title: Update of the Swiss guidelines on post-treatment Lyme disease syndrome.
abstract: Lyme borreliosis is caused by Borrelia burgdorferi sensu lato infection, which responds well to antibiotic therapy in the overwhelming majority of cases. However, despite adequate antibiotic treatment some patients report persisting symptoms which are commonly summarised as post-treatment Lyme disease syndrome (PTLDS). In 2005, the Swiss Society of Infectious Diseases published a case definition for PTLDS. We aimed to review the scientific literature with a special emphasis on the last 10 years, questioning whether the definitions from 2005 are still valid in the light of current knowledge. Furthermore, we describe the clinical history of infection with Borrelia burgdorferi sensu lato, the estimated prevalence of PTLDS, the possible pathogenesis of PTLDS, and treatment options with an emphasis on clinical studies. In summary, we were unable to find a scientific reason for modification of the PTLDS definitions published in 2005. Thus, the diagnostic criteria remain unchanged, namely documented clinical and laboratory evidence of previous infection with B. burgdorferi, a completed course of appropriate antibiotic therapy, symptoms including fatigue, arthralgia, myalgia, cognitive dysfunction or radicular pain persisting for >6 months, a plausible timely association between documented B. burgdorferi infection and onset of symptoms (i.e., persistent or recurrent symptoms that began within 6 months of completion of a recommended antibiotic therapy for early or late Lyme borreliosis), and exclusion of other somatic or psychiatric causes of symptoms. The main therapeutic options remain cognitive behavioural therapy and low-impact aerobic exercise programmes. Growing and unequivocal evidence confirms that prolonged or repeated antibiotic therapy for PTLDS is not beneficial, but potentially harmful and therefore contraindicated. The Guidelines of the Swiss Society of Infectious Diseases offer an evidence based, diagnostic and therapeutic framework for physicians caring for patients suffering from presumptive PTLDS in Switzerland.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Nemeth
authors.affiliation: Division of Infectious Diseases, Regional Hospital Lugano, Switzerland.
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.affiliation: Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Heininger
authors.affiliation: Division of Infectious Diseases, Geneva University Hospital, Switzerland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zürich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Nadal
authors.affiliation: Division of Infectious Diseases, Cantonal Hospital St. Gallen, Switzerland.
authors.forename: Carol
authors.initials: C
authors.lastname: Strahm
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Erb
authors.affiliation: Division of Infectious Diseases, University Hospital Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zimmerli
authors.affiliation: Division of Infectious Diseases, University Hospital Bern, Switzerland.
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.affiliation: Division of Infectious Diseases, University Hospital Lausanne (CHUV), Switzerland.
authors.forename: Julie
authors.initials: J
authors.lastname: Delaloye
authors.affiliation: Service of Neurology, University Hospital Lausanne (CHUV), Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Kuntzer
authors.affiliation: Swiss Federal Office of Public Health, Bern, Switzerland.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Altpeter
authors.affiliation: Department of Neurology, Inselspital, University Hospital of Bern, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Sturzenegger
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.lastname: For The Swiss Society For Infectious Diseases And The Swiss Society For Neurology
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D025065:Borrelia burgdorferi; D060085:Coinfection; D003376:Counseling; D015444:Exercise; D005221:Fatigue / Q000209:etiology; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008193:Lyme Disease / Q000150:complications / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D008603:Mental Health; D010146:Pain / Q000209:etiology; D017410:Practice Guidelines as Topic; D013557:Switzerland
chemical_list: D000900:Anti-Bacterial Agents; D018836:Inflammation Mediators