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Review

The conflict on posttreatment Lyme disease

syndrome: a clinical mini review

1
Manos Bogdos , Sotirios Giannopoulos , Maria Kosmidou 3
1,2
1 Department of Neurology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.
2 Neurosurgical Research Institute, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.
3 1st Division of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.

A B S T R AC T
Is Borrelia burgdorferi responsible for the persistence of symptoms after the standard successful course of antibiotics in Lyme disease
patients? This highly controversial issue, concerning the underlying mechanism of posttreatment Lyme disease syndrome (PTLDS), still
seems to be a matter of intense conflict of opinion. PTLDS is the manifestation of nonspecific symptoms including fatigue, musculoskeletal
pain, dysesthesias, and neurocognitive deterioration after the standard antimicrobial therapy administered to patients suffering from Lyme
disease. In this article, we review the conflicting views and published highlights of recent human studies regarding PTLDS.

Key words: Antibiotic therapy; duration of therapy; Lyme disease; nonspecific symptoms; posttreatment Lyme disease syndrome

INTRODUCTION treatment is associated with significantly increased
health care costs. [5]
There is no fundamentally widely accepted definition
of posttreatment Lyme disease syndrome (PTLDS). This NOT TO TREAT PTLDS
has led to confusion and controversies and to a lack of
data on its incidence, prevalence, and pathogenesis. The Infectious Diseases Society of America (IDSA)
The most accepted definition is that PTLDS is the reported that Lyme disease is not always properly
manifestation of nonspecific signs and symptoms diagnosed or treated and that some patients may
such as fatigue, muscle pain, arthropathy, neuropathy, continue to experience prolonged Lyme disease
and cognitive dysfunction after the standard course of symptoms even after an intense chemotherapeutic
antibiotics that are administered to patients between regimen. The diagnosis of so‑called “chronic Lyme
10 and 28 days depending on disease stage and disease”, implying an ongoing infection, is not
severity. It is expected that this syndrome persists for supported by scientific evidence and the treatment
at least 6 months. Additionally, all indicated known based on long‑term chemotherapy is not recommended.
diagnostic workup regarding neuroborreliosis has to Standard courses of antibiotics, between 10 and 28
be negative. [1,2] A sufficient amount of data shows that days depending on the manifestation of Lyme disease,
patients with PTLDS have reduced life functioning have been proven effective to cure the infection.
than those without the syndrome, or even when These chronic symptoms may be due to persisting
[3]
compared to patients with other chronic diseases. inflammatory responses to bacterial debris by
[4]
Intuitively, the presence of PTLDS after recommended
genetically predisposed individuals after the resolution
of the infection, as well as due to joint damages caused
Corresponding Author: Dr. Maria Kosmidou, 1st Division by the initial infection. Some already treated patients
[1]
of Internal Medicine, School of Medicine, University of
Ioannina, University Campus, 45110 Ioannina, Greece. E‑mail:
mkosmidou@uhi.gr This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
author is credited and the new creations are licensed under the identical terms.
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Cite this article as: Bogdos M, Giannopoulos S, Kosmidou M. The
conflict on posttreatment Lyme disease syndrome: a clinical mini review.
Neuroimmunol Neuroinflammation 2016;3:10-3.
DOI: 10.4103/2347-8659.171605
Received: 06-09-2015; Accepted: 22-10-2015

10 © 2016 Neuroimmunology and Neuroinflammation | Published by OAE Publishing Inc.