What are the symptoms of chronic Lyme disease?

Symptoms of Chronic Lyme Disease

There is no scientifically validated condition called "chronic Lyme disease" recognized by major medical authorities. The symptoms often attributed to "chronic Lyme disease" are actually manifestations of late-stage Lyme disease with objective clinical findings or post-treatment Lyme disease syndrome.

Late Manifestations of Lyme Disease

The CDC and Infectious Diseases Society of America (IDSA) recognize specific late manifestations of Lyme disease that occur when early infection is untreated or inadequately treated:

Musculoskeletal System

• Recurrent, brief attacks (weeks or months) of objective joint swelling in one or a few joints, sometimes followed by chronic arthritis 1
• Typically affects large, weight-bearing joints (especially the knee) 1, 2
• Pain and swelling may be intermittent if untreated 1

Nervous System

• Lymphocytic meningitis 1, 2
• Cranial neuritis, particularly facial palsy (may be bilateral) 1, 2
• Radiculoneuropathy 1, 2
• Encephalomyelitis (rare) - must be confirmed by demonstration of antibody production against B. burgdorferi in CSF 1
• Chronic axonal polyneuropathy with radicular pain or distal paresthesias 3
• Mild encephalopathy characterized by memory loss, mood changes, or sleep disturbance 3, 2
• Cognitive disorders, including memory impairment 1, 3

Cardiovascular System

• Acute onset of high-grade (2nd or 3rd degree) atrioventricular conduction defects 1
• May be associated with myocarditis 1
• Typically resolves in days to weeks 1

Important Distinctions

It's crucial to understand that:

1. Not all persistent symptoms indicate active infection:

   • Symptoms like arthralgia, myalgia, or fibromyalgia syndromes alone are not criteria for musculoskeletal involvement 1
   • Headache, fatigue, paresthesia, or mildly stiff neck alone are not criteria for neurologic involvement 1
   • Palpitations, bradycardia, bundle branch block, or myocarditis alone are not criteria for cardiovascular involvement 1

2. Post-Lyme Disease Syndrome:

   • Some patients experience persistent symptoms after appropriate antibiotic treatment 1, 2
   • These symptoms may include fatigue, sleep disturbance, cognitive complaints, and musculoskeletal pain 2, 3
   • This is not due to persistent infection and does not respond to additional antibiotics 2, 4

Diagnostic Considerations

For proper diagnosis of late Lyme disease:

• All patients should be seropositive by two-tier testing (ELISA/IFA followed by Western blot) 1, 2
• Objective clinical findings consistent with Lyme disease must be present 2
• Non-specific symptoms without objective findings should not prompt testing 2
• Positive PCR results from joint fluid in a seronegative patient should be viewed with skepticism 1

Common Pitfalls to Avoid

• Attributing non-specific symptoms to "chronic Lyme disease" without objective evidence 2
• Prescribing extended or unending courses of antibiotics for persistent symptoms 2, 4
• Diagnosing Lyme disease based on serologic testing alone without appropriate clinical context 2
• Confusing psychiatric illness, typical ALS, MS, Parkinson's disease, or new-onset seizures with Lyme disease 2

Remember that Lyme disease is rarely, if ever, fatal 1, but inappropriate diagnosis and treatment can lead to unnecessary medical interventions and delayed diagnosis of the true cause of symptoms.