Chronic Lyme disease

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