Edgar Sanchez1, Edouard Vannier1, Gary P Wormser2, Linden T Hu3. 1. Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts. 2. Division of Infectious Diseases, New York Medical College, Valhalla, New York. 3. Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts.
Abstract
IMPORTANCE: Lyme disease, human granulocytic anaplasmosis (HGA), and babesiosis are emerging tick-borne infections. OBJECTIVE: To provide an update on diagnosis, treatment, and prevention of tick-borne infections. EVIDENCE REVIEW: Search of PubMed and Scopus for articles on diagnosis, treatment, and prevention of tick-borne infections published in English from January 2005 through December 2015. FINDINGS: The search yielded 3550 articles for diagnosis and treatment and 752 articles for prevention. Of these articles, 361 were reviewed in depth. Evidence supports the use of US Food and Drug Administration-approved serologic tests, such as an enzyme immunoassay (EIA), followed by Western blot testing, to diagnose extracutaneous manifestations of Lyme disease. Microscopy and polymerase chain reaction assay of blood specimens are used to diagnose active HGA and babesiosis. The efficacy of oral doxycycline, amoxicillin, and cefuroxime axetil for treating Lyme disease has been established in multiple trials. Ceftriaxone is recommended when parenteral antibiotic therapy is recommended. Multiple trials have shown efficacy for a 10-day course of oral doxycycline for treatment of erythema migrans and for a 14-day course for treatment of early neurologic Lyme disease in ambulatory patients. Evidence indicates that a 10-day course of oral doxycycline is effective for HGA and that a 7- to 10-day course of azithromycin plus atovaquone is effective for mild babesiosis. Based on multiple case reports, a 7- to 10-day course of clindamycin plus quinine is often used to treat severe babesiosis. A recent study supports a minimum of 6 weeks of antibiotics for highly immunocompromised patients with babesiosis, with no parasites detected on blood smear for at least the final 2 weeks of treatment. CONCLUSIONS AND RELEVANCE: Evidence is evolving regarding the diagnosis, treatment, and prevention of Lyme disease, HGA, and babesiosis. Recent evidence supports treating patients with erythema migrans for no longer than 10 days when doxycycline is used and prescription of a 14-day course of oral doxycycline for early neurologic Lyme disease in ambulatory patients. The duration of antimicrobial therapy for babesiosis in severely immunocompromised patients should be extended to 6 weeks or longer.
IMPORTANCE: Lyme disease, human granulocytic anaplasmosis (HGA), and babesiosis are emerging tick-borne infections. OBJECTIVE: To provide an update on diagnosis, treatment, and prevention of tick-borne infections. EVIDENCE REVIEW: Search of PubMed and Scopus for articles on diagnosis, treatment, and prevention of tick-borne infections published in English from January 2005 through December 2015. FINDINGS: The search yielded 3550 articles for diagnosis and treatment and 752 articles for prevention. Of these articles, 361 were reviewed in depth. Evidence supports the use of US Food and Drug Administration-approved serologic tests, such as an enzyme immunoassay (EIA), followed by Western blot testing, to diagnose extracutaneous manifestations of Lyme disease. Microscopy and polymerase chain reaction assay of blood specimens are used to diagnose active HGA and babesiosis. The efficacy of oral doxycycline, amoxicillin, and cefuroxime axetil for treating Lyme disease has been established in multiple trials. Ceftriaxone is recommended when parenteral antibiotic therapy is recommended. Multiple trials have shown efficacy for a 10-day course of oral doxycycline for treatment of erythema migrans and for a 14-day course for treatment of early neurologic Lyme disease in ambulatory patients. Evidence indicates that a 10-day course of oral doxycycline is effective for HGA and that a 7- to 10-day course of azithromycin plus atovaquone is effective for mild babesiosis. Based on multiple case reports, a 7- to 10-day course of clindamycin plus quinine is often used to treat severe babesiosis. A recent study supports a minimum of 6 weeks of antibiotics for highly immunocompromised patients with babesiosis, with no parasites detected on blood smear for at least the final 2 weeks of treatment. CONCLUSIONS AND RELEVANCE: Evidence is evolving regarding the diagnosis, treatment, and prevention of Lyme disease, HGA, and babesiosis. Recent evidence supports treating patients with erythema migrans for no longer than 10 days when doxycycline is used and prescription of a 14-day course of oral doxycycline for early neurologic Lyme disease in ambulatory patients. The duration of antimicrobial therapy for babesiosis in severely immunocompromised patients should be extended to 6 weeks or longer.
Authors: Guiqing Wang; Gary P Wormser; Jian Zhuge; Patrick Villafuerte; Dawn Ip; Christine Zeren; John T Fallon Journal: Ticks Tick Borne Dis Date: 2015-03-24 Impact factor: 3.744
Authors: Katja Häselbarth; Astrid M Tenter; Volker Brade; Gerhard Krieger; Klaus-Peter Hunfeld Journal: Int J Med Microbiol Date: 2007-03-12 Impact factor: 3.473
Authors: David C Goff; Donald M Lloyd-Jones; Glen Bennett; Sean Coady; Ralph B D'Agostino; Raymond Gibbons; Philip Greenland; Daniel T Lackland; Daniel Levy; Christopher J O'Donnell; Jennifer G Robinson; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Paul Sorlie; Neil J Stone; Peter W F Wilson Journal: J Am Coll Cardiol Date: 2013-11-12 Impact factor: 24.094
Authors: Peter J Krause; Sukanya Narasimhan; Gary P Wormser; Alan G Barbour; Alexander E Platonov; Janna Brancato; Timothy Lepore; Kenneth Dardick; Mark Mamula; Lindsay Rollend; Tanner K Steeves; Maria Diuk-Wasser; Sahar Usmani-Brown; Phillip Williamson; Denis S Sarksyan; Erol Fikrig; Durland Fish Journal: Emerg Infect Dis Date: 2014-07 Impact factor: 6.883
Authors: Kai Zhang; Zhuan Qin; Yunjie Chang; Jun Liu; Michael G Malkowski; Saimtun Shipa; Li Li; Weigang Qiu; Jing-Ren Zhang; Chunhao Li Journal: Mol Microbiol Date: 2019-04-26 Impact factor: 3.501
Authors: Jose Thekkiniath; Sara Mootien; Lauren Lawres; Benjamin A Perrin; Meital Gewirtz; Peter J Krause; Scott Williams; J Stone Doggett; Michel Ledizet; Choukri Ben Mamoun Journal: J Clin Microbiol Date: 2018-09-25 Impact factor: 5.948
Authors: Allen C Steere; Franc Strle; Gary P Wormser; Linden T Hu; John A Branda; Joppe W R Hovius; Xin Li; Paul S Mead Journal: Nat Rev Dis Primers Date: 2016-12-15 Impact factor: 52.329
Authors: Erin E McClure; Adela S Oliva Chávez; Dana K Shaw; Jason A Carlyon; Roman R Ganta; Susan M Noh; David O Wood; Patrik M Bavoil; Kelly A Brayton; Juan J Martinez; Jere W McBride; Raphael H Valdivia; Ulrike G Munderloh; Joao H F Pedra Journal: Nat Rev Microbiol Date: 2017-06-19 Impact factor: 60.633
Authors: Neeharik Mareedu; Anna M Schotthoefer; Jason Tompkins; Matthew C Hall; Thomas R Fritsche; Holly M Frost Journal: Am J Trop Med Hyg Date: 2017-07-19 Impact factor: 2.345