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Lyme Disease (Borrelia burgdorferi)
1995 Case Definition
The 1995 case definition appearing on this page was previously published in the 1990 MMWR Recommendations
and Reports titled Case Definitions for Public Health Surveillance [MMWR 1990;39(RR13)]
(available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00025629.htm).
Thus, the 1990 and 1995 versions of the case definition are identical.
Clinical description
A systemic, tick-borne disease with protean manifestations,
including dermatologic, rheumatologic, neurologic, and cardiac
abnormalities. The best clinical marker for the disease is the
initial skin lesion, erythema migrans, that occurs among 60%-80%
of patients.
Clinical case definition
- Erythema migrans, or
- At least one late manifestation, as defined
below, and laboratory confirmation of infection
Laboratory criteria for diagnosis
- Isolation of Borrelia burgdorferi from
clinical specimen, or
- Demonstration of diagnostic levels of IgM and
IgG antibodies to the spirochete in serum or CSF, or
- Significant change in IgM or IgG antibody response
to B. burgdorferi in paired acute- and convalescent-phase
serum samples
Case classification
Confirmed: a case
that meets one of the clinical case definitions above
Comment
This surveillance case definition was developed
for national reporting of Lyme disease; it is NOT appropriate
for clinical diagnosis.
Definition of terms used in the clinical description
and case definition:
A. Erythema migrans (EM)
-
For purposes of surveillance, EM is defined
as a skin lesion that typically begins as a red macule or
papule and expands over a period of days to weeks to form
a large round lesion, often with partial central clearing.
A solitary lesion must reach at least 5 cm in size. Secondary
lesions may also occur. Annular erythematous lesions occurring
within several hours of a tick bite represent hypersensitivity
reactions and do not qualify as EM. For most patients, the
expanding EM lesion is accompanied by other acute symptoms,
particularly fatigue, fever, headache, mild stiff neck, arthralgia,
or myalgia. These symptoms are typically intermittent. The
diagnosis of EM must be made by a physician. Laboratory confirmation
is recommended for persons with no known exposure.
B. Late manifestations
- Late manifestations include any of the following
when an alternate explanation is not found:
- Musculoskeletal system
- Recurrent, brief attacks (weeks or months)
of objective joint swelling in one or a few joints, sometimes
followed by chronic arthritis in one or a few joints.
Manifestations not considered as criteria for diagnosis
include chronic progressive arthritis not preceded by
brief attacks and chronic symmetrical polyarthritis.
Additionally, arthralgia, myalgia, or fibromyalgia syndromes
alone are not criteria for musculoskeletal involvement.
- Nervous system
- Any of the following, alone or in combination:
Lymphocytic meningitis; cranial neuritis, particularly
facial palsy (may be bilateral); radiculoneuropathy;
or, rarely, encephalomyelitis. Encephalomyelitis must
be confirmed by showing antibody production against B.
burgdorferi in the cerebrospinal fluid (CSF), demonstrated
by a higher titer of antibody in CSF than in serum. Headache,
fatigue, paresthesia, or mild stiff neck alone are not
criteria for neurologic involvement.
- Cardiovascular system
- Acute onset, high-grade (2nd or 3rd degree)
atrioventricular conduction defects that resolve in days
to weeks and are sometimes associated with myocarditis.
Palpitations, bradycardia, bundle branch block, or myocarditis
alone are not criteria for cardiovascular involvement.
C. Exposure
-
Exposure is defined as having been in wooded,
brushy, or grassy areas (potential tick habitats) in a county
in which Lyme disease is endemic no more than 30 days before
onset of EM. A history of tick bite is NOT required.
D. Disease endemic to county
E. Laboratory confirmation
- As noted above, laboratory confirmation of
infection with B. burgdorferi is established when
a laboratory isolates the spirochete from tissue or body fluid,
detects diagnostic levels of IgM or IgG antibodies to the spirochete
in serum or CSF, or detects a significant change in antibody
levels in paired acute- and convalescent-phase serum samples.
States may determine the criteria for laboratory confirmation
and diagnostic levels of antibody. Syphilis and other known
causes of biologic false-positive serologic test results should
be excluded when laboratory confirmation has been based on
serologic testing alone.
See also:
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