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Lyme disease has become a major concern in endemic areas, in large measure because
of fears that it does not respond to current antibiotic regimens. This anxiety has
led to the use of untested drugs and longer courses of therapy than have been demonstrated
to be necessary, with attendant increase in cost and toxicity. Concern about the lack
of response to such therapy has convinced many patients that they have a permanent
disease, with profound effects on their lives and those of their families. A better
understanding of the natural history of Lyme disease and of possible causes for persisting
symptoms other than active infection is needed to optimize management of such patients.
Most symptoms persisting after adequate therapy can be explained by a small number
of pathogenic mechanisms, only one of which is ongoing infection. Individualization
of care and prudent analysis are crucial if overdiagnosis and overtreatment of Lyme
disease are to be avoided.
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References
- Experience with the first one hundred patients referred to a Lyme disease referral center.Am J Med. 1990; 88: 577-581
- “Chronic Lyme disease” as the incorrect diagnosis in patients with fibromyalgia.Arthritis Rheum. 1993; 36: 1493-1500
- Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia.Pediatrics. 1992; 90: 523-528
- Fibromyalgia following Lyme disease: association with neurologic involvement and lack of response to antibiotic therapy.Arthritis Rheum. 1990; 33: S136
- The overdiagnosis of Lyme disease.JAMA. 1993; 269: 1812-1816
- Current drug therapy recommendations for the treatment of Lyme disease.Drugs. 1992; 43: 683-699
- Lyme disease: recommendations for diagnosis and treatment.Ann Intern Med. 1991; 114: 472-481
- Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis.Infection. 1989; 17: 355-359
- The fate of Borrelia burgdorferi, the agent for Lyme disease, in mouse macrophages.J Immunol. 1993; 150: 909-915
- Ceftri-axone-associated biliary complications of treatment of suspected disseminated Lyme disease—New Jersey 1990–1992.MMWR. 1993; 42: 39-42
- Borrelia burgdorferi in the central nervous system: experimental and clinical evidence for early invasion.J Infect Dis. 1990; 161: 1187-1193
- Invasion of the central nervous system by Borrelia burgdorferi in acute disseminated infection.JAMA. 1992; 267: 1364-1367
- Immunopathogenic mechanisms in Lyme borreliosis.Clin Dermatol. 1993; 11: 415-422
- Lyme borreliosis: host response to Borrelia burgdorferi.Microbiol Rev. 1991; 55: 21-34
- Persisting complaints of Lyme disease: a conceptual review.Am J Med. 1994; 96: 365-374
- Editorial: The role of the Borrelia burgdorferi polymerase chain reaction assay in the diagnosis of Lyme disease.Ann Intern Med. 1994; 120: 520-521
- Nervous system Lyme borreliosis—revisited.Arch Neurol. 1992; 49: 102-107
- Neuroactive kynurenines in Lyme borreliosis.Neurology. 1992; 42: 43-50
- Lyme disease.N Engl J Med. 1989; 321: 586-596
- Academy of Medicine of New Jersey Lyme Disease Task Force.in: Lyme Disease in New Jersey: A Practical Guide for New Jersey Clinicians. The Academy of Medicine of New Jersey, Lawrenceville, NJ1993
- Lyme borreliosis: clinical laboratory considerations.in: Presented at the Sixth International Conference on Lyme Borreliosis, Bologna, ItalyJune 1994
- Treatment of “possible Lyme disease”. A practical policy position of the American College of Rheumatology and the Infectious Disease Society of America based on cost-benefit analysis.Ann Intern Med. 1993; 119: 503-509
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© 1995 Reed Publishing USA. Published by Elsevier Inc. All rights reserved.
