Lyme Disease May Lead to Disabling Posttreatment Problems

Although lyme disease can typically be treated with 2 to 4 weeks of oral antibiotic therapy, researchers have cautioned that severe posttreatment syndromes can develop following treatment. These syndromes seem to result from maladaptive host responses to the infection that persist after taking antibiotics, according to experts.

Lyme disease is caused by the tick-borne bacteria Borrelia burgdorferi and can result in persistent infection for years if left untreated. Treatment typically begins with an oral antibiotic therapy such as doxycycline for 30 days, according to an article in The Journal of Clinical Investigation by Allen Steere, MD, of the Center for Immunology & Inflammatory Diseases at Massachusetts General Hospital in Boston.

If patients have minimal or no response to this therapy, the next step is to treat them with intravenous antibiotics, typically ceftriaxone. Importantly, Steere said that the emergence of disabling postantibiotic syndromes can complicate these treatments.

Postinfectious Lyme arthritis, in which the arthritis seems to evolve following treatment, is a significant concern. According to Steere, the joint effusions are not as large, but massive synovial proliferation develops in 1 or both knees. This development can worsen in the posttreatment period, lasting from months to several years.

In treating posttreatment Lyme disease syndromes, Steere noted several arguments for and against long-term antibiotic use. Ceftriaxone and doxycycline both have potential benefits besides killing bacteria, including anti-inflammatory and neuroprotective effects, he said. However, results from studies of these effects did not find that patients treated with antibiotics had better outcomes than those treated with placebo. Further, prolonged use of antibiotics has the potential for significant adverse effects.

REFERENCE

Steere AC. Posttreatment Lyme disease syndromes: distinct pathogenesis caused by maladaptive host responses. J Clin Invest. 2020;130(5):2148-2151. doi:10.1172/JCI138062