Lyme disease, Rocky Mountain spotted fever, ehrlichiosis: emerging and established challenges for the clinician

OBJECTIVE: The goal of this review is to facilitate the management of patients with tick-associated diseases. This article will discuss the epidemiology, clinical diagnosis, and antimicrobial therapy of Lyme disease, Rocky Mountain spotted fever, and ehrlichiosis. DATA SOURCES: References are limited to the English language and extend back to the beginning of the twentieth century. The human and veterinary literature were reviewed. Sources include computerized databases and bibliographies of recent articles and books. STUDY SELECTION: Papers were selected on the basis of their timeliness, explanation of important findings by major investigators, extrapolation of clinical data from large patient populations, and clarification of controversial issues. Approximately 50% of the articles initially reviewed are included in the bibliography. RESULTS: Standardization of laboratory testing for Lyme disease should facilitate more accurate diagnosis in the future. Clinical diagnosis of Rocky Mountain spotted fever and ehrlichiosis prior to laboratory confirmation is necessary in order to ensure timely institution of antimicrobial therapy. CONCLUSIONS: Knowledge of endemic regions and seasonal cycles of vectors, varying clinical presentations of disease and appropriate utilization of the laboratory are critical for the appropriate diagnosis and management of patients with tick-associated diseases.