Lyme borreliosis is the most common tick-transmitted disease in the northern hemisphere and is caused by spirochaetes of the Borrelia burgdorferi species complex. A complete presentation of the disease is an extremely unusual observation in which a skin lesion results from a
tick bite and is followed by heart and nervous system involvement, and later on by
arthritis. Late involvement of eye, nervous system, joints, and skin can also occur. The only sign that enables a reliable clinical diagnosis of
Lyme borreliosis is
erythema migrans. Other features of some diagnostic value are earlobe
lymphocytoma, meningoradiculoneuritis (Garin-Bujadoux-Bannwarth syndrome), and
acrodermatitis chronica atrophicans. The many other symptoms and signs have little diagnostic value. Microbial or serological confirmation of borrelial
infection is needed for all manifestations of the disease except for typical early skin lesions. However, even
erythema migrans might not be pathognomonic for
Lyme borreliosis, especially in the southern part of the USA where there is no microbiological evidence for
infection with the agent. Treatment with
antibiotics is beneficial for all stages of
Lyme borreliosis, but is most successful early in the course of the illness. Prevention relies mainly on avoiding exposure to
tick bites but there is some interest in
chemoprophylaxis and also in
vaccine development following initial disappointments.