Abstract
Although Lyme disease is the most common tickborne illness in the USA and Eurasia, the pathophysiology and clinical course of chronic Lyme disease (CLD) have not been formally defined. The purpose of this paper is to present a working case definition of CLD based on analysis of more than 700 peer-reviewed publications. According to this definition, CLD is a multisystem illness with diverse musculoskeletal, neuropsychiatric and/or cardiovascular manifestations that result from ongoing infection with pathogenic members of the Borrelia spirochete complex often associated with other tickborne disease (TBD) pathogens. To qualify for the diagnosis of CLD, patients must have Lyme-compatible symptoms and signs that are either consistently or variably present for six or more months. Two subcategories of CLD include untreated chronic Lyme disease (CLD-U) and chronic Lyme disease following a limited course of antibiotic treatment (CLD-T). The symptom patterns and optimal therapy of CLD require further study.
Highlights
Lyme disease caused by the spirochete Borrelia burgdorferi (Bb) is the most common tickborne illness in the USA and Eurasia (Bacon et al, 2008; Centers for Disease Control and Prevention (CDC), 2017; Sykes and Makiello, 2017; Wormser et al, 2006; Cameron et al, 2014)
Lyme disease caused by the spirochete Borrelia burgdorferi (Bb) is the most common tickborne illness in the USA and Eurasia (Bacon et al, 2008; CDC, 2017; Sykes and Makiello, 2017; Wormser et al, 2006; Cameron et al, 2014)
We propose a working case definition of chronic Lyme disease (CLD) based on evidence that Bb and associated pathogens may cause persistent infection that correlates clinically with invasion of the diverse cells and tissues described above (Cameron et al, 2014; Szer et al, 1991; Borgermans et al, 2014; Oksi et al, 1999; Fallon et al, 2018; Miklossy et al, 2012; Donta, 2003; 1997)
Summary
Lyme disease caused by the spirochete Borrelia burgdorferi (Bb) is the most common tickborne illness in the USA and Eurasia (Bacon et al, 2008; CDC, 2017; Sykes and Makiello, 2017; Wormser et al, 2006; Cameron et al, 2014). CLD-T requires that patients had been diagnosed with Lyme disease and treated with a limited course of antibiotic therapy (generally < four weeks), but that the treatment regimen was inadequate to resolve the infection and that the symptoms persisted or recurred within six months after completion of treatment without a new tick exposure. Further support for the adverse health impact of CLD was recently provided by Adrion et al (2015) Based on retrospective data from medical claims over five years in the USA, 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of TBDs. The study found that as many as 63% of treated Lyme disease patients had persistent symptoms of CLD and that Lyme disease was associated with $2,968 higher total health care costs (95% CI: $2,807-$3,128, p
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