title: Update on persistent symptoms associated with Lyme disease.
abstract: OBJECTIVE
  Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne illness in the United States. The pathogenesis, ecology, and epidemiology of Lyme disease have been well described, and antimicrobial treatment is very effective. There has been controversy about whether infection can persist and cause chronic symptoms despite treatment with antimicrobials. This review summarizes recent studies that have addressed this issue.
  
  
  RESULTS
  The pathogenesis of persistent nonspecific symptoms in patients who were treated for Lyme disease is poorly understood, and the validity of results of attempts to demonstrate persistent infection with B. burgdorferi has not been established. One study attempted to use xenodiagnosis to detect B. burgdorferi in patients who have been treated for Lyme disease. Another study assessed whether repeated episodes of erythema migrans were due to the same or different strains of B. burgdorferi. A possible cause of persistent arthritis in some treated patients is slow clearance of nonviable organisms that may lead to prolonged inflammation. The results of all of these studies continue to provide evidence that viable B. burgdorferi do not persist in patients who receive conventional antimicrobial treatment for Lyme disease.
  
  
  CONCLUSIONS
  Patients with persistent symptoms possibly associated with Lyme disease often provide a challenge for clinicians. Recent studies have provided additional evidence that viable B. burgdorferi do not persist after conventional treatment with antimicrobials, indicating that ongoing symptoms in patients who received conventional treatment for Lyme disease should not be attributed to persistent active infection.
authors.affiliation: aDepartment of Pediatrics bDepartment of Epidemiology of Microbial Diseases cDepartment of Investigative Medicine, Yale University Schools of Medicine and of Public Health, Graduate School of Arts and Sciences, New Haven, Connecticut, USA.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Oliveira
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D025065:Borrelia burgdorferi / Q000472:pathogenicity*; D002648:Child; D002675:Child, Preschool; D005929:Glossitis, Benign Migratory / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D014481:United States / Q000453:epidemiology; D037521:Virulence Factors
chemical_list: D000890:Anti-Infective Agents; D037521:Virulence Factors