Antibiotic Treatment for Chronic Lyme Disease—Say No to the DRESS

2016 ◽  
Vol 176 (12) ◽  
pp. 1745 ◽  
Author(s):  
Clifford M. Marks ◽  
John E. Nawn ◽  
Julie A. Caplow
Keyword(s):  
Lyme Disease ◽  
Antibiotic Treatment ◽  
Chronic Lyme Disease

scholarly journals Antibiotic Treatment of Animals Infected with Borrelia burgdorferi

2009 ◽  
Vol 22 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Gary P. Wormser ◽  
Ira Schwartz
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Short Term Memory ◽  
Scientific Evidence ◽  
Disease Symptoms ◽  
Chronic Lyme Disease ◽  
Methodological Concern ◽  
Uncertain Etiology

SUMMARY Despite resolution of the objective manifestations of Lyme disease after antibiotic treatment, a minority of patients have fatigue, musculoskeletal pain, and/or difficulties with concentration or short-term memory of uncertain etiology; these are called post-Lyme disease symptoms or, in more severe cases, post-Lyme disease syndrome or “chronic Lyme disease.” Several recent studies in which Borrelia burgdorferi-infected animals were treated with antibiotic therapy have demonstrated the presence of PCR positivity for B. burgdorferi DNA in the absence of culture positivity. In mice that were treated with antibiotic therapy, residual spirochetes could be taken up by ticks during a blood meal and could be transmitted to SCID mice. These spirochetes are attenuated; their presence is not associated with either inflammation or disease. In this review the methodology and findings of these studies are critically analyzed, and the significance of the results with regard to human Lyme disease is evaluated, with special emphasis on whether these studies provide useful insights into post-Lyme disease syndrome. A serious methodological concern is the failure to consider the pharmacokinetic-pharmacodynamic properties of the antibiotic in choosing the dosage regimen used. We conclude that there is no scientific evidence to support the hypothesis that such spirochetes, should they exist in humans, are the cause of post-Lyme disease syndrome.

Chronic Lyme Disease: a Persistent Inflammatory Infection

2006 ◽  
Vol 1 (2) ◽  
pp. 51-51
Author(s):  
Raphael B. Stricker ◽  
Lorraine Johnson
Keyword(s):  
Lyme Disease ◽  
Chronic Lyme Disease

scholarly journals A comprehensive clinical and laboratory evaluation of 224 patients with persistent symptoms attributed to presumed tick-bite exposure

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247384
Author(s):  
Kenneth Nilsson ◽  
Elisabet Skoog ◽  
Viktor Jones ◽  
Lisa Labbé Sandelin ◽  
Christina Björling ◽  
...  
Keyword(s):  
Lyme Disease ◽  
The Other ◽  
University Hospital ◽  
Tick Bite ◽  
Laboratory Evaluation ◽  
Disease Course ◽  
Swedish Population ◽  
Persistent Symptoms ◽  
Chronic Lyme Disease ◽  
Multifactorial Approach

BackgroundPersistent symptoms attributed to presumed tick-bite exposure constitute an unresolved medical controversy. We evaluated whether Swedish adults who met the criteria for post-treatment Lyme disease syndrome (PTLDS) exhibited characteristics distinguishable from adults who did not, but who displayed similar symptoms and disease course after suspected previous tick-bite infection (TBI).Methods and findingsDuring 2015–2018, 255 patients–referred to the Centre for Vector-borne Infections, Uppsala University Hospital, Sweden with symptoms lasting longer than six months–were recruited. Of this group, 224 completed the study. Each patient was examined by an infectious disease specialist and, besides a full medical history, underwent a panel of blood and cerebrospinal fluid laboratory tests including hematological, biochemical, microbiological and immunological analyses, and the RAND-36 scale to measure quality of life. For analysis purposes, patients were divided into five subgroups, of which one represented PTLDS. According to serological results indicating TBI and documented/ reported objective signs of Lyme disease, 85 (38%) patients fulfilled the criteria for PTLDS and were compared with the other 139 (62%) serologically classified patients. In the PTLDS group, erythema chronicum migrans (ECM) was documented/reported in 86% of patients, previous neuroborreliosis in 15%, and acrodermatitis chronica atroficans (ACA) in 3.5%. However, there were no significant differences regarding symptoms, laboratory results or disease course between patients with PTLDS and those without laboratory evidence ofBorreliaexposition. Most reported symptoms were fatigue-related (70%), musculoskeletal (79%), neurological (82%) and neurocognitive (57%). Tick bites were recalled by 74%. The RAND-36 score was significantly below that of the general Swedish population. Signs of immunological/inflammatory reactivity with myositis antibodies were detected in 20% of patients, fibrinogen levels were moderately increased in 21% and elevated rheumatoid factor in 6%.ConclusionsThe PTLDS group did not differ exclusively in any respect from the other subgroups, which either lacked previously documented/reported evidence of borreliosis or even lacked detectable serological signs of exposure to Lyme disease. The results suggest that symptoms often categorized as Chronic-Lyme-Disease (CLD) in the general debate, cannot be uniquely linked to Lyme disease. However, approximately 20% of the total group of patients showed signs of autoimmunity. Further studies are needed to elucidate the underlying causes and mechanisms of PTLDS and there is reason to consider a multifactorial approach.

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