Lyme Disease and Related Tick-Borne Infections - Complications

Much controversy surrounds chronic Lyme disease, however, including whether it represents an actual persistence of the original infection, whether it is a persistent inflammatory reaction to the infection, and whether it can be treated.

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In most cases of post-Lyme syndrome, advanced diagnostic techniques fail to detect any persistent infection. (Even if there is some evidence of residual immune activity, it does not mean that the Lyme infection is active.) Some doctors contend, however, that Lyme disease was inadequately treated to begin with and that the infection persists, but that the antibody levels are too low to be detected. These doctors recommend intensive antibiotic treatments. However, the majority of experts are opposed to long-term, intensive antibiotic treatment.

A number of studies have reported no differences between groups of patients with post-Lyme disease syndrome who received intensive antibiotic treatments versus those who received placebo. In addition, other studies have reported no evidence of persistent Borrelia infection in many patients with post-Lyme disease syndrome. These results strongly suggest that the condition in some patients has other causes.

Different experts have suggested the following causes for the conditions:

It may be due to a persistent and abnormal immune response. In such cases, the patient develops an autoimmune response, in which the body produces immune factors that target its own cells and causes inflammation and injury.
The persistent symptoms may be due to an initial misdiagnosis and many of these patients never had Lyme disease to begin with.
A co-infection with ehrlichiosis, babesiosis, or other tick-borne pathogens may be the cause of persistent symptoms in many of these patients.
Because symptoms of post-Lyme syndrome are so nonspecific, some doctors believe they are simply psychological. Others believe that such thinking is a disservice to patients who experience genuine suffering and pain. Depression is certainly a common symptom of both early and late-stage Lyme, but may be a physical result of the disease.

Overall, studies report a low incidence of chronic Lyme disease. Reports from centers that have years of experience treating Lyme disease in children have been reassuring and state that there are very few cases of long-term or untreatable illness.