Table 4.

PTLD case definition

Presentation	Sign/symptom (detailed definition)	Evaluations(s)
Post-treatment Lyme disease	Prior documented case of clinically confirmed LD as per definitions in table 3. Treatment with accepted antibiotic regimen with resolution or stabilisation of objective manifestations of LD. Fatigue, musculoskeletal pain and cognitive difficulties that begin within 6 months and last for 6 months after completion of antibiotic therapy. Subjective symptoms are so severe that result in a substantial reduction in activities. No other comorbidities that can explain illness.	Final diagnosis of LD (clinical diagnosis only or laboratory confirmed). Participants with questionnaire scores exceeding the cut-off scores for fatigue (FSS mean score of 4 or higher), pain (SF-36, pain subscale, score 55 or lower)15 or neurocognitive functioning (CFQ Score 44 or higher), that begin within 6 months and last for 6 months after completion of antibiotic therapy, as assessed by afore-mentioned questionnaires.16 Subjective symptoms result in reduction of activities as assessed by either the ‘limitations in physical activities’ subscale (score 55 or lower) of the SF-36.15

CFQ, Cognitive Failures Questionnaire; FSS, Fatigue Severity Scale; LD, Lyme disease; SF-36, 36-Item Short Form Survey.