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Top 10 Lyme Unknowns

The following were voted the top 10 out of the long list of confirmed uncertainties in diagnosis and treatment of Lyme disease. See the JLA Process for how these were determined.

What is the best treatment for children and adults presenting with a) early Lyme disease without neurological involvement and not including erythema migrans and b) late Lyme disease of any manifestation? To include consideration of drug(s), dose, duration.

What key questions (clinical and epidemiological) should be considered to help make a diagnosis of Lyme disease in children and adults in the UK and would a weighting table be useful?

How effective are the current UK tests in detecting infections due to the genospecies and strains of B burgdorferi sl in the UK and which single test and what combination of tests performs best in diagnosing or ruling out active Lyme disease. Should stage of the disease and patient age be taken into account when interpreting these tests?

What are the outcomes of cases where long term treatment has been used?

What is the optimal course of action if symptoms relapse after a treatment course is finished?

What is the optimal course of action if symptoms persist after initial treatment: should antibiotic treatment be continued until all symptoms have resolved or should a different dose or different antibiotic be used and what is the course of action if treatment appears to fail completely?

Are continuing symptoms following conventional recommended treatment due to continued infection, or an immune response or other process?

How common is relapse and treatment failure and is it related to disease stage, gender, co-infections or any other factor?

Are there long-term consequences if treatment is delayed?

Can Lyme be transmitted via other means: person to person sexually, transplacentally or by breast feeding; through organ donation; through blood transfusion?


The Lyme rash

The rash is red, roughly circular and spreading outwards.

It is called erythema migrans (EM): erythema for red and migrans for spreading.

It may clear in the middle as it gets bigger. It is not normally itchy, hot or scaly.

See our rashes page for other images.

To help your doctor to take the possibility of Lyme disease seriously, see our page Resources / For the public. This has information expelling some myths and also links to official documents that will help.

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