Tired of Lyme borreliosis. Lyme borreliosis in the Netherlands

Abstract

Lyme borreliosis has become the most common vector-borne illness in North Eastern USA and Europe. It is a zoonotic disease, with well-defined symptoms, caused by B. burgdorferi sensu lato, and transmitted by ticks. Lyme borreliosis is endemic in the Netherlands with a yearly incidence of approximately 133 cases/100,000 inhabitants. Similar to another spirochetal disease, syphilis, it can be divided into three stages; early, early disseminated and late disseminated manifestations of disease, of which the specific clinical presentations will be discussed in detail. The diagnosis of Lyme borreliosis is based on a history of potential exposure to ticks and the risk of infection with B. burgdorferi s.l., development of specific symptoms, exclusion of other causes, and when appropriate, combined with serological and/or other diagnostic tests. The specific indications for, but also the limitations of, serology and other diagnostic tests, including the polymerase chain reaction (PCR), are detailed in this review. Lyme borreliosis is treated with antibiotics, which are usually highly effective. Recent literature discussing the indications for antibiotic treatment, the dosage, duration and type of antibiotic, as well as indications to withhold antibiotic treatment, are reviewed. This review presents the most recent, and when available Dutch, evidence-based information on the ecology, pathogenesis, clinical presentation, diagnosis, treatment and prevention of Lyme borreliosis, argues against the many misconceptions that surround the disease, and provides a framework for the Dutch physician confronted with a patient with putative Lyme borreliosis.