Antibiotic Treatment for Chronic Lyme Disease—Say No to the DRESS

Marks, Clifford M.; Nawn, John E.; Caplow, Julie

doi:10.1001/jamainternmed.2016.6229

Cited by 10 publications

(8 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 561 articles identi ed, 15 were included: 1 randomized clinical trial (RCT) [16], 7 observational studies [11][12][13][21][22][23][24] and 7 case reports [25][26][27][28][29][30][31] (Figure ). Tables 1 and 2 detail the lead author, year of publication, country of research, population, and diagnostic error-delay and adverse events.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of "chronic Lyme": primum non nocere. A review

Prat

Dalbin

Plotton

et al. 2023

Preprint

View full text Add to dashboard Cite

BACKGROUND: Approximately 10% of patients experience prolonged symptoms after Lyme disease. PTLDS (post treatment Lyme disease syndrome) is a controversial topic. It has been described as a source of overdiagnostic and off-label treatment. The objective of this work was to describe, in the context of the PTLDS, the diagnostic errors and adverse effects of drugs used outside the recommendations. METHODS: systematic review of the literature according to PRISMA criteria, including randomized clinical trials (RCT), observational studies, and case reports addressing diagnostic errors and adverse events published between January 2010 and November 2020 in English or French. RESULTS: 16 studies were included: 1 RCT, 7 observational studies and 8 case reports. In the 5 observational studies, overdiagnosis rates were very high, ranging from 80% to 100%. The new diagnoses were often psychiatric, rheumatological and neurological. Disorders with somatic symptoms were often cited. Diagnostic delays were identified for cancers and frontoparietal dementia. In the RCT and observational studies, prolonged anti-infective treatments were also responsible for adverse events, with emergency room visits and/or hospitalization. The most common adverse events were diarrhea, sometimes with Clostridium difficile colitis, electrolyte abnormalities, sepsis, bacterial and fungal infections, and anaphylactic reactions. CONCLUSION: This review informs patients and physicians of the risks of prolonged anti-infective treatment that has not been proven to be beneficial. It does not seem ethical to offer such treatments to patients given the imperative of the "primum non nocere" principle of non-maleficence.

show abstract

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of "chronic Lyme": primum non nocere. A review

Prat

Dalbin

Plotton

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Most patients recover from persisting symptoms with time 164,166,167 . Instead, self-diagnosed LB, misdiagnosed LB by physicians, or treatment of suspected LB not meeting the criteria for LB Introduction -Clinical manifestations and disease epidemiology -27 -can lead to serious, sometimes deadly complications as other severe disease may be ignored [167][168][169] . However, approval for use is not expected in the near future 146,175 .…”

Section: Post-treatment Lyme Disease Syndrome or Post-lyme Disease Symentioning

confidence: 99%

Molecular and serological tools for clinical diagnostics of Lyme borreliosis - can the laboratory analysis be improved?

Lager

2020

Linköping University Medical Dissertations

View full text Add to dashboard Cite

Lyme borreliosis (LB) is caused by spirochetes within the Borrelia burgdorferi sensu lato complex and is the most common tick-transmitted disease in the northern hemisphere. The transmission of the spirochetes to humans in Europe is done by the Ixodes ricinus ticks, which can also transmit the relapsing fever species Borrelia miyamotoi. LB may cause clinical manifestations in the skin, in the central nervous system, in joints, and in the heart. Diagnosis of LB is mainly based on the patient´s medical history, self-described symptoms, and clinical signs in combination with the detection of Borrelia-specific antibodies (serological methods). In some cases/issues, detection of Borrelia-specific deoxyribonucleic acid (molecular methods) may be used as a complement to serology. All diagnosed LB infections are treated with antibiotics to prevent disease progression, and most patients fully recover without further sequelae. The overall aims of this thesis were to evaluate molecular and serological tools for laboratory diagnosis of LB, with a special focus on Lyme neuroborreliosis (LNB), and to identify potential improvements. The results presented in this thesis showed that the immunoglobulin (Ig) G assays, currently in use in northern Europe for detection of antibodies in serum, had high diagnostic sensitivity (88 %) together with comparable results both between and within assays. For the IgM assays, the diagnostic sensitivity was lower (59 %) with more heterogeneous results. Small variations in diagnostic performance for IgM and IgG were mainly presented for samples within the borderline zone. These results support the theory that separate testing of IgM antibodies in serum has low diagnostic value. However, simultaneous detection in serum and cerebrospinal fluid (CSF) for both IgM and IgG antibodies was essential for the diagnosis of LNB, at least for certain assays. So far (to our knowledge), no systematic evaluation and optimisation of the pre-analytical handling of CSF samples before molecular testing has been performed. By use of the precipitate concentrated by moderate centrifugation, extraction of total nucleic acid followed by reversetranscription to complementary deoxyribonucleic acid, in combination with the absence of Abstract polymerase chain reaction (PCR) inhibitors, detection of Borrelia garinii, Borrelia afzelii, Borrelia burgdorferi sensu stricto, and B. miyamotoi was possible. These four species are all known to be pathogenic to humans. The results revealed a high analytical sensitivity and specificity for the optimised pre-analytical conditions. The thesis also presents results showing that the real-time PCR protocols currently used in Scandinavia have high analytical sensitivity, specificity, and concordance. This indicates that the low diagnostic sensitivity for detection of Borrelia in CSF was not a result of poorly designed and evaluated PCR protocols, but was possibly due to the low number of spirochetes in the samples. However, to further evaluate the diagnostic performance for detection of Bo...

show abstract

“…Doctors and patients represented by associations [2], demand recognition of a chronic form of the disease associated with non-specific symptoms such as pain, asthenia, and concentration disorders [3]. In this context, long-term antibiotic treatments are often prescribed despite the absence of proven benefits and may cause serious adverse reactions and even death in some patients [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Biographical Approach to Patients Consulting for Presumed Lyme Disease: A Contribution to the Understanding of Patient Pathways in Symptom-Based Diseases

Lutaud¹,

Verger²,

Peretti‐Watel³

et al. 2022

Preprint

View full text Add to dashboard Cite

Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10-20% of patients, with a significant number remaining in a diagnostic dead-end. The objective of our study was to understand the genesis of the LD hypothesis in care pathways. In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semi-structured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients’ medical trajectories were collected using a biographical approach. A majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. The diagnosis of Lyme disease was primarily triggered by identification with clinical stories circulating in the media. Most of participants had conducted the diagnostic investigation themselves. Diagnostic wandering in the diagnostic process suggests a failure of modern medicine to propose solutions for medically unexplained symptoms. Clinicians should systematically explore patients’ etiologic representations in a patient-centred care approach.

show abstract

Antibiotic Treatment for Chronic Lyme Disease—Say No to the DRESS

Cited by 10 publications

References 5 publications

Diagnosis and treatment of "chronic Lyme": primum non nocere. A review

Diagnosis and treatment of "chronic Lyme": primum non nocere. A review

Molecular and serological tools for clinical diagnostics of Lyme borreliosis - can the laboratory analysis be improved?

Biographical Approach to Patients Consulting for Presumed Lyme Disease: A Contribution to the Understanding of Patient Pathways in Symptom-Based Diseases

Contact Info

Product

Resources

About