Consequently, testing for anti-bodies to B. In addition, culturing the organism requires special media and is time-consuming, typically requiring weeks before results become available. burgdorferi grows very slowly, and there are relatively few organisms in the blood or cerebrospinal fluid during infection, making recovery of the organism difficult. Studies of the use of culture and PCR amplification assays to diagnose Lyme disease have consistently found that these tests are not sensitive enough to be clinically useful. There is a large body of evidence indicating that treatment with prolonged courses of antibiotics is not indicated for patients with PTLDS.ĪTTEMPTS TO FIND PERSISTENT INFECTION WITH BORRELIA BURGDORFERI , and the consensus remains that there are no significant enduring benefits, but significant risks of adverse events from long-term treatment with antibiotics. These trials have been re-analyzed and reviewed by Klempner et al. Four placebo-controlled clinical trials have been conducted to assess if there is any benefit to using prolonged antibiotic therapy for patients with PTLDS. One goal of making changes to the guidelines is to force insurance companies to pay for prolonged courses (months to years) of parenterally administered antibiotics. Despite the lack of evidence to support persistence of infection, advocates have been lobbying to have the accepted Lyme disease treatment guidelines modified. Some patients and Lyme disease ‘activists,’ as well as ‘Lyme-literate’ physicians, label this syndrome as ‘chronic Lyme disease’ and believe it is due to persistence of infection that requires long-term treatment with antibiotics to alleviate the symptoms. These are nonspecific symptoms such as fatigue, arthralgia, myalgia, or perceived cognitive impairment. Post-treatment Lyme disease syndrome (PTLDS) has been defined as persistent subjective symptoms without objective manifestations that persist for at least 6 months after conventional treatment for Lyme disease has been completed.
Therapy for Lyme disease is very effective, and objective clinical findings after completion of therapy are rare. In addition, we will discuss recent studies that have attempted to differentiate re-infection from relapse in repeat episodes of erythema migrans. We will also review recent studies discussing persistence of spirochetal remnants (in the absence of viable organisms) in connective tissues and joints that may fuel an inflammatory response that might persist during and after antimicrobial treatment. In this study, we will review several recent studies that tried to assess whether infection persists in patients with Lyme disease after completion of conventional antimicrobial therapy. A number of previous studies found no evidence of persistence of infection at the end of therapy, but little is known about why some patients with Lyme disease have ongoing nonspecific symptoms (or even whether the frequency of such symptoms is greater in patients who had been treated for Lyme disease than in the general population). burgdorferi are not being fully eradicated with recommended antimicrobial treatment and whether the persistent or new symptoms are causally related to persistent infection. Major points of controversy are whether B. Such symptoms may include fatigue, arthralgia, myalgia, or perceived impaired cognition. Over the past decade, there has been considerable controversy regarding ongoing, nonspecific symptoms that develop or persist in patients after they are treated for Lyme disease. Several studies have detailed the accepted diagnostic criteria for and appropriate treatment of patients with Lyme disease. The clinical features of Lyme disease have been well described therapy is well tolerated and effective, and complications are rare.
As a group, these may be classified as part of the B. burgdorferi sensu stricto (the sole cause of Lyme disease in the United States), B. Among those that commonly cause Lyme disease are B. The organism, found in Ixodes scapularis ticks, has since been subclassified into several genospecies. In 1982, Willy Burgdorfer was able to isolate a spirochete, later named Borrelia burgdorferi, which ultimately was found to be the cause of Lyme disease. Lyme disease was first described in 1977 when 51 children and adults from Lyme, Connecticut, were reported to have an unusual form of recurrent arthritis.
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