Are Lyme Borreliosis Patients Failing to Receive Treatment?

Persistent symptoms can complicate Lyme borreliosis diagnosis
Some patients have positive Borrelia IgG antibodies despite uncertain findings
Individualized assessment may help guide treatment decisions

The study, by Roaldsnes and colleagues, describes 110 patients with muscular and joint pain, fatigue, memory and concentration impairments, who were assessed for possible Lyme neuroborreliosis.

These patients had non-specific neurological symptoms. “Only one patient was diagnosed with possible Lyme neuroborreliosis. Altogether 27% had high levels of Borrelia-IgG serum antibodies,” the authors write.

Can Borrelia IgG antibodies persist after treatment?

Studies have shown that Borrelia IgG antibodies may remain detectable for months or years after a Lyme disease infection. Persistent antibodies do not necessarily prove active infection, but they may complicate the evaluation of patients who continue to experience fatigue, musculoskeletal pain, memory problems, concentration difficulties, or other persistent symptoms.

The challenge for clinicians is determining whether ongoing symptoms reflect immune dysregulation, tissue injury, another diagnosis, or a potentially treatable manifestation of persistent Lyme disease.

Many of the patients, Bjark points out, had their symptoms for more than one year. “It is difficult to read the article in any other way than this: that if a patient has had these symptoms for such a prolonged period, Lyme borreliosis is not a relevant diagnosis.”

Bjark explains that many of his patients were initially told they did not have any form of Lyme disease. “After contact with a number of patients I can state that not infrequently, patients with suspected Lyme borreliosis with no pathological findings in cerebrospinal fluid are told that they do not have Lyme neuroborreliosis, nor any other form of Lyme borreliosis that can be treated with antibiotics.”

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Meanwhile, another editorial minimizes the plight of these patients, Bjark states. “The same message is repeated in an editorial [3] which concludes that patients who do not fulfill the diagnostic requirements for active Lyme neuroborreliosis, irrespective of an antibody level or anamnesis, should not be ‘incorrectly treated with antibiotics.’”

Some neurologists deny the existence of “musculoskeletal borreliosis,” writes Bjark. But, “A prolonged disease picture that includes fatigue, myalgia, and elevated Borrelia-IgG serum antibody levels does not constitute a non-disease.”

Patients should be treated, Bjark argues. “If they are left untreated, it is impossible to know whether these are patients who would profit from standard, targeted antibiotic therapy.”

Bjark, who has had patients improve with treatment, believes it “is most likely associated with normalization of cytokines and elimination of Borrelia-specific immune complexes over time.”

Questions regarding diagnosis often arise when patients have persistent symptoms but do not meet strict criteria for Lyme neuroborreliosis. In these situations, clinicians may also review the limitations of Lyme disease testing and consider findings discussed in studies of persistent Lyme disease mechanisms.

“Based on my long experience with a large number of Lyme borreliosis cases, I believe that each patient must be assessed individually,” Bjark writes. “By failing to do this, we do many patients an injustice.”

Frequently Asked Questions

Can Borrelia IgG antibodies remain positive for years?

Yes. Borrelia IgG antibodies may remain detectable long after an infection and do not necessarily indicate active disease.

Does a normal spinal fluid test rule out all Lyme disease?

A normal cerebrospinal fluid test may make Lyme neuroborreliosis less likely, but clinicians may still evaluate other possible manifestations of Lyme disease based on symptoms, exposure history, and clinical findings.

What symptoms were common in the patients studied?

Patients commonly reported fatigue, muscle pain, joint pain, memory problems, and concentration difficulties.

Should patients with persistent Lyme symptoms be evaluated individually?

Bjark argues that each patient should be assessed individually rather than relying solely on a single diagnostic criterion.

Clinical Takeaway

Patients with prolonged fatigue, pain, cognitive symptoms, and elevated Borrelia-IgG antibodies may not always meet diagnostic criteria for Lyme neuroborreliosis. Bjark argues that these individuals still deserve careful clinical evaluation and individualized assessment rather than dismissal based solely on laboratory findings.

Persistent symptoms should prompt a thoughtful clinical assessment to determine whether additional evaluation or treatment may be appropriate.

Related Articles

Persistent Lyme disease overview
Mechanisms of persistent Lyme disease
Neurologic Lyme disease
Why Lyme disease testing can be challenging

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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