初诊不明确的患者可以随访 2-4 周,进行恢复期血清学检查。[21]Centers for Disease Control and Prevention. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep. 1995 Aug 11;44(31):590-1.http://www.cdc.gov/mmwr/preview/mmwrhtml/00038469.htmhttp://www.ncbi.nlm.nih.gov/pubmed/7623762?tool=bestpractice.com
初次治疗结束的患者(包括脑膜炎患者),应随访 1~2 周观察症状缓解的情况。
在身上发现蜱虫的人群(包括接受抗生素预防治疗的人群),应在 30 天内监测是否出现蜱媒传染病的症状和体征。[2]Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134.http://cid.oxfordjournals.org/content/43/9/1089.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17029130?tool=bestpractice.com
莱姆关节炎患者在完成合适的抗生素疗程后,如果症状持续存在或者复发,应接受第二个疗程的口服或者静脉抗生素治疗,为期 4 周。[2]Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134.http://cid.oxfordjournals.org/content/43/9/1089.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17029130?tool=bestpractice.com
如果莱姆心肌炎患者出现晕厥、呼吸困难、胸痛等症状或者出现 2 度、3 度房室传导阻滞,或者 1 度心脏传导阻滞伴 PR 间期延长(≥ 300 毫秒),应该收住心脏科治疗并接受持续监护。[2]Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134.http://cid.oxfordjournals.org/content/43/9/1089.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17029130?tool=bestpractice.com