On June 16, 2017, the CDC published a report that found that patients diagnosed with “chronic Lyme disease” may be treated with long courses of intravenous (IV) antibiotics which may cause serious bacterial infections. The term “chronic Lyme disease” is used by some health care providers as a diagnosis for various constitutional, musculoskeletal, and neuropsychiatric symptoms. Patients with a diagnosis of chronic Lyme disease have been provided a wide range of medications as treatment, including long courses of IV antibiotics. Studies have not shown that such treatments lead to substantial long-term improvement for patients, and they can be harmful. This report describes cases of septic shock, osteomyelitis, Clostridium difficile colitis, and paraspinal abscess resulting from treatments for chronic Lyme disease. Patients, clinicians, and public health practitioners should be aware that treatments for chronic Lyme disease can carry serious risks.
Lyme disease is a well-known condition caused by infection with the spirochete Borrelia burgdorferi sensu lato. Features of early infection include erythema migrans (an erythematous skin lesion with a bull’s-eye or homogeneous appearance), fever, headache, and fatigue. If left untreated, the spirochete can disseminate throughout the body to cause meningitis, carditis, neuropathy, or arthritis. The recommended treatment for Lyme disease is generally a 2 to 4-week course of antibiotics.
Chronic Lyme disease, on the other hand, is a diagnosis that some health care providers use to describe patients with a variety of conditions such as fatigue, generalized pain, and neurologic disorders. Many of these patients have experienced significant debilitation from their symptoms and have not found relief after consultation with conventional medical practitioners. As a result, some seek treatment from practitioners who might identify themselves as Lyme disease specialists (“Lyme literate” doctors) or from complementary and alternative medicine clinics, where these patients receive a diagnosis of chronic Lyme disease.
A diagnosis of chronic Lyme disease might be based solely on clinical judgment and without laboratory evidence of B. burgdorferi infection, objective signs of infection, or a history of possible tick exposure in an area with endemic Lyme disease. There is a belief among persons who support the diagnosis and treatment of chronic Lyme disease that B. burgdorferi can cause disabling symptoms even when standard testing is negative, despite evidence that the recommended two-tiered serologic testing is actually more sensitive the longer B. burgdorferi infection has been present. Some practitioners use tests or testing criteria that have not been validated for the diagnosis of Lyme disease. A significant concern is that after the diagnosis of chronic Lyme disease is made, the actual cause of a patient’s symptoms might remain undiagnosed and untreated.
Patients given a diagnosis of chronic Lyme disease have been prescribed various treatments for which there is often no evidence of effectiveness, including extended courses of antibiotics (lasting months to years), IV infusions of hydrogen peroxide, immunoglobulin therapy, hyperbaric oxygen therapy, electromagnetic frequency treatments, garlic supplements, colloidal silver, and stem cell transplants. At least five randomized, placebo-controlled studies have shown that prolonged courses of IV antibiotics in particular do not substantially improve long-term outcome for patients with a diagnosis of chronic Lyme disease and can result in serious harm, including death.
Clinicians and state health departments periodically contact the CDC concerning patients who have acquired serious bacterial infections during treatments for chronic Lyme disease. The report presented five illustrative cases described to the CDC over the past several years.
Antibiotics and immunoglobulin therapies are effective and necessary treatments for many conditions. However, unnecessary antibiotic and immunoglobulin use provides no benefit to patients while putting them at risk for adverse events. When used for extended periods, the risks associated with these treatments increase, so it is important that they be used appropriately.
The illustrative cases highlight the severity and scope of adverse effects that can be caused by the use of unproven treatments for chronic Lyme disease. In addition to the dangers associated with inappropriate antibiotic use, such as selection of antibiotic-resistant bacteria, these treatments can lead to injuries related to unnecessary procedures, bacteremia and resulting metastatic infection, venous thromboses, and missed opportunities to diagnose and treat the actual underlying cause of the patient’s symptoms. Patients and their health care providers need to be aware of the risks associated with treatments for chronic Lyme disease.
The number of persons who undergo treatments for chronic Lyme disease is unknown, as is the number of complications that result from such treatments. Systematic investigations would be useful to understand the scope and consequences of adverse effects resulting from treatment of persons with a diagnosis of chronic Lyme disease.
See the CDC Report
See also Medical Law Perspectives Report: Danger and Controversy: Lyme Disease Liability Risks
See also Medical Law Perspectives Report: How Risky Is Going to the Hospital? The Dangers and Liabilities of Healthcare-Associated Infections
See also Medical Law Perspectives Report: Hospital-Acquired Infections: Who Is Liable and Why?
See also Medical Law Perspectives Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication
See also Medical Law Perspectives Report: Complementary and Alternative Medicine: Practitioner Liability
See also Medical Law Perspectives Report: Off-Label Use of Prescriptions: When is this Medical Malpractice? Is the Pharmaceutical Company Liable for Overpromotion?
See the Medical Law Perspectives Blog: Problems of Proving a Lyme Disease Diagnosis