Posttreatment Lyme Disease Syndrome—What It Might Be and What It Is Not

doi:10.1097/INF.0000000000002772

Paper

Posttreatment Lyme Disease Syndrome—What It Might Be and What It Is Not

Published May 1, 2021 · H. Schmid, U. Heininger

The Pediatric Infectious Disease Journal

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Abstract

Lyme disease is a multisystem disease caused by Borrelia burgdorferi infection and accounts for well-defined manifestations, appearing either at an early or late stage. Appropriate antibiotic therapy generally leads to a favorable outcome. Still, unspecific persisting symptoms such as fatigue, myalgia, arthralgia or cognitive dysfunction are reported by several patients months to years after adequate treatment. Their underlying pathophysiologic mechanism is unclear. However, there is no evidence for microbiological persistence in these cases and attempts to resolve the symptoms by repeated or prolonged antibiotic treatment have not been convincingly successful, but they may rather be harmful. To narrow down the controversially handled entity of posttreatment Lyme disease syndrome (PTLDS) and to avoid overdiagnosis and overtreatment, case definitions have been proposed, acknowledging PTLDS as a complex of nonspecific, subjective symptoms, which are neither caused by ongoing infection nor by any other identifiable disease. PTLDS is mainly a diagnosis of exclusion and requires careful evaluation of differential diagnosis followed by counseling about optimal management in light of missing specific therapeutic options.

Study Snapshot

Posttreatment Lyme disease syndrome (PTLDS) is a complex of nonspecific, subjective symptoms that are not caused by ongoing infection or any other identifiable disease, and require careful evaluation and counseling for optimal management.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Paper

Posttreatment Lyme Disease Syndrome—What It Might Be and What It Is Not

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References

Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease

The updated CDC recommendation for serologic diagnosis of Lyme disease emphasizes the importance of implementing standardized protocols for laboratory testing, ensuring accurate and consistent results.

Evaluation of the Modified Two-Tiered Testing Method for Diagnosis of Lyme Disease in Children

Modified two-tiered testing (MTTT) shows high agreement with conventional two-tiered testing (CTTT) for Lyme disease diagnosis in children, offering a promising alternative for children.

Lyme neuroborreliosis in children: Report of nine cases and a review of the literature.

Pediatric neuroborreliosis, caused by Borrelia species transmitted by ticks, is a rare but potentially treatable infection with favorable outcomes after a 2- to 3-week course of third-generation cephalosporin treatment.

Lyme Disease in 2018: What Is New (and What Is Not)

The incidence of Lyme disease has increased from 2007 to 2016, but the number of reported cases in the United States has not significantly increased over the last 4 years (2013-2016).

Surveillance for Lyme Disease — United States, 2008–2015

Lyme disease cases have stabilized or decreased in high-incidence states, but have increased in neighboring states, highlighting the need for ongoing prevention, early diagnosis, and appropriate treatment strategies.

Citations

Immune Responses to Some Viral Infections That Have a High Evolutionary Potential—A Case Report with Literature Review

A patient with a slow immune response can survive complex viral infections like Lyme disease, post-treatment Lyme disease syndrome, Kawasaki disease, and MISC-C relatively well, compared to individuals with exaggerated immune responses.