Summary
The aim of this paper is to review the current literature on the diagnosis, etiology, risk factors, treatments and heterogeneity of patients with persistent symptoms of Lyme disease. The meaning and relevance of existing patient subgroups are discussed, as are future research priorities, including the need to develop illness biomarkers, elucidate the biologic mechanisms of disease, drive improvements in therapeutic options, and study additional subgroups.
Why was this study done?
The aim of this paper is to review the current literature on the diagnosis, etiology, risk factors, treatments and heterogeneity of patients with persistent symptoms of Lyme disease. The meaning and relevance of existing patient subgroups are discussed, as are future research priorities, including the need to develop illness biomarkers, elucidate the biologic mechanisms of disease, drive improvements in therapeutic options, and study additional subgroups.
How was this study done?
This study reviewed the published literature from a variety of academic disciplines and perspectives on symptoms which persist or recur in Lyme disease. The authors acknowledge this is a broad topic and not all related concepts, such as non-FDA approved novel treatments, could be addressed due to space constraints.
What were the major findings?
This extensive literature review showed the complexities of Lyme disease diagnostics, clinical presentations, risk factors, etiology, and treatments. The authors stress the importance of establishing research subgroups to better understand the biologic mechanisms and drivers of persistent symptoms. The etiology of persistent symptoms in humans is likely multifactorial with research hypotheses including microbial persistence, host immune dysregulation, and/or altered neural networks.
What is the Impact of this Work?
It is likely that the number of new Lyme disease cases will continue to increase in the coming decades, and consequently so will the number of patients with persistent symptoms that can be debilitating. The review shows how subgroups, such as Post-Treatment Lyme Disease, can help move the research field forward scientifically by improving the understanding of disease mechanisms and risk factors. This review reveals there is a critical need to develop and refine scientifically rigorous, multidisciplinary studies to better understand complex biologic mechanisms, find reliable direct biomarkers of persistent infection, and improve treatment options.
Publication Information
https://www.frontiersin.org/articles/10.3389/fmed.2020.00057/full
Alison W. Rebman, MPH, Senior Research Data Analyst, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine Co-Director for Clinical and Epidemiological Research, Johns Hopkins Lyme Disease Research Center
John N. Aucott, MD, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine
Director, Johns Hopkins Lyme Disease Research Center
