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ILADS Lyme Disease Treatment Guidelines Summary

We are proud to offer the most up-to-date version of the Diagnostic Hints and Treatment Guidelines for Lyme and other Tick-Borne Illnesses, written by the world-renowned, Lyme-literate physician Dr. Joseph J. Burrascano Jr.

Basic Information about Lyme disease:
  1. Lyme disease is prevalent across the United States. Ticks do not know geographic boundaries. A patient's county of residence does not accurately reflect their total Lyme disease risk, since people travel, pets travel, and ticks travel. This creates a dynamic situation with many opportunities for exposure for each individual.

  2. Lyme disease is a clinical diagnosis. Spirochetal infection of multiple organ systems causes a wide range of symptoms. Familiarity with its varied presentations is key to recognizing disseminated Lyme disease. Case reports in the medical literature document its protean manifestations.

  3. Fewer than half of patients with Lyme disease recall a tick bite. In some studies this number is as low as 15% in culture-proven Lyme borrelial infection.

  4. Fewer than half of patients with Lyme disease recall any rash. Although the bull's eye presentation is considered classic, it is not the most common dermatologic manifestation of early-localized Lyme infection. Atypical forms of this rash are seen far more commonly. It is important to know that the Erythema Migrans rash is pathognomonic of Lyme disease and requires no further verification prior to starting 6 weeks of antibiotic therapy. Shorter treatment courses have resulted in upwards of a 40% relapse rate.

  5. There has never in the history of this illness been one study that proves even in the simplest way that 30 days of antibiotic treatment cures Lyme disease. However, there is a plethora of documentation in the US and European medical literature demonstrating histologically and in culture that short courses of antibiotic treatment fail to eradicate the Lyme spirochete.

  6. An uncomplicated case of chronic Lyme disease requires an average of 6-12 months of high-dose antibiotic therapy. The return of symptoms and evidence of the continued presence of Borrelia burgdorferi indicates the need for further treatment. The very real consequences of untreated chronic, persistent Lyme infection far outweigh the potential consequences of long-term antibiotic therapy.

  7. Many patients with Lyme disease require treatment for 1-4 years, or until the patient is symptom free. Relapses occur and maintenance antibiotics may be required. There are no tests available to assure us whether the organism is eradicated or the patient is cured.

  8. There are 5 subspecies of Borrelia burgdorferi, over 100 strains in the US, and 300 strains worldwide. This diversity is thought to contribute to Borrelia burgdorferi's antigenic variability and its various antibiotic resistances.

  9. Lyme disease is the latest great imitator and should be considered in the differential diagnosis of MS, ALS, seizure and other neurological conditions, as well as arthritis, CFS, gulf war syndrome, ADHD, hypochondriasis, fibromyalgia, somatization disorder and patients with various difficult-to-diagnose multi-system syndromes.

  10. Lyme is the number one tick-borne illness in the US. The CDC reports there are 24,000 new cases of Lyme disease in the US, but the CDC says that figure could be under reported by tenfold. ILADS believes newly diagnosed cases of Lyme may occur at a rate five times higher than the number of new AIDS cases. Chronic Lyme is reported in up to half of patients treated for Lyme.

  11. Symptomatic presentations of Lyme disease include:
    • Fatigue
    • Low grade fevers, "hot flashes" or chills
    • Night sweats
    • Sore throat
    • Swollen glands
    • Stiff neck
    • Migrating arthralgias, stiffness and frank arthritis
    • Myalgia
    • Chest pain and palpitations
    • Abdominal pain, nausea
    • Diarrhea
    • Sleep disturbance
    • Poor concentration and memory loss
    • Irritability and mood swings
    • Depression
    • Back pain
    • Blurred vision and eye pain
    • Jaw pain
    • Testicular/pelvic pain
    • Tinnitus
    • Vertigo
    • Cranial nerve disturbance (facial numbness, pain, tingling, palsy or optic neuritis)
    • Headaches
    • Lightheadedness
    • Dizziness
 
 
 
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