TABLE 2.

Lyme Disease: Comparison of Evidence-based Guidelines Versus Non-evidence-based Concepts Favored by LLMDs and Advocacy Groups

Description	Evidence-based†	Not Evidence-based‡
Terminology	Late Lyme disease	Chronic Lyme disease
	Post-Lyme disease syndrome	Chronic Lyme disease
Epidemiology	Tick-borne	Sexually transmitted
	Known geography	Geographically unrestricted
		Congenital infection
Pathophysiology	Not an intracellular pathogen; no evidence of cystic forms in vivo	Chronic infection resistant to antibiotics due to cyst formation or intracellular location
		Stealth mechanisms establish and maintain chronic infection
Clinical	Objective and subjective signs and symptoms	Subjective symptoms only necessary for diagnosis
	Treatment effective for early or late infection	If not treated early, infection may be incurable
	Defined clinical spectrum	Cause of learning disabilities, autism, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, Morgellons disease, psychiatric disease (Lyme rage), Alzheimer's disease,
	Occasional tick-borne disease co-infections	Frequent co-infections (Babesia, Bartonella, Ehrlichia, Anaplasma, Chlamydophila, Mycoplasma)
	Rare reports of death related to Lyme disease	Lethal disease
Diagnostic tests	Negative Lyme serology seen in early infection	Seronegative Lyme disease common, late disease
	IgM immunoblot used for acute illness diagnosis only	IgM immunoblot sufficient to diagnose long-standing symptoms
	FDA approved B. burgdorferi serology	Lyme specialty labs using non-validated tests or test interpretations
		Use of markers CD57, C4a
Therapy	Single antibiotic course 10-28 days with rare situations to retreat	Persistent symptoms demand long-term treatment until resolution of symptoms (months-years)
	Treated patients with persistent symptoms have no evidence of remaining infection	Combination and/or parenteral antibiotics necessary for cure

†Data derived from (2, 3, 36, 37).

‡Data derived from (12, 38, 39).