Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review

JAMA. 2016 Apr 26;315(16):1767-77. doi: 10.1001/jama.2016.2884.


Importance: Lyme disease, human granulocytic anaplasmosis (HGA), and babesiosis are emerging tick-borne infections.

Objective: To provide an update on diagnosis, treatment, and prevention of tick-borne infections.

Evidence review: Search of PubMed and Scopus for articles on diagnosis, treatment, and prevention of tick-borne infections published in English from January 2005 through December 2015.

Findings: The search yielded 3550 articles for diagnosis and treatment and 752 articles for prevention. Of these articles, 361 were reviewed in depth. Evidence supports the use of US Food and Drug Administration-approved serologic tests, such as an enzyme immunoassay (EIA), followed by Western blot testing, to diagnose extracutaneous manifestations of Lyme disease. Microscopy and polymerase chain reaction assay of blood specimens are used to diagnose active HGA and babesiosis. The efficacy of oral doxycycline, amoxicillin, and cefuroxime axetil for treating Lyme disease has been established in multiple trials. Ceftriaxone is recommended when parenteral antibiotic therapy is recommended. Multiple trials have shown efficacy for a 10-day course of oral doxycycline for treatment of erythema migrans and for a 14-day course for treatment of early neurologic Lyme disease in ambulatory patients. Evidence indicates that a 10-day course of oral doxycycline is effective for HGA and that a 7- to 10-day course of azithromycin plus atovaquone is effective for mild babesiosis. Based on multiple case reports, a 7- to 10-day course of clindamycin plus quinine is often used to treat severe babesiosis. A recent study supports a minimum of 6 weeks of antibiotics for highly immunocompromised patients with babesiosis, with no parasites detected on blood smear for at least the final 2 weeks of treatment.

Conclusions and relevance: Evidence is evolving regarding the diagnosis, treatment, and prevention of Lyme disease, HGA, and babesiosis. Recent evidence supports treating patients with erythema migrans for no longer than 10 days when doxycycline is used and prescription of a 14-day course of oral doxycycline for early neurologic Lyme disease in ambulatory patients. The duration of antimicrobial therapy for babesiosis in severely immunocompromised patients should be extended to 6 weeks or longer.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Amoxicillin / therapeutic use
  • Anaplasma / isolation & purification
  • Anaplasmosis* / diagnosis
  • Anaplasmosis* / drug therapy
  • Anaplasmosis* / prevention & control
  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Babesiosis* / diagnosis
  • Babesiosis* / drug therapy
  • Babesiosis* / prevention & control
  • Blotting, Western
  • Cefuroxime / analogs & derivatives
  • Cefuroxime / therapeutic use
  • Clindamycin / therapeutic use
  • Doxycycline / therapeutic use
  • Drug Administration Schedule
  • Humans
  • Immunoenzyme Techniques
  • Lyme Disease* / diagnosis
  • Lyme Disease* / drug therapy
  • Lyme Disease* / prevention & control
  • Microscopy
  • Neutrophils / microbiology
  • Polymerase Chain Reaction
  • Quinine / therapeutic use


  • Anti-Bacterial Agents
  • Clindamycin
  • Amoxicillin
  • Quinine
  • Doxycycline
  • Cefuroxime
  • cefuroxime axetil