In those studies, physicians examined long-term antibiotic therapy in patients with a well-documented history of previous Lyme disease, but who reported persistent pain, fatigue, impaired cognitive function, or unexplained numbness.
In a first-of-its-kind study for Lyme disease, NIAID-supported researchers have used live, disease-free ticks to see if Lyme disease bacteria can be detected in people who continue to experience symptoms such as fatigue or arthritis after completing antibiotic therapy). This study remains underway.
Her early work demonstrated that at four months post-infection, neither a 28-day course of doxycycline nor a 90-day course of antibiotics (30 days IV Rocephin, followed by 60 days oral doxycycline) could eradicate Lyme disease. More recently, she found spirochetes in multiple organs after a 28-day course of doxycycline.
How long to treat patients with Lyme remains an issue of controversy. With traditional antibiotic therapy, lasting 2-4 weeks, 10-20% of patients will have ongoing symptoms including fatigue, joint pain, insomnia and complaints of “brain fog.”
Most people with Lyme disease respond well to antibiotics and fully recover. Varying degrees of permanent nervous system damage may develop in people who do not receive treatment in the early stages of illness and who develop late-stage Lyme disease.
Early localized Lyme disease — Early localized Lyme disease (the erythema migrans rash, with or without flu-like symptoms) is treated with oral antibiotics, usually doxycycline, amoxicillin, or cefuroxime, taken daily. Doxycycline is given for 10 to 21 days, and amoxicillin and cefuroxime are given for 14 to 21 days.
Like the less severe forms of Lyme disease, late Lyme disease can be treated with antibiotics, although medical opinions differ about the appropriate length of an antibiotic treatment course.
Steere and two colleagues who studied the disease cautioned that only a few Lyme patients suffer this lingering nerve disorder, and most can be cured with antibiotics given early in their infections.
The guidelines have consistently recommended a 10-day course of doxycycline for uncomplicated early Lyme disease.
Doxycycline is considered the first-line drug of choice for Lyme disease by most physicians.
The neurologic abnormalities of stage 3 Lyme disease involve both the central and peripheral nervous systems. Typical presentations include subacute encephalopathy, chronic progressive encephalomyelitis, and late axonal neuropathies, as well as symptoms consistent with fibromyalgia.
Neurologic conditions associated with late Lyme disease are treated with intravenous antibiotics, usually ceftriaxone or cefotaxime, given daily for two to four weeks.
As with many infectious diseases, there is no test that can “prove” cure. Tests for Lyme disease detect antibodies produced by the human immune system to fight off the bacteria (Borrelia burgdorferi) that cause Lyme disease. These antibodies can persist long after the infection is gone.
Lyme disease may affect the central nervous system causing organic brain disease or syndromes suggestive of demyelination.
For Lyme neuroborreliosis without brain or spinal cord involvement, including peripheral neuropathy, there is evidence and consensus that oral doxycycline (100-200 mg twice a day) or amoxicillin (500 mg three times a day) for three to four weeks are both safe and highly effective.
Lyme disease symptoms may also have a relapsing-remitting course. In addition, Lyme disease occasionally produces other abnormalities that are similar to those seen in MS, including positive findings on magnetic resonance imaging (MRI) scans of the brain and analysis of cerebrospinal fluid (CSF).
Lyme arthritis typically develops within one to a few months after infection .
Lyme arthritis in the knee. Lyme arthritis occurs when Lyme disease bacteria enter joint tissue and cause inflammation. If left untreated, permanent damage to the joint can occur. Lyme arthritis accounts for approximately one out of every four Lyme disease cases reported to CDC. Because of reporting practices, this statistic may overstate ...
What are the symptoms? The main feature of Lyme arthritis is obvious swelling of one or a few joints. While the knees are affected most often, other large joints such as the shoulder, ankle, elbow, jaw, wrist, and hip can also be involved. The joint may feel warm to the touch or cause pain during movement.
Patients with persistent joint inflammation and pain after the first course of antibiotics may require a second course (see tables below). In some cases, joint swelling and pain can persist or recur after two courses of antibiotics.
Lyme arthritis can be mistaken for septic arthritis, especially in children. Whereas septic arthritis may require surgical intervention, Lyme arthritis generally does not. Talk to patients about tick bite prevention.
Four patients (1.4%) had serious reactions to the ceftriaxone, three of which required hospitalization for hives and respiratory distress. 29% had a rash or allergic reaction. Diarrhea occurred in 26% of patients during the initial ceftriaxone phase.
Some hypothesize that there are persistent intracellular bacteria that have evaded antibiotic treatment, but there is no proof. (For more on Lyme persisters, see works by Ying Zhang at Johns Hopkins, such as this paper .) Others believe antigens on the spirochete may be inflammatory, causing some of the symptoms.
But Lyme can be difficult to diagnose, and the assays miss a lot of patients (half the patients had negative antibody tests before treatment and 29% never developed antibodies in a recent gene expression study ).
What are the symptoms? Neurological complications most often occur in early disseminated Lyme disease, with numbness, pain, weakness, facial palsy/droop (paralysis of the facial muscles), visual disturbances, and meningitis symptoms such as fever, stiff neck, and severe headache.
Most people with Lyme disease respond well to antibiotics and fully recover.
Nervous system infection, most typically meningitis, cranial neuritis, radiculoneuritis, and other forms of mononeuropathy multiplex, is highly antibiotic responsive. The encephalopathy that can be seen in some patients with active infection represents the same phenomenon that occurs in patients with many other inflammatory disorders, ...
The tick-borne spirochete responsible for Lyme disease is highly antibiotic-sensitive. Treatment related misconceptions can be attributed to confusion in three principal realms: (1) the appropriate approach to diagnosis (who should be treated); (2) necessary and appropriate treatment; and (3) what actually constitutes nervous system infection ...
And if pain relief is required, other anti-inflammatory drugs—like ibuprofen (brand names: Advil, Motrin, Brufen, Nurofen)—are much safer.
Decades of research have demonstrated with overwhelming evidence that Lyme disease is easily cured with generic antibiotics, even in late stage. However, some individuals with a history of Lyme disease may have persistent symptoms even after treatment. These symptoms have been called Post-Treatment Lyme Disease Syndrome (PTLDS) ...
To date, there is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease. Since 2010, the evidence against long term antibiotics and “chronic Lyme” has become only stronger. In 2020, the Infectious Diseases Society ...
In 2010, members of an independent review panel unanimously agreed that the 2006 Lyme disease guidelines produced by the Infectious Diseases Society of America (IDSA) were medically and scientifically justified. The review panel was certified by an independent ombudsman to be free from conflicts of interest.
Other red flags of Chronic Lyme quackery. Because they may not apply to humans, studies in animals and in vitro (petri dish or test tube) are among the weaker forms of evidence when determining if a treatment is safe and effective. Cherry picked evidence may introduce bias.
Ideally, the subjects should be blinded so they do not know which treatment they are receiving. The outcomes of the groups are then compared. As shown below, four American RCTs and two European RCTs all found that long term antibiotics were not meaningfully better for patients than those who received a control treatment (shorter courses or placebo.)
The CDC currently recommends 10-21 days of oral antibiotics, but in a recently published study of Lyme arthritis from Massachusetts General Hospital/Harvard Medical School, all patients had been treated with one-to-four months of oral antibiotics, followed by one month of IV ceftriaxone. It would be informative to know which antibiotics these JH ...
The fact is, too many patients with Lyme disease are left with chronic, debilitating symptoms following treatment for Lyme disease. In the nearly 40 years since the discovery of Lyme, no one has been able to determine why some patients get better with treatment and others remain ill.
The authors do suggest that drugs designed to curb neuroinflammation may be able to treat PTLDS. Interestingly, there is a lot of research showing the antibiotic minocycline is commonly used to inhibit proinflammatory microglia (a certain kind of glial cell).
They also acknowledge a 2017 study by Monica Embers that found Lyme bacteria survive a 28-day course of antibiotics, producing antigens in the central nervous system (CNS) of monkeys.
The JH study shows glial inflammation is also related to persistent cognitive symptoms. So, it makes sense that Lyme patients report a lot of pain and neurological symptoms.
Lyme neuroborreliosis (LNB) can develop anywhere from a few days post infection to several months or even years later . Neuroborreliosis can be the primary and only manifestation in some patients with Lyme disease.
Neurological Lyme can affect many parts of the nervous system alone or in various combinations resulting in: Lyme meningitis – inflammation of the membranes that cover the brain/spinal cord. Lyme encephalitis – inflammation inside the brain. Lyme myelopathy – inflammation of the spinal cord. Lyme cranial neuritis – inflammation ...
Persistent Lyme. Many academic researchers and physicians refer to the persistent symptoms of Lyme as post-treatment Lyme disease syndrome (PTLDS). But if you ask patients who are left disabled after being treated for Lyme, they will tell you it’s “chronic Lyme disease.”.
Common symptoms of LNB include facial palsy, headache, stiff neck, vertigo (dizziness), cognitive dysfunction, memory or concentration problems, mood changes, sleep disturbances, or paresthesias (numbness and tingling.) The symptoms of LNB and dementia depend on which portions of the brain are affected as follows:
At age 60, the patient was treated with IV ceftriaxone for eight weeks , which led to 60% improvement in cognition and interpersonal engagement. Although oral amoxicillin was continued three times daily for the next six months, her symptoms gradually returned. Further antibiotic treatment with minocycline did not help.
LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme.
All the while her IgG Western blot for Lyme disease remained positive. Over time, the patient’s visual, mental and executive functions continued to deteriorate. At age 62, a cerebrospinal fluid (CSF) study demonstrated a positive Western blot.
In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy. In patients who have non-specific symptoms after being treated for Lyme disease and who have no evidence of active infection (patients with PTLDS), studies have shown that more antibiotic therapy is not helpful ...
What is "chronic Lyme disease?". Lyme disease is an infection caused by the bacterium Borrelia burgdorferi. In the majority of cases, it is successfully treated with oral antibiotics. In some patients, symptoms, such as fatigue, pain and joint and muscle aches, persist even after treatment, a condition termed “Post Treatment Lyme Disease Syndrome ...
In a complicated statistical model, the ceftriaxone group showed a slightly greater improvement at 12 weeks, but at 24 weeks both the ceftriaxone and the placebo groups had improved similarly from baseline. In addition, adverse effects attributed to IV ceftriaxone occurred in 26 percent of patients.
The susceptibility of B.burgdorferi to the antibiotics used. The ability of the antibiotics to both cross the blood-brain barrier and access the central nervous system and to persist at effective levels throughout the course of therapy. The ability of the antibiotics to kill bacteria living both outside and inside mammalian cells.
In a first-of-its-kind study for Lyme disease, NIAID-supported researchers have used live, disease-free ticks to see if Lyme disease bacteria can be detected in people who continue to experience symptoms such as fatigue or arthritis after completing antibiotic therapy). This study remains underway.