.Lyme borreliosis–a review of the late stages and treatment of four cases.

 Acta Clin Belg. 1998 Jun;53,3:178-83.Lyme borreliosis--a review of the late stages and 
treatment of four cases. Petrovic M, Vogelaers D, Van Renterghem L, Carton D, De Reuck J, Afs
chrift M. Department of Internal Medicine, University Hospital Ghent, Belgium.
Difficulties in diagnosis of late stages of Lyme disease include low sensitivity of serological testing 
and late inclusion of Lyme disease in the differential diagnosis.Longer treatment modalities may 
have to be considered in order to improve clinical outcome of late disease stages. These 
52difficulties clinical cases of Lyme borreliosis. The different clinical cases illustrate several aspects 
of late borreliosis: false negative serology due to narrow antigen composition of the used ELISA 
format, the need for prolonged antibiotic treatment in chronic or recurrent forms and typical 
presentations of late Lyme disease, such as lymphocytic meningo-encephalitis and 
polyradiculoneuritis.
A five-week treatment with doxycycline at a dose of 200 mg daily was prescribed. Fatigue, 
arthralgia en myalgia seemed to respond positively to Carton D; et al. the initiated 
therapy.However, they reappeared two weeks after cessation of doxycycline. ..it was decided to 
treat with ceftriaxone IM 2 g daily for three weeks. This resulted in a complete resolution of 
the general symptoms. However, three weeks later arthralgia of the knees and myalgia in both 
legs recurred. Symptoms and signs may improve only temporarily shortly after treatment, but 
re-emerge within weeks or month




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