Intended for healthcare professionals


Lyme disease: time for a new approach?

BMJ 2015; 351 doi: (Published 03 December 2015) Cite this as: BMJ 2015;351:h6520
  1. Liesbeth Borgermans, professor1,
  2. Christian Perronne, professor2,
  3. Ran Balicer, professor 3,
  4. Ozren Polasek, professor 45,
  5. Valerie Obsomer, ecological and environmental risk expert6
  1. 1Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
  2. 2 Infectious Diseases Unit, Hôpitaux Universitaires Paris-Ile de France-Ouest, Saint Quentin en Yvelines, France
  3. 3Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
  4. 4Department of Public Health and Croatian Centre for Global Health, University of Split, Croatia
  5. 5Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
  6. 6 Agriculture, Environment, Natural Resources and Environmental Risk Management, Public Service of Wallonia, Namur, Belgium
  1. Correspondence to: L Borgermans liesbeth.borgermans{at}

Many more questions than answers

Lyme disease is the most common vector borne disease in North America and Europe, with 300 000 new cases in the United States1 and an estimated 100 000 new cases in Europe each year.2 These numbers are likely to be underestimates because case reporting is inconsistent3 and many infections go undiagnosed.4 Climate change may have contributed to a rapid increase in tick borne diseases, with migratory birds disseminating infected ticks.5

Our common understanding of Lyme disease is that a tick bite is followed by the development of a classic rash pattern (erythema migrans). When treated early with a relatively short course of antibiotics, most patients have good outcomes.6 But the standard two tier testing for Lyme disease is inaccurate in the early …

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