A critical appraisal of “chronic Lyme disease.”

Department of Family Medicine and Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
New England Journal of Medicine (Impact Factor: 55.87). 11/2007; 357(14):1422-30. DOI: 10.1056/NEJMra072023
Source: PubMed


"Chronic Lyme disease" is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme disease. Once this diagnosis is given, prolonged treatment with multiple antimicrobial agents may follow. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme disease.

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    • "Chronic Lyme disease (CLD) is a term that describes a constellation of persistent symptoms in patients with or without exposure to Borrelia burgdorferi. These symptoms may include fatigue, night sweats, arthralgia, myalgia, arrhythmias, abdominal pain, nausea, diarrhea, sleep disturbance, cognitive dysfunction, irritability, depression, back pain, and headache [1]. There is no standard definition of CLD; the Infectious Diseases Society of America distinguishes between ‘post-Lyme disease syndrome’ or ‘late Lyme disease’ in which arthralgia and other symptoms persist after documented B. burgdorferi infection [2], while Feder et al. [1] categorize similar syndromes into post-Lyme disease syndrome, symptoms of unknown cause (with our without antibodies to B. burgdorferi), and defined illnesses unrelated to B. burgdorferi infection. "
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    ABSTRACT: Background Chronic Lyme disease is a term that describes a constellation of persistent symptoms in patients with or without evidence of previous Borrelia burgdorferi infection. Patients labeled as having chronic Lyme disease have a substantial clinical burden. Little is known about chronic Lyme disease patient experiences in the healthcare system and their relationships with healthcare providers. The purpose of this study was to gather insights about the experiences of patients who carry a diagnosis of chronic Lyme disease in the United States healthcare system. Methods Qualitative, phenomenological study in 12 adult participants who identified themselves as having chronic Lyme disease. Semi-structured face-to-face in-depth interviews were conducted, 60–90 minutes in length, focusing on perceptions of disease burden and of their healthcare providers, using the dimensions of the Health Belief Model. Transcribed interviews were analyzed for emergent topics and themes in the categories of beliefs/understanding, personal history/narrative, consequences/limitations, management, and influences on care. Results Enrollment continued until theoretical saturation was obtained. Four major themes emerged from participants’ descriptions of their experiences and perceptions: 1) changes in health status and the social impact of chronic Lyme disease, 2) doubts about recovery and the future, 3) contrasting doctor-patient relationships, 4) and the use of unconventional therapies to treat chronic Lyme disease. Conclusions Participants reported a significant decline in health status associated with chronic Lyme disease and were often unsatisfied with care in conventional settings. Negative experiences were associated with reports of dismissive, patronizing, and condescending attitudes. Positive experiences were associated with providers who were reported to be attentive, optimistic, and supportive. Consultations with CAM practitioners and use of CAM therapies were common. Actively engaged and sympathetic clinical encounters may foster greater satisfaction in healthcare settings.
    BMC Family Practice 05/2014; 15(1):79. DOI:10.1186/1471-2296-15-79 · 1.67 Impact Factor
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    • "This complex infection has a number of objective manifestations, including a characteristic skin lesion called erythema migrans (the most common presentation of early Lyme disease), certain neurologic and cardiac manifestations, and pauciarticular arthritis (the most common presentation of late Lyme disease), all of which usually respond well to conventional antibiotic therapy. Despite resolution of the objective manifestations of infection after antibiotic treatment, a minority of patients have fatigue, musculoskeletal pain, difficulties with concentration or short-term memory, or all of these symptoms [11]. "
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    ABSTRACT: Lyme borreliosis (LB) is the most common tick-borne disease in the United States and Europe. The incidence is 13.4 per 100,000 inhabitants in the United States and more than 300 per 100,000 inhabitants in Europe. Children are at highest risk of LB. In the Netherlands in 2007, the incidence of tick bites in children between 10-14 years varied from 7,000 -11,000 per 100,000, depending on age. This study among Dutch school children aimed to examine the knowledge, perceived threat, and perceived importance of protective behaviour in relation to tick bites and their potential consequences. In April 2012, the municipal health services (MHS) contacted primary schools to recruit children 9-13 years by telephone, e-mail, or advertisement in MHS newsletters. In total, 1,447 children from 40 schools participated in this study by completing a specifically developed and pretested compact paper questionnaire. Regression models were used to determine which covariates (e.g. forest cover, previous education, knowledge) are associated with our response variables. 70% (n = 1,015) of the children answered at least six out of seven knowledge questions correctly. The vast majority (93%; n = 1345) regarded body checks as very or somewhat important, 18% (n = 260) was routinely checked by their parents. More frequent body checks were associated with good knowledge about ticks and tick-borne diseases and knowing persons who got ill after tick bite. Children in areas with a higher forest cover were more likely to be checked frequently. Most children have a good knowledge of ticks and the potential consequences of tick bites. Knowing persons who personally got ill after tick-bite is associated with a good knowledge score and leads to higher susceptibility and better appreciation of the need for body checks. Perceived severity is associated with a good knowledge score and with knowing persons who got ill after tick-bite. Is seems to be useful to additionally address children in health education regarding ticks and tick-borne diseases. The relationship between health education programs for children (and their parents) about ticks and their possible consequences and prevention of these deserves further study.
    BMC Public Health 12/2013; 13(1):1148. DOI:10.1186/1471-2458-13-1148 · 2.26 Impact Factor
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    • "In cases of co-infection, symptoms induced by these microorganisms are often non-specific and can be aggravated by pre-existing or concurrent diseases [9] making diagnosis exceedingly difficult. It is estimated that up to half of human tick-borne disease has an unknown microbiological origin [10]. Consequently, in order to identify novel or unexpected tick-borne pathogens in their natural hosts, concerted efforts are required to develop efficient detection methods. "
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    ABSTRACT: Ticks are highly susceptible to global environmental and socio-economical changes. Several tick-borne pathogens have been reported in new geographical regions while new species, strains or genetic variants of tick-borne microorganisms are continually being detected. However, tick-borne pathogens are still poorly understood, and it is estimated that half of all human tick-borne disease has an unknown origin. Therefore in order to prevent these diseases, more effort is required to identify unknown or unexpected tick-borne pathogens. Ixodes ricinus is the vector for a broad range of bacterial pathogens and the most prevalent tick in Europe. The aim of the present study was to evaluate the capability of Next Generation Sequencing (NGS) to extend the inventory of pathogenic bacteria carried by this species of tick in France. RNA and DNA were extracted from 1450 I. ricinus questing nymphs collected by flagging in Alsace, France. RNA was pooled and used for NGS. Following de novo assembly, bacterial contigs were assigned to the closest known taxonomy. DNA was used for real time PCR to confirm taxonomic species assignment of NGS-derived contigs for the doubtful cases, and for determination of prevalence. We have generated a global in-depth picture of tick-borne bacteria. We identified RNA from the main pathogenic bacterial species known to be transmitted by I. ricinus. In addition we also identified unanticipated bacterial species for which we have estimated the prevalence within those ticks inhabiting the studied areas. The data obtained from this study has proven that NGS has an enormous potential to detect the unexpected and provides the means to monitor pathogen occurrence.
    PLoS ONE 11/2013; 8(11):e81439. DOI:10.1371/journal.pone.0081439 · 3.23 Impact Factor
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