Why is Chronic Lyme Disease Still Controversial?

Journal of Infectious Diseases & Therapy (Kinderlehrer, DA), 04.25.24 published “Chronic Lyme Disease: Why Is This Still Controversial?” In this article, Lyme Literate Medical Doctor, Daniel Kinderlehrer, MD describes that multiple mechanisms may be responsible for development of chronic Lyme disease. He evaluates many factors including the persistence of Borrelia burgdorferi infection; coinfections with other pathogens; inflammation associated with dysregulation of the immune system resulting in chronic systemic inflammation, autoimmunity, and mast cell activation; and autonomic nervous system dysregulation. Kinderlehrer implores physicians to thoroughly investigate the underlying mechanisms of chronic symptoms in patients rather than relying on the flawed Infectious Disease Society of America (IDSA) guidelines.

Though Kinderlehrer acknowledges the consensus of the medical community– that if Lyme is diagnosed early in the disease state and is treated with an “appropriate” course of antibiotics, a cure is likely for the majority of people. However, it is also well accepted that 10-20% of these patients treated for acute Lyme disease will go on to develop chronic symptoms of disease despite early treatment. Kinderlehrer presents evidence from several studies that demonstrates the prevalence of individuals who get treated early and still go on to develop chronic symptoms may be far greater than the currently accepted 10-20%. The fact that some patients who receive early diagnosis and antibiotic treatment continue to be symptomatic, is not explained by IDSA guidelines. 

Kinderlehrer performed a review of the medical literature regarding the physiological processes associated with the disease process of Borrelia burgdorferi (B. burgdorferi). He looked at evidence for persistent infection; methods of immune suppression, evasion, and antibiotic resistance; and the prevalence of tick-borne coinfections. He also conducted an analysis of the IDSA guidelines in reference to Lyme disease.

Kinderlehrer found that patients who were never diagnosed/treated for infection with B. burgdorferi during the acute disease state have a persistent infection. And, for patients that were treated for acute Lyme and continue to be symptomatic, the existence of persistent infection remains a controversial concept. For these patients, evidence exists that chronic Lyme symptoms may persist due to a variety of mechanisms. These mechanisms include persistent infection with B. burgdorferi; persistent infection with one or more untreated coinfections; systemic inflammation (immune dysregulation, autoimmunity, mast cell activation); autonomic nervous system dysregulation, or a combination of these factors.

Due to the complexities involved in both diagnosis and treatment of chronic Lyme disease, Kinderlehrer urges that it is critical for physicians to validate patients’ complaints and thoroughly investigate the root mechanisms for their ongoing symptoms. To rely on the flawed IDSA guidelines does not address the complexities and multiple etiologies driving the persistent disease process. Kinderlehrer states that clinically relevant research for better diagnostics and treatments are desperately needed to progress the growing issue and treatment of Lyme disease.

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For More Information: 

Read the Journal of Infectious Diseases & Therapy Article

Read More LDA Articles on Chronic Lyme Controversy