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Clear evidence of a persistent disease pattern following Lyme disease
There is considerable controversy regarding the disorder variously known as “post-LD syndrome” or “chronic LD” or “post-treatment chronic LD”
“The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America” 14 authors Wormser et al., 2006 Clinical Infectious Diseases 43:1089-134
It appears that a non-committal, ambiguous approach is still being taken
Wormser et al, 2006: “To summarize, it can be expected that a minority of patients with LD will be symptomatic following a recommended course of antibiotic treatment as a result of the slow resolution of symptoms over the course of weeks to months or as a result of a variety of other factors, such as the high frequency of identical complaints in the general population.”
Wormser et al.: “In many patients, posttreatment symptoms appear to be more related to the aches and pains of daily living rather than to either LD or a tickborne coinfection.” and
“Objective clinical manifestations are uncommon after treatment of patients with LD. A much more likely scenario after treatment is the persistence or development of subjective symptoms without any residual or new objective manifestation.” and
“More often, patients categorized as having post-Lyme disease syndrome have subjective symptoms alone, such as musculoskeletal pains, cognitive complaints, and/or fatigue without objective abnormalities on physical examination.” and
“Previous studies of various infectious diseases have suggested that delayed convalescence can be related to the emotional state of the patients before onset of the illness … One study of LD showed that poor outcome was associated with prior traumatic events and/or past treatment with psychotropic medications. This is an important consideration for future investigations.”
AND YET, to provide a framework for future research, Wormser et al. propose a definition of post-LD syndrome. Briefly:
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Jon Godwin and I performed a meta-analysis of 5 studies comparing symptoms in - subjects who had had LD and - randomly selected subjects from the general population
Those who had had LD were significantly more likely to have the following symptoms:
Criticisms of the meta-analysis by Wormser et al:
Criticisms of the meta-analysis, continued:
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Frequency of post-LD syndrome
Many remaining questions