A Critical Appraisal of “Chronic Lyme Disease”

“Chronic Lyme disease” is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme disease. Once this diagnosis is given, prolonged treatment with multiple antimicrobial agents may follow. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme disease. “Chronic Lyme disease” is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme disease. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme disease. Lyme disease, the most common tick-borne infection in the northern hemisphere, is a serious public health problem. In North America, it is caused exclusively by Borrelia burgdorferi sensu stricto (hereafter referred to as B. burgdorferi ), whereas in Europe it is caused by B. afzelii, B. garinii, B. burgdorferi, and occasionally by other species of borrelia. 1 This complex infection has a number of objective manifestations, including a characteristic skin lesion called erythema migrans (the most common presentation of early Lyme disease), certain neurologic and cardiac manifestations, and pauciarticular arthritis (the most common presentation of late Lyme disease), all of which . . .