Update of the Swiss guidelines on post-treatment Lyme disease syndrome.

Details

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State: Public
Version: Final published version
Serval ID
serval:BIB_8CFA6AB6E3C7
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Update of the Swiss guidelines on post-treatment Lyme disease syndrome.
Journal
Swiss medical weekly
Author(s)
Nemeth J., Bernasconi E., Heininger U., Abbas M., Nadal D., Strahm C., Erb S., Zimmerli S., Furrer H., Delaloye J., Kuntzer T., Altpeter E., Sturzenegger M., Weber R.
Working group(s)
For The Swiss Society For Infectious Diseases And The Swiss Society For Neurology
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
146
Pages
w14353
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: epublish
Abstract
Lyme borreliosis is caused by Borrelia burgdorferi sensu lato infection, which responds well to antibiotic therapy in the overwhelming majority of cases. However, despite adequate antibiotic treatment some patients report persisting symptoms which are commonly summarised as post-treatment Lyme disease syndrome (PTLDS). In 2005, the Swiss Society of Infectious Diseases published a case definition for PTLDS. We aimed to review the scientific literature with a special emphasis on the last 10 years, questioning whether the definitions from 2005 are still valid in the light of current knowledge. Furthermore, we describe the clinical history of infection with Borrelia burgdorferi sensu lato, the estimated prevalence of PTLDS, the possible pathogenesis of PTLDS, and treatment options with an emphasis on clinical studies. In summary, we were unable to find a scientific reason for modification of the PTLDS definitions published in 2005. Thus, the diagnostic criteria remain unchanged, namely documented clinical and laboratory evidence of previous infection with B. burgdorferi, a completed course of appropriate antibiotic therapy, symptoms including fatigue, arthralgia, myalgia, cognitive dysfunction or radicular pain persisting for >6 months, a plausible timely association between documented B. burgdorferi infection and onset of symptoms (i.e., persistent or recurrent symptoms that began within 6 months of completion of a recommended antibiotic therapy for early or late Lyme borreliosis), and exclusion of other somatic or psychiatric causes of symptoms. The main therapeutic options remain cognitive behavioural therapy and low-impact aerobic exercise programmes. Growing and unequivocal evidence confirms that prolonged or repeated antibiotic therapy for PTLDS is not beneficial, but potentially harmful and therefore contraindicated. The Guidelines of the Swiss Society of Infectious Diseases offer an evidence based, diagnostic and therapeutic framework for physicians caring for patients suffering from presumptive PTLDS in Switzerland.

Keywords
Anti-Bacterial Agents/therapeutic use, Borrelia burgdorferi, Coinfection, Counseling, Exercise, Fatigue/etiology, Humans, Inflammation Mediators/metabolism, Lyme Disease/complications, Lyme Disease/physiopathology, Lyme Disease/psychology, Lyme Disease/therapy, Mental Health, Pain/etiology, Practice Guidelines as Topic, Switzerland
Pubmed
Web of science
Open Access
Yes
Create date
12/12/2016 18:23
Last modification date
20/08/2019 14:51
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