Chronic Lyme; diagnostic and therapeutic challenges.

Area of Science:

• Infectious Diseases
• Neurology
• Rheumatology

Background:

• Chronic Lyme disease results from persistent Borrelia burgdorferi (Bb) infection.
• Common manifestations include encephalitis, myelitis, acrodermatitis chronica atrophicans, and arthritis.
• Isolated subjective symptoms are not characteristic of chronic Lyme.

Purpose of the Study:

• To review the definition, clinical and laboratory features, diagnostics, and management of chronic Lyme disease.
• To clarify diagnostic criteria, emphasizing seropositivity and cerebrospinal fluid findings in neuroborreliosis.
• To provide guidance on appropriate antibiotic treatment and differential diagnoses.

Main Methods:

• Review of existing literature on chronic Lyme disease.
• Analysis of diagnostic markers, including antibody detection (IgG, IgM) and cerebrospinal fluid analysis.
• Evaluation of recommended treatment protocols and differential diagnoses.

Main Results:

• Direct detection of Bb is often low-yield; seropositivity (detectable Bb IgG antibodies) is nearly universal.
• Specific Western blot criteria and simultaneous IgG/IgM detection are crucial for accurate serodiagnosis.
• Neuroborreliosis cases typically show pleocytosis and intrathecal Bb antibody production.
• Standard antibiotic therapy, not exceeding 4 weeks, is recommended; combination therapy is not advised.

Conclusions:

• Accurate diagnosis of chronic Lyme disease requires strict adherence to diagnostic guidelines and consideration of differential diagnoses.
• Standard-duration, guideline-adherent antibiotic treatment is the recommended management approach.
• A systematic diagnostic process and open communication are essential for patients with suspected chronic Lyme disease.