Chronic Lyme Disease: A Review
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
References (78)
Summary of the first 100 patients seen at a Lyme disease referral center
Am J Med
(1990)- et al.
Long-term follow-up of patients with culture-confirmed Lyme disease
Am J Med
(2003) - et al.
Treatment of late Lyme borreliosis—randomised comparison of ceftriaxone and penicillin
Lancet
(1988) - et al.
Amoxicillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis
Lancet
(1990) - et al.
Long-term outcome of Lyme disease in children given early treatment
J Pediatr
(1993) - et al.
Musculoskeletal pain in the Netherlands: prevalences, consequences, and risk groups, the DMC(3)-study
Pain
(2003) - et al.
Treatment of early Lyme disease
Am J Med
(1992) - et al.
A critical appraisal of chronic Lyme disease
N Engl J Med
(2007) Lyme disease. Patients scarce in test of long-term therapy
Science
(1999)- et al.
Study and treatment of post Lyme disease (STOP-LD): a randomized double-masked clinical trial
Neurology
(2003)
A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy
Neurology
The overdiagnosis of Lyme disease
JAMA
The overdiagnosis of Lyme disease in children residing in an endemic area
Clin Pediatr
Pitfalls in the diagnosis and treatment of Lyme disease in children
JAMA
The consequences of overdiagnosis and overtreatment of Lyme disease: an observational study
Ann Intern Med
Overdiagnosis and overtreatment of Lyme disease in children
Pediatr Infect Dis J
Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans
Ann Intern Med
Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial
Ann Intern Med
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
Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis
J Infect Dis
Treatment of Lyme arthritis
Arthritis Rheum
Evaluation of study patients with Lyme disease, 10- to 20-year follow-up
J Infect Dis
Peripheral neuropathy in acrodermatitis chronica atrophicans—effect of treatment
Acta Neurol Scand
5-y follow-up study of patients with neuroborreliosis
Scand J Infect Dis
A comparison of two treatment regimens of ceftriaxone in late Lyme disease
Wien Klin Wochenschr
Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis
Scand J Infect Dis
Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study
Eur J Clin Microbiol Infect Dis
Elucidation of Lyme arthritis
Nat Rev Immunol
Antibiotic therapy of early European Lyme borreliosis and acrodermatitis chronica atrophicans
Ann N Y Acad Sci
Azithromycin versus doxycycline for treatment of erythema migrans: clinical and microbiological findings
Infection
Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease
N Engl J Med
Symptoms of post-Lyme syndrome in long-term outcome of patients with neuroborreliosis
Scand J Infect Dis
Treatment of the early manifestations of Lyme disease
Ann Intern Med
A randomized trial of ceftriaxone versus oral penicillin for the treatment of early European Lyme borreliosis
Infection
The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study
Ann Intern Med
Lyme disease: an infectious and postinfectious syndrome
J Rheumatol
Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group
N Engl J Med
Outcomes of children treated for Lyme disease
J Rheumatol
Cognitive effects of Lyme disease in children: a 4-year follow-up study
J Rheumatol
Cited by (166)
Risk of post-treatment Lyme disease in patients with ideally-treated early Lyme disease: A prospective cohort study.
2022, International Journal of Infectious DiseasesA selective antibiotic for Lyme disease
2021, CellHost transcriptome response to Borrelia burgdorferi sensu lato
2021, Ticks and Tick-borne DiseasesCitation 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).
This research was supported by the Intramural Research Program of the NIH, NIAID.
The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.