Review of European and American guidelines for the diagnosis of Lyme borreliosis

Med Mal Infect. 2019 Mar;49(2):121-132. doi: 10.1016/j.medmal.2018.11.011. Epub 2018 Dec 6.


Lyme disease is a tick-borne bacterial disease with polymorphic clinical manifestations (cutaneous, rheumatological, and neurological). In recent years the issue of the diagnosis of this infection has been highly publicized on the Internet and other media in Europe and America. Some patients and physicians may share the perception that the diagnosis of the infection is not reliable in France. We reviewed current European and American guidelines on Lyme disease and performed a methodological evaluation of all guidelines. We retrieved 16 guidelines from seven countries. Our analysis revealed a global consensus regarding diagnosis at each stage of the infection. All guidelines indicate that the diagnosis is currently based on a two-tier serology at all stages of the infection, except for the early localized dermatological presentation known as Erythema migrans. One text of so-called guidelines has discordant recommendations when compared with the other guidelines, possibly explained by its low quality score. Contrary to the intense debate taking place on the Internet and in the European and American media, our analysis shows that the great majority of medical scientific guidelines with a high quality score, agree on the clinical diagnostic methods of Lyme disease.

Keywords: Borrelia; Guidelines; Lyme; Recommandations.

Publication types

  • Review

MeSH terms

  • Diagnosis, Differential
  • Europe
  • Humans
  • Lyme Disease / diagnosis*
  • Practice Guidelines as Topic*
  • United States