Is chronic Lyme disease (Lyme borreliosis) real in patients with negative Western blot testing results?

From the Guidelines

Chronic Lyme disease is not supported by scientific evidence in patients with negative Western blot testing, and alternative explanations for persistent symptoms should be considered. The existence of chronic Lyme disease in patients with negative Western blot testing is a topic of controversy in the medical community 1. While some patients experience persistent symptoms after standard Lyme disease treatment despite negative tests, these symptoms may not necessarily indicate ongoing Borrelia burgdorferi infection. Western blot testing has limitations, including potential false negatives, especially if performed too early or after antibiotic treatment 1. Some key points to consider include:

• The lack of a standardized case definition or biologic marker to identify patients with post-Lyme disease syndrome 1
• The possibility of slow or incomplete resolution of objective manifestations of Lyme disease, such as seventh nerve palsy or Lyme arthritis, which may not be due to persistent infection but rather residual, irreversible damage 1
• The presence of subjective symptoms, such as arthralgia, myalgia, fatigue, and cognitive complaints, which may be due to slow resolution of an inflammatory process or other conditions, such as fibromyalgia 1
• The importance of considering alternative diagnoses, such as other tick-borne infections, autoimmune reactions, or unrelated conditions with similar symptoms 1 A comprehensive approach addressing specific symptoms and considering alternative diagnoses may be more beneficial than focusing solely on Lyme disease when tests are negative. In terms of treatment, standard therapy for confirmed Lyme disease typically involves doxycycline (100mg twice daily for 10-21 days), amoxicillin, or cefuroxime, but extended antibiotic therapy for symptoms with negative testing remains controversial and carries risks 1. If you're experiencing ongoing symptoms despite negative tests, it's essential to seek evaluation from an infectious disease specialist or Lyme-literate physician who can consider your complete clinical picture and provide guidance on the best course of action.

From the Research

Chronic Lyme Disease and Western Blot Testing

• The existence of chronic Lyme disease is a topic of debate, and its diagnosis can be challenging, especially when Western blot testing is negative 2.
• A study published in 2021 reported a case of a patient with clinically suspected disseminated Lyme disease who had negative enzyme immunoassay test results for anti-Borrelia antibodies, but later showed seroconversion after antibiotic therapy 3.
• This case highlights the importance of clinical evaluation in diagnosing Lyme disease, as some patients may not test positive for antibodies initially, but may still have the disease.

Diagnosis and Treatment of Lyme Disease

• Lyme disease is typically diagnosed clinically, and treatment is usually accomplished with doxycycline or amoxicillin 4.
• In some cases, patients may experience persistent symptoms after treatment, which can be referred to as post-treatment Lyme disease syndrome (PTLDS) or chronic Lyme disease 5.
• A study published in 2015 found that some patients with PTLDS may have persistent Borrelia burgdorferi organisms, which can be difficult to eradicate with standard antibiotic therapy 5.

Antibody Tests and Chronic Lyme Disease

• Antibody tests, such as Western blot, are commonly used to diagnose Lyme disease, but they may not always be accurate 2.
• A study published in 2011 found that some patients with purported chronic Lyme disease may have antiphospholipid antibodies, which can cause similar symptoms to Lyme disease 2.
• Another study published in 2021 found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease, but did not observe significant efficacy and safety of doxycycline for treating Lyme disease 6.

Limitations of Current Research

• There is limited research on the efficacy and safety of antibiotics for treating chronic Lyme disease, and more studies are needed to fully understand the disease and its treatment 6.
• The diagnosis of chronic Lyme disease can be challenging, and more research is needed to develop accurate diagnostic tests and effective treatments 3, 2.