Chronic Lyme Disease: A Review

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Studies have shown that most patients diagnosed with chronic Lyme disease either have no objective evidence of previous or current infection with Borrelia burgdorferi or are patients who should be classified as having post-Lyme disease syndrome, which is defined as continuing or relapsing nonspecific symptoms (such as fatigue, musculoskeletal pain, and cognitive complaints) in a patient previously treated for Lyme disease. Despite extensive study, there is currently no clear evidence that post-Lyme disease syndrome is caused by persistent infection with B burgdorferi. Four randomized placebo-controlled studies have shown that antibiotic therapy offers no sustained benefit to patients who have post-Lyme disease syndrome. These studies also showed a substantial placebo effect and a significant risk of treatment-related adverse events. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and controlled trials of new approaches to the treatment and management of these patients are needed.

Section snippets

Chronic Lyme disease

Most patients who are labeled as having chronic Lyme disease will fall into categories 1 and 2. Patients in category 1 are diagnosed with chronic Lyme disease based on unexplained symptoms without objective or valid laboratory evidence of infection Borrelia burgdorferi. Patients in category 2 have other recognized diseases and have been misdiagnosed with Lyme disease. The distribution of patients who fall into these categories can be estimated by the difficulty in accruing patients into the

Post-Lyme disease syndrome

Many studies have shown that Lyme disease is treated successfully with antibiotics in most cases, and patients who have objective evidence of treatment failure are rare with currently recommended regimens [11], [12], [13], [14]. Patients who have late manifestations can have a slower response to therapy, sometimes taking weeks or months to recover [15], [16], [17], [18], [19], [20], [21], [22], [23]. Some patients may have incomplete resolution because of irreversible damage, as can occur in

Summary

At this point, the overwhelming evidence shows that prolonged antibiotic therapy, as tested in the clinical trials, does not offer lasting or substantive benefit in treating patients who have post-Lyme disease syndrome. Therefore, it is time to move forward to test other approaches that may help these patients. Unfortunately, no prospective studies of other treatment modalities for patients who have post-Lyme disease syndrome have been performed. Because of the significant placebo effect and

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      Citation Excerpt :

      Recent surveillance of reported cases by the CDC indicates that approximately 30 % of individuals will develop arthritis (Schwartz, 2017). Although active infection may be cleared through antibiotics, some patients may experience persistent inflammation within the CNS and joints that may last for months to years (Marques, 2008; Pícha et al., 2006; Steere and Angelis, 2006). Because B. burgdorferi s.l. does not produce or secrete any known toxins that can be attributed to the manifestations of the disease, it is suggested that the host immune and inflammatory response elicited by the bacteria is the major contributing factor to the pathogenesis of the disease (Stanek et al., 2012).

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    This research was supported by the Intramural Research Program of the NIH, NIAID.

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