Treatment Guidelines

Failure to diagnose and treat Lyme disease soon after a tick bite can lead to chronic debilitating illness. TXLDA and other patient advocacy groups support the use of evidence-based, patient-centered guidelines for the care of patients. The following were updated and published in 2014:

Evidence Assessments and Guideline Recommendations in Lyme Disease from the International Lyme and Associated Diseases Society (ILADS) Obtain a copy here.

Printed Material
What Every Primary Care Physician Should Know about the Diagnosis of Lyme Disease
by Elizabeth Maloney, MD


Frequency and Distribution of Rickettsiae, Borreliae, and Ehrlichiae Detected in Human-Parasitizing Ticks, Texas, USA
Elizabeth A. Mitchell, Phillip C. Williamson, Peggy M. Billingsley, Janel P. Seals, Erin E. Ferguson, and Michael S. Allen Author affiliations: University of North Texas Health Science Center, Fort Worth, Texas, USA (E.A. Mitchell, P.C. Williamson, P.M. Billingsley, J.P. Seals, E.E. Ferguson, M.S. Allen); Creative Testing Solutions, Tempe, Arizona, USA (P.C. Williamson); University of Utah, Salt Lake City, Utah, USA (P.M. Billingsley) Read the full article on the CDC’s Emerging Infectious Diseases site.

Lyme disease in Texas, Mexico, and the South
Lyme disease in Texas, Mexico, and the South: Implications of climate change on the distribution of the tick vector Ixodes scapularis and risk for Lyme disease in the Texas-Mexico transboundary region. Corresponding author: Maria D Esteve-Gassent. Parasites and Vectors 2014, 7:199 doi:10.1186/1756-3305-7-199

A determination of the spatial concordance between Lyme disease incidence and habitat probability of its primary vector Ixodes scapularis (black-legged tick), Samuel F. Atkinson1, Sahotra Sarkar, Aldo Avia, Jim A. Schuermann, Phillip Williamson, Geospatial Health 9(1), 2014, pp. 203-212 Read the article here.

Geographical and genospecies distribution of Borrelia burgdorferi sensu lato DNA detected in humans in the USA, Kerry L. Clark1, Brian F. Leydet2 and Clifford Threlkeld3, J Med Microbiol May 2014 vol. 63 no. Pt 5 674-684 Read the article here.

EM Rash
Along with the ‘flu-like’ symptoms, many victims (about 35%) develop an unusual skin lesion.
More Information

Classic bulls-eye is NOT the most common presentation of EM as is believed (Tibbles CD, Edlow JA. Does this Patient Have Erythema Migrans? JAMA 2007; 297:26172627.)

In approximately 70-80% of cases, patients develop a characteristic rash, erythema migrans (EM), within 30 days of infection with B. burgdorferi. (CDC. Surveillance for Lyme diseaseUnited States. 19922006. MMWR 2008; 57(SS10): 19)

Erythema migrans is the only manifestation of Lyme disease in the United States that is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory confirmation. (Clin Infect Dis 2006; 43:1101)(IDSA Guidelines)

The etiology of residual patient complaints after treatment may include an inflammatory response unrelated to active infection or may be due to alternative disease processes. The possibility that these symptoms may be related to a tick-transmitted coinfection was not evaluated in any of the studies. (Clin Infect Dis 2006; 43: 1103.)(IDSA Guidelines)

Animal Studies

Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection, Monica E. Embers , Stephen W. Barthold, Juan T. Borda, Lisa Bowers, Lara Doyle, Emir Hodzic, Mary B. Jacobs, Nicole R. Hasenkampf, Dale S. Martin, Sukanya Narasimhan, Kathrine M. Phillippi-Falkenstein, Jeanette E. Purcell, Marion S. Ratterree, Mario T. Philipp, Published: January 11, 2012, DOI: 10.1371/journal.pone.0029914 Read the article here.

Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Hodzic E1, Feng S, Holden K, Freet KJ, Barthold SW, Antimicrob Agents Chemother. 2008 May;52(5):1728-36. doi: 10.1128/AAC.01050-07. Epub 2008 Mar 3. Read the article here.

Lyme neuroborreliosis in 2 horses, Imai DM1, Barr BC, Daft B, Bertone JJ, Feng S, Hodzic E, Johnston JM, Olsen KJ, Barthold SW, Vet Pathol. 2011 Nov;48(6):1151-7. doi: 10.1177/0300985811398246. Epub 2011 Feb 1. Read the article here.

Human Studies

A good selection of studies on Lyme disease in humans can be found at the Lyme and Tick-Borne Diseases Research Center at Columbia University Medical Center. The best resource for current Bartonella research in humans currently is Dr. Ed. Breitschwerdt at North Carolina State University. The best resource for current Morgellons research is the Charles E. Holman Morgellons Disease Foundation.

Books for Medical Professionals

Why Cant I Get Better, Solving the Mystery of Lyme and Chronic Disease,
Richard I. Horowitz, MD
Hardcover/Paperback, Published Nov. 2013. A comprehensive overview of Lyme and other tick-borne diseases with a map that can apply to all chronic diseases.

The Pathogenic Spirochetes;strategies for evasion of host immunity and persistence by Monica Embers. ISBN-13: 9781461454038

Lyme Disease: Molecular and Immunologic Approaches (Current Communications in Cell & Molecular Biology, Vol. 6)
Steven E. Schutzer (Editor)
Paperback / Published 1992

Aspects of Lyme Borreliosis
K. Weber, W. Borgdorfer (Editor)
Hardcover / Published 1992
History and Characteristics of Borrelia burgdorferi / Ecology and histopathology of Lyme borreliosis / Clinical features of Lyme borreliosis / Microbiological diagnosis of Lyme borreliosis / Therapy of Lyme borreliosis / Epidemiology of Lyme borreliosis.
A total of 29 papers by various authors.

Infectious Diseases of the Fetus and Newborn Infant
Jack S. Remington, Jerome O. Klein (Editor)
Hardcover / Published 1995
This contains eighty pages devoted to Lyme disease, by Tessa Gardner, M.D., The Organism / Epidemiology and Transmission / Pathology and Pathogenesis / Clinical Manifestations / Diagnosis and Differential Diagnosis / Therapy / Prevention.
With 428 references.

Ecology and Environmental Management of Lyme Disease
Howard S. Ginsberg (Editor)
Hardcover / Published 1993

White Papers

Texas Children with Lyme Disease
At the request of the Texas Pediatric Society, following legislative hearings about Lyme disease in 2000, a member of the TXLDA board submitted a white paper on three Texas pediatric Lyme cases.
A pdf may be downloaded here.