Does chronic Lyme disease exist?
Does chronic Lyme exist?
Not even the general medical opinion doubts about a chronic (or late) stage of Lyme disease anymore. However, it is believed to be a rather rare condition, described by only 3-5%. The question is “of what” and “from how many”? Medical insurances companies in Germany have found many different figures that are no real indication to what the reality might be.
Until this year the CDC reported about 30.000 new cases of Lyme disease per year in the USA. In this year (2015) the CDC reported about 300.000 new cases of Lyme disease/year! This is 10-times higher than before! Is there an explanation for these new numbers?
Neuroborreliosis vs. borreliosis
It is important to note that there is a difference between chronic Lyme disease and chronic neuroborreliosis. Chronic neuroborreliosis only refers to manifestations of an illness in the nervous system. Here, it is important to consider that all parts of the nervous system can be affected (in various degrees), such as the central nervous system, the cranial nerves, the peripheral and in all probability the autonomous nerve system. For the latter, the necessary literature is yet missing but why should borrelias spare this part of the nervous system or be “unable” to reach it? Patients might describe varying pain appearing in various locations and intensities throughout the nervous system, which can be considered astonishing or even “crazy” and represent a real challenge for both the patient and the doctor. As a result, the main reaction is to diagnose psychic illnesses, anxiety disorders or other illnesses (e.g. rheumatism, etc.). Is a chronic infection, therefore, not possible?
Of course, we consider the exclusion of any other possible illnesses essential, as you may read in the following chapter. Still, we recommend not to rule out a chronic infection right away.
The general chronic type of process (or “late form”) of the Lyme disease refers to a multisystem disorder that goes far beyond the nervous system. It also affects other organs and organ systems. This is to say that neuroborreliosis does not necessarily mean borreliosis (or Lyme disease) in general; it is not correct to rule out a Lyme diagnosis just because the patient does not show signs of a neuroborreliosis. It is also known that different borrelia strains prefer different organ systems and, therefore, trigger different symptoms.
We do not know how recurrent the general chronic Lyme disease (or borreliosis) is and we do not wish to speculate. In turn, we do not know either how recurrent the acute and chronic neuroborreliosis are. We do not know if this would give us a better idea if more tests were carried out and if the test procedures for antibodies were more sensitive (see: Determination of Antibodies). Besides, there might be many borrelia strains that we have not identified yet or that cannot be detected (see: General Information). It does not alter treatment in each particular case.
Nonetheless, we believe that we should consider a possibility of chronic progression of Lyme disease in each individual case, even if the statistics would indicate that it is rare.
We found a new study: Review Article: Borgermans Liesbeth et. al.”Relevance of Chronic Lyme Disease to Family Medicine as a Complex Multidimensional Chronic Disease Construct: A Systemic Review”, International Journal of Family Medicine, Volume 2014, Article ID 138016, 10 pages, http://dx.doi.org/10.1155/2014/138016
An overview research article is from: Daniel J. Cameron: “Proof That Chronic Lyme Disease Exists”, Interdisciplinary Perspectives on Infectious Diseases; Volume 2010, Article ID 876450, 4 pages.
A case report: Jasenka Markeljevic et.al.: “Tremor, Seizures and Psychosis as presenting symptoms in a patient with chronic Lyme Neuroborreliosis (Lnb)”, Coll. Anthropol. 35 (2011), Suppl. 1: 313-318
Sam T Donta: “Issues in the Diagnosis and Treatment of Lyme Disease”, The Open Neurology Journal, 2012, 6, (Suppl 1-M8), 140-145
The complete list includes over 700 peer reviewed articles, which you can find on www.ilads.org. (and see below on this page). This collection was done by Dr. R. Bransfield.
Persistence of Lyme Disease ( means existence of chron. Lyme Disease):
- Donta, ST, Tetracycline therapy in chronic Lyme disease. Chronic Infectious Diseases, 1997; 25 (Suppl 1): 552-56
- Dorward DW,et al. Virulent Bb specifically attach to, activate, and kill TIB-215 Human B lymphocytes (Abstract) VIII Annual Lyme Disease International Scientific Conference. Vancouver, BC. April 28,29, 1995
- Phillips SE; Mattman LH, et al. A proposal for the reliable culture of Borrelia burgdorferi from patients with chronic Lyme disease, even from those previously aggressively treated. Infection 1998 Nov-Dec;26(6):364-7
- Fallon BA, et al. Late-Stage Neuropsychiatric Lyme Borreliosis. Case Reports. Psychosomatics 1995;36:295-300
- Liegner KB, et al. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia borgdorferi infection. J Am Acad Dermatol 1993;2:312-314
- Liegner KB, et al. Culture-confirmed treatment failure of cefotaxime and minocycline in a case of Lyme meningoencephalomyelits in the United States. Abstract, V Intl Conference on Lyme Borreliosis, Arlington, Va, May 30-June 2, 1992.
- Liegner KB et al, Lyme disease and the clinical spectrum of antibiotic responsive chronic meningoencephalmyelitides. Journal of Spirochetal and Tick-Borne Dis. 1997, pp61-73
- Luft BJ, et al. Invasion of the CNS by Bb in acute disseminated infection. JAMA 192; 267:1364-1367.
- Masters EJ, et al. Spirochetemia after continuous high-dose oral amoxicillin therapy. Infect Dis Clin Practice 1994;3:207-208
- Ma Y, et al. Intracellular localization of Borrelia burgdorferi within human endothelial cells. Infect Immun 1991;59:671-678
- Montgomery RR, Malawista SE, et al. The fate of Borrelia burgdorferi within endothelial cells. Infect Immun 10991;59:671-678
- Meier P, et al. Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis. Klin Monatsbl Augenheilkd 1998 Dec;213(6):351-4
- Preac-Mursic V, et al. Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection 1989;17:355-359.
- Preac-Mursic V, et al. Persistence of Borrelia burdorferi and Histopathological Alterations in Experimentally Infected Animals. A comparison with Histopathological Findings in Human Lyme Disease. Infection 1990;18(6):332-341
- Schmidli J, et al. Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis. J Infect Dis 1988;158:905-906
- Straubinger RK, et al. Persistence of Borrelia burgdorferi in Experimentally Infected Dogs after Antibiotic Treatment. J Clin Microbiol 1997;35(1):111-116
- Strle F, et al. Persistence of Borrelia burgdorferi Sensus Lato in Resolved Erythema Migrans Lesions. Clin Inf Dis 1995;23:380-389
- Weber K. Treatment failure in erythema migrans-A review. Infection 1996;24:73-75
- Wolbart K, Priem S. et al. Detection of Borrelia Burgdorferi by PCR in synovial membrane, but not in synovial fluid from patients with persistent Lyme arthritis after antibiotic therapy. Ann Rheum Dis 1998 Feb;57(2):118-21
Chronic-persisting infection with B.burgdorferi despite intensive therapy with antibiotics:
- Asch ES, et al, Lyme Disease: An Infectious and Postinfectious Syndrome, JNL of Rheum 1994;21:454-461
- Bradley JF,et al, The Persistence of Spirochetal Nucleic Acids in Active Lyme Arthritis. Ann Int Med 1994;487-9
- Diringer MN, et al, Lyme meningoencephalitis- report of a severe, penicillin resistant case. Arthritis & Rheum, 1987;30:705-708
- Bayer ME, Zhang L, Bayer MH. Borrelia burgdorferi DNA in the urine of treated patients with chronic Lyme Disease symptoms. A PCR study of 97 cases. Infection 1996. Sept-Oct;24(5):347-53
- Fallon BA, et al. Repeated antibiotic treatment in chronic Lyme disease, Journal of Spirochetal and Tick-borne Diseases, 1999; 6 (Fall/Winter):94-101
- Fraser DD, et al. Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyositis. Clinical and Exper Rheum. 1992;10:387-390
- Fried MD et al, Borrelia burdorferi persists in the gastrointestinal tract of children and adolescents with Lyme Disease, JNL of Spirochetal and Tick-borne Diseases, Spring/Summer 2002; 9:11-15
- Fitzpatrick JE, et al. Chronic septic arthrits caused by Borrelia burgdorferi. Clin Ortho 1993 Dec;(297):238-41
- Georgilis K, Peacocke M, & Klempner MS. Fibroblasts protect the Lyme disease spirochete, Borrelia burgdorferi, from ceftriaxone in vitro. J Infect Dis 1992;166: 440-444
- Girschick HJ, et al. Intracellular persistence of Borrelia burgdorferi in human synovial cells. Rheumatol Int 1996;16(3):125-132
- Hassler D, et al. Pulsed high-dose cefotaxime therapy in refractory Lyme Borreliosis (letter). Lancet 1991;338:193
- Haupl T, et al. Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis. Arthritis Rheum 1993;36:1621-1626
- Horowitz RI. Chronic Persistent Lyme Borreliosis: PCR evidence of chronic infection despite extended antibiotic therapy: A Retrospective Review. Abstract XIII Intl Sci Conf on Lyme Disease. March 24-26, 2000.
- Karma A, et al. Long term follow-up of chronic Lyme neuroretinitis. Retina 1996;16:505-509
- Keller TL, et al. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of Lyme neuroborreliosis patients. Neurology 1992;43:32-42
- Keszler K, and Tilton RC. Persistent PCR Positivity in a Patient Being Treated for Lyme Disease. Jnl of Spirochetal and Tick-Borne Diseases. 1995;2(3):57-58
- Krupp, LB et al, Study and treatment of post Lyme disease: a randomised double masked clinical trial, Neurology, 2003: June 24;60 (12:1923-30)
- Lawrence C, Lipton RB, Lowy RD, and Coyle PK. Seronegative Chronic Relapsing Neuroborreliosis. Eur Neurol. 1995;35:113-117
- Liegner KB. Lyme disease: The Sensible Pursuit of Answers. J Clin Microbiol 1993;31:1961-1963
For the complete list, click here.