCR, culture of blood, and/or detection of specific A. phagocytophilum antibodies in serum (Table 2). Patients who present with an acute clinical illness compatible with HGA should always be considered for specific antibiotic treatment.…”

“…Patients who present with an acute clinical illness compatible with HGA should always be considered for specific antibiotic treatment. 12,14,41,56 HGA is a reportable illness and all confirmed cases must be reported to the CDC or to the local state health department in the state where the diagnosis was made. The tabular list of International Classification of Diseases (ICD-9) has categorized HGA under the subheading tick-borne rickettsioses/other ehrlichiosis with the numerical code 082.49 (ICD-10 code A77.49).…”

Chronic Lyme Disease: A Review

“…Many studies have shown that Lyme disease is treated successfully with antibiotics in the majority of cases, and patients with objective evidence of treatment failure are rare with currently recommended regimens [11][12][13][14]. Patients with late manifestations can have a slower response to therapy, sometimes taking weeks or months to recover [15][16][17][18][19][20][21][22][23].…”

“…In some cases, facial palsy and brief episodes of arthritis were grouped together with nonspecific symptoms as part of minor manifestations of late Lyme disease [29,30], and, in some studies, all patients were grouped together [29,31]. While arthritis, meningoencephalitis, carditis and other objective manifestations of Lyme disease are clear evidence of treatment failure and require antibiotic therapy [14], there was uncertainty about whether nonspecific "minor" symptoms could also represent treatment failures and that longer courses of antibiotics or different antibiotic regimens may be needed in some of the patients [30,31,52,53].…”