Chronic Lyme Disease: A Working Case Definition

Abstract

Although Lyme disease is the most common tickborne illness in the USA and Eurasia, the pathophysiology and clinical course of chronic Lyme disease (CLD) have not been formally defined. The purpose of this paper is to present a working case definition of CLD based on analysis of more than 700 peer-reviewed publications. According to this definition, CLD is a multisystem illness with diverse musculoskeletal, neuropsychiatric and/or cardiovascular manifestations that result from ongoing infection with pathogenic members of the Borrelia spirochete complex often associated with other tickborne disease (TBD) pathogens. To qualify for the diagnosis of CLD, patients must have Lyme-compatible symptoms and signs that are either consistently or variably present for six or more months. Two subcategories of CLD include untreated chronic Lyme disease (CLD-U) and chronic Lyme disease following a limited course of antibiotic treatment (CLD-T). The symptom patterns and optimal therapy of CLD require further study.

Detection and Transstadial Passage of Babesia Species and Borrelia burgdorferi Sensu Lato in Ticks Collected from Avian and Mammalian Hosts in Canada

“…Lyme disease spirochetes have an affinity for immune privileged sites, and side-step the immune response, and lodge in niche reservoirs including bone [115], brain [116][117][118], eye [119], muscle [120], collagenous tissues (ligaments, tendons) [121,122], glial and neuronal cells [123][124][125], and fibroblasts/scar tissue [126]. Left untreated or inadequately treated, this insidious spirochetosis can be persistent [9][10][11]113,116,[127][128][129], and develop into chronic Lyme disease [12,13]. Often, patients advance to chronic Lyme disease before they get diagnosed and treated.…”

“…Bbsl is pleomorphic and has diverse forms, and can evade the immune response, and become persistent [9][10][11][12]. If this complex, multisystem zoonosis is not recognized and treated early, it can develop into chronic Lyme disease [12,13].…”

A novel plan to deal with SARS‐CoV‐2 and COVID‐19 disease

“…A recurring theme is that the earlier one can treat the tick-borne diseases, the better the outcome for patients. Conversely, many of our patients require prolonged antibiotic therapy because they were not diagnosed and treated promptly due to insensitive tickborne disease testing [1,2]. Although prolonged combination antibiotic therapy modeled on treatment for HIV/AIDS, hepatitis C virus and tuberculosis is controversial when it comes to tick-borne diseases, we and others have published our positive results and we continue to see benefit for our patients.…”

“…Although prolonged combination antibiotic therapy modeled on treatment for HIV/AIDS, hepatitis C virus and tuberculosis is controversial when it comes to tick-borne diseases, we and others have published our positive results and we continue to see benefit for our patients. [1,2] One unexpected benefit is that none of our active patients on antibacterial treatments have come down with severe COVID-19 disease. None.…”

Lyme Disease: Diversity of Borrelia Species in California and Mexico Detected Using a Novel Immunoblot Assay

“…Patients of either sex qualified for the study provided they were at least 18 years of age, had a medical history of musculoskeletal, neuropsychiatric, and/or cardiac symptoms consistent with LD, and gave written informed consent for data collection. Subjects were included in the study if they met the case definition of untreated or previously treated chronic LD with symptoms lasting more than six months, as described in detail elsewhere [23,24]. Patients were not required to have had a documented tickbite or erythema migrans rash for participation in the study because serological testing was used to detect exposure rather than active infection.…”