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Open AccessConcept Paper

Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group

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Internal Medicine of Northern Virginia, George Washington University Health Care Sciences’, 1860 Town Center Drive #G220, Reston, VA 20191, USA
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Family Medicine, Green Oaks Medical Center, Mountain View, CA 94040, USA
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Internal Medicine, Pediatrics and Adolescent Medicine, P.O. Box 549, Lincoln, ME 04457, USA
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Internal Medicine Private Practice 944 Danbury Road, Wilton, CT 06897, USA
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592 Route 22-Suite 1B, Pawling, NY 12564, USA
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Northwell Hospital Systems, Northern Westchester Hospital, Mount Kisco, NY 10549, USA
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Nuvance Hospital Systems, Sharon Hospital, Sharon, CT 06069, USA
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Superior Biologics, NY 10532, USA
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Department of Psychiatry Rutgers, RWJ Medical School, 225 Highway 35, Ste 107 Red Bank, Monmouth, NJ 07701, USA
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Partnership for Tick-borne Diseases Education, P.O. Box 84 Wyoming, MN 55092, USA
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Author to whom correspondence should be addressed.
International Lyme and Associated Diseases Society.
Antibiotics 2019, 8(4), 269; https://doi.org/10.3390/antibiotics8040269
Received: 8 October 2019 / Revised: 9 December 2019 / Accepted: 11 December 2019 / Published: 16 December 2019
(This article belongs to the Special Issue Antibiotics Resistance of Borrelia)
Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease. Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories, CLD, untreated (CLD-U) and CLD, previously treated (CLD-PT). The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more. Methods: Systematic review of over 250 peer reviewed papers in the international literature to characterize the clinical spectrum of CLD-U and CLD-PT. Conclusion: This evidence-based definition of chronic Lyme disease clarifies the term’s meaning and the literature review validates that chronic and ongoing Bbsl infections can result in chronic disease. Use of this CLD definition will promote a better understanding of the infection and facilitate future research of this infection. View Full-Text
Keywords: Lyme disease; Borrelia infection; borreliosis; chronic Lyme; CLD; untreated Lyme; neuroborreliosis; late Lyme; persistent Lyme disease; post-treatment Lyme disease syndrome (PTLDS) Lyme disease; Borrelia infection; borreliosis; chronic Lyme; CLD; untreated Lyme; neuroborreliosis; late Lyme; persistent Lyme disease; post-treatment Lyme disease syndrome (PTLDS)
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Shor, S.; Green, C.; Szantyr, B.; Phillips, S.; Liegner, K.; Burrascano, J.J., Jr.; Bransfield, R.; Maloney, E.L. Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics 2019, 8, 269.

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