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Lyme Disease

This article explores the diagnosis and treatment of Lyme disease, a tick borne illness. It is part one of a four part series “Four Tickborne Diseases: Lyme Disease, Ehrlichiosis, Anaplasmosis and Babesiosis” .

Diagnosis can be challenging, as the tick bite may not have been noticed, clinical symptoms may be non-specific, and laboratory confirmation of infection can be problematic, especially early in the course of these diseases. At times clinicians may need to treat on clinical suspicion alone.

Written for the Curious (Non-Medical) Reader



By Stuart M. Caplen, MD

Although there are only about 30,000 cases of Lyme disease reported to the CDC per year, the CDC estimates the actual total is about 476,000 cases per year in the United States.[2]

As can be seen on the map below, most cases of Lyme disease occur in the Mid-Atlantic states, New England and the Midwest, although there is significant distribution around the country. . .

Read more About Lyme Disease:

  • Tick Life Cycle and Infection Transmission

  • How to Remove a Tick

  • Should a Tick be Sent for Laboratory Testing?

  • Lyme Disease Testing

  • Symptoms of Early Lyme Disease

  • Possible Signs and Symptoms of Disseminated Lyme Disease

  • Recommended Treatment for Lyme Disease - Antibiotic Prophylaxis

  • Recommended Treatment of Erythema Migrans Rash/Early Lyme Disease

  • Treatment of Disseminated Lyme Disease

  • Post-Treatment Lyme Disease

Read PART 2 - Ehrlichiosis | PART 3 - Anaplasmosis | PART 4 - Babesia



The conclusion to Part 1-4 of this article is available in the FibonacciLIBRARY

The CME version of this article is available for the medical community with an online CME test in the APP.

Not an APP member? Membership info.



Stuart M. Caplen, MD, FACEP, MSM

Dr. Caplen is a retired emergency medicine physician and former emergency department medical director, who also has a Master of Science in Management degree, and green belt certification in Lean/Six Sigma.


[1] Lyme Disease, CDC, last reviewed: February 24, 2021. Retrieved from:

[2] Lyme Disease, Data and Surveillance, CDC, last reviewed January 14, 2021. Retrieved from:

[3] Tickborne Diseases of the United States, CDC, last reviewed September 22, 2020. Retrieved from:

[4] How ticks spread disease, CDC, last reviewed: September 21, 2020. Retrieved from:

[5] Lyme Disease Transmission. CDC, last reviewed January 29, 2020. Retrieved from:,disease%20bacterium%20can%20be%20transmitted

[6] Hofhuis, A et al., Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model. PloS one vol. 12,7 e0181807. 24 Jul. 2017. Retrieved from:

[7] Nadelman RB et al. Prophylaxis with Single-Dose Doxycycline for the Prevention of Lyme Disease after an Ixodes scapularis Tick Bite, N Engl J Med 2001; 345:79-84, July 12, 2001. Retrieved from:

[8] Tick removal and testing, CDC, last reviewed April 22, 2019. Retrieved from:

[9] Gammons M, Salam G, Tick Removal, Am Fam Physician. 2002 Aug 15;66(4):643-646. Retrieved from:

[10] Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease, Clinical Infectious Diseases, November 30, 2020. Retrieved from:

[11] Tick removal and testing, CDC, last reviewed: April 22, 2019. Retrieved from:

[12] Moore, Andrew et al. “Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States.” Emerging infectious diseases vol. 22,7 (2016): 1169–1177. Retrieved from

[13] Theel, Elitza S et al., “Limitations and Confusing Aspects of Diagnostic Testing for Neurologic Lyme Disease in the United States.” Journal of clinical microbiology vol. 57,1 e01406-18. 2 Jan. 2019. Retrieved from:

[14] Two-tiered Testing Decision Tree, CDC, last updated: November 15, 2011. Retrieved from:

[15] Tickborne Diseases of the United States, CDC, 5th edition 2018. Retrieved from:

[15A]Signs and Symptoms of Untreated Lyme Disease, CDC, last reviewed: January 15, 2021. Retrieved from:

[16] Photo credits: Alison Young, Taryn Holman, Yevgeniy Balagula/, Lyme Disease Rashes and Look-alikes, CDC, last reviewed: October 9, 2020. Retrieved from:

[17] Photo Credit: Bernard Cohen/, Lyme Disease Rashes and Look-alikes, CDC, last reviewed: October 9, 2020. Retrieved from:

[18] Moniuszko-Malinowska A, Czupryna P, Dunaj J, et al. Acrodermatitis chronica atrophicans: various faces of the late form of Lyme borreliosis. Postepy Dermatol Alergol. 2018;35(5):490-494. Retrieved from:

[19] Photo credit, Glatz M et al., Clinical Spectrum of Skin Manifestations of Lyme Borreliosis in 204 Children in Austria, Advances in Dermatology and Venereology, Vol 95, Issue 5, Nov 4, 2014. Retrieved from:

[20] Warshafsky S et al., Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis, Journal of Antimicrobial Chemotherapy, Volume 65, Issue 6, June 2010, Pages 1137–1144. Retrieved from:

[21] Nadelman R et al., Prophylaxis with Single-Dose Doxycycline for the Prevention of Lyme Disease after an Ixodes scapularis Tick Bite, N Engl J Med 2001; 345:79-84. Retrieved from:

[22] Photo Credit- Ticks Image Gallery, CDC, last reviewed: December 18, 2020. Retrieved from:

[23] Smith G et al., Management of Tick Bites and Lyme Disease During Pregnancy, J Obstet Gynaecol Can 2012;34(11):1087–1091. Retrieved from:

[24] Treatment for erythema migrans, CDC, last reviewed: November 3, 2020. Retrieved from:

[25] Post-Treatment Lyme Disease Syndrome, CDC, last reviewed: November 8, 2019. Retrieved from:




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