Should patients who have persistent symptoms after standard treatment for Lyme disease be given long-term courses of antibiotics?
P.G. Auwerter (Clin Infect Dis. 2007; 45:143-148) believes that giving more antibiotics is not the answer to the later postinfection symptoms that include fatigue, musculoskeletal aches, and neurocognitive disorders. He objects to the term chronic Lyme disease that others use to describe the syndrome and cites similar late syndromes after Epstein Barr virus, Brucellosis, and viral hepatitis. Dr Auwerter does not believe in continued infection as the presence of the B burgdorferi cannot be demonstrated after it has been adequately treated with antibiotics.
R.B. Stricker in the same journal (149-157) argues that the infection continues in chronic form. He cites strong evidence from the laboratory for Borrelias ability to hide itself by causing immunosuppression, genetic, phase, and antigenic variation. With secreted factors, the spirochaete can remain obscure and difficult to detect. It therefore requires continued courses of antibiotics for complete elimination. He emphasizes the need to exclude other reasons for the chronic postinfection problems.
Over 18,000 papers have been published on Lyme disease, yet the jury is still out on persistent infection.
|Blue Notes Editor:|
Charles Sorbie, MB, ChB, FRCS(E), FRCS(C)
Dr. Charles Sorbie is Professor of Surgery at Queens University and a member of the Attending Staff at the General and Hotel Dieu Hospitals in Kingston, Ontario.
A former chairman of the Department of Surgery at Queens University, Dr. Sorbie has been President of the Canadian Orthopaedic Research Society, the Canadian Orthopaedic Association, and the Societé Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT).