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post Lyme disease syndrome
Etiology:
- association with Lyme disease, but cause-effect not proven
Pathology:
- a peptidoglycan in the cell envelope of Borrelia burgdorferi is released but not degraded when the bacterium dies [3]
- the peptidoglycan lingers in synovial fluid & elicits an ongoing immune response*
* systemic administration of the peptidoglycan ellicits acute arthritis in mice [3]
Clinical manifestations:
- fatigue
- widespread musculoskeletal pain (myalgia, arthralgia)
- cognitive impairment
* symptom onset within 6 months of Lyme disease diagnosis, continuing for at least 6 months after antibiotic treatment
Differential diagnosis:
- fibromyalgia
- chronic fatigue syndrome
- unrefreshing sleep, post-exertional malaise, orthostatic intolerance
Management:
- antibiotics not effective
Related
Lyme disease
General
syndrome
References
- Medical Knowledge Self Assessment Program (MKSAP) 18, 19
American College of Physicians, Philadelphia 2018, 2021
- Aucott JN.
Posttreatment Lyme disease syndrome.
Infect Dis Clin North Am. 2015 Jun;29(2):309-23. Review.
PMID: 25999226
- Jutras BL, Lochhead RB, Kloos ZA et al.
Borrelia burgdorferi peptidoglycan is a persistent antigen in
patients with Lyme arthritis.
Proc Natl Acad Sci U S A 2019 Jul 2; 116:13498.
PMID: 31209025 Free PMC Article
https://www.pnas.org/content/116/27/13498