Long-term antibiotics and other treatments for chronic Lyme disease, also called post–Lyme disease syndrome, led to septic shock, Clostridium difficile colitis, osteodiscitis, abscess, and death, according to a review of five cases reported to the Centers for Disease Control and Prevention in recent years.

"Clinicians, public health practitioners, and patients should be aware that treatments for chronic Lyme disease lack proof of effectiveness and can result in serious complications," write Natalie S. Marzec, MD, a resident in preventive medicine at the University of Colorado in Aurora, and colleagues in an article published in the June 16 issue of the Morbidity and Mortality Weekly Report.

"The term 'chronic Lyme disease' is used by some health care providers as a diagnosis for various constitutional, musculoskeletal, and neuropsychiatric symptoms," the authors write.

Although there is insufficient evidence to support the use of prolonged antibiotics, immunoglobulin therapy, or other treatments in these patients, the treatments are prescribed by some clinicians and sometimes lead to serious harm, Dr Marzec and colleagues note.

For example, a recent study reported by Medscape Medical News provides further evidence that long-term antibiotic treatment is not an effective therapy for chronic Lyme disease, despite the fact that some guidelines recommend it.

In the current report, the researchers describe five cases of patients who suffered complications after undergoing one of these nonstandard treatments. In one case, a female patient in her late 30s had fatigue and joint pain, which led to a diagnosis of chronic Lyme disease, babesiosis, and Bartonella infection. She was prescribed several courses of oral antibiotics, but did not respond. She was then placed on intravenous ceftriaxone and cefotaxime delivered through a peripherally inserted central catheter. Three weeks later, with worsening joint pain, she developed a fever and rash, was admitted to an intensive care unit, and was placed on broad-spectrum antibiotics. Despite the supportive care, she died from septic shock related to central venous catheter-associated bacteremia.

Another patient, an adolescent, was diagnosed with chronic Lyme disease based on long-term muscle and joint pain, backaches, headaches, and lethargy. She received oral and intravenous antibiotics through a peripherally inserted central catheter for a 5-month period without improvement. After discontinuing the antibiotic treatment, she developed septic shock. Her blood cultures tested positive for Acinetobacter spp, which were successfully treated with broad-spectrum antibiotics in the intensive care unit.

The third patient, a women in her late 40s, developed influenza-like symptoms after multiple arthropod bites and tested positive for Lyme disease. She received two 4-week courses of oral doxycycline. Two years later, with "fatigue, cognitive difficulties, and poor exercise tolerance," she was diagnosed with chronic Lyme disease. After prolonged intravenous antibiotic treatment, blood and catheter tip cultures grew Pseudomonas aeruginosa, for which she was treated. Continued back pain led to a diagnosis of osteodiscitis based on computed tomography findings, and a bone biopsy that was also positive for P aeruginosa. Treatment for osteodiscitis was eventually successful.

The final two cases involved a patient in her 50s and one in her 60s, both of whom had one or multiple comorbidities. The former had symptoms of weakness, swelling, and tingling in her extremities, which led to an initial diagnosis of chronic inflammatory demyelinating polyneuropathy and 5 years of unsuccessful treatment. Subsequently, she was diagnosed with amyotrophic lateral sclerosis, as well as chronic Lyme disease, babesiosis, and Rocky Mountain spotted fever. After 7 months of intensive intensive antibiotic treatment, she developed an intractable C difficile infection requiring more than 2 years of treatment. This patient died from complications of amyotrophic lateral sclerosis.

The older of the two patients had autoimmune neutropenia, mixed connective tissue disease, and degenerative arthritis when she was diagnosed with chronic Lyme disease neuropathy. After treatment with intravenous immunoglobulin every 3 weeks for more than 10 years, this patient developed methicillin-resistant Staphylococcus aureus, which was treated with intravenous antibiotics. The S aureus infection later reemerged, with magnetic resonance imaging evidence of infection in her lumber facet joints. The patient ultimately required drainage of a paraspinal abscess.

"These cases highlight the severity and scope of adverse effects that can be caused by the use of unproven treatments for chronic Lyme disease," the authors write. "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."

The authors call for increased awareness of the risks associated with the treatments for chronic Lyme disease, and they advocate for additional research based on clinician surveys, administrative claims databases, and information that could be gleaned by implementing reporting systems for treatment-related adverse outcomes to better understand the risks.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2017;66:607-609. Full text

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