Borrelia burgdorferi: Difference between revisions

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==Treatment==
===Antimicrobial regimen===
====Lyme boreliosis (non-neuroborreliosis)====
:*1. '''Early Lyme Disease'''<ref>{{cite journal |vauthors=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB |title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America |journal=Clin. Infect. Dis. |volume=43 |issue=9 |pages=1089–134 |year=2006 |pmid=17029130 |doi=10.1086/508667 |url=}}</ref>
::*1.1 '''Erythema migrans'''
:::*1.1.1 '''Adult'''
::::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 10-21 days 
::::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid for 14-21 days
::::* Preferred regimen (3): [[Cefuroxime axetil]] 500 mg bid for 14-21 days
::::* Alternatie regimen (1): [[Azithromycin]] 500 mg PO qd for 7–10 days 
::::* Alternatie regimen (2): [[Clarithromycin]] 500 mg PO bid for 14–21 days (if the patient is not pregnant)
::::* Alternatie regimen (3): [[Erythromycin]] 500 mg PO qid for 14–21 days
:::*1.1.2 '''Pediatric'''
::::*1.1.2.1 '''children < 8 years of age'''
:::::* Preferred regimen (1): [[Amoxicillin]] 50 mg/kg PO per day in 3 divided doses (maximum of 500 mg per dose) 
:::::* Preferred regimen (2): [[Cefuroxime axetil]] 30 mg/kg PO per day in 2 divided doses（maximum, 500 mg per dose)
:::*1.1.2.2 '''children ≥ 8 years of age'''
:::::* Preferred regimen (1): [[Doxycycline]] 4 mg/kg PO per day in 2 divided doses（maximum, 100 mg per dose）
:::::* Preferred regimen (2): [[Azithromycin]] 10 mg/kg PO qd (maximum, 500 mg qd)
:::::* Preferred regimen (3): [[Clarithromycin]] 7.5 mg/kg PO bid (maximum, 500 mg per dose) 
:::::* Preferred regimen (4): [[Erythromycin]] 12.5 mg/kg PO qid (maximum, 500 mg per dose)
::*1.2 '''When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis'''
:::* Preferred regimen: [[Amoxicillin-Clavulanate]] 500 mg PO tid
:::* Pediatric regimen: [[Amoxicillin-Clavulanate]] 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose)
::*1.3 '''Lyme carditis'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 10–28 days
:::* Note: patients with advanced heart block, a temporary pacemaker may be required; expert consultation with a cardiologist is recommended; Use of the pacemaker may be discontinued when the advanced heart block has resolved; An oral antibiotic treatment regimen should be used for completion of therapy and for outpatients, as is used for patients with erythema migrans without carditis (see above)
::*1.4 '''Borrelial lymphocytoma'''
:::* Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)
:*2. '''Late Lyme Disease'''
::*2.1 '''Lyme arthritis'''
:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid
:::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid
:::* Alternative regimen: [[Cefuroxime axetil]] 500 mg PO bid for 28 days
:::* Pediatric regimen: [[Amoxicillin]] 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose); [[Cefuroxime axetil]] 30 mg/kg per day in 2 divided doses (maximum,500 mg per dose); (≥8 years of age) [[Doxycycline]] 4 mg/ kg per day in 2 divided doses (maximum, 100 mg per dose)
:::* Note: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4 weeks course of [[Ceftriaxone]] IV
::*2.2 '''patients with arthritis and objective evidence of neurologic disease'''
:::* Preferred regimen: [[Ceftriaxone]] IV for 2–4 weeks
:::* Alternative regimen (1): [[Cefotaxime]] IV
:::* Alternative regimen (1): [[Penicillin G]] IV
:::* Pediatric regime: [[Ceftriaxone]]; [[Cefotaxime]]; [[Penicillin G]] IV
::*2.3 '''Acrodermatitis chronica atrophicans'''
:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 21 days
:::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid for 21 days
:::* Preferred regimen (3): [[Cefuroxime axetil]] 500 mg PO bid for 21 days
:*3. '''Post–Lyme Disease Syndromes'''
:::* Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)
====Lyme neuroborreliosis====
*1. '''Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines'''<ref>{{Cite journal| doi = 10.1086/508667| issn = 1537-6591| volume = 43| issue = 9| pages = 1089–1134| last1 = Wormser| first1 = Gary P.| last2 = Dattwyler| first2 = Raymond J.| last3 = Shapiro| first3 = Eugene D.| last4 = Halperin| first4 = John J.| last5 = Steere| first5 = Allen C.| last6 = Klempner| first6 = Mark S.| last7 = Krause| first7 = Peter J.| last8 = Bakken| first8 = Johan S.| last9 = Strle| first9 = Franc| last10 = Stanek| first10 = Gerold| last11 = Bockenstedt| first11 = Linda| last12 = Fish| first12 = Durland| last13 = Dumler| first13 = J. Stephen| last14 = Nadelman| first14 = Robert B.| title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2006-11-01| pmid = 17029130}}</ref>
:*1.1 '''Early neurologic disease'''
::*1.1.1 '''Cranial nerve palsy (adult)'''
:::* Preferred regimen (1): [[Amoxicillin]] 500 mg PO tid for 14 (14–21) days 
:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 14 (14–21) days 
:::* Preferred regimen (3): [[Cefuroxime]] 500 mg PO bid for 14 (14–21) days
:::* Alternative regimen (1): [[Azithromycin]] 500 mg PO qd for 7–10 days
:::* Alternative regimen (2): [[Clarithromycin]] 500 mg PO bid for 14–21 days (not for pregnant)
:::* Alternative regimen (3): [[Erythromycin]] 500 mg PO qid for 14–21 days
::*1.1.2 '''Cranial nerve palsy (pediatric)'''
:::* Preferred regimen (1): [[Amoxicillin]] 50 mg/kg/day PO tid (Maxmum, 500 mg/dose) for 14 (14–21) days
:::* Preferred regimen (2): [[Doxycycline]] (for children aged ≥ 8 years) 4 mg/kg/day PO q12h (Maxmum, 100 mg/dose) for 14 (14–21) days 
:::* Preferred regimen (3): [[Cefuroxime]] 30 mg/kg/day PO q12h (Maxmum, 500 mg/dose) for 14 (14–21) days
:::* Alternative regimen (1): [[Azithromycin]] 10 mg/kg/day PO (Maxmum, 500 mg/dose) for 7–10 days
:::* Alternative regimen (2): [[Clarithromycin]] 7.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
:::* Alternative regimen (3): [[Erythromycin]] 12.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
::*1.1.3 '''Meningitis or radiculopathy (adult)'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
:::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days 
:::* Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days
:::* Note: for nonpregnant adult patients intolerant of β-lactam agents, [[Doxycycline]] 200–400 mg/day PO/IV q12h may be considered.
::*1.1.4 '''Meningitis or radiculopathy (pediatric)'''
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days
:::* Alternative regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6-8h (Maxmum, 6 g/day) for 14 (10–28) days 
:::* Alternative regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
:::* Note: for children ≥ 8 years of age intolerant of β-lactam agents, [[Doxycycline]] 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered
:*1.2 '''Late neurologic disease'''
::*1.2.1 '''Central or peripheral nervous system disease (adult)'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
:::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days 
:::* Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days
::*1.2.2 '''Central or peripheral nervous system disease (pediatric)'''
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days.
:::* Alternative regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h (Maxmum, 6 g/day) for 14 (10–28) days
:::* Alternative regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
*2. '''American Academy of Neurology (AAN) Practice Parameter'''<ref>{{Cite journal| doi = 10.1212/01.wnl.0000265517.66976.28| issn = 1526-632X| volume = 69| issue = 1| pages = 91–102| last1 = Halperin| first1 = J. J.| last2 = Shapiro| first2 = E. D.| last3 = Logigian| first3 = E.| last4 = Belman| first4 = A. L.| last5 = Dotevall| first5 = L.| last6 = Wormser| first6 = G. P.| last7 = Krupp| first7 = L.| last8 = Gronseth| first8 = G.| last9 = Bever| first9 = C. T.| last10 = Quality Standards Subcommittee of the American Academy of Neurology| title = Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology| journal = Neurology| date = 2007-07-03| pmid = 17522387}}</ref>
:*2.1 '''Meningitis'''
::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
::* Preferred regimen (2):[[Cefotaxime]] 2 g IV q8h for 14 days 
::* Preferred regimen (3):[[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
:*2.2 '''Any neurologic syndrome with CSF pleocytosis'''
::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days 
::* Preferred regimen (3): [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
:*2.3 '''Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)'''
::* Preferred regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Alternative regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days 
::* Alternative regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days 
::* Alternative regimen (3): [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Pediatric regimen: [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
:*2.4 '''Encephalomyelitis'''
::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days 
::* Preferred regimen (3): [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
:*2.5 '''Encephalopathy'''
::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q8h for 14 days 
::* Preferred regimen (3): [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
:*2.6 '''Post-treatment Lyme syndrome'''
::* Preferred regimen: symptomatic management
::* Note: Antibiotic therapy is not indicated.


==References==
==References==

Revision as of 18:52, 7 August 2015

Borrelia burgdorferi
Scientific classification
Kingdom: Bacteria
Phylum: Spirochaetes
Class: Spirochaetes
Order: Spirochaetales
Genus: Borrelia
Species: B. burgdorferi
Binomial name
Borrelia burgdorferi

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This page is about microbiologic aspects of the organism(s).  For clinical aspects of the disease, see Lyme disease.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Template:Seealso

Main article: Lyme disease microbiology

Overview

Borrelia burgdorferi is species of bacteria of the spirochete class of the genus Borrelia. B. burgdorferi is predominant in North America, but also exists in Europe, and is the agent of Lyme disease.

It is a zoonotic, vector-borne disease transmitted by ticks and is named after the researcher Willy Burgdorfer who first isolated the bacterium in 1982. B. burgdorferi is one of the few pathogenic bacteria that can survive without iron, having replaced all of its iron-sulphur cluster enzymes with enzymes that use manganese, thus avoiding the problem many pathogenic bacteria face in acquiring iron.

B. burgdorferi infections have been linked to non-Hodgkin lymphomas.[1]

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References

  1. ↑ Guidoboni M, Ferreri AJ, Ponzoni M, Doglioni C, Dolcetti R (2006). "Infectious agents in mucosa-associated lymphoid tissue-type lymphomas: pathogenic role and therapeutic perspectives". Clinical lymphoma & myeloma. 6 (4): 289–300. PMID 16507206.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 "Public Health Image Library (PHIL)".

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