Borrelia burgdorferi and Lyme Disease (page 6)
(This chapter has 6 pages)
© Kenneth Todar, PhD
Treatment of Lyme disease
Since the diagnosis of Lyme disease is based primarily on clinical
it is often appropriate to treat patients with early disease solely on
the basis of objective signs and a known exposure.
Several antibiotics are effective in the treatment of Lyme disease.
The present drug of choice is doxycycline, a semisynthetic derivative
tetracycline. Even patients who are treated in later stages of the
respond well to antibiotics. In a few patients who are treated for Lyme
disease, symptoms of persisting infection may continue or recur, making
additional antibiotic treatment necessary. Varying degrees of permanent
damage to joints or the nervous system can develop in patients with
chronic Lyme disease. Typically these are patients in whom Lyme disease
was unrecognized in the early stages or for whom the initial treatment
Removing leaves and clearing brush and tall grass around houses and
at the edges of gardens may reduce the numbers of ticks that transmit
disease. A relationship has been observed between the abundance of deer
and the abundance of deer ticks in some parts United States. Reducing
managing deer populations in geographic areas where Lyme disease occurs
may reduce tick abundance.
CDC recommends the following for personal protection from tick bites
and Lyme disease:
Avoid tick-infested areas, especially in May, June, and July.
Wear light-colored clothing so that ticks can be spotted more
Tuck pant legs into socks or boots and shirt into pants or ape the area
where pants and socks meet so that ticks cannot crawl under clothing.
Spray insect repellent containing DEET on clothes and on exposed
other than the face, or treat clothes (especially pants, socks, and
with permethrin, which kills ticks on contact.
Wear a hat and a long-sleeved shirt for added protection.
Walk in the center of trails to avoid overhanging grass and brush.
After being outdoors, remove clothing and wash and dry it at a high
temperature; inspect body carefully and remove attached ticks with
grasping the tick as close to the skin surface as possible and pulling
straight back with a slow steady force; avoid crushing the tick's body.
In some areas, ticks (saved in a sealed container) can be submitted to
the local health department for identification.
Preventive antibiotic treatment with erythromycin or doxycycline to
prevent Lyme disease after a known tick bite may be warranted.
Personal protective measures, such as repellent use and routine tick
checks, are key components of primary prevention. Removing infected
within 48 hours of attachment can reduce the likelihood of
and prompt antimicrobial prophylaxis of tick bites,
might be beneficial under certain circumstances. Exposure to ticks in
and recreational areas can be reduced 50-90% through simple landscaping
practices, such as removing brush and leaf litter or creating a buffer
of wood chips or gravel between forest and lawn or recreational areas.
Correctly timed applications of pesticides to yards once or twice a
can decrease the number of nymphal ticks 68-100%.
In addition to these interventions, several novel approaches to Lyme
disease prevention are under investigation and may soon be available.
include bait boxes and "four-poster" devices that deliver acaricides to
rodents and deer without harming them, and the use of biologic agents,
such as fungi that kill Ixodes ticks.
Vaccines for Lyme disease
In 1998, the Food and Drug Administration licensed the LYMErixTM
vaccine against Lyme disease for human use. LYMErixTM
lipidated recombinant outer surface protein A (OspA) of Borrelia
sensu stricto, the causative agent of Lyme disease in North
adsorbed onto aluminum adjuvant. It was indicated for use in persons
15-70 years. Three doses of the vaccine are administered by
injection. The initial dose is followed by a second dose one month
and a third dose 12 months after the first. Vaccine administration
be timed so the second dose and the third dose are given several weeks
before the beginning of the B. burgdorferi transmission season
usually begins in April.
The vaccine was targeted at persons at risk for exposure to infected
vector ticks. This risk should be assessed by considering the regional
distribution of the disease and the extent to which a person's
place them in contact with ticks. A Lyme disease risk map (below) is
from CDC. Vaccination of persons with frequent or prolonged exposure to
ticks in areas endemic for Lyme disease was touted to be an important
preventive strategy. Recommendations for use of the LYMErixTM
vaccine were developed by the Advisory Committee for Immunization
Practices of the CDC.
In February, 2002, the manufacturer of the FDA-approved LYMErixTM
vaccine withdrew it from the market, reportedly because of poor
sales. However, several other effective preventive measures remain
to persons living in areas where the disease is endemic.
Didn't find what you are looking for? For current comprehensive information relating to Lyme Disease, go to the excellent CDC website Lyme Disease.
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