Lyme Disease: Acute and Chronic-Defined
Samuel M Shor, MD
Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease.
Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories,
- CLD, untreated (CLD-U)
- CLD, previously treated (CLD-PT)
The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more.
Methods: Systematic review of over 250 peer reviewed papers in the international literature to characterize the clinical spectrum of CLD-U and CLD-PT.
Conclusion: This evidence-based definition of chronic Lyme disease clarifies the term’s meaning and the literature review validates that chronic and ongoing Bbsl infections can result in chronic disease.
Use of this CLD definition will promote a better understanding of the infection and facilitate future research of this infection.
This, right here, is a main difference between what mainstream medicine ascribes to and what a Lyme literate doctor ascribes to. The difference is life-changing to say the least. Those in the former camp will treat patients with the woefully inadequate 21 days of doxycycline while the latter camp realizes this illness can wax, wane, and linger – and this isn’t even taking into account the many coinfections that can also wax, wane, and linger.
If patients have numerous persisting infections they have more severe cases for a longer duration of time, requiring numerous medications for far longer than the unscientific CDC Lyme guidelines.
http:// Approx. 42 Min.
Sept. 30, 2020
It Ain’t Just One Thing
David Kaufman, MD; Ilene Ruhoy, MD, PhD
Chronic Lyme Disease (CLD) is a complex chronic illness. Controversy exists regarding whether it represents persistent Lyme infection or a post-infectious, possibly autoimmune syndrome, or a combination of both. This is an important topic as a greater understanding of CLD can help guide treatment options for these patients who suffer sometimes for decades and are often turned away from healthcare providers. Effective treatment has been notoriously difficult. Importantly, patients with CLD generally meet all the criteria for a diagnosis of ME/CFS. Interestingly as discussed below, these same patients very often present with similar signs, symptoms, and diagnoses that are seen in a large majority of ME/CFS patients regardless of any history of CLD.
We will discuss the diagnostic concept of a Septad which includes:
- Autoimmune disease
- Mast Cell Activation Syndrome
- Dysautonomia including small and large fiber neuropathy
- hypermobility Ehler Danlos Syndrome (hEDS)
- Cranial Cervical Instability (CCI)/Tethered Cord (TC)
- Infection including especially tick borne diseases, viral reactivation, and mycoplasma
The Septad concept provides a guide for both physician and patient regarding both the work up and the treatment plans. The identification of these particular entities can be made with objective data and can assist physicians in implementing management options. This presentation will briefly discuss each of these disorders including symptoms, evaluation, and possible treatment suggestions.