For Medical Professionals

Borrelia burgdorferi, the bacteria that cause Lyme disease, is a cause of both localized and systemic infection. The acute infection of the skin has a high rate of bacteremia with approximately 40-50% of patients having positive blood cultures in research studies. The spirochete bacteria has mechanisms to avoid the human immune systems response. When not treated with effective antibiotics in the early phase of infection Lyme disease is associated with chronic infection and late arthritis in 60% of patients.

Antibiotic treatment of Lyme disease is effective in treating the acute physical signs of skin rash and early manifestations of infection. However, patients may continue to report symptoms such as fatigue, pain, and cognitive dysfunction months to years after antibiotic treatment. This persistent illness is known as Post Treatment Lyme Disease Syndrome, and is commonly referred to as chronic Lyme disease by patients.

What is known about Post Treatment Lyme Disease Syndrome:
  • The prognosis for Lyme disease is mixed - as many as 20% of patients experience persistent symptoms after antibiotic therapy. This accounts for what is commonly called Post Treatment Lyme Disease Syndrome or Chronic Lyme Disease."
  • The risk factors for Post Treatment Lyme Disease Syndrome include delayed diagnosis of the primary infection, more severe initial disease and the presence of neurologic symptoms. The rash of early Lyme disease is more difficult to diagnose than is appreciated with many atypical appearances of the rash which do not fit the classic "bull's eye" appearance. An educational poster is available to help health care providers recognize the many appearances of the Lyme rash and may be downloaded, printed, and displayed at your convenience. Click here for poster.
  • The cause of persistent symptoms in Lyme disease is unknown. There are many hypotheses, none proven.

    - Post Treatment Lyme Disease Syndrome may affect women differently from men. Post Treatment Lyme Disease Syndrome may trigger a syndrome called fibromyalgia in women more often than in men.

    - Lyme blood tests are not useful for diagnosing Post Treatment Lyme Disease Syndrome. Early antibiotic treatment may blunt the immune response to infection. Therefore patients with Post Treatment Lyme Disease Syndrome often have negative antibody tests or only positive IgM western blots and negative IgG blots.

  • There are currently no FDA approved treatments for Post Treatment Lyme Disease Syndrome. This has engendered a controversial debate about how to best care for patients with persistent symptoms after standard antibiotic therapy of Lyme disease.

Opinions on the Chronic Lyme debate:

A Patient's Perspective: The doctor diagnosed chronic Lyme disease, but many experts say it doesn't exist
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Point: Antibotic Therapy is not the answer for patients with persisting symptoms attributable to Lyme Disease
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Counterpoint: Long-Term Antibiotic Therapy Improves persistent symptoms Associated with Lyme disease
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Critical Needs and Gaps in Understanding Tick-Borne Diseases: Practicing Physician Perspective

Read the remarks of John Aucott, M.D.