From the Guidelines
For a patient with a positive Lyme disease IgG immunoblot who was treated with doxycycline two months ago but still has active symptoms, the recommended next step is to not initiate additional antibiotic therapy, as evidence suggests that this does not improve outcomes in patients with persistent nonspecific symptoms following standard treatment for Lyme disease 1. The patient's positive IgG immunoblot result indicates past infection, but the persistence of symptoms despite previous treatment could be due to various factors, including Post-Treatment Lyme Disease Syndrome (PTLDS) or other conditions.
- The CDC criteria for a positive Lyme disease IgG immunoblot require reactivity to at least 5 of 10 specific borrelial proteins, which is met in this case with reactivity to multiple bands, including 18 kd, 28 kd, 30 kd, 39 kd, 41 kd, 45 kd, 58 kd, 66 kd, and 93 kd.
- However, the presence of these antibodies does not necessarily indicate current active infection, as they can persist for months or years after successful treatment.
- A comprehensive clinical evaluation is necessary to rule out other potential causes of persistent symptoms, including laboratory testing such as a complete blood count, comprehensive metabolic panel, and inflammatory markers.
- If symptoms persist, referral to an infectious disease specialist is warranted for further evaluation and management, as the current evidence does not support additional antibiotic therapy for patients with persistent nonspecific symptoms following standard treatment for Lyme disease 1.
From the Research
Interpretation of Lyme Disease Test Results
- The patient's Lyme disease IgG immunoblot result is positive, indicating exposure to Borrelia burgdorferi, the bacteria that causes Lyme disease 2.
- The patient was treated with doxycycline 2 months ago, but still exhibits active symptoms of Lyme disease.
- According to the CDC criteria, a positive Lyme disease IgG immunoblot result requires reactivity to at least 5 of 10 specific borrelial proteins.
Next Steps for Treatment
- The patient's persistent symptoms despite treatment with doxycycline may indicate the need for further treatment or a different treatment approach 3.
- Studies have shown that longer-term antibiotic treatment may not be effective in eradicating Borrelia burgdorferi persisters, which can cause persistent symptoms 2.
- Alternative treatment options, such as intravenous ceftriaxone, may be considered for patients with persistent symptoms 4.
- The use of drug combinations, such as daptomycin/doxycycline/ceftriaxone, may be effective in killing biofilm-like microcolony persisters 3.
Considerations for Treatment
- The choice of antibiotic treatment should take into account the patient's specific symptoms and medical history 5.
- Doxycycline and erythromycin have been shown to be effective in killing Borrelia burgdorferi when grown in the presence of eucaryotic cells 5.
- Ceftriaxone has been shown to be effective in treating acute disseminated Lyme disease, but may not be effective in eradicating persisters 6.