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Patient Instructions

Chronic persistent Lyme disease is a late stage of an inflammatory disease caused by Borrelia burgdorferi bacteria. It is also called Stage 3, or tertiary, Lyme disease.

See also:

• Lyme disease
• Lyme disease - early disseminated
• Lyme disease - primary

Lyme disease is transmitted by the bite of a deer tick.

Some people may not be treated for Lyme disease because they do not have any symptoms or their symptoms are mild. Stage 3 Lyme disease may develop months or even years after the Lyme disease infection.

Even people who were treated may develop Stage 3 Lyme disease.

Chronic, or Stage 3 Lyme disease can affect the skin, brain, and nervous system, and muscles, bones, and cartilage.

Symptoms include:

• Chronic arthritis
• Fatigue
• Headaches
• Joint inflammation in the knees and other large joints
• Memory loss
• Mood changes
• Sleep disorders

Other symptoms that may occur with this disease:

• Abnormal sensitivity to light
• Confusion
• Decreased consciousness
• Numbness and tingling

A blood test can be done to check for antibodies to the bacteria that cause Lyme disease. The most common one used is the ELISA for Lyme disease test. A Western blot test is done to confirm ELISA results.

A spinal tap will be abnormal if you have central nervous system symptoms from the disease.

Antibiotics are given to fight the infection. Medications sometimes need to be given through a vein (intravenously).

Stage 3 Lyme disease is treated for up to 28 days with antibiotics. If arthritis symptoms do not go away, a second 2 - 4 week course of antibiotics may sometimes be used. Antibiotics given by mouth (doxycycline, amoxicillin, or cefuroxime) are used most of the time.

A 2 - 4 week course of intravenous ceftriaxone may be used for treating severe Lyme disease that affects the nervous system.

Treating patients for longer periods of time is generally not thought to be helpful, even if symptoms do not go away.

Arthritis symptoms may not get better with treatment. Other symptoms should improve with treatment.

Rarely, a person will continue to have symptoms that can sometimes interfere with daily life or activities. Some people call this post-Lyme disease syndrome. There is no effective treatment for people with these symptoms.

• Arthritis symptoms may continue
• Heart problems (slow heart rate, and effects on the electrical system of the heart)

Call your health care provider if you develop symptoms, especially if you have had Lyme disease before, or live or travel in high-risk areas.

Early diagnosis and appropriate antibiotic treatment for primary Lyme disease is the most effective way to prevent tertiary Lyme disease.

Here are some tips for preventing primary Lyme disease:

When walking or hiking in wooded or grassy areas:

• Spray all exposed skin and your clothing with insect repellent (spray outdoors only, do not use on face, use just enough to cover all other exposed skin, don't spray under clothing, don't apply over wounds or irritated skin, wash skin after going inside)
• Wear light-colored clothing to make it easier to spot ticks
• Wear long-sleeved shirts and long pants with the cuffs tucked into shoes or socks
• Wear high boots, preferably rubber

Check yourself and your pets frequently during and after your walk or hike.

Ticks that carry Lyme disease are so small that they are very hard to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp.

If possible, ask someone to help you examine your body for ticks. Adults should carefully examine children.

Tertiary Lyme disease; Stage 3 Lyme disease; Late persistent Lyme disease; Lyme arthritis

Bratton RL, Whiteside JW, Hoyan MJ, Engle RL, Edwards FD. Diagnosis and treatment of Lyme disease. Mayo Clin Proc. 2008;83:566-571.

Feder HM Jr, Johnson BJ, O'Connell S, Shapiro ED, Steere AC, Wormser GP. Ad Hoc International Lyme Disease Group. A critical appraisal of "chronic Lyme disease." N Engl J Med. 2007;357:1422-1430.

Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69:91-102.

Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089-1134.

Updated by: Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.