eMedicine Specialties > Ophthalmology > Infectious Disease

Lyme Disease: Follow-up

Author: Gerald W Zaidman, MD, Professor of Clinical Ophthalmology, New York Medical College; Chief of Cornea Service; Director, Department of Ophthalmology, Westchester Medical Center
Contributor Information and Disclosures

Updated: Aug 26, 2009

Follow-up

Deterrence/Prevention

  • Preventive measures for Lyme disease rely on personal protection. People in endemic areas should wear long pants and light-colored clothing and use insect repellents whenever venturing into the wooded areas preferred by the Ixodes tick.
  • In December 1998, the Food and Drug Administration (FDA) approved the use of the vaccine, LYMERix (Smith-Kline-Beecham), to prevent Lyme disease. However, because of poor demand for the product, the sale was later discontinued in the United States (2002).
    • The vaccine is considered a supplement and not a replacement for standard precautions against Lyme disease. The best way to prevent Lyme disease is for individuals to take preventive measures against tick bites. They should wear long pants and light-colored clothing that they inspect before removal, use appropriate landscape measures around homes, and use insect repellants. However, for patients who live in endemic areas of Lyme disease and who will be outdoors, the vaccine may be advisable.
    • The vaccine is a recombinant outer-surface protein A (rOspA) of B burgdorferi, the bacteria that causes Lyme disease. It induces antibodies that prevent the bacteria from causing illness in vaccinated individuals. However, use of the vaccine presents certain difficulties. The vaccine is approved only for people aged 15-70 years. It is not approved for children, elderly individuals, pregnant woman, or people with chronic joint or neurologic Lyme disease. Also, for maximum protection, at least 3 dosages are required over 1 year. The first dose at 0 time, the next dose at 1 month, and the last dose at 12 months. Finally, the vaccine is not expected to give immunity. Patients require periodic boosters. Current evidence indicates that, even in the best case scenario, the vaccine has an efficacy of about 80%. Therefore, it is only indicated for patients at high risk.
    • Other problems with the use of the vaccine are that it does not protect against other diseases carried by the deer tick, such as ehrlichiosis and babesiosis. The vaccine costs approximately $100 per individual per year, and some insurance companies may not cover the vaccine. The duration of protection is unknown; also, the long-term safety of the vaccine has not been determined. Finally, patients should be warned that they probably will develop some local adverse affects, including swelling, pain, and inflammation in the area of the vaccine.

Complications

  • Complications depend on the severity of the disease.

Prognosis

  • With early detection and treatment, the prognosis is favorable.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Because Lyme disease is a disease with varied and complex (and confusing) manifestations, it can be difficult to diagnose. There often are problems with the initial diagnosis, and there can be delays in diagnosis; also, there can be a tendency to overdiagnose the disease, especially in patients with a lifestyle that puts them in a high-risk category. The best way to avoid these problems is to follow the Centers for Disease Control and Prevention (CDC) guidelines regarding diagnosis and to obtain the assistance of an infectious disease expert when one has any questions. Also, be careful as to how the laboratory tests are interpreted, and be sure that they are obtained from a reputable laboratory with experience in testing for Lyme disease.
  • Difficulties can arise in choosing the appropriate antibiotic treatment regimen, especially in children or potentially pregnant women. Again, an infectious disease consult is helpful in these situations.
  • Finally, if one decides to become actively involved in the management of these patients, stay abreast of the literature, especially in the rapidly changing areas of diagnosis and treatment.

Special Concerns

 


More on Lyme Disease

Overview: Lyme Disease
Differential Diagnoses & Workup: Lyme Disease
Treatment & Medication: Lyme Disease
Follow-up: Lyme Disease
References
[ CLOSE WINDOW ]

References

  1. Berglöff J, Gasser R, Feigl B. Ophthalmic manifestations in Lyme borreliosis. A review. J Neuroophthalmol. Mar 1994;14(1):15-20. [Medline].

  2. Johnson BJ, Robbins KE, Bailey RE, et al. Serodiagnosis of Lyme disease: accuracy of a two-step approach using a flagella-based ELISA and immunoblotting. J Infect Dis. Aug 1996;174(2):346-53. [Medline].

  3. Karma A, Seppala I, Mikkila H, et al. Diagnosis and clinical characteristics of ocular Lyme borreliosis. Am J Ophthalmol. Feb 1995;119(2):127-35. [Medline].

  4. Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am. Feb 2008;26(1):217-31, viii. [Medline].

  5. Lesser RL. Ocular manifestations of Lyme disease. Am J Med. Apr 24 1995;98(4A):60S-62S. [Medline].

  6. Lesser RL, Kornmehl EW, Pachner AR, et al. Neuro-ophthalmologic manifestations of Lyme disease. Ophthalmology. Jun 1990;97(6):699-706. [Medline].

  7. Magnarelli LA. Current status of laboratory diagnosis for Lyme disease. Am J Med. Apr 24 1995;98(4A):10S-12S; discussion 12S-14S. [Medline].

  8. Mikkila HO, Seppala IJT, Viljanen MK, et al. The expanding clinical spectrum of ocular Lyme borreliosis. Ophthalmology. Mar 2000;107(3):581-7. [Medline].

  9. Nadelman RB, Wormser GP. A clinical approach to Lyme disease. Mt Sinai J Med. May 1990;57(3):144-56. [Medline].

  10. Rothermel H, Hedges TR 3rd, Steere AC. Optic neuropathy in children with Lyme disease. Pediatrics. Aug 2001;108(2):477-81. [Medline].

  11. Steere AC. Lyme disease. N Engl J Med. Aug 31 1989;321(9):586-96. [Medline].

  12. Steere AC. Lyme disease. N Engl J Med. Jul 12 2001;345(2):115-25. [Medline].

  13. Steere AC, Sikand VK. The presenting manifestations of Lyme disease and the outcomes of treatment. N Engl J Med. Jun 12 2003;348(24):2472-4. [Medline].

  14. Winward KE, Smith JL, Culbertson WW, et al. Ocular Lyme borreliosis. Am J Ophthalmol. Dec 15 1989;108(6):651-7. [Medline].

  15. Wormser GP. Prospects for a vaccine to prevent Lyme disease in humans. Clin Infect Dis. Nov 1995;21(5):1267-74. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Lyme disease, borreliosis, Lyme borreliosis, ticks, tick bite, tick-borne disease, tick-borne illness, infection, Borrelia burgdorferi, B burgdorferi, ocular Lyme disease, Lyme uveitis, arthropod-related disease, spirochetal disorder, ocular manifestations of Lyme disease

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Gerald W Zaidman, MD, Professor of Clinical Ophthalmology, New York Medical College; Chief of Cornea Service; Director, Department of Ophthalmology, Westchester Medical Center
Gerald W Zaidman, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Uveitis Society, Association for Research in Vision and Ophthalmology, Medical Society of the State of New York, Medical Society of Virginia, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.