University of Maryland, Baltimore, 21201, USA.
Am Fam Physician. 2012 Jun 1;85(11):1086-93.
Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common tick-borne illness in the United States. Transmission occurs primarily through the bite of an infected deer tick (Ixodes scapularis). Identification of an erythema migrans rash following a tick bite is the only clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation. The Centers for Disease Control and Prevention recommends a two-tier serologic testing protocol using an enzyme-linked immunosorbent assay initially, followed by the more specific Western blot to confirm the diagnosis when the assay samples are positive or equivocal. The treatment of Lyme disease is determined mainly by the clinical manifestations of the disease. Doxycycline is often the preferred agent for oral treatment because of its activity against other tick-borne illnesses. Preventive measures include avoiding areas with high tick burdens, wearing protective clothing, using tick repellants (e.g., diethyltoluamide [DEET]), performing frequent body checks and bathing following outdoor activities, and instituting environmental landscape modifications (e.g., grass mowing, deer exclusion fencing) to reduce the tick burden. Although there is controversy regarding treatment of post-Lyme disease syndrome and chronic Lyme disease, there is no biologic or clinical trial evidence indicating that prolonged antibiotic therapy is of benefit.
莱姆病是由伯氏疏螺旋体引起的，是美国最常见的蜱传疾病。主要通过感染的鹿蜱（Ixodes scapularis）叮咬传播。在没有实验室确认的情况下，在蜱叮咬后出现游走性红斑疹是唯一足以诊断莱姆病的临床表现。美国疾病控制与预防中心建议采用两阶段血清学检测方案，最初使用酶联免疫吸附试验，然后在检测样本阳性或可疑时使用更特异的 Western blot 进行确认。莱姆病的治疗主要取决于疾病的临床表现。由于多西环素对其他蜱传疾病也具有活性，因此常作为口服治疗的首选药物。预防措施包括避免高蜱虫负担的地区、穿着防护服、使用蜱虫驱避剂（如二乙基甲苯酰胺 [DEET]）、户外活动后经常进行身体检查和洗澡，以及进行环境景观改造（如割草、防鹿围栏）以降低蜱虫负担。尽管关于莱姆病后综合征和慢性莱姆病的治疗存在争议，但没有生物学或临床试验证据表明延长抗生素治疗有益。
