Lyme borreliosis: evidence-based data useful for primary care

Background: Controversies around Lyme Borreliosis lead patients and general practitioners to raise some questions. Method: A literature analysis and the use of the AGREE II template for quality control allowed 24 scientific societies to develop guidelines for LB. Results: Primary prevention relies on physical protection measures in order to avoid bites. After a tick bite, the benefit/risk balance of antibiotics does not justify its use (risk of developing LB is < 5 %). Cutaneous manifestations are the most common in LB, mostly erythema migrans which treatment is primarily based on doxycycline. Lyme neuroborreliosis (meningoradiculitis and cranial nerve palsy) and monoarthritis are less common and a specialised opinion or an hospitalisation is required. Ophtalmologic and cardiac manifestations are even more uncommon. Serological monitoring is not required for erythema migrans diagnosis nor for LB follow up. Prolonged or combined antibacterial treatment has not proved any effectiveness on prolonged symptoms. LB overdiagnosis seems to be frequent with a potential loss of chance for appropriate care because of diagnostic delay and a pointless antibiotic therapy with potential adverse drug effects. Among these wrong diagnoses, some suffer from functional somatic syndromes requiring a global approach. Conclusion: The discussion between the patient and the general practitioner facilitates primary prevention, diagnosis, and limits the patient concern in this context of controversies around LB.