Chronic Lyme disease
From IDWiki
Background
- Possibly related to post-Lyme disease syndrome
Clinical Manifestations
- Chronic fatigue syndrome-like presentation with fatigue, myalgias, and neurocognitive symptoms following possible Lyme exposure
- However, chronic post-Lyme arthritis is well-defined lasting at least a year
Differential Diagnosis
- Confirmed Lyme disease (12%)
- Psychiatric disorders (25%): depression, post-traumatic stress disorder, burnout, harassment, and other
- Rheumatologic disorders (16%): osteoarthritis, scoliosis, or other
- Neurologic disorders (12%): amyotrophic lateral sclerosis, Parkinson disease, small fiber disease, multiple sclerosis, or other
- Obstructive sleep apnea (5%)
- Miscellaneous (17%): thyroid diseases, fibromyalgia, cardiomyopathy, infectious diseases, inflammatory diseases, and others
- Unknown etiology (7%)
Management
- RCT has shown that 30 days ceftriaxone followed by 60 days doxy does not improve symptoms in patients with documented history of Lyme disease and persistent symptoms
Further Reading
- Holistic Approach in Patients With Presumed Lyme Borreliosis Leads to Less Than 10% of Confirmation and More Than 80% of Antibiotic Failures. Clin Infect Dis. 2019;68(12):2060-2066. doi: 10.1093/cid/ciy799
