Persistent Symptoms After Treatment of Lyme Disease

The controversy regarding the underlying mechanisms of PTLDs and the increasingly bitter debate over CLD, continues unabated over the past years. If anything, it has become more contentious. For health care providers, it is important that patients be offered the best advice based on current, evidence-based information. Patients treated for Lyme disease can be reassured that most will fully recover after recom-mended antibiotic therapy,2 and that nonspecific symptoms will improve over time. Evaluation of patients with PTLDs and CLD can be quite challenging. Practitioners should carefully review the evidence for the diagnosis of Lyme disease, and not lose sight of that symptoms may be due to unrelated conditions. Most importantly is a collaborative approach to the treatment process with the patient, with warmth, empathy, and positive communication. More research on the pathogenesis of PTLDs, particularly biomarkers that would allow for differentiation accordingly to the underly-ing process, is urgently needed. Such markers could give insights into pathways and lead to valuable treatments. Current evidence shows that prolonged antibiotic ther-apy, as tested in the randomized placebo-controlled clinical trials, does not offer sub-stantive benefits for patients with PTLDs. These studies also showed a significant placebo effect and variability of the intensity of subjective symptoms over time. There-fore, interventional studies in this population must have a double-blind, randomized controlled design. There is a critical need for high-quality research to better under-stand "chronic Lyme disease," and how to best help this large and heterogenous group of patients,