LYME-DISEASE, ROCKY-MOUNTAIN-SPOTTED-FEVER, EHRLICHIOSIS - EMERGING AND ESTABLISHED CHALLENGES FOR THE CLINICIAN

Objective: The goal of this review is to facilitate the management of patients with tick-associated diseases. This article will discuss the epidemiology, clinical diagnosis, and antimicrobial therapy of Lyme di sease, Rocky Mountain spotted fever, and ehrlichiosis. Data Sources: R eferences are limited to the English language and extend back to the b eginning of the twentieth century. The human and veterinary literature were reviewed. Sources include computerized databases and bibliograph ies of recent articles and books. Study Selection: Papers were selecte d on the basis of their timeliness, explanation of important findings by major investigators, extrapolation of clinical data from large pati ent populations, and clarification of controversial issues. Approximat ely 50% of the articles initially reviewed are included in the bibliog raphy. Results: Standardization of laboratory testing for Lyme disease should facilitate more accurate diagnosis in the future. Clinical dia gnosis of Rocky Mountain spotted fever and ehrlichiosis prior to labor atory confirmation is necessary in order to ensure timely institution of antimicrobial therapy. Conclusions: Knowledge of endemic regions an d seasonal cycles of vectors, varying clinical presentations of diseas e and appropriate utilization of the laboratory are critical for the a ppropriate diagnosis and management of patients with tick-associated d iseases.