Below is a list of peer-reviewed papers by health experts on “chronic Lyme disease”, a fake diagnosis distinct from real Lyme disease and post-Lyme symptoms.
It can be confusing to distinguish between fact and fiction when it comes to Lyme disease.
Lantos PM. Chronic Lyme disease. Infect Dis Clin North Am. 2015;29(2):325-40.
Feder HM, et al. A critical appraisal of “chronic Lyme disease”. N Engl J Med. 2007;357(14):1422-30.
Marques A. Chronic Lyme disease: a review. Infect Dis Clin North Am. 2008;22(2):341-60, vii-viii.
Habegger S. Lyme Disease in Canada: An Update on Case Definitions and Treatments. 2014.
Halperin JJ. Chronic Lyme disease: misconceptions and challenges for patient management. Infect Drug Resist. 2015;8:119-28.
Duerden, B. and the independent working group Independent Appraisal and Review of ILADS 2004 guidelines on Lyme disease. U.K. Health Protection Agency. 2010.
Halperin et al. Lyme Disease: the Great Controversy (book chapter)
Halperin JJ, et al. Common misconceptions about Lyme disease. Am J Med. 2013 Mar;126(3):264.e1-7.
Sigal LH. Misconceptions about Lyme disease: confusions hiding behind ill-chosen terminology. Ann Intern Med. 2002;136(5):413-9.
Halperin JJ. Nervous system Lyme disease, chronic Lyme disease, and none of the above. Acta Neurol Belg. 2016;116(1):1-6.
On politics and anti-science advocacy
Auwaerter PG, et al. Antiscience and ethical concerns associated with advocacy of Lyme disease. Lancet Infect Dis. 2011;11(9):713-9.
Shapiro ED, et al. False and Misleading Information About Lyme Disease. Am J Med. 2017;130(7):771-772.
Naktin JP. Late You Come: Legislation on Lyme Treatment in an Era of Conflicting Guidelines. Open Forum Infect Dis. 2017;4(4):ofx152.
Beaman MH. Lyme disease: why the controversy? Intern Med J. 2016;46(12):1370-1375.
Baker PJ. Chronic Lyme disease: in defense of the scientific enterprise. FASEB J. 2010;24(11):4175-7.
Auwaerter PG, Melia MT. Bullying Borrelia: when the culture of science is under attack. Trans Am Clin Climatol Assoc. 2012;123:79-89.
Cooper JD, Feder HM. Inaccurate information about lyme disease on the internet. Pediatr Infect Dis J. 2004;23(12):1105-8.
Sood SK. Effective retrieval of Lyme disease information on the Web. Clin Infect Dis. 2002;35(4):451-64.
Franklin, Joseph B. Antibiotic Maximalism: Legislative Assaults on the Evidence-Based Treatment of Lyme Disease, 90 Wash. U. L. Rev. 199 (2012).
Auwaerter PG, et al. Scientific evidence and best patient care practices should guide the ethics of Lyme disease activism. J Med Ethics. 2011;37(2):68-73. [mirror]
Gentilini M, Bricaire F. Chronic Lyme disease: A scam that should be condemned! (Maladie de Lyme chronique: un scandal médical à condamner!) Med Mal Infect. 2019. [original, pdf]
Pascal C, et al. Emergence of Lyme disease as a social problem: analysis of discourse using the media content. Eur J Public Health. 2019.
Feder HM Jr. Differences are voiced by two Lyme camps at a Connecticut public hearing on insurance coverage of Lyme disease. Pediatrics. 2000;105(4 Pt 1):855-857.
McPhail M. Making Lyme Disease Law: The Role of Patient Advocacy in Health Law and Policy. Queen’s Policy Review. 2017.
Kraemer JD, Gostin LO. Science, politics, and values: the politicization of professional practice guidelines. JAMA. 2009.
On individuals diagnosed with “chronic Lyme disease”
Wormser GP, Shapiro ED. Implications of gender in chronic Lyme disease. J Womens Health (Larchmt). 2009;18(6):831-4.
Hassett AL, et al. Role of psychiatric comorbidity in chronic Lyme disease. Arthritis Rheum. 2008;59(12):1742-9.
Hassett AL, et al. Psychiatric comorbidity and other psychological factors in patients with “chronic Lyme disease”. Am J Med. 2009;122(9):843-50.
Patrick DM, et al. Lyme Disease Diagnosed by Alternative Methods: A Phenotype Similar to That of Chronic Fatigue Syndrome. Clin Infect Dis. 2015;61(7):1084-91.
Barbour AG. “Lyme”: Chronic Fatigue Syndrome by Another Name?. Clin Infect Dis. 2016;62(1):134-5.
Baker PJ. The pain of “chronic Lyme disease”: moving the discourse in a different direction. FASEB J. 2012;26(1):11-2.
Ali A, et al. Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study. BMC Fam Pract. 2014;15:79.
Sigal LH, Hassett AL. Contributions of societal and geographical environments to “chronic Lyme disease”: the psychopathogenesis and aporology of a new “medically unexplained symptoms” syndrome. Environ Health Perspect. 2002;110 Suppl 4:607-11.
Sigal LH. The Lyme disease controversy. Social and financial costs of misdiagnosis and mismanagement. Arch Intern Med. 1996;156(14):1493-500.
Brown JD. A Description of ‘Australian Lyme Disease’ Epidemiology and Impact: An Analysis of Submissions to an Australian Senate Inquiry. Intern Med J. 2018;48(4):422-426.
Hsu VM, et al. “Chronic Lyme disease” as the incorrect diagnosis in patients with fibromyalgia. Arthritis Rheum. 1993;36(11):1493-500.
Sigal LH, Patella SJ. Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia. Pediatrics. 1992;90(4):523-8.
Forestier E, et al. [Pathway to diagnosis and real-life experience of patients believing they are affected by “chronic Lyme disease”]. Rev Med Interne. 2018; [French language paper with English abstract]
Tseng YJ, et al. Claims-Based Diagnostic Patterns of Patients Evaluated for Lyme Disease and Given Extended Antibiotic Therapy. Vector Borne Zoonotic Dis. 2017;17(2):116-122.
Ljøstad U, Mygland Å. The phenomenon of ‘chronic Lyme’; an observational study. Eur J Neurol. 2012;19(8):1128-35. [paper mirror]
Csallner G, et al. Patients with “organically unexplained symptoms” presenting to a borreliosis clinic: clinical and psychobehavioral characteristics and quality of life. Psychosomatics. 2013;54(4):359-66.
Murphy M, et al. Electronic Support Groups: An Open Line of Communication in Contested Illness. Psychosomatics. 2016;57(6):547-555.
Zomer TP, et al. Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in Those Without Evidence of Lyme Borreliosis. Clin Infect Dis. 2017;65(10):1689-1694.
Zomer TP, et al. Lyme borreliosis and depressive symptoms in patients aged 65 years and older referred to a tertiary Lyme centre. Eur J Intern Med. 2018;51:e19-e20.
Garakani A, Mitton AG. New-onset panic, depression with suicidal thoughts, and somatic symptoms in a patient with a history of lyme disease. Case Rep Psychiatry. 2015;2015:457947.
V. Eijrond. Living with a Contested Diagnosis Lyme Disease. 2016.
Cheema J, Prat SS. Multiple Sclerosis and Psychosis: A case report. 2019.
Brakoulias V. Lyme disease or a complication of delusional parasitosis? Aust N Z J Psychiatry. 2014;48(1):97-8. [text mirror]
Wurtz R. Psychiatric diseases presenting as infectious diseases. Clin Infect Dis. 1998;26(4):924-32.
Dumes AA. Lyme Disease and the Epistemic Tensions of “Medically Unexplained Illnesses”. Med Anthropol. 2019;:1-16.
Aronowitz RA. Lyme disease: the social construction of a new disease and its social consequences. Milbank Q. 1991;69(1):79-112.
Gocko X., et al. Genesis and dissemination of a controversial disease: chronic Lyme. Médecine et Maladies Infectieuses. 2020.
Groenevelt I. “It’s not all nice and fun”: Narrating contested illness on YouTube and Instagram. Health (London). 2021.
Raffetin A. Perceptions, Representations, and Experiences of Patients Presenting Nonspecific Symptoms in the Context of Suspected Lyme Borreliosis. Microorganisms. 2021.
Mattoon, S., et al. Primary care clinical provider knowledge and experiences in the diagnosis and treatment of tick-borne illness: a qualitative assessment from a Lyme disease endemic community. BMC Infect Dis. 2021.
Consequences of treatment for “chronic Lyme disease”
Strizova Z, et al. Internet-based self-diagnosis of Lyme disease caused death in a young woman with systemic lupus erythematosus. Joint Bone Spine. 2019.
Marzec NS, et al. Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease – United States. MMWR Morb Mortal Wkly Rep. 2017;66(23):607-609. [press coverage]
De wilde M, et al. Ceftriaxone-induced immune hemolytic anemia as a life-threatening complication of antibiotic treatment of ‘chronic Lyme disease’. Acta Clin Belg. 2017;72(2):133-137.
Ettestad PJ, et al. Biliary complications in the treatment of unsubstantiated Lyme disease. J Infect Dis. 1995;171(2):356-61.
Patmas MA. Eosinophilia-myalgia syndrome not associated with L-tryptophan. N J Med. 1992.
Feder HM, Rosenthal KE. Diagnostic Tests for Lyme Disease. JAMA. 1990;264(6):693.
CDC. Ceftriaxone-associated biliary complications of treatment of suspected disseminated Lyme disease–New Jersey, 1990-1992. MMWR Morb Mortal Wkly Rep. 1993;42(2):39-42.
Holzbauer SM, et al. Death due to community-associated Clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected lyme disease. Clin Infect Dis. 2010;51(3):369-70.
Patel R, et al. Death from inappropriate therapy for Lyme disease. Clin Infect Dis. 2000;31(4):1107-9.
Marks CM, et al. Antibiotic Treatment for Chronic Lyme Disease-Say No to the DRESS. JAMA Intern Med. 2016;176(12):1745-1746.
Johnstone T, et al. Seven cases of probable endotoxin poisoning related to contaminated glutathione infusions. Epidemiol Infect. 2018;:1-4. [LymeScience discussion]
Goodlet KJ, Fairman KA. Adverse Events Associated with Antibiotics and Intravenous Therapies for Post-Lyme Disease Syndrome in a Commercially Insured Sample. Clin Infect Dis. 2018.
Check JH, Cohen R. Sympathetic neural hyperalgesia edema syndrome, a frequent cause of pelvic pain in women, mistaken for Lyme disease with chronic fatigue. Clin Exp Obstet Gynecol. 2011;38(4):412-3.
CDC. Reports of Chronic Lyme patients being injected with malaria, 1990-1991.
Flythe JE, et al. Silicate nephrolithiasis after ingestion of supplements containing silica dioxide. Am J Kidney Dis. 2009;54(1):127-30.
Nadelman RB, et al. Life-threatening complications of empiric ceftriaxone therapy for ‘seronegative Lyme disease’. South Med J. 1991;84(10):1263-5.
Shelton, A, et al. A case of Mycobacterium goodii infection related to an indwelling catheter placed for the treatment of chronic symptoms attributed to Lyme disease. Infectious Disease Reports. 2019; 11(2).
Bingham A, Platt M. A Non-ST Elevation Myocardial Infarction Associated with Alternative Medicine Ozone Infusion. J Emerg Med. 2019. [excerpts]
Haden M, et al. Toxic levels of glycosides in herbal medication: a potential cause of hyperkalaemia. Scott Med J. 2011;56(4):236. [excerpts]
Tabbalat RR. Two Cases of Gastrointestinal Delusional Parasitosis Presenting as Folie á Deux. ACG Case Reports Journal. 2019.
Verma A, et al. Acute kidney injury due to intravenous bleach injection. J Med Toxicol. 2013;9(1):71-4.
Weiss E, et al. Side-by-side Comparison of a Picosecond 755-nm Alexandrite Laser and a Quality-switched 1064-nm Neodymium-doped Yttrium Aluminum Garnet Laser in the Treatment of Argyria. Cureus. 2019;11(7):e5206.
Natelson EA, et al. Anemia and leukopenia following intravenous colloidal silver infusions-Clinical and hematological features, unique peripheral blood film appearance and effective therapy with supplemental oral copper and apheresis. Clin Case Rep. 2019;7(9):1757-1762.
Regina A, et al. Acute Hepatitis Following Self Administration of Fenbendazole, A Veterinary Antihelmintic, Abstracts from the 2017 American College of Medical Toxicology (ACMT) Annual Scientific Meeting. J Med Toxicol. 2017;13(1):3-46. [pdf]
Greco TP, et al. Antiphospholipid antibodies in patients with purported ‘chronic Lyme disease’. Lupus. 2011;20(13):1372-7.
Catral J, Hitchcock E. Ceftriaxone-Induced Immune Hemolytic Anemia from Treatment of Post-Treatment Lyme Disease Syndrome. 2020.
Wriston DJ, et al. Doxycycline-Induced Antinuclear Antibody and Antineutrophil Cytoplasmic Antibody Associated Vasculitis: A Case Report and Literature Review. Case Rep Rheumatol. 2020;2020:3853671. 2020.
Vos B, et al. Adverse events associated with pediatric complementary and alternative medicine in the Netherlands: a national surveillance study. Eur J Pediatr. 2021
Aji B Njie, et al, Peripherally Inserted Central Catheter-Associated Nocardia nova Endocarditis in a Patient Receiving Intravenous Antibiotics for Chronic Lyme Disease, Open Forum Infectious Diseases, 2021.
Nasir S, et al. Non-alcoholic Wernicke’s encephalopathy: toxic ingestion or an honest mis-steak? J Community Hosp Intern Med Perspect. 2021.
Frankl, S. Devastating Neurological Injury as a Result of Treatment of “Chronic Lyme Disease”. Mayo Clinic Proceedings. 2021.
Chronic Lyme treatments
Lantos PM, et al. Unorthodox alternative therapies marketed to treat Lyme disease. Clin Infect Dis. 2015;60(12):1776-82.
Auwaerter PG. Point: antibiotic therapy is not the answer for patients with persisting symptoms attributable to lyme disease. Clin Infect Dis. 2007;45(2):143-8.
Melia MT, Auwaerter PG. Time for a Different Approach to Lyme Disease and Long-Term Symptoms. N Engl J Med. 2016;374(13):1277-8. [paper mirror]
Klempner MS, et al. Treatment trials for post-Lyme disease symptoms revisited. Am J Med. 2013;126(8):665-9.
- Long-term antibiotics
- Ozone therapy
- Bee venom therapy
- Hyperbaric Oxygen Therapy (HBOT)
- Detox foot baths
- Herbs and Supplements
- Samento/Cat’s Claw
- MARCoNS treatments
- Intravenous Glutathione
Other papers useful to debunk myths about Lyme disease
Lantos PM, Wormser GP. Chronic coinfections in patients diagnosed with chronic lyme disease: a systematic review. Am J Med. 2014;127(11):1105-10.
Baker PJ, Wormser GP. The Clinical Relevance of Studies on Borrelia burgdorferi Persisters. Am J Med. 2017;130(9):1009-1010.
Lantos PM, et al. A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease. Clin Infect Dis. 2014;58(5):663-71.
Halperin JJ. Nervous system Lyme disease, chronic Lyme disease, and none of the above. Acta Neurol Belg. 2016;116(1):1-6.
Oliveira CR, Shapiro ED. Update on persistent symptoms associated with Lyme disease. Current opinion in pediatrics. 2015;27(1):100-104.
Iyer R, et al. Detection of Borrelia burgdorferi nucleic acids after antibiotic treatment does not confirm viability. J Clin Microbiol. 2013;51(3):857-62.
Sigal LH. Myths and facts about Lyme disease. Cleve Clin J Med. 1997;64(4):203-9.
Wormser GP, et al. Studies that report unexpected positive blood cultures for Lyme borrelia – are they valid? Diagn Microbiol Infect Dis. 2017;89(3):178-181.
Wormser GP, Schwartz I. Antibiotic treatment of animals infected with Borrelia burgdorferi. Clin Microbiol Rev. 2009;22(3):387-95.
Addressing the flawed Embers monkey trials
Wormser GP, et al. Critical analysis of treatment trials of rhesus macaques infected with Borrelia burgdorferi reveals important flaws in experimental design. Vector Borne Zoonotic Dis. 2012;12(7):535-8.
Wormser GP, et al. Critical analysis of a doxycycline treatment trial of rhesus macaques infected with Borrelia burgdorferi. Diagnostic Microbiology and Infectious Disease, 2018.
Long term outcomes of Lyme disease
Auwaerter PG. Editorial commentary: life after Lyme disease. Clin Infect Dis. 2015;61(2):248-50.
Kugeler KJ, et al. A review of death certificates listing Lyme disease as a cause of death in the United States. Clin Infect Dis. 2011;52(3):364-7.
Kalish RA, et al. Evaluation of study patients with Lyme disease, 10-20-year follow-up. J Infect Dis. 2001;183(3):453-60.
Forrester JD, et al. Notes from the field: update on Lyme carditis, groups at high risk, and frequency of associated sudden cardiac death–United States. MMWR Morb Mortal Wkly Rep. 2014;63(43):982-3.
Wang TJ, et al. Coexposure to Borrelia burgdorferi and Babesia microti does not worsen the long-term outcome of lyme disease. Clin Infect Dis. 2000;31(5):1149-54.
Wills AB, et al. Long-term Follow-up of Patients With Lyme Disease: Longitudinal Analysis of Clinical and Quality-of-life Measures. Clin Infect Dis. 2016;62(12):1546-1551.
Wormser GP, et al. Long-term assessment of health-related quality of life in patients with culture-confirmed early Lyme disease. Clin Infect Dis. 2015;61(2):244-7.
Wormser GP, et al. Long-term assessment of fatigue in patients with culture-confirmed Lyme disease. Am J Med. 2015;128(2):181-4. [commentary: Late Lyme Disease and Severe Fatigue: Very Rarely Linked, additional commentary by Dr. Gregory W. Rutecki, MD]
Shadick NA, et al. Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease. Ann Intern Med. 1999;131(12):919-26.
Obel N, et al. Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study. BMJ. 2018;361:k1998. (blog, editorial)
Haahr R, et al. Risk of neurological disorders in patients with European Lyme neuroborreliosis. A nationwide population-based cohort study. Clin Infect Dis. 2019.
Nowakowski J, et al. Long-term follow-up of patients with culture-confirmed Lyme disease. Am J Med. 2003;115(2):91-6.
Schoen RT. A case revealing the natural history of untreated Lyme disease. Nat Rev Rheumatol. 2011;7(3):179-84.
Weitzner E, et al. Comparison of males versus females with culture-confirmed early Lyme disease at presentation and at 11-20 years after diagnosis. Diagn Microbiol Infect Dis. 2016;85(4):493-5.
Hulshof MM, et al. Long-term prognosis in patients treated for erythema chronicum migrans and acrodermatitis chronica atrophicans. Arch Dermatol. 1997;133(1):33-7.
Lipsker D, et al. Long-term prognosis of patients treated for erythema migrans in France. Br J Dermatol. 2002;146(5):872-6.
Grillon A, et al. Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis. Semin Arthritis Rheum. 2018. [pdf mirror]
Dersch R, et al. Quality of life, fatigue, depression and cognitive impairment in Lyme neuroborreliosis. J Neurol. 2015;262(11):2572-7.
Dersch R, et al. Prevalence and spectrum of residual symptoms in Lyme neuroborreliosis after pharmacological treatment: a systematic review. J Neurol. 2016;263(1):17-24.
Kowalski TJ, et al. Antibiotic treatment duration and long-term outcomes of patients with early lyme disease from a lyme disease-hyperendemic area. Clin Infect Dis. 2010;50(4):512-20.
Cerar D, et al. Subjective symptoms after treatment of early Lyme disease. Am J Med. 2010;123(1):79-86.
Schmidt H, et al. Neurocognitive functions and brain atrophy after proven neuroborreliosis: a case-control study. BMC Neurol. 2015;15:139.
Eliassen KE, et al. Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice. Scand J Prim Health Care. 2017;35(1):75-83.
Dryden MS, et al. Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy. Epidemiol Infect. 2015;143(3):561-72.
Ruiz VH, et al. Association of Seropositivity to Borrelia burgdorferi With the Risk of Neuropsychiatric Disorders and Functional Decline in Older Adults: The Aging Multidisciplinary Investigation Study. JAMA Neurol. 2019;
Wormser GP, et al. Long-Term Assessment of Fibromyalgia in Patients with Culture-Confirmed Lyme Disease. Arthritis Rheumatol. 2015;67(3):837-839.
Ogrinc K, et al. Course and Outcome of Early European Lyme Neuroborreliosis (Bannwarth Syndrome): Clinical and Laboratory Findings. Clin Infect Dis. 2016;63(3):346-53.
Stupica D, et al. Comparison of Clinical Course and Treatment Outcome for Patients With Early Disseminated or Early Localized Lyme Borreliosis. JAMA Dermatol. 2018;154(9):1050-1056.
Skogman BH, et al. Long-term clinical outcome after Lyme neuroborreliosis in childhood. Pediatrics. 2012;130(2):262-9. [commentary: Headache, fatigue not considered sequelae after Lyme neuroborreliosis]
Adams WV, et al. Long-term cognitive effects of Lyme disease in children. Appl Neuropsychol. 1999;6(1):39-45.
Szer IS, et al. The long-term course of Lyme arthritis in children. N Engl J Med. 1991;325(3):159-63.
Tory HO, et al. Outcomes of children treated for Lyme arthritis: results of a large pediatric cohort. J Rheumatol. 2010;37(5):1049-55.
Adams WV, et al. Cognitive effects of Lyme disease in children. Pediatrics. 1994;94(2 Pt 1):185-9.
Chason ME, et al. Symptom Resolution in Pediatric Patients With Lyme Disease. J Pediatric Infect Dis Soc. 2019;8(2):170-173.
Forde KM, et al. The clinical presentation, treatment and outcome of serologically confirmed paediatric Lyme disease in the Republic of Ireland over a 5-year period: a retrospective cohort study. Eur J Clin Microbiol Infect Dis. 2020.
General Lyme disease information
Kullberg BJ. Lyme borreliosis: diagnosis and management. BMJ. 2020.
Steere AC, et al. Lyme borreliosis. Nat Rev Dis Primers. 2016;2:16090.
Shapiro ED. Clinical practice: Lyme disease. N Engl J Med. 2014;370(18):1724-31.
Marques AR, et al. Comparison of Lyme Disease in the United States and Europe. Emerging Infectious Diseases. 2021.
Sanchez E, et al. Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review. JAMA. 2016;315(16):1767-77. [pdf mirror]
Schwartz AM, et al. Surveillance for Lyme Disease – United States, 2008-2015. MMWR Surveill Summ. 2017;66(22):1-12.
Halperin JJ. Neuroborreliosis and Neurosyphilis. Continuum (Minneap Minn). 2018;24(5, Neuroinfectious Disease):1439-1458.
Halperin JJ. Lyme disease: neurology, neurobiology, and behavior. Clin Infect Dis. 2014;58(9):1267-72.
Sigal LH. Musculoskeletal features of Lyme disease: understanding the pathogenesis of clinical findings helps make appropriate therapeutic choices. J Clin Rheumatol. 2011;17(5):256-65.
Bockenstedt LK, Wormser GP. Review: unraveling Lyme disease. Arthritis Rheumatol. 2014;66(9):2313-23.
Stanek G, Strle F. Lyme borreliosis-from tick bite to diagnosis and treatment. FEMS Microbiol Rev. 2018;42(3):233-258. [European perspective]
Updated October 10, 2021