Chronic Lyme

Lyme borrelia infection

Lyme borreliosis is a vector-borne disease caused by Borrelia bugdorferi sensu lato, transmitted by the ticks of the Ixodes ricinus complex. Children, adolescents, and middle-aged adults are considered to be at risk of acquiring B. burgdorferi infection.

Lyme disease stages

Stage 1: The incubation period lasts from 3 to 32 days. Lyme disease manifests with erythema migrans – slowly expanding Lyme disease on healthcare concept inspiration on yellow background.erythematous macule or papule, which appears on the site of the tick bite.

Stage 2: B. burgdorferi disseminates throughout the body within days or weeks after the onset of the disease. On the skin appear multiple secondary annular lesions which remind the initial erythema, which disappears within 3 to 4 weeks. Other symptoms of disseminated Lyme disease include rash, conjunctivitis, severe headache, mild stiffness of the neck, fever, chills, migratory musculoskeletal pain, arthralgias, and malaise and fatigue. Generalized lymphadenopathy or splenomegaly, hepatitis, sore throat, nonproductive cough, conjunctivitis, iritis, or swelling of the testicles may also be observed.

Stage 3: Months to years after the primary infection develops late symptoms of Lyme disease such as musculoskeletal and neurologic disorders and acrodermatitis chronica.

What is chronic Lyme?

It was estimated that about 10-20% of infected persons who received antibiotic treatment experience lingering symptoms which are usually described as post-treatment Lyme disease (PTLD) or chronic Lyme and last from 6 months and up to several years.

Despite its name sometimes the diagnosis of chronic Lyme has been made even if there were no evidence of the B. burgdorferi infection in the past whereas post-treatment Lyme disease diagnosis the information suggestive of previously treated B. burgdorferi infection.

Controversy

The concept of the post-Lyme disease remains controversial. Although the bacteria were found in the animal organisms after the antibiotic treatment, there is no evidence that borrelias are able to persist in the human organism and that they are responsible for the persisting symptoms. It is suggested that the persistent complaints are caused by the autoimmune response triggered by the bacteria rather than an active infection and the residual tissue damage. 

Symptoms of chronic Lyme

Symptoms of chronic Lyme include the following:       

  • Malaise and fatigue (which reminds chronic fatigue syndrome);
  • Joint symptoms (pain, swellings);
  • Muscular pain (which may be considered as fibromyalgia and should be distinguished from fibromyalgia);
  • Neck and backache;
  • Cognitive impairment (especially difficulties concentrating and memory loss);
  • Irritability and depression;
  • Headaches;
  • Neurologic deficits (facial nerve palsy, hearing disturbances);
  • Sleep disorders;

Approximately 75% of individuals with chronic Lyme report of severe or very severe symptoms which may significantly impair the quality of life. About 63% of persons who suffer from chronic Lyme describe two and more symptoms as severe or very severe.

Exlusion criteria

As there are no specific symptoms or investigations to make a diagnosis of post-treatment Lyme disease or to deny it, the diagnosis of PTLD is mainly the diagnosis of exclusion.

Therefore, the diagnosis of PTLD should be excluded if there is:

  • An active, untreated coinfection (for example, babesiosis);
  • The objective abnormalities on physical examination or on neuropsychologic testing which may be suggestive of refractory to antibiotics B. burdorferi infection;
  • A diagnosis of fibromyalgia or chronic fatigue syndrome before the Lyme disease manifest;
  • A prolonged history of somatic complaints before the onset of Lyme borreliosis;
  • A diagnosis of another disease or condition or abnormalities upon examination and testing, which may cause the symptoms;

Treatment

As chronic Lyme symptoms usually persist after the initial antibiotic treatment of Lyme disease further antibiotic intake is not recommended.

Symptomatic therapy with analgetics and antidepressants may be suggested.

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