Abstract
Chronic Lyme syndrome represents a controversial term that groups together a set of persistent and nonspecific symptoms, mostly rheumatological and / or neurological, among which is the Post Lyme Disease, whose epidemiological incidence is low, pathophysiology is controversial and the diagnostic approach is based especially on clinical interpretation, directing its therapeutic approach towards symptomatic resolution. We present a case of a female patient of 17 years of age with Lyme disease of recent diagnosis of apparent evolution of 3 years, with previous diagnosis of demyelinating disease, who consulted for neurological deterioration. Scientific considerations on its clinical approach and therapeutic principles are reviewed, contrasting them with those applied.
References
Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldst E, Davis JP. Lyme disease. A tick-borne spirochetosis? Science. 1982;216(4552): 1317-1319.
Tilly K, Rosa PA, Stewart PE. Biology of infection with Borrelia burgdorferi. Infect Dis Clin North Am. 2008;22(2):217-34.
Ramesh G, Didier PJ, England JD, Santana-Gould L, Doyle-Meyers LA, Martin DS, et al. Inflammation in the pathogenesis of lyme neuroborreliosis. Am J Pathol. 2015;185(5):1344-60.
Mitchell KF, Jeffrey AG, George WY, Leonard BK. Challenging Neuropathic pain syndromes. Elsevier; 2018.
Rupprecht T, Koedel U, Fingerle V, Pfister H-W The pathogen-esis of Lyme neuroborreliosis: from infection to inflammation. Mol Med. 2008;14(3-4):205-12.
Lantos PM. Chronic Lyme disease. Infect Dis Clin North Am. 2015;29(2):325-40.
Sordet C. Chronic Lyme disease: ¿Fact or fiction? Joint Bone Spine. 2014;81(2):110-1.
Feder Jr HM, Johnson BJ, Q'Connell S, Eugene DS, Allen CS, Gary P. W et al. A critical appraisal of "chronic Lyme disease". N Engl J Med. 2007;357:1422-30.
Marques A. Chronic Lyme disease: A review. Infect Dis Clin North Am. 2008;22(2):341-60.
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-134.
Smith RC, Dwamena FC. Classification and diagnosis of patients with medically unexplained symptoms. J Gen Intern Med 2007;22(5):685-91.
Berglund J, Eitrem R, Qrnstein K, Lindberg A, Ringnér Á, Elmrud H, et al. An epidemiologic study of Lyme disease in Southern Sweden. N Engl J Med. 1995;333(20):1319-24.
Fallon BA, Keilp JG, Corbera KM, Petkova E, Britton CB, Dwyer E, et al. A randomized, placebo-controlled trial of repeated iv antibiotic therapy for Lyme encephalopathy symbol. Neurology. 2008;70(13):992-1003.
Buchwald D, Umali P, Umali J, Phalla K, Tsilke P, Anthony LK. Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system. Ann Intern Med 1995;123(2):81-8.
Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med 1986;15(1):74-81.
Steere AC, Hutchinson GJ, Rahn DW, Sigal LH, Craft JE, DeSanna ET, et al. Treatment of early manifestations of Lyme disease. Ann Intern Med. 1983;99(1):22-6.
Weber K, Preac-Mursic V, Wilske B, Thurmayr R, Neubert U, Scherwitz C. A randomized trial of ceftriaxone versus oral penicillin for the treatment of early european lyme borreliosis. Infection. 1990;18(2):91-6.
Shadick NA, Phillips CB, Logigian EL, Steere AC, Kaplan RF, Berardi VP, et al. The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study. Ann Intern Med. 1994;121(8):560-7.
Chandra A, Wormser GP, Marques AR. Anti-Borrelia burgdorferi antibody profile in post-Lyme disease syndrome. Clin Vaccine Immunol. 2011;18(5):767-71.
Hytõnen J, Kortela E, Waris M, Puustinen J, Salo J, Qksi J. CXCL13 and neopterin concentrations in cerebrospinal fluid of patients with Lyme neuroborreliosis and other diseases that cause neuroinflammation. J Neuroinflammation. 2014;11:1-11.
Cabello FC, Godfrey HP, Newman SA. Hidden in plain sight: Borrelia burgdorferi and the extracellular matrix. Trends Microbiol. 2007;15(8):350-4.
Lantos PM, Auwaerter PG, Wormser GP. A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease. Clin Infect Dis. 2014;58(5):663-71.
Chandra A, Latov N, Wormser GP, Marques AR, Alaedini A. Epitope mapping of antibodies to VlsE protein of Borrelia burgdorferi in post-Lyme disease syndrome. Clin Immunol. 2011;141(1):103-10.
Jacek E, Fallon BA, Chandra A, Mary KC, Gary P. W, Armin A. Increased IFN ? activity and differential antibody response in patients with a history of Lyme disease and persistent cognitive deficits. J Neuroimmunol. 2013;255:85-91.
García M, Skinner C, Salas J, Qcampo J. Enfermedad de Lyme: actualizaciones. Gac Med Mex. 2014;150(1):84-95.
Lantos PM. Chronic Lyme disease. Infect Dis Clin North Am. 2015;29(2):325-40.
Rupprecht T, Koedel U, Fingerle V, Pfister H-W The pathogenesis of lyme neuroborreliosis: from infection to inflammation. Mol Med. 2008;14(3-4):205-12.
Dworkin RH, Q'Connor AB, Audette J, Baron R, Gourlay GK, Haanpãã ML, et al. Recommendations for the pharmacological management of neuropathic pain: An overview and literature update. Mayo Clin Proc. 2010;85(3 Supl.).
Pfister HW, Rupprecht TA. Clinical aspects of neuroborreliosis and Post Lyme disease síndrome in adult patients. Int J Med Microbiol. 2006;296(Supl. 40):11-16.
Dadabhoy D, Clauw DJ. Therapy insight: fibromialgia a different type of pain needing a different type of treatment. Nat Clin Pract Rheumatol. 2006;2(7):364-72.
Weissenbacher S, Ring J, Hofmann H. Gabapentin for the sympatic treatment of chronic neuropathic pain in patients with late state Lyme borreliosis: a pilot study. Dermatology. 2005;211(2):123-7.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.