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Post-Lyme Disease Symptoms Revisited

Ixodes scapularis, the primary vector of Lyme disease in eastern North America. (Image Credit: Public Library of Science, Wiki CC License.)

Ixodes scapularis, the primary vector of Lyme disease in eastern North America. (Image Credit: Public Library of Science, Wiki CC License.)

On the Internet, in the halls of academia, and on self-help television shows, the chronic Lyme disease battle rages on.

In March 2013 issue, The American Journal of Medicine published Common Misconceptions About Lyme Disease by Halperin et al. This review– as the title suggests– carefully outlines misconceptions about Lyme disease and explains the research and the facts. From the Journal

Lyme disease, infection with Borrelia burgdorferi, is a focally endemic tick-transmitted zoonosis. During the 3 decades since the responsible spirochete was identified, a series of misconceptions and misunderstandings have become widely prevalent, leading to frequent misdiagnosis and inappropriate treatment. Persistent misconceptions concern the reliability of available diagnostic tools, the signs and symptoms of nervous system involvement, the appropriate choice and duration of antimicrobial therapy, the curability of the infection, and the cause of symptoms that may persist in some patients after treatment. Concern about disparate perspectives led the Institute of Medicine to review the subject. In this article we review the principal misconceptions, discussing their origins and the best currently available scientific evidence related to each one.

Publication of this comprehensive review sparked a flurry of YouTube comments from people diagnosed with chronic Lyme disease and a few letters to the editor.

In the August 2013 issue of AJM, we have published a selection of letters related to the March article and a new review: Treatment Trials for Post-Lyme Disease Symptoms Revisited by Klempner et al. This second review specifically addresses clinical trials of treatments and concludes that “extended antibiotic therapy provides no meaningful benefit” and “carries significant risk.” From the Journal

The authors of 4 National Institutes of Health–sponsored antibiotic treatment trials of patients with persistent unexplained symptoms despite previous antibiotic treatment of Lyme disease determined that retreatment provides little if any benefit and carries significant risk. Two groups recently provided an independent reassessment of these trials and concluded that prolonged courses of antibiotics are likely to be helpful. We have carefully considered the points raised by these groups, along with our own critical review of the treatment trials. On the basis of this analysis, the conclusion that there is a meaningful clinical benefit to be gained from retreatment of such patients with parenteral antibiotic therapy cannot be justified.

You can read these articles and the related letters (linked below) on our website.

Chronic Lyme Disease: Liberation from Lyme Denialism

Alternative Considerations for “Common Misconceptions About Lyme Disease”

The Reply

For more on the debate, check out Deconstructing Lyme Disease on the New York Times website.



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