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Lyme disease: Part 3 | To treat or not to treat | VETgirl Veterinary CE Podcasts

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In this VetGirl podcast, we discuss clinical signs seen with Lyme disease. Lyme disease is caused by the spirochete Borrelia burgdorferi (Bb). In canine patients suspected of having Lyme disease based on a positive 3DX or 4DX SNAP test, the decision to treat should be based on the presence of clinical signs, breeds at risk for developing life-threatening chronic effects (e.g., breeds predisposed to Lyme nephritis), and presence of proteinuria or microalbuminuria.

In Lyme-positive dogs that are asymptomatic and without evidence of proteinuria, treatment is generally not recommended. Risks of treatment with antibiotic therapy (e.g., doxycycline) include increased liver enzymes, gastrointestinal signs (e.g., anorexia, vomiting, diarrhea, esophagitis, esophageal strictures, etc.), and antibiotic resistance. That said, thorough discussion with the owner should include preventative care (see Prevention below), follow up monitoring (e.g., quantitative C6, proteinuria, etc.), and rare but potentially deadly risks (e.g., Lyme nephritis) in breeds at risk.

In positive dogs that are symptomatic, treatment should be initiated and the patient monitored for proteinuria. Typically, clinical signs should resolve within 2-3 days after the initiation of antibiotic therapy. Vaccination is not currently recommended in positive, symptomatic dogs. If antibiotic treatment does not result in clinical improvement within several days, then the patient should be assessed and worked up for potential other diseases. In one study, non-Lyme-related causes of clinical signs were found in 40% of dogs that were originally diagnosed with Lyme disease. Other differentials should include:

• Rocky Mountain spotted fever
• Canine ehrlichiosis
• Orthopedic disease (e.g., panosteitis, osteoarthritis, degenerative joint disease, cruciate injury, etc.)
• Immune-mediated disease (rheumatoid arthritis, lupus erythematosis, etc.)
• Neoplasia

For this reason, in a symptomatic, Lyme-positive dog (tentatively diagnosed with acute Lyme disease), the use of corticosteroids and NSAIDs isn’t typically recommended, as it may mask the diagnostic value of antibiotic therapy (or mask other underlying diseases), warranting additional work-up.

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