Lyme Disease, Tests and Treatment: A Review of The Controversy on The Ineffectiveness of Biological Tests and Proof of The Existence of A Chronic Form

Author(s): Alexis Lacout, Christian Perronne

Lyme disease is caused by infection with the bacterium Borrelia burgdorferi. Other species of Borrelia have been discovered and cause similar diseases. The first described species, Borrelia burgdorferi sensu stricto, was isolated in the United States. Lyme disease is a great imitator that can resemble many illnesses, including autoimmune diseases. ELISA and Western Blot diagnostic tests, which are supposed to have a sensitivity of almost 100%, are in fact often negative in many patients with genuine Lyme disease. These tests are poorly calibrated, of mediocre quality, with an arbitrarily defined threshold for antibody positivity, so that no more than 50% of patients with a positive test are ever found. Controversy surrounds the existence of the chronic form. However, chronicity is observed in many patients, and the mechanisms of Borrelia persistence are well documented in the literature. Recently, in 2018, the Haute Autorité de Santé (French National Authority for Health) defined SPPT (Syndrome Persistant Polymorphe Après-Piqure de Tique), which enables empirical antibiotic treatment even in the absence of erythema migrans and with negative Lyme serology. Lyme disease is frequently associated with a number of other infections known as co-infections, whether parasitic, bacterial or viral. Treatment must be effective against Borrelia and other co-infections. A long course of antibiotics lasting several weeks or months may be required. Relapses are frequent when treatment is stopped, due to Borrelia's persistence mechanisms, and require rapid reintroduction of previously effective treatments. Denial of the scientific realities described in this article has resulted in hundreds of thousands of patients wandering around with untreated, disabling symptoms, despite the fact that appropriate, low-cost anti-infective treatment enables remission in many cases.