Johns Hopkins Study Supports Early Identification of Lyme Disease Patients for Re-Treatment
Early identification of Lyme disease patients for re-treatment remains a critical clinical challenge. Even after standard antibiotic therapy, a subset of patients continue to experience fatigue, pain, and cognitive symptoms—raising important questions about who may benefit from closer follow-up or additional treatment.
In the Archives of Clinical Neuropsychology, investigators reported that a substantial number of patients experienced persistent symptoms six months after completing a three-week course of antibiotics for an erythema migrans rash. [4]
Out of 107 patients, 6 (6%) developed Post-Treatment Lyme Disease Syndrome (PTLDS), with ongoing severe fatigue, pain, and functional impairment.
An erythema migrans rash often seen in the early stage of Lyme disease.
The authors emphasized that patients with symptoms such as pain, fatigue, and depression—identified through standardized instruments—may benefit from targeted behavioral and medical interventions to reduce the impact on daily functioning.
Bechtold noted that patients with persistent concerns after initial management may warrant referral for neuropsychological evaluation.
At the same time, emerging evidence raises the question of whether some patients may benefit from additional antibiotic therapy. “Studies using rodent and primate models have suggested that the persistence of bacteria and/or spirochetal antigens after antibiotic therapy may drive disease,” according to Aucott from Johns Hopkins University School of Medicine. [5]
“The use of short-term antibiotic retreatment in the early, post-treatment phase of Lyme disease has yet to be formally tested, although it may be widely applied in clinical practice.”
In this cohort, Bechtold and colleagues identified 8 cases that underwent early re-treatment. Of the 107 patients, these individuals were treated again with antibiotics after the initial 3-week course of doxycycline due to:
- New objective findings such as neuropathy (5 cases)
- Persistent erythema migrans rash or development of new rashes (3 cases)
Notably, only 2 of the 6 patients who developed PTLDS were re-treated, and most individuals with severe fatigue and pain did not receive additional antibiotic therapy.
Clinical takeaway: Early identification of Lyme disease patients at risk for persistent symptoms remains essential. A subset of patients may benefit from closer monitoring, neurocognitive evaluation, and consideration of re-treatment—particularly when new objective findings emerge or symptoms fail to resolve.
References
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
- Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001;345(2):85-92.
- Fallon BA, Keilp JG, Corbera KM, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008;70(13):992-1003.
- Bechtold KT, Rebman AW, Crowder LA, Johnson-Greene D, Aucott JN. Standardized symptom measurement of individuals with early Lyme disease over time. Arch Clin Neuropsychol. 2017;32(2):129-141.
- Aucott JN, Soloski MJ, Rebman AW, et al. CCL19 as a chemokine risk factor for post-treatment Lyme disease syndrome: a prospective clinical cohort study. Clin Vaccine Immunol. 2016.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Why is it not recognized by most Dr’s? I googled for a Dr here in WV and out of 20 listested, all but 3 were psychiatrists? I was need Dr taken seriously at ER or Dr’s and never given antibiotics. Now I am bed ridden. Would give anything to be tested correctly. I have found black specks coming put of my skin using coconut oil, or peroxide, also small sperm shaped things in mouth after eating cherry popcycle, put samples in alcohol to preserve, coughed up fluke looking things, thrown up worms after ingesting turpentine and found worms in mucous from bowls. I have hard scabs all over head that are clear and red spots, when pick them off, if I am able to pry up, there’s black specks and hard salt like things. I have crusted scabs on my face and body I can’t get rid of. The rx I was given for cream costs 9000. This is insane and ruining my life…..
It can be difficult to find a diagnosis. There are a growing number of conditions that are yet to be explained even in the tick borne illnesses. Morgellon’s includes a rash but the etiology remains unknown. There are people with Morgellon’s who also have Lyme disease.
Until people live it they will not truly help you. They’re too concerned with discrediting Morgellons, to actually listen and see what is obviously happening right in front of them. They can take biopsies and see for them selves that you are living in a nightmare. Rather than researching for answer and options that have been successful for others with Morgellons, and talking with MD’s who’ve treated patients successfully, they just shrug you away with “we don’t know what’s causing this” or “it’s a psychosis and you’re doing this to yourself,” it’s difficult especially if you’re a woman, to be heard, believed, supported and helped with basic health problems. Keep searching, you’ll find someone who will actually put in effort to search for answers and help heal your symptoms and give you back a quality of life. I am sorry you’re faced with such skepticism.