title: Chronic Lyme disease: the controversies and the science.
abstract: The diagnosis of chronic Lyme disease has been embroiled in controversy for many years. This is exacerbated by the lack of a clinical or microbiologic definition, and the commonality of chronic symptoms in the general population. An accumulating body of evidence suggests that Lyme disease is the appropriate diagnosis for only a minority of patients in whom it is suspected. In prospective studies of Lyme disease, very few patients go on to have a chronic syndrome dominated by subjective complaints. There is no systematic evidence that Borrelia burgdorferi, the etiology of Lyme disease, can be identified in patients with chronic symptoms following treated Lyme disease. Multiple prospective trials have revealed that prolonged courses of antibiotics neither prevent nor alleviate such post-Lyme syndromes. Extended courses of intravenous antibiotics have resulted in severe adverse events, which in light of their lack of efficacy, make them contraindicated.
authors.affiliation: Departments of Internal Medicine and Pediatrics, Division of Pediatric Infectious Diseases, Hospital Medicine Program, Duke University Medical Center, DUMC 100800, Durham, NC 27710, USA. paul.lantos@duke.edu
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lantos
mesh_terms: D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology; D025065:Borrelia burgdorferi / Q000187:drug effects* / Q000254:growth & development; D002908:Chronic Disease; D000075202:Contraindications; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003937:Diagnosis, Differential; D000077206:Gabapentin; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D019636:Neurodegenerative Diseases / Q000175:diagnosis / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy; D059408:Pain Management / Q000379:methods*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013577:Syndrome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000900:Anti-Bacterial Agents; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin