Principles of the diagnosis and antibiotic treatment of Lyme borreliosis

Clinical signs and symptoms are an essential aspect of the diagnosis of Lym e borreliosis. Thus, a thorough knowledge of the clinical features of the d isease is important. Established clinical definitions could be of help in e veryday clinical practice and especially to compare the findings of differe nt authors or groups. The characteristic sign that permits the diagnosis of Lyme borreliosis is a typical erythema migrans skin lesion. Highly suggest ive manifestations are ear lobe lymphocytoma, acrodermatitis chronica atrop hicans and Bannwarth's syndrome. The majority of other signs and symptoms a re only suggestive and, when expressed individually, may have a very limite d or even symbolic value for the purpose of diagnosis. Laboratory confirmation of borrelial infection is needed, as a rule, for al l manifestations of Lyme borreliosis with the exception of typical erythema migrans. In clinical practice indirect laboratory methods are usually empl oyed. Determination of borrelial IgM and IgG antibodies by immunofluorescen ce assays or enzyme-linked immunosorbent assays has not been standardised, and correlation of the results from different laboratories and/or different commercial tests may be poor. Immunoblotting may solve some of the many di lemmas but could (especially in Europe) raise additional questions in a fie ld in which numerous uncertainties already exist. The reliability of method s for direct detection of borrelial injection other than culture to ascerta in spirochetes in tissue specimens is open to question. Treatment with antibiotics is reasonable in all stages of Lyme borreliosis and for all clinical manifestations; however, it has been most effective ea rly in the course of the illness. The choice of antibiotic depends upon man y factors including the efficacy, pharmacokinetic profile, side effects, ex pected compliance and price. For the majority of manifestations the most ef fective antibiotic, the optimal dosage, and the most appropriate duration o f treatment have not been exactly determined. Recommendations for the treatment of Lyme borreliosis in Slovenia are prese nted.