Papers on Chronic Lyme Disease Beliefs

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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.

For more, see our list of good journalism on chronic Lyme disease or our list of doctor and scientist commentaries.

For statements from medical societies, see our page on the scientific consensus. There is also a page documenting the massive number of false positive Lyme diagnoses.

General discussion

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. [paper mirror]

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.

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.

Rorat M, et al. [Growing boreliosis anxiety and its reasons]. Psychiatr Pol. 2010;44(6):895-904. [English translation]

Peretti-watel P, et al. Lyme disease: Insight from social sciences. Med Mal Infect. 2019;

Gentilini M, Bricaire F. Chronic Lyme disease: A scam that should be condemned! Med Mal Infect. 2019. [PDF mirror, excerpts]

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. [paper mirror]

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]

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. [Press coverage]

Nelson C, et al. Neoplasms misdiagnosed as “chronic lyme disease”. JAMA Intern Med. 2015;175(1):132-3. [Press coverage]

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.

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.

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.

Klempner MS, et al. Treatment trials for post-Lyme disease symptoms revisited. Am J Med. 2013;126(8):665-9.

LymeScience reviews:

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)

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. 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.


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.

General Lyme disease information

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.

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.