From the Guidelines
Chronic Lyme disease symptoms can include persistent fatigue, joint and muscle pain, headaches, cognitive difficulties, sleep disturbances, and neurological problems, but additional antibiotic therapy is not recommended for patients with persistent nonspecific symptoms following standard treatment, according to the 2020 guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) 1. The symptoms of chronic Lyme disease can vary widely and may include:
- Persistent fatigue
- Joint and muscle pain
- Headaches
- Cognitive difficulties, often called "brain fog"
- Sleep disturbances
- Neurological problems such as numbness or tingling in extremities
- Heart palpitations
- Dizziness
- Mood changes, including depression or anxiety
- Recurrent fevers or chills These symptoms often fluctuate in intensity, with periods of flare-ups and remissions. Some individuals develop more severe manifestations like arthritis in large joints, particularly the knees, or neurological complications such as Bell's palsy (facial paralysis). The 2020 guidelines recommend against additional antibiotic therapy for patients with persistent or recurring nonspecific symptoms following recommended treatment for Lyme disease, but who lack objective evidence of reinfection or treatment failure 1. The diagnosis of chronic Lyme disease can be challenging as symptoms overlap with many other conditions, and standard blood tests may not always detect chronic infections. Treatment approaches remain controversial among medical professionals, but the guidelines suggest that a second course of oral antibiotics for up to 1 month may be a reasonable alternative for patients with Lyme arthritis with partial response to initial treatment, while a 2–4-week course of IV ceftriaxone is suggested for patients with no or minimal response to initial treatment 1. Supportive therapies to manage specific symptoms and lifestyle modifications to boost immune function are also important components of managing chronic Lyme disease.
From the Research
Symptoms of Chronic Lyme Disease
- Fatigue, cognitive dysfunction, and musculoskeletal pain that persist beyond 6 months and are associated with disability have been termed post-treatment Lyme disease syndrome (PTLDS), a subset of a broader term "chronic Lyme disease" 2
- Non-specific symptoms such as fatigue, musculoskeletal pain, and cognitive complaints can persist in patients previously treated for Lyme disease, also known as post-Lyme disease syndrome 3
- Nonspecific symptoms like fatigue, perceived cognitive slowing, headache, and others can occur in patients with Lyme disease and are indistinguishable from comparable symptoms occurring in other inflammatory states 4
- Chronic fatigue states have been reported to occur following any number of infections, including Lyme disease, but the mechanism underlying this association is unclear 4
Common Symptoms
- Fatigue
- Musculoskeletal pain
- Cognitive dysfunction
- Headache
- Cognitive complaints
- Arthralgias
- Myalgias
Diagnosis and Treatment
- Diagnosis is usually made clinically 5
- Treatment is accomplished with doxycycline or amoxicillin; cefuroxime axetil or erythromycin can be used as an alternative 5
- Oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease 6
- Cefuroxime and penicillin were safe for treating Lyme disease 6