Spirochetal ‘debris’ versus persistent infection in chronic Lyme disease: from semantics to science.

Lyme disease is a highly controversial illness that features two opposing camps [1–4]. One camp espouses the viewpoint of the International Lyme and Associated Diseases Society (ILADS) that infection with the Lyme spirochete, Borrelia burgdorferi, can be difficult to detect given the current state of diagnostic tests and that the organism can be hard to eradicate given its ability to evade the host immune response and antibiotic therapy [1,2]. The other camp espouses the viewpoint of the Infectious Diseases Society of America (IDSA) that Lyme disease is a simple infection that is easily diagnosed and treated. According to this camp, the notion that infection may persist after a short course of antibiotics lacks ‘credible scientific evidence’, persistence mechanisms of B. burgdorferi are deemed ‘implausible’ and the diagnosis of chronic Lyme disease is no more than a ‘misnomer’ [3,4]. The IDSA Lyme treatment guidelines do not provide antibiotic treatment options for patients with persistent Lyme disease symptoms, nor do they acknowledge the role of clinical judgment in the treatment of these patients [5].

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