Treatment Trials for Post-Lyme Disease Symptoms Revisited

Abstract

The authors of four National Institutes of Health (NIH)-sponsored antibiotic treatment trials of patients with persistent unexplained symptoms despite previous antibiotic treatment of Lyme disease determined that retreatment provides little if any benefit and carries significant risk. Recently, two groups have provided an independent reassessment of these trials and concluded that prolonged courses of antibiotics are likely to be helpful. We have carefully considered the points raised by these groups, along with our own critical review of the treatment trials. Based on this analysis, the conclusion that there is a meaningful clinical benefit to be gained from retreatment of such patients with parenteral antibiotic therapy cannot be justified.

Long-term Assessment of Fatigue in Patients with Culture-confirmed Lyme Disease

“…However, a clue that fatigue of such severity is probably rare came from the difficulty experienced by the investigators in finding a sufficient number of patients eligible for participation in the retreatment trials. 9 Our study suggests that Lyme disease is an exceptional cause of fatigue at 11 to 20 years after a diagnosis of early Lyme disease in patients with culture-proven B. burgdorferi infection. Of note, Lyme disease was not the cause of fatigue for any of the 9 subjects in our prospective cohort who were found to have severe fatigue based on a score !4.0 on the FSS-11.…”

Virome Analysis of Amblyomma americanum, Dermacentor variabilis, and Ixodes scapularis Ticks Reveals Novel Highly Divergent Vertebrate and Invertebrate Viruses

“…Although it seems plausible that there are tick-borne viruses that have not been amenable to isolation via tissue culture, to our knowledge, no extensive culture-independent studies have been attempted to examine tick viromes. Such studies not only might identify viruses associated with acute disease but also could provide insights into the pathogenesis of more controversial chronic illnesses associated with tick bites (20,21). Thus, to survey viral diversity, we examined the viromes of three human-biting ticks in the United States (Amblyomma americanum, Dermacentor variabilis, and Ixodes scapularis) by HTS.…”

Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics

“…So far, persistent infection with viable borrelia has not been documented after standard antibiotic treatment for stage and manifestation of disease [89] and neither is it proven that persistent borrelia infection is the unequivocal cause of persistent symptoms if benefit from prolonged treatment with antibiotics is not shown [90]. Significant risks of adverse events from long-term antibiotic therapy may reflect concerns [71,91]. Animal data suggest the presence of persistent nucleic acids of B. burgdorferi in tissues after antibiotic treatment [92]; however, the presence of nucleic acids B. burgdorferi in tissues does not necessarily mean the presence of viable organisms [93].…”