Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group

Abstract

Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease. Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories, CLD, untreated (CLD-U) and CLD, previously treated (CLD-PT). The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more. Methods: Systematic review of over 250 peer reviewed papers in the international literature to characterize the clinical spectrum of CLD-U and CLD-PT. Conclusion: This evidence-based definition of chronic Lyme disease clarifies the term’s meaning and the literature review validates that chronic and ongoing Bbsl infections can result in chronic disease. Use of this CLD definition will promote a better understanding of the infection and facilitate future research of this infection.

Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease

“…By contrast, the International Lyme and Associated Diseases Society (ILADS) have issued markedly different clinical recommendations focused on often open-ended antibiotic treatment of persistent infection and the potential for multiple tick-borne co-infecting agents (162). These recommendations are based on extensive review of the literature supporting the hypothesis of microbial persistence as a mechanism of persistent symptoms in both untreated and previously treated Lyme disease (163). The debate over appropriate and effective treatment strategies for patients with persistent symptoms is one of the primary drivers of the on-going controversy in Lyme disease.…”

“…Notably, the ILADS organization has also released a broader, more inclusive definition for CLD which encompasses those patients meeting the IDSA definition for PTLDS, as well as those with similar symptoms who would be excluded for lack of functional impairment or weaker evidence for prior Lyme disease (163). The ILADS CLD definition also differs from the IDSA's PTLDS definition in that it distinguishes between previously treated (CLD-PT) and untreated (CLD-U) presentations, and specifies on-going B. burgdorferi sensu lato infection as the underlying illness mechanism for both.…”

“…A schematic of clinical-and research-defined patient subgroups among those with persistent symptoms associated with Lyme disease(14,163,174). The size of each patient subgroup is not meant to represent actual population frequency, as prevalence data is extremely limited.…”

Monitoring of Nesting Songbirds Detects Established Population of Blacklegged Ticks and Associated Lyme Disease Endemic Area in Canada

“…Lyme disease is an insidious, multisystem spirochetosis that involves many body systems, including cardiac, cutaneous, endocrine, gastrointestinal, genitourinary, musculoskeletal, neurological, otologic, ophthalmological, encephalitic, and neuropsychiatric [59,60]. Only 14%-41% of Lyme disease patients remember a tick bite [61,62], and 9%-39% exhibit an erythema migrans (EM) rash; more than 50% of those with a rash have a homogenous rash [61,63,64].…”

A Clinical Diagnostic System for Late-Stage Neuropsychiatric Lyme Borreliosis Based upon an Analysis of 100 Patients

“…This makes it difficult to establish clearly defined diagnostic criteria, especially for late-stage disease. A number of definitions for the late-stage, chronic, manifestations have been proposed [4][5][6]. Like syphilis, the symptoms that occur later in the course of the illness are different from the early symptoms.…”