Late-Stage Neuropsychiatric Lyme Borreliosis

Fallon, Brian A.; Schwartzberg, Mori; Bransfield, Robert C.; Zimmerman, Barry J.; Scotti, Angelo; Weber, Charles A.; Liebowitz, Michael R.

doi:10.1016/s0033-3182(95)71669-3

Cited by 36 publications

(14 citation statements)

References 16 publications

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“…Researchers have noted that manifestations often followed an intermittent, recurrent course, that disease latency varied by system, and that symptom migration within and between systems did not follow a predictable temporal pattern [4,[93][94][95][96][97]136,137,[175][176][177]. These observations are consistent with detailed studies of the pathogenesis of Borrelia infections in mammals.…”

Section: Pathophysiologic Basis Of Chronic Lyme Diseasesupporting

confidence: 55%

“…Literature reports and studies dating back to 1979 have documented chronic and late manifestations of active infection with B. burgdorferi including carditis, meningitis, cranial nerve palsy, radiculopathy, arthritis, reversible peripheral neuropathies, reversible chronic encephalopathy, polyneuropathy, leukoencephalitis, cognitive and psychiatric symptoms as well as fatigue, headache, hearing loss, tinnitus and fibromyalgia [4,[92][93][94][95][96][97]. Importantly, some studies used objective assessments of pathology to confirm subjective data that lacked corresponding physical exam findings [13,92].…”

Section: Pathophysiologic Basis Of Chronic Lyme Diseasementioning

confidence: 99%

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

Shor

Green

Szantyr³

et al. 2019

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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.

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Section: Pathophysiologic Basis Of Chronic Lyme Diseasesupporting

confidence: 55%

Section: Pathophysiologic Basis Of Chronic Lyme Diseasementioning

confidence: 99%

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

Shor

Green

Szantyr³

et al. 2019

Antibiotics

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“…This led to tragic delays in diagnosis and treatment to both patients. The first author has seen and published descriptions of many other tragic cases in his practice [57][58][59][60][61][62].…”

Section: Discussion Of Case Presentationsmentioning

confidence: 99%

Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty

Bransfield

Friedman

2019

Healthcare

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There is often difficulty differentiating between psychosomatic, somatopsychic, multisystem illness, and different degrees of medical uncertainty. Uncommon, complex, and multisystem diseases are commonly misdiagnosed. Two case histories are described, and relevant terms differentiating psychosomatic, somatopsychic, and multisystem illnesses are identified, reviewed, and discussed. Adequate differentiation requires an understanding of the mind/body connection, which includes knowledge of general medicine, psychiatry, and the systems linking the body and the brain. A psychiatric diagnosis cannot be given solely based upon the absence of physical, laboratory, or pathological findings. Medically unexplained symptoms, somatoform disorder, and compensation neurosis are outdated and/or inaccurate terms. The terms subjective, nonspecific, and vague can be used inaccurately. Conversion disorders, functional disorders, psychogenic illness, factitious disorder imposed upon another (Munchausen’s syndrome by proxy), somatic symptom disorder, psychogenic seizures, psychogenic pain, psychogenic fatigue, and delusional parasitosis can be over-diagnosed. Bodily distress disorder and bodily distress syndrome are scientifically unsupported and inaccurate. Many “all in your head” conditions may be related to the microbiome and the immune system. Better education concerning the interface between medicine and psychiatry and the associated diagnostic nomenclature as well as utilizing clinical judgment and thorough assessment, exercising humility, and maintaining our roots in traditional medicine will help to improve diagnostic accuracy and patient trust.

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“…An evidence of persistent Lyme borreliosis was found in both cases. 4 Another study reported in 2002 by Juchnowicz et al suggested that patients with Lyme borreliosis can experience psychiatric issues during both acute and late phases of the disease, most common being depression. 5 In some cases, it slowly progresses to severity and suicidality as explained in the above cases, but in some cases, it is unpredictable.…”

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confidence: 99%