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

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BORIS DOI
10.7892/boris.91218
Date of Publication
2016
Publication Type
Article
Division/Institute

Universitätsklinik fü...

Universitätsklinik fü...

Author
Nemeth, Johannes
Bernasconi, Enos
Heininger, Ulrich
Abbas, Mohamed
Nadal, David
Strahm, Carol
Erb, Stefan
Zimmerli, Stephan
Universitätsklinik für Infektiologie
Furrer, Hansjakoborcid-logo
Universitätsklinik für Infektiologie
Delaloye, Julie
Kuntzer, Thierry
Altpeter, Ekkehard
Sturzenegger, Matthias
Universitätsklinik für Neurologie
Weber, Rainer
Subject(s)

600 - Technology::610...

Series
Swiss medical weekly
ISSN or ISBN (if monograph)
1424-7860
Publisher
EMH Schweizerischer Ärzteverlag
Language
English
Publisher DOI
10.4414/smw.2016.14353
PubMed ID
27922168
Description
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.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/147016
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