There is no evidence that “chronic Lyme disease” exists and if it does, the risks of prolonged antibiotic treatment outweigh any benefits, according to a review article by researchers at Yale and other institutions in the October 4 New England Journal of Medicine.
Lyme disease is the most common tick-borne infection in the Northern hemisphere. The disease is caused by bacteria, Borrelia burgdorferi (B. burgdorferi), and typically manifests as a rash, while later—less common—symptoms may include meningitis, facial nerve palsy and arthritis. All of these conditions typically respond well to conventional antibiotic treatment, but a minority of patients subsequently complain of fatigue, musculoskeletal pain, and difficulty with concentration or short-term memory. These symptoms are usually mild and self-limited and are referred to as “post-Lyme disease symptoms.” If they last longer than six months, they are called “post-Lyme disease syndrome.”
The review article, written by Eugene D. Shapiro, M.D., of Yale and colleagues from other institutions, focused on what the authors refer to as the “imprecisely defined” condition “chronic Lyme disease.” The authors note that this term is used by a small number of physicians to describe patients they claim have persistent B. burgdorferi infection, a condition that they say requires long-term antibiotic treatment and may be incurable.
“Although ‘chronic Lyme disease’ clearly encompasses post-Lyme disease syndrome, it also includes a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to B. burgdorferi infection,” said Shapiro, who is professor of pediatrics, epidemiology and public and investigative medicine at Yale School of Medicine.
The article advises clinicians to tell their patients that there is no scientific evidence of “chronic Lyme disease,” and to inform patients of the risks of unnecessary antibiotic therapy. The authors say that patients should also be thoroughly evaluated for medical conditions that could explain the symptoms.
“Explaining that there is no medication, such as an antibiotic, to cure the condition is one of the most difficult aspects of caring for such patients,” said Shapiro. “Failure to do so leaves the patient susceptible to those who would offer unproven and potentially dangerous therapies.”
Shapiro and his colleagues maintain that “chronic Lyme disease” is a misnomer, and the use of prolonged, dangerous, and expensive antibiotic treatments is not warranted.
Other authors on the study included Henry M. Fender, Jr., M.D., Barbara J.B. Johnson, Susan O’Connell, M.D., Allen C. Steere, M.D., Gary P. Wormser, M.D. and the Ad Hoc International Lyme Disease Group.
Citation: N. Engl J Med, Vol. 357, No. 14 (October 4, 2007)
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