A Critical Appraisal of “Chronic Lyme Disease”

Feder, Henry M.; Johnson, Barbara J. B.; O’Çonnell, Susan; Shapiro, Eugene D.; Steere, Allen C.; Wormser, Gary P.

doi:10.1056/nejmra072023

Cited by 481 publications

(361 citation statements)

References 47 publications

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“…These include patients with objective manifestations of late Lyme disease (for example, arthritis, encephalomyelitis or peripheral neuropathy, addressed in detail in other chapters), patients with post-Lyme disease syndrome, and patients with nonspecific signs and symptoms of unclear cause who receive this diagnosis based on unproven and/or non validated laboratory tests and clinical criteria. In a recent article [1], patients diagnosed with "chronic Lyme disease" were classified in 4 categories ( Table 1). This article addresses mainly patients with post-Lyme disease syndrome (category 4) as there have been relatively fewer studies addressing patients in categories 1 and 2; and no studies focusing on patients in category 3.…”

Section: Introductionmentioning

confidence: 99%

Chronic Lyme Disease: A Review

Marques

2008

Infectious Disease Clinics of North America

173

123

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Section: Introductionmentioning

confidence: 99%

Chronic Lyme Disease: A Review

Marques

2008

Infectious Disease Clinics of North America

173

123

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“…Known as antibiotic-refractory Lyme arthritis, this manifestation is believed to involve a mechanism other than active infection and usually responds to anti-inflammatory therapies [2]. In addition, some Lyme disease patients experience persistent symptoms of pain, fatigue, and/or cognitive difficulties despite standard antibiotic treatment and in the absence of evidence for active infection [3]. The causes of these symptoms, collectively referred to as post-treatment Lyme disease syndrome (PTLDS) when they last longer than 6 months, remain largely unknown, and no biomarkers or effective therapies are available.…”

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confidence: 99%

Expression of C-Reactive Protein and Serum Amyloid A in Early to Late Manifestations of Lyme Disease

Uhde

Ajamian

et al. 2016

Clin Infect Dis.

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Background. Infection with Borrelia burgdorferi, the causative agent of Lyme disease, triggers host immune responses that affect the clinical outcome and are a source of biomarkers with diagnostic utility. Although adaptive immunity to B. burgdorferi has been extensively characterized, considerably less information is available about the development of innate acute-phase responses in Lyme disease. Our aim in this study was to evaluate the expression of C-reactive protein (CRP) and serum amyloid A (SAA), the prototype acute-phase response proteins, in the context of the varying manifestations associated with Lyme borreliosis.Methods. Circulating concentrations of CRP and SAA in patients with a range of early to late objective manifestations of Lyme disease and in individuals with post-treatment Lyme disease syndrome were compared with those in healthy control groups.Results. CRP and SAA levels were significantly elevated in early localized and early disseminated Lyme disease but not in the later stages of active infection. Levels of CRP, but not SAA, were also found to be significantly increased in patients with antibioticrefractory Lyme arthritis and in those with post-treatment Lyme disease syndrome.Conclusions. These findings indicate that circulating CRP and SAA levels are highest when the concentration of spirochetes is greatest in skin and/or blood and that levels decline after the dissemination of the organism to extracutaneous sites in subsequent stages of infection. The data also suggest that antibiotic-refractory Lyme arthritis and post-treatment Lyme disease syndrome are associated with elevated CRP responses that are driven by inflammatory mechanisms distinct from those in active infection.

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“…Analysis by thin section transmission electron microscopy (tsTEM) has revealed the presence of coiled protoplasmic cylinders and flagella inside RBs that lead investigators to hypothesize that they are pleiomorphic stages of spirochetes (1) or that they are moribund. Anglophone medical discussion of spirochetoses (spirochete-associated infirmities, such as Lyme disease or syphilis) omit mention of ''round bodies'' or state that they have no clinical relevance (2). Yet evidence abounds not only that RBs are viable but also that they may locomote, grow, and reproduce.…”

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confidence: 99%