Borrelia burgdorferi infection, treatment

The causative agent in Lyme disease is a spirochetal bacterium (Borrelia burgdorferi) that is transmitted directly through the bite of a deer tick. Optic neittopathy can occur due to Lyme disease and manifests as papillitis, retrobulbar neuropathy, or ischemic optic neiu-opathy. Serologic testing may help to identify Lyme infection by use of indirect immunofluorescent assay and enzyme-linked immunosorbent assay.The treatment of Lyme disease includes oral or intravenous peniciUin, doxycycUne, erythromycin, or ceftriaxone. 

Lyme disease, caused by the spirochete Borrelia burgdorferi, incites a variety of ocular manifestations, the most common being a conjunctivitis that occurs in up to 10% of patients with early disease. Although the characteristics of the conjunctivitis have not been clearly defined, several reports have described fitlhcular conjunctivitis. Increased antibody titers to B. burgdorferi indicate the presence of Lyme disease. A history of tick bite or erythema chronicum migrans should alert the clinician to consider Lyme disease in the differential diagnosis in areas of the country where this disease is prevalent. Treatment of Lyme disease conjunctivitis should include topical tetracycline as an adjunct to oral doxycycline, 100 mg twice daily for 2 to 3 weeks, which is used to treat the systemic infection. 

For skin and soft tissue infections, roxithromycin is an effective and well-tolerated therapy for erysipelas and acne [162, 163]. As with other macrolide antibiotics, its immunomodulatory effects make it useful as an adjunctive therapy of psoriasis vulgaris [164]. Despite its in vitro activity against Borrelia burgdorferi, monotherapy with this macrolide was not effective for the treatment of Lyme borrelio-sis [165]. However, a small, nonrandomized, open prospective clinical study of 17 patients with confirmed late Lyme disease (stage n/III) showed a 76% complete recovery rate from a therapeutic combination of roxithromycin 300 mg... 

Other Infections Actinomycosis, although most responsive to peniciUin G, may be successfully treated with a tetracychne. Minocychne is an alternative for the treatment of nocardiosis, but a sulfonamide should be used concurrently. Tetracychnes are useful in the acute treatment and for prophylaxis of leptospirosis. Borrelia spp., including B. recurrentis (relapsing fever) and B. burgdorferi (Lyme disease), respond to tetracychnes. The tetracychnes have been used to treat susceptible atypical mycobacteria. 

---