Cognitive function in post-treatment Lyme disease Do additional antibiotics help?

Boston University, Boston, Massachusetts, United States
Neurology (Impact Factor: 8.29). 07/2003; 60(12):1916-22. DOI: 10.1212/01.WNL.0000068030.26992.25
Source: PubMed


It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD).
To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD.
A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied. Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative. Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos. Assessments were made at 90 and 180 days after treatment. Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS). Memory, attention, and executive functioning were assessed using objective tests. Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory.
There were no significant baseline differences between seropositive and seronegative groups. Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores. The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days. However, there were no significant differences between those receiving antibiotics and placebo.
Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.

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    • "Finally, antibiotic treatment was not found to be beneficial for those patients in controlled trials [6] [19]. On the other hand, evaluation of the antibody profile in PLDS patients from the USA showed different reactivities to several specific proteins of B. burgdorferi sensu lato than in a control population [15]. "
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    ABSTRACT: The aim of the study was to find out whether patients with antibodies against Borrelia burgdorferi sensu lato (sl) or who report a history of erythema migrans (EM) or tick bite are more likely to have nonspecific symptoms such as musculoskeletal pain, fatigue, sensory disorder and headache. The study group comprised 423 subjects with nonspecific symptoms tested for antibodies against B. burgdorferi sl between July 2012 and December 2014 because of suspicion of Lyme borreliosis (LB). Of these, 285 were females (67%) and 138 males (33%); the median age was 53 years (range 7-89). Patients with confirmed diagnosis of LB and patients with a known underlying disease, which could influence the development of the symptoms, were excluded from the evaluation. Subjects were assigned to the seronegative group or one of three seropositive groups and the history of EM and tick bite was also recorded. Statistical analysis was performed using single chi-square tests of independence and multiple logistic regression models. No differences in occurrence of nonspecific symptoms were observed between patients grouped according to antibody status. History of EM showed no significant effect on any of the nonspecific symptoms. History of tick bite was weakly correlated with joint pain and joint swelling (P<0.05). In conclusion, it is highly unlikely that the complaints are related to a previous infection with B. burgdorferi sl. The results show that testing patients with nonspecific symptoms for antibodies against B. burgdorferi sl in everyday clinical setting does not provide any useful information about their etiology. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Aug 2015 · Clinical Microbiology and Infection
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    • "infection had subjective symptoms only, similar to patients diagnosed with questionable LB, with the difference that they had received (inappropriate) antibiotic treatment for a prior (questionable) LB episode and that their symptoms were progressive over time (Table 2). Although partially against published trials [9] [10] [11] [12], and not recommended by the IDSA guidelines [4], retreatment of questionable persistent B. burgdorferi s.l. infection cases, especially those in patients who had had received prior inappropriate treatment, is in accordance with recommendations from the recent Dutch national guidelines ( and was the result of a compromise between physician and patient. "
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    ABSTRACT: To provide better care for patients suspected of having Lyme borreliosis (LB) we founded the Amsterdam Multidisciplinary Lyme borreliosis Center (AMLC). The AMLC reflects a collaborative effort of the departments of internal medicine/infectious diseases, rheumatology, neurology, dermatology, medical microbiology and psychiatry. In a retrospective case series, characteristics of 200 adult patients referred to the AMLC were recorded, and patients were classified as having LB, post-treatment LB syndrome (PTLBS), persistent Borrelia burgdorferi sensu lato (s.l.) infection despite antibiotic treatment or no LB. In addition, LB, PTLBS and persistent B. burgdorferi s.l. infection cases were classified as 'definite,' 'probable' or 'questionable.' Of the 200 patients, 120 (60%) did not have LB and 31 (16%) had a form of localized or disseminated LB, of which 12 were classified as definite, six as probable and 13 as questionable. In addition, 34 patients (17%) were diagnosed with PTLBS, of which 22 (11%) were probable and 12 (6%) questionable. A total of 15 patients (8%) were diagnosed with persistent B. burgdorferi s.l. infection, of which none was classified as definite, three as probable and 12 as questionable. In conclusion, in line with previous studies, the number of definite and probable (persisting) LB cases was low. The overall high number of questionable cases illustrates the fact that it can sometimes be challenging to either rule out or demonstrate an association with a B. burgdorferi s.l. infection, even in an academic setting. Finally, we were able to establish alternative diagnoses in a large proportion of patients. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · Nov 2014 · Clinical Microbiology and Infection
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    • "). Several randomized, double-blind, placebo-controlled trials have shown little or no benefit and considerable risk of serious adverse events from such prolonged therapy (Klempner et al. 2001, Kaplan et al. 2003, Krupp et al. 2003, Oksi et al. 2007, Fallon et al. 2008). Although several studies have addressed the public perceptions of Lyme disease risk and prevention (Herrington et al. 1997, Herrington 2004, McKenna et al. 2004, Johnson and Feder 2010), few have inquired about beliefs regarding persistent symptoms and prolonged antibiotic therapy. "
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    ABSTRACT: Most physicians prescribe Lyme disease antibiotic therapy regimens that are recommended by the Centers for Disease Control and Prevention, the Infectious Disease Society of America, and the National Institutes of Health. An alternative approach by some physicians consists of prolonged antibiotic treatment for >2 months because they believe that Lyme disease often results in persistent Borrelia burgdorferi infection. Understanding how patients perceive the disease is important for effective doctor-patient communication. We conducted interviews and surveys on Block Island, Rhode Island, and Storrs, Connecticut, to explore the public perception of persistent symptoms following Lyme disease and the need for long-term treatment. Most of our participants believed that symptoms and the Lyme disease bacteria can persist after antimicrobial therapy for Lyme disease. When asked about the value of continuing antibiotic treatment for >2 months, about half thought that it was sometimes useful and about a quarter thought it was always useful. Almost all of the respondents stated that they knew people who had experienced Lyme disease, and these personal observations were more frequently cited as an important source of Lyme disease information than official sources such as medical professionals. We conclude that healthcare workers should review the scientific literature regarding appropriate therapy for Lyme disease, discuss such information with their patients, and identify sources of information that their patients can review. Medical societies, private foundations, and State and Federal Health agencies should increase efforts to educate physicians and the general public about the standard diagnosis and treatment of Lyme disease and provide additional funding to determine why some people experience persistent symptoms following this infection.
    Full-text · Article · Mar 2011 · Vector borne and zoonotic diseases (Larchmont, N.Y.)
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