What is Lyme Disease?
Lyme disease (LD) is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete (pronounced spy-ro-keet) that is carried by deer ticks (Click here for pictures of deer ticks). An infected tick can transmit the spirochete to the humans and animals it bites. Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe. Often, an erythema migrans (EM) rash appears within 7-14 days at the site of a tick bite (click to see picture of a typical EM rash). LD manifests itself as a multisystem inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later, disseminated stages. If diagnosed and treated early with antibiotics, LD is almost always readily cured. Generally, LD in its later stages can also be treated effectively, but because the rate of disease progression and individual response to treatment varies from one patient to the next, some patients may have symptoms that linger for months or even years following treatment. In rare instances, LD may cause permanent damage.
Although LD is now the most common arthropod-borne illness in the U.S. (more than 150,000 cases have been reported to the Centers for Disease Control and Prevention [CDC] since 1982), its diagnosis and treatment can be challenging for clinicians due to its diverse manifestations and the limitations of currently available serological (blood) tests. The prevalence of LD in the northeast and upper mid-west is due to the presence of large numbers of the deer tick’s preferred hosts – white-footed mice and deer – and their proximity to humans. White-footed mice serve as the principal “reservoirs of infection” on which many larval and nymphal (juvenile) ticks feed and become infected with the LD spirochete. An infected tick can then transmit infection the next time it feeds on another host (e.g., an unsuspecting human).

Borrelia burdgorferi
The LD spirochete, Borrelia burgdorferi, infects other species of ticks but is known to be transmitted to humans and other animals only by the deer tick (also known as the black-legged tick) and the related Western black-legged tick. Studies have shown that an infected tick normally cannot begin transmitting the spirochete until it has been attached to its host about 36-48 hours; the best line of defense against LD, therefore, is to examine yourself at least once daily and remove any ticks before they become engorged (swollen) with blood. Generally, if you discover a deer tick attached to your skin that has not yet become engorged, it has not been there long enough to transmit the LD spirochete. Nevertheless, it is advisable to be alert in case any symptoms do appear; a red rash (especially surrounding the tick bite), flu-like symptoms, or joint pains in the first month following any deer tick bite could signal the onset of LD. Manifestations of what we now call Lyme disease were first reported in medical literature in Europe in 1883. Over the years, various clinical signs of this illness have been noted as separate medical conditions: acrodermatitis, chronica atrophicans (ACA), lymphadenosis benigna cutis (LABC), erythema migrans (EM), and lymphocytic meningradiculitis (Bannwarth’s syndrome). However, these diverse manifestations were not recognized as indicators of a single infectious illness until 1975, when LD was described following an outbreak of apparent juvenile arthritis, preceded by a rash, among residents of Lyme, Connecticut.
Where is Lyme Disease Prevalent?
LD is spreading slowly along and inland from the upper east coast, as well as in the upper midwest. The mode of spread is not entirely clear and is probably due to a number of factors such as bird migration, mobility of deer and other large mammals, and infected ticks dropping off of pets as people travel around the country. It is also prevalent in northern California and Oregon coast, but there is little evidence of spread. In order to assess LD risk you should know whether infected deer ticks are active in your area or in places you may visit. The population density and percentage of infected ticks that may transmit LD vary markedly from one region of the country to another. There is even great variation from county to county within a state and from area to area within a county. For example, less than 5% of adult ticks south of Maryland are infected with B. burgdorferi, while up to 50% are infected in hyperendemic areas (areas with a high tick infection rate) of the northeast. The tick infection rate in Pacific coastal states is between 2% and 4%.
Recent Tick Surveillance Data
Lyme Disease Incidence Rates for 2002-2019, Global, United States, and Canada (Johns Hopkins Bloomberg School of Public Health)
Symptoms of Lyme Disease
The spirochetal agent of Lyme disease, Borrelia burgdoferi, is transmitted to humans through a bite of a nymphal stage deer tick Ixodes scapularis (or Ixodes pacificus on the West Coast). The duration of tick attachment and feeding is a key factor in transmission. Proper identification of tick species and feeding duration aids in determining the probability of infection and the risk of developing Lyme disease. Spirochete transmission poster: how long has that tick been feeding on you? The early symptoms of LD can be mild and easily overlooked. People who are aware of the risk of LD in their communities and who do not ignore the sometimes subtle early symptoms are most likely to seek medical attention and treatment early enough to be assured of a full recovery.

The first symptom is usually an expanding rash (called erythema migrans, or EM, in medical terms) which is thought to occur in 80% to 90% of all LD cases. An EM rash generally has the following characteristics:
- Usually (but not always) radiates from the site of the tickbite
- Appears either as a solid red expanding rash or blotch, OR a central spot surrounded by clear skin that is in turn ringed by an expanding red rash (looks like a bull’s-eye)
- Appears an average of 1 to 2 weeks (range = 3 to 30 days) after disease transmission
- Has an average diameter of 5 to 6 inches (range = 2 inches to 2 feet)
- Persists for about 3 to 5 weeks
- May or may not be warm to the touch
- Is usually not painful or itchy
EM rashes appearing on brown-skinned or sun-tanned patients may be more difficult to identify because of decreased contrast between light-skinned tones and the red rash. A dark, bruise-like appearance is more common on dark-skinned patients. Ticks will attach anywhere on the body, but prefer body creases such as the armpit, groin, back of the knee, and nape of the neck; rashes will therefore often appear in (but are not restricted to) these areas. Please note that multiple rashes may, in some cases, appear elsewhere on the body sometime after the initial rash, or, in a few cases, in the absence of an initial rash. Around the time the rash appears, other symptoms such as joint pains, chills, fever, and fatigue are common, but they may not seem serious enough to require medical attention. These symptoms may be brief, only to recur as a broader spectrum of symptoms as the disease progresses. As the LD spirochete continues spreading through the body, a number of other symptoms including severe fatigue, a stiff, aching neck, and peripheral nervous system (PNS) involvement such as tingling or numbness in the extremities or facial palsy (paralysis) can occur. The more severe, potentially debilitating symptoms of later-stage LD may occur weeks, months, or, in a few cases, years after a tick bite. These can include severe headaches, painful arthritis and swelling of joints, cardiac abnormalities, and central nervous system (CNS) involvement leading to cognitive (mental) disorders. The following is a checklist of common symptoms seen in various stages of LD: Localized Early (Acute) Stage:
- Solid red or bull’s-eye rash, usually at site of bite
- Swelling of lymph glands near tick bite
- Generalized achiness
- Headache
Early Disseminated Stage:
- Two or more rashes not at site of bite
- Migrating pains in joints/tendons
- Headache
- Stiff, aching neck
- Facial palsy (facial paralysis similar to Bell’s palsy)
- Tingling or numbness in extremities
- Multiple enlarged lymph glands
- Abnormal pulse
- Sore throat
- Changes in vision
- Fever of 100 to 102 F
- Severe fatigue
Late Stage:
- Arthritis (pain/swelling) of one or two large joints
- Disabling neurological disorders (disorientation; confusion; dizziness; short-term memory loss; inability to concentrate, finish sentences or follow conversations; mental “fog”)
- Numbness in arms/hands or legs/feet
Diagnosis of Lyme Disease
If you think you have LD symptoms you should see your physician immediately. The EM rash, which may occur in up to 90% of the reported cases, is a specific feature of LD, and treatment should begin immediately. Even in the absence of an EM rash, diagnosis of early LD should be made on the basis of symptoms and evidence of a tick bite, not blood tests, which can often give false results if performed in the first month after initial infection (later on, the tests are more reliable). If you live in an endemic area, have symptoms consistent with early LD and suspect recent exposure to a tick, present your suspicion to your doctor so that he or she may make a more informed diagnosis. If early symptoms are undetected or ignored, you may develop more severe symptoms weeks, months or perhaps years after you were infected. In this case, the CDC recommends using the ELISA and Western-blot blood tests to determine whether you are infected. These tests, as noted above, are considered more reliable and accurate when performed at least a month after initial infection, although no test is 100% accurate. If you have neurological symptoms or swollen joints your doctor may, in addition, recommend a PCR (Polymerase Chain Reaction) test via a spinal tap or withdrawal of synovial fluid from an affected joint. This test amplifies the DNA of the spirochete and will usually indicate its presence. Issues and Insights Related to the Diagnosis of Lyme Disease:
- Use of Host Lipids by the Lyme Disease Spirochete May Lead to Biomarkers
- Antiphospholipid Autoantibodies in Lyme Disease Arise After Scavenging of Host Phospholipids by Borrelia burgdorferi
- Misdiagnosis of Lyme Disease: When not to Order Serologic Tests
- Executive Summary: 2nd Banbury Conference on the Laboratory Diagnosis of Lyme Disease
- Straight Talk About the Diagnosis of Lyme Disease
- Natural Killer Cell Counts are not Different Between Patients with Post-Lyme Disease Syndrome and Controls
- Comprehensive Seroprofiling of 16 B. burgdoreferi OspCs: Implications for Lyme Disease Diagnostics Design
- The Laboratory Diagnosis of Lyme Borreliosis: Guidelines from the Canadian Public Health Laboratory Network
- Two-tiered Antibody Testing for Early and Late Lyme Disease, Using an Immunoglobulin G Blot with the Addition of a VlsE Band in the Second Tier: a Rapid, Simple, Quantitative and Highly Sensitive Serological Test for Lyme Disease
- CDC Issues Cautions Regarding Testing for Lyme Disease —
- BBK07 Immunodominant Peptides as Serodiagnostic Markers of Lyme Disease
- Misdiagnosis of Late Lyme Arthritis by Inappropriate Use of Synovial Fluid in Borrelia burgdorferi Immunoblot Testing
- Single-tier Testing with the C6 Peptide ELISA Kit Compared with Two-tier Testing for Lyme Disease
- High Frequency of False Positive IgM Immunoblots for Borrelia burgdoreferi in Clinical Practice
- CXCL13 May Improve Diagnosis of Early Neuroborreliosis with Atypical Laboratory Findings: a Case Report
- The Nervous System as an Ectopic Germinal Center: CXCL13 and IgG in Lyme Neuroborreliosis
- An Outer Surface Protein C (OspC) Peptide Derived from Borrelia burgdorferi sensu stricto as a Target for the Serodiagnosis of Early Lyme Disease
- Laboratory Diagnostic Testing for Borrelia burgdorferi Infection
- Performance of United States Serologic Assays in the Diagnosis of Lyme Borreliosis Acquired from Europe
- Identification of OppA2 Linear Epitopes as Serodiagnostic Markers for Lyme Disease
- U.S. Healthcare Providers’ Experience with Lyme Disease and Other Tick-borne Diseases
- A Concise Critical Analysis of Serologic Testing for the Diagnosis of Lyme Disease
- Development of a Metabolic Biosignature for the Detection of Early Lyme Disease
- Lyme Disease Diagnosed by Alternative Methods: a Common Phenotype with Chronic Fatigue Syndrome
- Understanding Antibody-based Diagnostic Tests for Lyme Disease
- Testing Patients with Nonspecific Symptoms for Antibodies against Borelia burgdorferi sensu lato does not Provide Useful Clinical Information About Their Etiology
- Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence.
- The Positive Predictive Value of Lyme ELISA for the Diagnosis of Lyme Disease in Children
- Lyme Disease Diagnosed by Alternative Methods: a Phenotype Similar to that of Chronic Fatigue Syndrome
- Development of a Multi-antigen Panel for Improved Detection of Borrelia burgdorferi Infection in Early Lyme Disease
- Testing Practices and Volume of Non-Lyme Tickborne Diseases in the United States
- Lyme Disease Diagnosis and Serology
- New Serological Test Proposed for the Diagnosis of Infection caused by Borrelia myomotoi
- False Positive Lyme Disease IgM Immunoblots in Children
- Current Guidelines, Common Clinical Pitfalls, and Future Directions for the Laboratory Diagnosis of Lyme Disease, United States.
- Comparison of Males versus Females with Culture-confirmed Early Lyme Disease at Presentation and at 11-20 Years after Diagnosis
- Detection of Borrelia burgdorferi Nucleic Acids after Antibiotic Therapy does not Confirm Viability
- Evaluation of Modified 2-tiered Serodiagnostic Testing Algorithms for Early Lyme Disease
- Metabolic Differentiation of Early Lyme Disease from Southern Tick-associated Rash Illness (STARI)
- High Volume of Lyme Disease Laboratory Reporting in a Low-incidence State- Arkansas, 2015-2016
- Seroreactivity to the C6 Peptide in Borrelia miyamotoi Infections Occurring in the Northeastern United States
- Diagnosis of Lyme Disease
- Evaluation of Modified Two-Tiered Algorithms for Lyme Disease Laboratory Diagnosis Using Well-Characterized Serum Samples
- Limitation and Confusing Aspects of Diagnostic Testing for Neurologic Lyme Disease in the United States.
- Is it Possible to Make a Correct Diagnosis of Lyme Disease on Symptoms Alone? Review of Key Issues and Public Health Implications
- FDA clears new indications for existing Lyme disease tests that may help streamline diagnosis
- Misdiagnosis of Lyme Disease with Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic
- Evaluation of the modified two-tiered testing (MTTT) method in children
- The Lyme Disease Polymerase Chain Reaction Test Has Low Sensitivity
Updates and Recent Reports
- Concerns Regarding a New Culture Method for Borrelia burgdorferi not Approved for the Diagnosis of Lyme Disease
- A Critical Assessment of the New Culture Test for the Diagnosis of Lyme Disease
- Several U.S. Senators Request Expedited Release of Draft Guidelines by the FDA on Regulation of Laboratory Developed Tests (LDTs)
Announcements from the FDA and CDC on the Diagnosis of Lyme Disease
- FDA-approved Diagnostic Tests
- Updated CDC Recommendation for the Serologic Diagnosis of Lyme Disease
Treatment Guidelines
Recommended courses and duration of treatment for both early and late Lyme symptoms are shown in our Table of Recommended Antibiotics and Dosages (see also table footnotes). Early treatment of LD (within the first few weeks after initial infection) is straightforward and almost always results in a full cure. Treatment begun after the first three weeks will also likely provide a cure, but the cure rate decreases the longer treatment is delayed. Doxycycline, amoxicillin and ceftin are the three oral antibiotics most highly recommended for treatment of all but a few symptoms of LD. A recent study of Lyme arthritis in the New England Journal of Medicine indicates that a four-week course of oral doxycycline is just as effective in treating late LD, and much less expensive, than a similar course of intravenous Ceftriaxone (Rocephin) unless neurological or severe cardiac abnormalities are present. If these symptoms are present, the study recommends immediate intravenous (IV) treatment. Treatment of late-Lyme patients can be more complicated. Usually LD in its later stages can be treated effectively, but individual variation in the rate of disease progression and response to treatment may, in some cases, render standard antibiotic treatment regimens ineffective. In a small percentage of late-Lyme patients, the disease may persist for many months or even years. These patients will experience slow improvement and resolution of their persisting symptoms following oral or IV treatment that eliminated the infection. Although treatment approaches for patients with late-stage LD have become a matter of considerable debate, many physicians and the Infectious Disease Society of America recognize that, in some cases, several courses of either oral or IV (depending on the symptoms presented) antibiotic treatment may be indicated. However, long-term IV treatment courses (longer than the recommended 4-6 weeks) are not usually advised due to adverse side effects. While there is some speculation that long-term courses may be more effective than the recommended 4-6 weeks, there is currently no scientific evidence to support this assertion. Click here for an article from the New England Journal of Medicine which presents clinical recommendations in the treatment and prevention of early Lyme disease.
More Information on Treatment Guidelines
- The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines
- Practice Parameter: Treatment of Nervous System Lyme Disease (an Evidence-based review) : Report of the Quality Standards Subcommittee of the American Academy of Neurology
- The Laboratory Diagnosis of Lyme Borreliosis: Guidelines from the Canadian Public Health Laboratory Network
- Recommendations for Diagnosis and Treatment of Lyme Borreliosis: Guidelines and Consensus from Specialist Societies and Expert Groups in Europe and North America
- EFNS Guidelines on the Diagnosis and Management of European Lyme Neuroborreliosis
- Infectious Diseases Society of America’s Recommendations on the Treatment of Lyme Disease Unanimously Approved by an Independent Review Panel
- Endorsement of IDSA Guidelines on Lyme Disease by the Association of Medical Microbiology and Infectious Disease (AMMI), Canada –Link it to this page and have it open in another window
- Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: a Review (2016)
- Update of the Swiss guidelines on post-treatment Lyme disease syndrome
- Why does the CDC only link to one set of treatment guidelines?
- Cutaneous Lyme Borreliosis: Guideline for the German Dermatological Society
- Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease
Dangers of Long-Term Antibiotic Treatment for Lyme Disease.
- Death From Inappropriate Therapy for Lyme Disease
- Death Due to Community-associated Clostridium difficile in a Woman Receiving Prolonged Antibiotic Therapy for Lyme Disease
- A case of Mycobacterium goodie infection related to an indwelling catheter placed for the treatment of chronic symptoms attributed to Lyme disease
- Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Lyme Disease – United States.
- Neoplasms Misdiagnosed as “Chronic Lyme Disease”
- Ceftriaxone-Induced Immune Hemolytic Anemia as a Life-Threatening Complication of Antibiotic Treatment of “Chronic Lyme Disease”.
- Biliary Complications in the Treatment of Unsubstantiated Lyme Disease
- Ceftriaxone-Associated Biliary Complications of Treatment of Suspected Disseminated Lyme Disease- New Jersey, 1990-1992
- Adverse Events Associated with Antibiotics and Intravenous Therapies for Post-Lyme Disease Syndrome in a Commercially Insured Sample
- Life Threatening Complications of Empiric Ceftriaxone Therapy for “Sero-Negative Lyme Disease”
Current Clinical Studies
- Current Clinical Studies on Lyme Disease Sponsored by the National Institutes of Health
- Neurological Complications of Lyme Disease
- Chronic Pain
- Cognitive impairments in patients with persistent symptoms attributed to Lyme disease.
- Prospective Evaluation of the Frequency and Severity of Symptoms in Lyme Disease Patients with Erythema Migrans Compared with Matched Controls at Baseline, 6 Months and 12 Months
- Pediatric Lyme Disease Biobank, United States, 2015-2020
NIAID Clinical Trials
Two Controlled Trials of Antibiotic Treatment in Patients with Persistent Symptoms and a History of Lyme Disease ( The above clinical trials were conducted under the following protocols that were approved by the NIAID Clinical Studies Group, the Institutional Review Board, the NIAID Biostatistics Group, and the Food and Drug Administration (FDA) before the trails were conducted. To ensure complete compliance with the protocols, all procedures associated with the trials were carefully monitored by an independent Data Safety and Monitoring Board (DSMB) that included several distinguished biostatisticians. Note that the protocols stipulated that an interim statistical analysis be performed when 100 subjects have been enrolled.)
- Clinical Protocol for the Seropositive Arm of the Trial
- Clinical Protocol for the Seronegative Arm of the Trail
Research and Clinical Studies
- Lyme Neuroborreliosis: Known Knowns, Known Unknowns
- Lyme neuroborreliosis in Children: a Prospective Study of Clinical Features, Prognosis , and Outcome
- Lyme borreliosis: a European Perspective on Diagnosis and Clinical Management
- Antibiotic Treatment of Animals Infected with Borrelia burgdorferi
- Lyme Disease: Current State of Knowledge
- Lyme Disease in Pregnancy: Case Report and Review of the Literature
- Lyme Disease Serology in Amylotrophic lateral sclerosis (ALS
- Editor’s Note: Since ceftriaxone has been reported to have profound neuroprotective effects (Nature 433: 73-77, 2005) and is often used to treat Lyme disease with neurological complications, clinical studies are now in progress to assess its efficacy in the treatment of ALS.
- Antibiotic Treatment Duration and Long-term Outcomes of Patients with Early Lyme Disease from a Lyme Disease –Hyperendemic Area
- Efficacy of Antibiotic Prophylaxis for the Prevention of Lyme Disease: an Updated systemic Review and Meta-Analysis
- Neurological Manifestations of Lyme Disease
- A Case Revealing the Natural History of Untreated Lyme Disease ( Although the data are not shown in the publication, the author confirms that the IgG Western blot was positive by the CDC criteria and showed the presence of 21,28,30,39,41,45,58,66, and 93 kDa bands. )
- Long-term Lyme Disease Antibiotic Therapy Beliefs Among New England Residents
- On-going and Completed NIH-supported Clinical Trials on Lyme Disease
- Musculoskeletal Features of Lyme Disease: Understanding the Pathogenesis of Clinical Findings Helps Make Appropriate Therapeutic Choices
- Biodiversity of Borrelia burgdorferi Strains in Tissues of Lyme Disease Patients
- Lyme Borreliosis
- The Amber Theory of Lyme Arthritis: Initial Description and Clinical
- The Nervous System as Ectopic Germinal Center: CXCL13 and IgG in Lyme Neuroborreliosis
- A Critical Analysis of Treatment Trials of Rhesus macaques Infected with Borrelia burgdorferi Reveals Important Flaws in Experimental Design
- Spirochete Antigens Persist Near Cartilage after Murine Borreliosis
- A Novel Human Autoantigen, Endothelial Growth Factor, is a Target of T and B Cell Responses in Patients with Lyme Disease
- Lyme Disease-Human Granulocytic Anaplasmosis Co-Infection-Impact of Case Definition on Co-Infected Rates and Illness
- Differentiation of Reinfection from Relapse in Recurrent Lyme Disease
- Detection of Borrelia burgdorferi Nucleic Acids after Antibiotic Treatment does not Confirm Viability
- Reductions in Human Lyme Disease Risk Due to the Effects of Oral Vaccination on Tick-to-Mouse and Mouse-to-Tick Transmission
- Common Misconceptions about Lyme Disease
- Nervous System Lyme Disease: Diagnosis and Treatment
- Borrelia burgdorferi BbHtrA Degrades Host ECM Proteins and Stimulates Release of Inflammatory Cytokines in Vitro
- Non-viable Borrelia burgdorferi Induce Inflammatory Mediators and Apoptosis in Human Oligodendrocytes
- A Systematic Review of Borrelia burgdorferi Morphologic Variants does not Support a Role in Chronic Lyme Disease
- Evidence for Strain-specific Immunity in Patients Treated for Early Lyme Disease
- Functional Outcomes in Patients with Borrelia burgdorferi Reinfection
- Xenodiagnsosis to Detect Borrelia burgdorferi Infection: a First-in-human Study —
- The Role of Eocosanoids in Experimental Lyme Arthritis
- Oral Doxycycline for Lyme Neuroborreliosis with Symptoms of Encephalitis,, myelitis, Vasculitis, or Intracranial Hypertension
- Natural Killer Cell Counts are not Different Between Patients with Post-Lyme Disease Syndrome and Controls
- Implications of Gender in Chronic Lyme Disease
- Ceftriaxone-induced Hemolysis in a Child with Lyme Arthritis: a case for Antimicrobial Stewardship
- Sympathetic Neural Hyperalgesia Edema Syndrome, a Frequent Cause of Pelvic Pain in Women, Mistaken for Lyme Disease with Chronic Fatigue
- Views and Facts About Chronic Lyme Disease from the National Institute of Allergy and Infectious Diseases (NIAID)
- Immune hemolytic anemia as a life-threatening complication of extended antibiotic therapy for “chronic Lyme disease’
- Insights into Borrelia miyamotoi infection
- Fatigue in patients with erythema migrans
- Neuroboreliosis
- Clinical Relevance of Borrelia burgdorferi persisters
- Clinical Association: Lyme Disease and Guillian-Barre Syndrome
- Borrelia Infection and Risk of Celiac Disease
- Oral management for pediatric Lyme meningitis
- Borrelia miyamotoi : an emerging tick-borne pathogen
- Internet-based self-diagnosis of Lyme disease caused death of a young woman with systemic lupus erythematosus
- Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in those Without Evidence of Lyme Disease
- Lyme Borreliosis and Depressive Symptoms in Patients Aged 65 Years and Older Referred to a Tertiary Lyme Center
- Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis.
- Evaluation of the clinical relevance of vancomycin for the treatment of Lyme disease.
- Global Transcriptome Analysis Identifies a Diagnostic Signature for Early Disseminated Lyme Disease and its Resolution
How to Evaluate the Claims About Cures and Treatments for Long-term, Chronic Conditions
“I Don’t Know What to Believe…”
Studies on Chronic Lyme Disease Syndromes
- Neuropathogenicity of Non-Viable Borrelia burgdorferi ex vivo
- Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease
- Post-Treatment Lyme Disease Syndrome
- Chronic Lyme Disease: in Defense of the Scientific Enterprise
- Chronic Lyme Disease: a Dubious Diagnosis
- Chronic Lyme disease: misconceptions and challenges for patient management
- Chronic Lyme Disease and other Medically Unexplained Syndromes
- A Critical Appraisal of Chronic Lyme Disease
- Dispelling the Chronic Lyme Disease Myth
- Perspectives on Chronic Lyme Disease
- Psychiatric Co-morbidity and Other Psychological Factors in Patients with “Chronic Lyme Disease”
- Subjective Symptoms after Treatment of Early Lyme Disease
- Anti-neural Antibody Reactivity in Patients with a History of Lyme Borreliosis
- Chronic Lyme Disease: the Controversies and the Science
- The Pain of Chronic Lyme Disease: Moving the Discourse in a different Direction
- Chronic Lyme Disease
- Chronic Lyme: Diagnostic and Therapeutic Challenges
- Neoplasms Misdiagnosed a “chronic Lyme Disease”
- Long-term Assessment of Fibromyalgia in Patients with Culture-confirmed Lyme Disease
- Long-term Assessment of Fatigue in Patients with Culture-confirmed Lyme Disease
- Long-term Assessment of Post-Treatment Symptoms in Patients with Culture-Confirmed Early Lyme Disease.
- Quality of life, fatigue, depression, and cognitive impairment in Lyme neuroborreliosis
- Long-term assessment of health-related quality of life in patients with culture-confirmed early Lyme disease.
- Nervous system Lyme disease, chronic Lyme disease, and none of the above
- NIH takes action to bolster research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
- Causes of neuropathy in patients referred a “idiopathic neuropathy”.
- No geographic correlation between Lyme disease and death due to 4 neurodegenerative disorders, United States, 2001-2010
- Association of immune response to endothelial cell growth factor with early disseminated and late manifestations of Lyme disease, but not post-treatment Lyme disease syndrome
- Can human B cell responses to Borrelia burgdorferi VlsE protein be used as a biological marker for distinguishing early to late stages of Lyme disease?
- Longitudinal transcriptome analysis reveals a sustained differential gene expression signature in patients treated for acute Lyme disease
- Comorbid conditions can influence the overall quality of life of patients with post-treatment Lyme disease symptoms.
- Claims-based diagnostic patterns of patients evaluated for Lyme disease and given extended antibiotic therapy
- Adverse events associated with antibiotics and intravenous therapies for post-Lyme disease syndrome in a commercially insured sample
- Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis
- Posttreatment Lyme disease syndromes: distinct pathogenesis caused by maladaptive host response
- A Distinct Microbiome Signature in Posttreatment Lyme Disease Patients
News Articles and Commentaries
- Doctors and Others Indicted in Lyme Disease Case Ticks Aren’t the Only Parasites Living Off Patients in Borreliosis-prone Areas
- Lyme Disease in pregnancy: case report and review of the literature
- Four Patients Falsely Diagnosed with Lyme Disease win Verdicts Totaling $30 Million
- Unorthodox Alternative Therapies Marketed to Treat Lyme Disease
- New Insights into the Tyrolean Iceman’s Origin and Phenotype as Inferred by Whole-Genome Sequencing
- Confronting the Misnomer of Chronic Lyme Disease.
- Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease – United States.
- More Political Science: Proposed laws protect “Lyme literate” doctors from discipline
Peer-Reviewed Scientific Publications
- Misconceptions About Lyme Disease: Confusion Hiding Behind Ill-chosen Terminology
- Practice Parameter: Treatment of Nervous System Lyme Disease (an Evidence-Based Review
- Bullying Borrelia: When the Culture of Science is Under Attack
Clinical Trials on the Efficacy of Extended Antibiotic Therapy
Two Controlled Trials of Antibiotic Treatment in Patients with Persistent Symptoms and a History of Lyme Disease ( The above clinical trials were conducted under the following protocols that were approved by the NIAID Clinical Studies Group, the Institutional Review Board, the NIAID Biostatistics Group, and the Food and Drug Administration (FDA) before the trails were conducted. To ensure complete compliance with the protocols, all procedures associated with the trials were carefully monitored by an independent Data Safety and Monitoring Board (DSMB) that included several distinguished biostatisticians. Note that the protocols stipulated that an interim statistical analysis be performed when 100 subjects have been enrolled.)
- Clinical Protocol for the Seropositive Arm of the Trial
- Clinical Protocol for the Seronegative Arm of the Trail
- Study and Treatment of Post Lyme Disease (STOP-LD) : a Randomized Double Masked Clinical
- Cognitive Function in Post-treatment Lyme Disease: Do Additional Antibiotics Help?
- NA Randomized, Placebo-controlled Trial of repeated IV Antibiotic Therapy for Lyme Encephalopathy
- Treatment Trials for Post-Lyme Disease Symptoms Revisited
- Randomized trial of longer-term therapy for symptoms attributed to Lyme disease
- Time for a different approach to Lyme disease and long-term symptoms (For additional perspective on this important issue, see “The Pain of Chronic Lyme Disease: Moving the Discourse in a Different Direction“)
Lyme Disease and Co-Infections
- Chronic Co-infections in Patients with Chronic Lyme Disease: A Systematic Review
- There is no Published Evidence Supporting the Diagnosis of Chronic Lyme Disease, Atypical Tick-borne Co-infections in Patients Diagnosed with Chronic Lyme Disease
- The Results of European Studies Show That Patients with Early Lyme Disease are Rarely Co-infected with Other Tick-transmitted Agents
- Co-infections in Persons with Early Lyme Disease, New York, USA
- Microbiome analysis of Ixodes scapularis ticks from New York and Connecticut
Vaccines
- mRNA Vaccination Induces Tick Resistance and Prevents Transmission of the Lyme Disease Agent
- CDC Webinar on Vaccines for Lyme Disease, 2015
- Vaccines against Lyme disease: what happened and what lessons can we learn?
- Live-vaccinia virus encapsulation in pH-sensitive polymer increases safety of a reservoir-targeted Lyme disease vaccine by targeting gastrointestinal release
- Pre-exposure prophylaxis with OspA-specific human monoclonal antibodies protects mice against tick transmission of Lyme disease spirochetes
- It’s past time for a Lyme disease vaccine
- Can a New Lyme Disease Vaccine Overcome a History of Distrust and Failure?
- Field evaluation of a novel oral-reservoir-targeted vaccine against Borrelia burgdorferi utilizing an inactivated whole-cell bacterial antigen expression vehicle
- Blocking Borrelia burgdorferi transmission from infected ticks to nonhuman primates with a human monoclonal antibody
- The Two-Decade Delay in Lyme-Disease Vaccines
Antibiotics
- Popular Antibiotics May Carry Serious Side Effects
- Beta-lactam Antibiotics Offer Neuroprotection by Increasing Glutamate Transporter Expression
- Evaluation of the clinical relevance of vancomycin for the treatment of Lyme disease
Commentaries and Reviews on Lyme Disease
- Lyme Disease: the Great Controversy
- Autism-Lyme Correlation Debunked
- Nervous System Lyme Disease: Diagnosis and Treatment.
- An Open Letter to the Editors of the Poughkeepsie Journal: In Defense of the Scientific Enterprise
- Neoplasms Misdiagnosed as “Chronic Lyme Disease”
- Political Science: Chronic Lyme Disease
- Chronic Coinfections in Patients with Chronic Lyme Disease: a Systematic Review
- Ending the Lyme Disease Wars
- Chronic Lyme Disease: In Defense of the Scientific Enterprise
- The Pain of Chronic Lyme Disease: Moving the Discourse in a Different Direction
- What Do Experts Recommend about the Treatment of Lyme Disease?
- Borrelia burgdorferi vs Treponema pallidum- what’s in a name?
- Understanding Chronic Pain
- False and Misleading Information about Lyme Disease
- Lyme Disease (a 2017 review article)
- Critical analysis of a doxycycline treatment trial of rhesus macaques infected with Borrelia burgdorferi
- Discovery of the Lyme Disease Agent
- A neurologist’s view of Lyme disease and other tick-borne infections
- Challenges in the Diagnosis and Treatment of Lyme Disease
- Borrelia burgdorferi vs Treponema pallidum – what’s in a name?
- There is no published evidence supporting the diagnosis of chronic, atypical tick-borne co-infections in patients diagnosed with chronic Lyme disease.
- The results of European studies show that patients with early Lyme disease are rarely co-infected with other tick-transmitted agents.
- Understanding Chronic Pain
- Vaccines against Lyme disease: what happened and what lessons can we learn?
- Jarisch-Herxheimer and Lyme Disease
- There are 350 unrelated medical conditions with symptoms associated with those of Lyme disease.
- Lyme Disease in Humans
- Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes
- Lyme Disease Pathogenesis
- Human and Veterinary Vaccines for Lyme Disease
- Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes
- Host Transcriptome Response to Borrelia burgdorferi sensu lato
- Persistent Borrelia burgdorferi sensu lato Infection after Antibiotic Treatment: Systematic Overview and Appraisal of Current Evidence from Animal Models
From the Desk of the Executive Director
- Ending the Lyme Disease Wars
- Chronic Lyme Disease: in Defense of the Scientific Enterprise
- Lyme Borreliosis is not Sexually Transmitted
- The Pain of Chronic Lyme Disease: Moving the Discourse in a Different Direction
- What do the Experts Recommend about the Treatment of Lyme Disease?
- Understanding Antibody-based Diagnostic Tests for Lyme Disease
- The Media Must Exercise Greater Responsibility in Reporting Information on Lyme Disease
- Is there a need to conduct still more clinical trials on the benefit of extended antibiotic therapy for the treatment of persistent post-treatment symptoms of Lyme disease?
- Straight Talk About Chronic Lyme Disease
- Does Chronic Rocky Mountain Spotted Fever (RMSF) Exist?
- Light at the End of the Tunnel
- A Review of Antibiotic-Tolerant Persisters and Their Relevance to Post-Treatment Lyme Disease Symptoms
Misinformation on Lyme Disease
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- Does Lyme Disease cause either Alzheimer’s Disease or Lewy Body Dementia?
- Are antibiotic-tolerant persisters relevant to posttreatment Lyme disease symptoms?
- Does Borrelia burgdorferi produce a neurotoxin ?
- Did Lyme disease originate in the eastern U.S.from Borrelia burgdorferi-infected ticksthat escaped from a laboratory at the Plum Island Animal Disease Center where scientists were conducting top-secret biological warfare experiments ?
- Does Lyme disease occur in every State in the continental United States ?
- Is there an association between Lyme disease and certain neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson’s disease?
- Does Lyme disease induce autism in children ?
- Is Lyme disease sexually transmitted ?
- Does Lyme disease affect the brain and nervous system ?
- Are serological tests of any value in the diagnosis of Lyme disease ?
- Can Lyme disease be transmitted to humans by mosquitoes, horse flies, and deer flies ?
- Is it Possible to Make a Valid Diagnosis of Lyme Disease Based on Symptoms Alone ?
- Combating Lyme disease myths and the “chronic Lyme industry”
- Do Borrelia burgdorferi form cysts that protect them from being attacked and eliminated by antibiotics and host immune defense mechanisms ?
Quiz on Lyme Disease
Lyme Disease Stories
- Stories from the CDC website
- Lyme Science: Because Patients Deserve Better
- Maybe It’s Lyme
- Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease- United States
- Lyme Science: Patients Deserve Better Treatment
Unorthodox Treatments Being Promoted to Treat Lyme Disease
Readers should note that there is no published, peer-reviewed evidence to indicate that any of the treatments presented in this incomplete listing is beneficial for the treatment of Lyme disease and/or “chronic Lyme disease”. In fact, some of them may even be unsafe when used a prescribed. Consequently, the reader is urged to demand to see documented evidence of their benefit before even considering their use. This listing in no way implies endorsement by the American Lyme Disease Foundation.
- Ozone Therapy
- Ultraviolet Blood Irradiation Therapy
- Cold Laser Therapy
- Rife Machines
- Sauna detox Therapy
- Heavy Metal Chelation
- Colloidal Silver Therapy
- Neurotoxin Elimination
- Natural Remedies for the Treatment of Lyme Disease
- Coffee Enemas
Informative Videos and Websites About Lyme Disease
- How Should Clinician Manage Patients with Chronic Lyme Disease?”
- Chronic Lyme Disease Video
- Tufts University Lyme Disease Initiative
- Centers for Disease Prevention and Control (CDC): Lyme Disease
- National Institute of Allergy and Infectious Diseases (NIAID): Lyme Disease
Please note that the ALDF does not sell or distribute the 4-poster bait system. For additional information please contact: Dandux Outdoors 3451 Ellicott Center Drive Ellicott City, MD 21043 Phone: 800-933-2638 (extension: #481) FAX: 410-461-2987 E-mail: info@crdaniels.com–>