{ "condition": "Chronic Lyme / PTLDS – Post-Treatment Lyme Disease Syndrome", "key": "lyme", "last_updated": "2026-07-08T06:39:31.306579Z", "count": 75, "source": "PubMed (NCBI)", "studies": [ { "pmid": "42402029", "title": "Antiphospholipid antibodies in acute and post-treatment Lyme disease.", "pub_date": "2026-07-05", "journal": "Infection and immunity", "authors": "Shrestha, Muskan, Hickman, Anna F, Zhong, Yuelin, Zvinys, Audre et al.", "abstract": "Acute Lyme disease is caused by a", "url": "https://pubmed.ncbi.nlm.nih.gov/42402029/" }, { "pmid": "42391726", "title": "Therapeutic plasma exchange and immunomodulatory strategies in post-infectious syndromes: A review of immune dysregulation in PTLDS, long COVID, ME/CFS, and PANS/PANDAS.", "pub_date": "2026-07-03", "journal": "Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis", "authors": "Kaplan, Gary", "abstract": "Post-infectious syndromes including post-treatment Lyme disease syndrome (PTLDS), long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and pediatric acute-onset neuropsychiatric syndrome (PANS)/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) share overlapping clinical phenotypes characterized by fatigue, cognitive dysfunction, sleep disturbance, and neuropsychiatric symptoms. Increasing evidence suggests that immune dysregulation-including persistent inflammation, autoantibody production, and cellular immune dysfunction-may underlie these conditions. This narrative review synthesizes peer-reviewed literature describing immune abnormalities across these syndromes and evaluates the rationale for immunomodulatory therapies, including intravenous immunoglobulin (IVIG), rituximab, and therapeutic plasma exchange (TPE). Evidence supporting immune-targeted treatment strategies is strongest in subsets of patients with identifiable immunologic abnormalities. Notably, the phase III RituxME trial in ME/CFS and a phase II trial of TPE in post-COVID condition both failed to demonstrate efficacy in unselected populations, reinforcing the importance of biomarker-guided patient stratification. TPE functions by removing circulating immune complexes, autoantibodies, and inflammatory mediators, and observational data suggest benefit in patients with demonstrable autoantibody burden. Further controlled studies incorporating immunologic phenotyping and early intervention are needed to define the therapeutic role of immune-directed interventions across these conditions.", "url": "https://pubmed.ncbi.nlm.nih.gov/42391726/" }, { "pmid": "42374672", "title": "Assessment of the frequency of IgM and IgG antibodies against", "pub_date": "2026-06-30", "journal": "Annals of agricultural and environmental medicine : AAEM", "authors": "Koczanowicz, Sylwia, Nowak-Chmura, Magdalena, Hudy, Dorota, Baranowska, Karolina et al.", "abstract": "Borreliosis, also known as Lyme disease, is a chronic, multi-organ illness that is very difficult to diagnose. It is caused by the spirochete Serum for the study was obtained from 99 randomly selected patients who reported for routine testing at the medical diagnostic laboratory in Krynica-Zdrój. The presence of IgM and IgG antibodies against In total, positive or borderline results for at least one class of anti-Borrelia antibodies were found in 22.2% of human sera. Only in two samples were the positive results in anti-Borrelia IgM and IgG shown. Antibodies against the spirochete Studies have shown a high percentage of people with antibodies against detected", "url": "https://pubmed.ncbi.nlm.nih.gov/42374672/" }, { "pmid": "42359130", "title": "Patient roadmap and economic burden of chronic tick-borne illness and post-treatment Lyme disease syndrome in Ireland, and public health issues arising.", "pub_date": "2026-06-26", "journal": "Frontiers in public health", "authors": "Avramovic, Gordana, Gilbert, Leona, Kujawski, Sławomir, Blehle, Sigrid et al.", "abstract": "Lyme borreliosis (LB), commonly referred to as Lyme disease (LD), is a prominent global health issue, exhibiting a seroprevalence rate of 14.5%. Heightened incidence levels of LD have been recorded in parts of Europe, Poland, Eastern Europe, and the Baltic States. The research aimed to inform the cost of LD and post-treatment Lyme disease syndrome (PTLDS) in Ireland through results from a patient questionnaire, disease modelling, the construction of a patient roadmap, and attempts to arrive at prevalence calculation estimates based on local data. Patient data encompassed sociodemographic particulars, disease attributes, healthcare resource utilization, and the influence on their employment status. Of 301 patients, 210 were diagnosed with LD and/or a tick-borne infection (TBI), the cohort's average age was 40.07 (SD 13.5) (", "url": "https://pubmed.ncbi.nlm.nih.gov/42359130/" }, { "pmid": "42347267", "title": "Anti-", "pub_date": "2026-06-25", "journal": "Pathogens (Basel, Switzerland)", "authors": "Aslan Başbulut, Eşe, Yavuz, Demet, Demir, Tülin", "abstract": "Lyme borreliosis is a multisystemic tick-borne infection caused by The study included 45 patients and 45 age and sex matched controls. Serum samples were tested for anti- Overall, anti- IgG seropositivity was numerically higher among patients with CKD of unknown etiology than among healthy controls; however, this difference was not statistically significant. Larger, risk-factor-adjusted studies are needed to clarify whether", "url": "https://pubmed.ncbi.nlm.nih.gov/42347267/" }, { "pmid": "42265463", "title": "Risk factors for EBV reactivation and impact of graft composition following GVHD prophylaxis with rabbit ATG or PTCy.", "pub_date": "2026-06-10", "journal": "Bone marrow transplantation", "authors": "Thiant, Stéphanie, Dufresne, Simon, Ahmad, Imran, Cohen, Sandra et al.", "abstract": "EBV reactivation is frequent after allogeneic HCT and can lead to post-transplant lymphoproliferative disorder (PTLD). While ATG and PTCy are established strategies to prevent GVHD, their comparative impact on EBV reactivation remains insufficiently characterized. We conducted a retrospective study in patients who received either rabbit ATG or PTCy. Primary endpoints were incidences of positive and high-level EBV DNAemia (≥10⁴ copies/mL). Secondary endpoints were incidence of PTLD, predictive risk factors for EBV reactivation, GVHD, survival, immune reconstitution and response to hepatitis B vaccination. 286 patients were included; 215 received ATG and 71 PTCy. High-level EBV DNAemia occurred earlier and more frequently after ATG (42.3% vs 22.5%, p < 0.0001). All PTLDs were in ATG recipients. In these, high CD19+ B cell doses ( ≥ 3.88 × 10 Rabbit ATG, high CD19+ content and CD19+/CD8+ ratio in infused grafts are associated with a higher risk of EBV. Novel strategies targeting these patients while preserving immune reconstitution are warranted.", "url": "https://pubmed.ncbi.nlm.nih.gov/42265463/" }, { "pmid": "42148664", "title": "Designing studies for post-treatment Lyme disease and other infection-associated chronic illnesses.", "pub_date": "2026-05-18", "journal": "Brain : a journal of neurology", "authors": "Arnaboldi, Paul M, Becker, Jacqueline, Nath, Avindra, Coyle, Patricia K et al.", "abstract": "Infection-associated chronic illnesses (IACIs) encompass a spectrum of poorly understood syndromes often marked by significant neurologic and multisystem symptoms following an infectious event. This review focuses on several diseases representative of the IACI spectrum. These are post-treatment Lyme disease syndrome (PTLDS), long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and multiple sclerosis (MS). Their clinical and biological complexity, combined with a lack of clear diagnostic criteria and objective available laboratory biomarkers, makes them difficult to distinguish from conditions with overlapping features. This presents challenges for research studies, as well as diagnosis and clinical management. This diagnostic ambiguity, coupled with heterogeneous patient presentations, has led to challenges in research, including misclassification of study participants and inconsistent or irreproducible findings. Some PTLDS research exemplifies these issues, which also extend to other IACIs. To advance the field, we highlight key methodological refinements and approaches for studying IACIs, including rigorous participant selection, standardized sample collection protocols, and the use of appropriate control groups, including those with microbiologic proof of the initial infection when known and technologically feasible. We also address broader influences on research quality, such as stigma, historical neglect, and the urgency to find treatments, which have contributed to the proliferation of poorly controlled studies and questionable practices. Drawing lessons from past challenges, we propose a path forward grounded in fit-for-purpose methodological rigour to improve scientific understanding and support evidence-based therapeutic development for IACIs.", "url": "https://pubmed.ncbi.nlm.nih.gov/42148664/" }, { "pmid": "42083310", "title": "Borrelia burgdorferi sensu lato Employs Several Escape Mechanisms to Bypass the Human Defense System.", "pub_date": "2026-05-05", "journal": "European journal of immunology", "authors": "Karami, Zara, Hofstede, Hadewych J M Ter, Joosten, Leo A B", "abstract": "Lyme borreliosis (LB), caused by Borrelia burgdorferi sensu lato (Bbsl) through Ixodes tick bites, presents diverse clinical manifestations and may lead to persistent symptoms. This review summarizes current knowledge on the pathogen-host interactions and immune responses. Early infection can be influenced by tick saliva, which suppresses local host defense and promotes spirochete survival, and by pattern recognition receptors activating proinflammatory cascades. Bbsl employs a variety of immune evasion strategies, notably impairing antigen presentation-through disruption of MHC II and IFN-γ pathways-and continuously varying surface antigens to hinder long-lasting antibody formation. Autophagy plays a central role in modulating inflammation and T helper 17 adaptive immune responses, representing an underappreciated mechanism potentially influencing disease outcome. Adaptive immunity in LB is characterized by robust but often dysregulated humoral and cellular responses, with transient germinal centers and enduring IgM production contributing to incomplete pathogen clearance. Persistent immune defects include impaired long-term B cell memory, suppressed T cell activation, and ongoing immunosuppression after pathogen clearance. Similar patterns are observed in other postinfectious fatigue syndromes. Despite advances, gaps remain in understanding mechanisms of Bbsl persistence and the immunopathology underlying chronic disease, challenging diagnosis and therapy. Emerging molecular and cellular approaches offer new avenues to address immunity, diagnostics, and prevention. A multidisciplinary effort will be needed to improve long-term patient outcomes in the evolving epidemiology of LB.", "url": "https://pubmed.ncbi.nlm.nih.gov/42083310/" }, { "pmid": "42075745", "title": "Promoting a Positive Relationship Between Physicians and Patients with Lyme Disease During Pregnancy and Parenthood.", "pub_date": "2026-05-04", "journal": "Pathogens (Basel, Switzerland)", "authors": "Hickman, Emma T, Williams, Meagan E, DeBiasi, Roberta L, Mulkey, Sarah B", "abstract": "Patients with Lyme disease often face uncertainty when navigating the healthcare system during pregnancy and when seeking healthcare for their children exposed to Lyme disease in utero. Little is known about these families' experiences. This qualitative study explored the perspectives of 27 parents in the United States who had acute or chronic Lyme-related diagnoses while pregnant. Semi-structured interviews were coded and thematically analyzed. Six themes characterized positive patient-physician interactions: (1) validation of patient experiences, (2) transparency, (3) willingness to learn, (4) shared decision making, (5) empathy, and (6) continuity of care. These findings offer guidance for clinicians counseling patients facing prognostic uncertainty related to Lyme disease and similarly complex conditions.", "url": "https://pubmed.ncbi.nlm.nih.gov/42075745/" }, { "pmid": "42075735", "title": "Seroprevalence of", "pub_date": "2026-05-04", "journal": "Pathogens (Basel, Switzerland)", "authors": "Aydin, Gokhan, Akyol, Taner", "abstract": "No abstract available.", "url": "https://pubmed.ncbi.nlm.nih.gov/42075735/" }, { "pmid": "41988178", "title": "From forest floor to doctor's office: the immunological journey of", "pub_date": "2026-04-16", "journal": "Frontiers in immunology", "authors": "Singh, Preeti, Bankhead, Troy", "abstract": "Lyme disease, caused by the spirochete", "url": "https://pubmed.ncbi.nlm.nih.gov/41988178/" }, { "pmid": "41972549", "title": "In Silico-Identified Peptides of Five", "pub_date": "2026-04-13", "journal": "Biology", "authors": "Georgopoulos, Apostolos P, James, Lisa M, Sanders, Matthew", "abstract": "To date, Lyme vaccine development has largely overlooked the vaccinee's human leukocyte antigen (HLA) genetic makeup on which antibody production critically depends. Here, we evaluated in silico the predicted binding affinities of 192 HLA-II alleles with all 15-mer peptide sequences of five", "url": "https://pubmed.ncbi.nlm.nih.gov/41972549/" }, { "pmid": "41967005", "title": "Making Invisible Illnesses Visible: Recognizing and Responding to Infection Associated Chronic Conditions.", "pub_date": "2026-04-12", "journal": "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America", "authors": "Iskander, John K, Haridopolos, Stephanie", "abstract": "The emergence of post-COVID conditions (PCC) has renewed attention to infection-associated chronic conditions and illnesses (IACCI), including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Lyme disease-associated chronic symptoms. Millions of Americans are affected by these debilitating, misunderstood conditions, which share symptom profiles and pathophysiologic abnormalities. IACCI have received insufficient clinical attention and research investment. We outline elements of a patient-centered approach to care, emphasizing validation of patients' experiences, multidisciplinary management, and symptom-focused treatment. Opportunities to strengthen clinical practice include a new CMS code for chronic condition management, extended visits, and creation of welcoming care environments. Advances in PCC and ME/CFS research provide a foundation for exploring shared mechanisms and developing targeted therapies. Improved surveillance, harmonized research, and inclusive trial designs are needed to define disease burden and accelerate therapeutic progress. Coordinated action by clinicians, researchers, and policymakers can help address longstanding gaps and improve outcomes for all individuals with IACCI.", "url": "https://pubmed.ncbi.nlm.nih.gov/41967005/" }, { "pmid": "41965542", "title": "Epidemiology, diagnosis and emerging therapies for Lyme disease of the Northern Hemisphere.", "pub_date": "2026-04-12", "journal": "International journal of emergency medicine", "authors": "Priya, Shairy, Sridhar, Sathvik Belagodu, Shareef, Javedh, Wadhwa, Tarun et al.", "abstract": "BACKGROUND: Lyme disease is the most widespread tick-borne infection in the Northern Hemisphere and is challenging to diagnose and treat due to its changing clinical presentation, antigenic variation, tissue tropism, and the expanding distribution of vectors. This review includes ecology, pathogenesis, diagnostics, treatment, post-treatment, prevention, and novel translational approaches. METHODS: A literature review was conducted to include literature published between January 2000 and March 2026 in PubMed/MEDLINE, Scopus, and Web of Science, with landmark studies used where applicable. Original research, clinical trials, systematic reviews, and major public health reports were prioritised. RESULTS: Two-tier serology is the most common diagnostic technique, but it has limited sensitivity in early infection and does not distinguish between active and past infection. Culture and PCR are only useful in a few instances. The use of new technologies such as multiomics biomarkers, metagenomics, T-cell assays, and AI-enhanced diagnostics is promising but has not yet been tested in a prospective multicentre study. Most of the early and disseminated disease can be treated with standard antibiotics, whereas the long-term therapy of PTLD is not justified and can cause more adverse effects. These preventive and curative advancements involve VLA15 vaccination, anti-tick and reservoir-specific approaches, microbiome-engineered vectors, and anti-persister/ biofilm. CONCLUSION: Lyme disease requires combined prevention, improved diagnostics, enhanced biomarker research, and well-designed PTLD trials. The short-term benefits will be based on the optimisation of existing diagnostics and vector control, and the long-term benefits will be based on rigorous validation of vaccines, biomarkers, and specific therapies. Not applicable. [Image: see text]", "url": "https://pubmed.ncbi.nlm.nih.gov/41965542/" }, { "pmid": "41939499", "title": "The Role of Borrelia Burgdorferi in the Etiology of Chronic Urticaria.", "pub_date": "2026-04-06", "journal": "Medical archives (Sarajevo, Bosnia and Herzegovina)", "authors": "Krkic-Dautovic, Sajma", "abstract": "Lyme borreliosis/European borreliosis (LB/EB) is a multisystemic infection caused by the bacterium The aim of this paper was to determine how much In the 13-year period from January 1, 2013 to December 31, 2025, a study of all manifestations of Lyme borreliosis was conducted on a sample of 1,059 patients, treated and monitored in the Private practice of an infectious disease specialist. The research was retrospective-prospective, descriptive, clinical and analytical. It was carried out in three phases: the first retrospective phase and the second two prospective phases. The diagnosis of LB was established on the basis of anamnestic-epidemiological data, clinical picture, clinical findings of new borreliosis markers and performed examinations. Serological confirmation of borreliosis was done using ELISA, WB and Immunoblot methods, as well as the ex-yuvantibus method, and in the last six months of 2025, additionally, the finding of bacteria Borreliosis in a dark field with a light microscope. The results showed that 92.1% of the patients in the study group had intermittent migratory redness with itching. In the majority of patients, redness was without exudation or with little or no exudation. In 4.8% of patients, typical urticarial changes were found that occurred occasionally or daily. In all subjects, we serologically confirmed the presence of Borrelia burgdorferi. All patients had intermittent itching of the skin, which lasted for years. Based on the results, it can be concluded that", "url": "https://pubmed.ncbi.nlm.nih.gov/41939499/" }, { "pmid": "41922149", "title": "Repulsive and precious: thinking with the tick in Canadian Lyme disease discourse.", "pub_date": "2026-04-02", "journal": "Medical humanities", "authors": "Gaudet, Loren", "abstract": "The purpose of this paper is to take seriously the role of the tick in Canadian Lyme disease discourse. I analyse Public Health Agency of Canada Lyme disease awareness materials alongside patient narratives from the 2016 Canadian Conference to Develop a Federal Framework on Lyme Disease to show that the tick has a more complex, symbiotic relationship to the Lyme disease sufferer. The tick, therefore, is not just a threat, but also is essential in the making of sufferers. This analysis draws on animal studies and new materialisms to understand public health messaging about Lyme disease in terms of preserving distance and separation between humans and ticks. I argue that public health messaging that emphasises the need for excluding the tick makes space for one kind of Lyme disease experience-the acute sufferer-and simultaneously renders impossible other forms of illness experience-the chronic sufferer. In contrast to Public Health messaging that emphasises exclusion, chronic Lyme disease sufferers embrace a human/tick entanglement as a way of claiming reality of their existence. The tick, then, is not just the vector for Lyme disease, but this creature plays a central role in determining the ontological possibilities of patients and sufferers and offers certification of an identity that is often characterised as not possible in mainstream medicine.", "url": "https://pubmed.ncbi.nlm.nih.gov/41922149/" }, { "pmid": "41900360", "title": "Characterization of", "pub_date": "2026-03-28", "journal": "Microorganisms", "authors": "Birkaya, Barbara, Byne, Ahana, Irfan, Sumaiya, Gallagher, Joseph et al.", "abstract": "The cause of chronic neurological effects associated with Lyme disease (LD) remains unclear. We propose that bacterial extracellular vesicles (BEVs) released by", "url": "https://pubmed.ncbi.nlm.nih.gov/41900360/" }, { "pmid": "41893059", "title": "Ischemic Stroke as the First Manifestation of Takayasu Arteritis: A Case Report.", "pub_date": "2026-03-27", "journal": "Neurology international", "authors": "Jakubowicz-Lachowska, Dominika, Sarnowska, Magdalena, Chorąży, Monika, Kułakowska, Alina", "abstract": "Ischemic stroke in young adults is uncommon and is frequently associated with rare etiologies, including autoimmune diseases and vasculitis. Takayasu arteritis (TA) is a chronic inflammatory large-vessel arteriopathy involving the aorta and its major branches and may result in cerebral ischemia due to arterial stenosis or thrombosis. We report the case of a 26-year-old woman with a history of suspected rheumatoid arthritis and Lyme disease who presented with acute left-sided hemiparesis and dysarthria. At admission, large-vessel vasculitis had not yet been suspected, and the patient was treated according to standard acute stroke protocols. Computed tomography angiography (CTA) revealed occlusion of the right middle cerebral artery bifurcation and the right common carotid artery, with inflammatory changes involving the brachiocephalic trunk and subclavian arteries. Intravenous thrombolysis (iv rtPA) was followed by mechanical thrombectomy (MT), resulting in neurological improvement. Further diagnostic work-up confirmed TA, and immunosuppressive therapy with cyclophosphamide and infliximab was initiated. This case underscores the importance of considering inflammatory large-vessel disease in young patients presenting with acute ischemic stroke and illustrates that endovascular reperfusion may be feasible in this clinical setting.", "url": "https://pubmed.ncbi.nlm.nih.gov/41893059/" }, { "pmid": "41845441", "title": "Efficacy of Revolution", "pub_date": "2026-03-18", "journal": "Parasites & vectors", "authors": "Isdale, Rachael, Myers, Jamie A E, Holzmer, Susan, Shaw, Kaci et al.", "abstract": "Borrelia burgdorferi and Anaplasma phagocytophilum are transmitted by Ixodes spp., with antibodies having been detected in cats in endemic areas. The combination of selamectin plus sarolaner (Revolution Ten cats per group were treated once topically either with placebo solution (0.1 ml/kg) or with the minimum label dose of RP (6.0 mg/kg selamectin plus 1.0 mg/kg sarolaner). Thirty days post-treatment, cats were infested with 50 wild-caught adult I. scapularis. Ticks were counted, categorized, and removed on day 35. Blood collections for serology occurred on days -6, 30 (prior to infestation), 49, 63, 77, 91, and 104. Serum antibody assay results (B. burgdorferi and A. phagocytophilum) and polymerase chain reaction (PCR) of skin biopsies (B. burgdorferi) were used to define infection rates in the cats. Treatment with RP resulted in a 100% reduction of I. scapularis ticks compared with placebo-treated cats. In placebo-treated cats, antibodies against B. burgdorferi, A. phagocytophilum, both agents, and B. burgdorferi DNA in skin (five, nine, six, and three cats, respectively) were detected by day 104. In contrast, none of the RP-treated cats developed B. burgdorferi antibodies or DNA in skin biopsies, and A. phagocytophilum antibodies were detected in only two cats, significantly lower than in placebo-treated cats. Results suggest that a single application of RP at the minimum label dose reduces the risk of infection by both B. burgdorferi and A. phagocytophilum, when infected at the end of the dosing interval.", "url": "https://pubmed.ncbi.nlm.nih.gov/41845441/" }, { "pmid": "41826406", "title": "Evaluation of immunoreactive epitopes in the sera and cerebrospinal fluid of patients with post-treatment Lyme disease syndrome.", "pub_date": "2026-03-14", "journal": "Scientific reports", "authors": "Marques, Adriana R, Sanchez-Vicente, Santiago, Nagapurkar, Akash, Eschman, Aleah et al.", "abstract": "While most patients fully recover after treatment for Lyme disease with recommended antibiotic regimens, some report non-specific symptoms after treatment. When these symptoms are unexplained by other conditions and persist for ≥ 6 months, this condition is called post-treatment Lyme disease symptoms or syndrome (PTLDS). The pathogenesis of PTLDS is unknown and no specific diagnostic biomarkers have been identified. In this study, we used a high-density peptide array to examine antibody responses to > 60 primary antigens of B. burgdorferi from a cohort of patients diagnosed with PTLDS and recovered patients with similar Lyme disease manifestations. Using matched serum and cerebrospinal fluid (CSF), we mapped the primary reactive B. burgdorferi epitopes associated with PTLDS. We found that VlsE had a greater antibody response within the PTLDS cohort than recovered patients. The reactivity to OspC-specific epitopes revealed a predominance of antibodies to OspC type K and A in the PTLDS cohort. However, the major immunodominant epitopes were similar in PTLDS and recovered patients, and we were unable to identify specific diagnostic targets for PTLDS. We found a more robust reactivity in the serum over CSF and did not identify antigenic regions that were specifically associated with the infection of the central nervous system.", "url": "https://pubmed.ncbi.nlm.nih.gov/41826406/" }, { "pmid": "41808193", "title": "Efficacy of Simparica and Simparica TRIO for the prevention of Borrelia burgdorferi by Ixodes scapularis.", "pub_date": "2026-03-11", "journal": "Parasites & vectors", "authors": "Geurden, Thomas, Holzmer, Susan, Myers, Jamie A E, Kryda, Kristina et al.", "abstract": "Both Simparica® and Simparica TRIO® chewable tablets are efficacious within 12 h against existing Ixodes scapularis infestations and within 24 h against re-infestations for 1 month. It is therefore expected that treatment with either product prevents Lyme infections due to their efficacy against I. scapularis ticks before the anticipated transmission of Borrelia burgdorferi by infected ticks. In total, four laboratory studies were conducted in which dogs were randomly allocated to two treatment groups of 10 dogs each. On day 0, dogs were either administered a placebo treatment (Pet-Tabs® Palatable Vitamin-Mineral Supplement for Dogs), Simparica TRIO tablets at the minimum dose of 1.2 mg/kg sarolaner, 24 μg/kg moxidectin and 5 mg/kg pyrantel (study 1 and 2) or Simparica at the minimum dose of 2 mg/kg sarolaner (study 3 and 4). On post-treatment day 28, each dog was infested with approximately 50 unfed, wild-caught adult I. scapularis ticks with a high B. burgdorferi infection rate. Blood samples were collected from each prior dog to treatment and on post-treatment days 27, 49, 63, 77, 91 and 104, and qualitatively tested for B. burgdorferi antibodies using the SNAP® 4Dx Plus and Lyme Quant C6® antibody tests. Four skin biopsies from each dog were collected on day 104 from the most common areas of tick attachment and tested by PCR for the quantitative presence of B. burgdorferi. In all studies, at least nine out of 10 placebo-treated dogs were infected with B. burgdorferi before the end of the study. In study 1, one Simparica Trio-treated dog tested positive, whereas in the other studies none of the dogs treated with sarolaner tested positive at any time point during the study. Both Simparica and Simparica Trio at the minimum label dose prevent the transmission of B. burgdorferi infections as a direct result of killing the I. scapularis vector ticks.", "url": "https://pubmed.ncbi.nlm.nih.gov/41808193/" }, { "pmid": "41807010", "title": "Feasibility of an adjunctive INtervention for Debilitating symptom complexes attributed to ticks (FIND): study protocol for a randomised, waitlist-controlled feasibility trial.", "pub_date": "2026-03-11", "journal": "BMJ open", "authors": "Kanaan, Richard A A, Macdonell, Richard, Long, Michelle, Richardson, Robert J et al.", "abstract": "Debilitating Symptom Complexes Attributed to Ticks (DSCATT) is a new term for an unexplained Australian syndrome-people who suffer from a chronic, multifaceted and debilitating illness, characteristically attributed to tick bites, but in a country without endemic Lyme disease. Despite the profound morbidity of DSCATT, no single causative agent has been identified and there are no recognised treatments for the illness at present. An increasing body of evidence shows psychological therapies such as Acceptance and Commitment Therapy (ACT) can be effective in reducing symptom-related disability and improving quality of life for other unexplained syndromes. Here we present a study protocol to assess the feasibility of an ACT-informed intervention for patients suffering from DSCATT, to be used adjunctively to their pre-existing healthcare. The study aims to assess the acceptability, practicality and demand for the treatment. Additionally, we will examine the effects of therapy on participants' health and well-being, its safety, potential mediators of response to therapy and its preliminary cost-effectiveness. We will assess the feasibility of a 32-week, randomised, waitlist-controlled, parallel convergent mixed-methods pilot trial for DSCATT. Participants will be randomised in a 1:1 ratio to receive either 16 sessions of ACT-informed therapy adjunctive to their pre-existing healthcare, delivered one-to-one with a trial therapist within a 20-week period or be assigned to the waitlist control group where they will continue their treatments as usual. We will collect quantitative and qualitative data to address study aims, with retention rate being the primary feasibility outcome. The study has ethical approval from Austin Health Human Research Ethics Committee (HREC). The outcomes will be published in peer-reviewed journals. Data from participants who have given extended consent will be available for other HREC-approved studies. ACTRN12623000372684, prospectively registered 13 April 2023, URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385579&isReview=true; the last participant is expected to complete in November 2026.", "url": "https://pubmed.ncbi.nlm.nih.gov/41807010/" }, { "pmid": "41796643", "title": "Feasibility and preliminary efficacy of an online yoga program for managing symptoms of post-treatment lyme disease syndrome.", "pub_date": "2026-03-09", "journal": "Complementary therapies in medicine", "authors": "Brown, Adriel, Mamat, Zulkayda, Mahoney, Louise A, Bayley, Peter J", "abstract": "We evaluated the feasibility and efficacy of a 12-week synchronous online yoga program for managing post-treatment Lyme disease syndrome (PTLDS) symptoms, focusing on pain, physical functioning, and cognitive performance. Thirteen participants with PTLDS (aged 21-60 years; 92% female) participated in 75-minute weekly sessions led by certified yoga instructors, with 15-20 min of daily homework on five non-treatment days. Outcome measures included the Health-Related Quality of Life - Short Form (SF-36), Brief Pain Inventory (BPI), and the Cambridge Neuropsychological Test Automated Battery (CANTAB). The primary feasibility goals were met with a retention rate of 92.50%, treatment adherence of 82.70%, and a treatment satisfaction score of 3.4/4. The missing data rate was low at 3.90%. Significant improvements were observed in pain levels, as indicated by the SF-36 pain scale (t[11] = -3.19, p = 0.01, d = -0.92), and pain interference significantly decreased during daily activities, as measured by the BPI (t[11] = 2.61, p = 0.02, d = 0.75). Participants also reported fewer physical limitations during personal activities (t[11] = -2.46, p = 0.03, d = -0.71; SF-36). Cognitive improvement was indicated by a significant reduction in errors on the CANTAB Spatial Working Memory task (t[8] = 3.11, p = 0.02, d = 1.04). Online yoga is feasible and associated with significant reductions in pain, improved physical functioning, and enhanced cognitive performance among participants with PTLDS. These findings suggest that online yoga may be a scalable, accessible, and effective intervention for managing PTLDS symptoms.", "url": "https://pubmed.ncbi.nlm.nih.gov/41796643/" }, { "pmid": "41782738", "title": "A complex case of chronic cutaneous", "pub_date": "2026-03-05", "journal": "JAAD case reports", "authors": "Diiorio, Marisa R, Huang, Guohong, Shah, Payal C, Yan, Shaofeng et al.", "abstract": "No abstract available.", "url": "https://pubmed.ncbi.nlm.nih.gov/41782738/" }, { "pmid": "41756944", "title": "Making the best of a sticky situation: Infection-mediated endothelial activation promotes new interactions with adhesins of the host-adapted Lyme disease spirochete.", "pub_date": "2026-02-27", "journal": "bioRxiv : the preprint server for biology", "authors": "Olmedo, Daiana Alvarez, Tan, Xi, Scott, Colton, Shcherbakova, Aleksandra et al.", "abstract": "Lyme disease, caused by the spirochete", "url": "https://pubmed.ncbi.nlm.nih.gov/41756944/" }, { "pmid": "41741501", "title": "Pilot study of psilocybin in patients with post-treatment lyme disease.", "pub_date": "2026-02-26", "journal": "Scientific reports", "authors": "Garcia-Romeu, Albert, Naudé, Gideon P, Rebman, Alison W, So, Sara et al.", "abstract": "Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common vector-borne disease in the United States and Europe. Although antibiotics effectively treat most cases, an estimated 10-20% of patients develop post-treatment Lyme disease (PTLD), a chronic syndrome marked by fatigue, pain, cognitive difficulties, mood disturbance, and reduced quality of life. There are no established treatments for PTLD. The serotonin 2A receptor agonist psychedelic psilocybin has recently shown potential antidepressant and anxiolytic effects in clinical trials as well as preliminary evidence for anti-inflammatory effects in animals. This open-label, single-arm pilot study evaluated the effects of psilocybin in 20 participants with well-characterized PTLD. The 8-week intervention included two psilocybin sessions (15 mg in week 4; 15 or 25 mg in week 6) with psychological support. Participants (11 women, 9 men, mean age 44, median illness duration 5.7 years) showed significant improvements in PTLD symptom burden and quality of life from study enrollment through 1-month following the second dose of psilocybin (primary endpoint), with significant benefits sustained through 6 months. At the 6-month follow-up, general PTLD symptom burden (GSQ-30) was decreased 40% from baseline (p < .001; Cohen's d", "url": "https://pubmed.ncbi.nlm.nih.gov/41741501/" }, { "pmid": "41727610", "title": "Multiplexed single-tier immunoassay for improved Lyme disease diagnosis across all disease stages.", "pub_date": "2026-02-23", "journal": "Research square", "authors": "Stafford, Phillip, Ahern, Holly, Aucott, John, Rebman, Alison et al.", "abstract": "Lyme disease is the most common vector-borne infection in North America and Europe, yet current two-tier serologic testing shows poor sensitivity during early infection when antibiotic treatment is most effective. We developed and validated a single-tier multiplex immunoassay that combines ten", "url": "https://pubmed.ncbi.nlm.nih.gov/41727610/" }, { "pmid": "41727126", "title": "Type I interferon signaling promotes early innate control of", "pub_date": "2026-02-23", "journal": "bioRxiv : the preprint server for biology", "authors": "Priya, Raj, Raghunandanan, Sajith, Mihaljica, Darco, Alakhras, Nada S et al.", "abstract": "No abstract available.", "url": "https://pubmed.ncbi.nlm.nih.gov/41727126/" }, { "pmid": "41700859", "title": "Strain-specific immune response patterns to", "pub_date": "2026-02-17", "journal": "Infection and immunity", "authors": "Zhou, Guozhong, Dong, Yan, Zhao, Huangjuan, Zhang, Yu et al.", "abstract": "No abstract available.", "url": "https://pubmed.ncbi.nlm.nih.gov/41700859/" }, { "pmid": "41658709", "title": "Chronic Tonsillitis as a Focal Infection: A Decade-Long Case Involving Severe Systemic Symptoms.", "pub_date": "2026-02-09", "journal": "Cureus", "authors": "Lakos, András", "abstract": "Unlike acute tonsillitis, which is readily recognized as infectious, chronic tonsillitis, tonsilloliths, and tonsillar detritus are often considered non-infectious and benign, despite their potential to act as focal infections causing systemic inflammatory symptoms that are frequently overlooked when tonsillar compression is not performed. We report the case of a 29-year-old female with a decade-long history of progressive musculoskeletal pain, episodic low-grade fever, headaches, and exercise-induced inflammatory arthralgia affecting the feet, ankles, wrists, and spine. The initial otolaryngologic (ENT) evaluation revealed purulent material expressed on tonsillar compression, and tonsillectomy was recommended but deferred. Over subsequent years, the patient developed chronic plantar fasciitis, seronegative polyarthritis, and widespread pain, leading to multiple rheumatologic and autoimmune diagnoses, including an undifferentiated autoimmune syndrome. Repeated ENT examinations were largely unremarkable because tonsillar compression was not performed, and tonsillar stones or detritus were repeatedly dismissed as clinically insignificant. Laboratory investigations showed no sustained systemic inflammation, and repeated Borrelia serology yielded false-positive IgM results, prompting referral for suspected Lyme disease. Focused re-evaluation identified chronic tonsillitis as a focal infectious source. Tonsillectomy was performed a decade after symptom onset. Following surgery, the patient experienced a gradual and complete resolution of all symptoms and has remained symptom-free on long-term follow-up through the end of 2025, despite prior skepticism regarding the potential benefit of the procedure. This report demonstrates that chronic tonsillitis, including tonsillar stones and detritus, can act as a focal infection capable of causing severe and persistent systemic inflammatory symptoms even in the absence of overt local signs or laboratory abnormalities. Failure to distinguish chronic tonsillitis from recurrent acute bacterial tonsillitis may result in prolonged morbidity and diagnostic error. Manual tonsillar compression is essential for accurate diagnosis, and tonsillectomy can be curative even after years of symptoms. Greater clinical awareness of oral and tonsillar focal infections is needed to prevent unnecessary diagnostic delays and inappropriate treatment.", "url": "https://pubmed.ncbi.nlm.nih.gov/41658709/" }, { "pmid": "41653328", "title": "Sex and menopause-based differences in presentation of early Lyme disease: A prospective cohort study.", "pub_date": "2026-02-07", "journal": "Clinical and experimental medicine", "authors": "Rebman, Alison W, Yang, Ting, Aucott, John N", "abstract": "Although prior research has established sex and menopausal status-based differences in immune response, susceptibility, and severity to a variety of pathogens, their relevance in early Lyme disease is understudied. We examined the clinical and serologic presentation of patients with early Lyme disease, stratified first by sex then by menopausal status. We also explored the hypothesis that males would present with more severe early Lyme disease. In this prospective cohort study from the Mid-Atlantic US, 243 adult, antibiotic-naïve patients were enrolled with a diagnostic erythema migrans rash present. Demographic, physical exam, symptom, laboratory, and two-tier serology data were collected at a baseline, and a post-treatment visit 3 weeks later. Lyme disease severity was operationalized through six indicators: rash size, number of acute symptoms, dermatologic dissemination, positive serology, liver function elevation, and elevated neutrophil-lymphocyte ratio. Unadjusted group comparisons and multivariate regression adjusting for potential confounders were used to assess difference. In logistic models adjusted for age, Lyme disease duration, systemic steroid use, and co-morbid thyroid disease, males had higher odds of testing two-tier positive (OR = 1.77 [1.03, 3.04], p = 0.039). This difference was more pronounced between males and pre-menopausal females (OR = 2.93 [1.26-6.79], p = 0.012) and no significant difference was found comparing males to post-menopausal females. In ordinal logistic models with Lyme disease severity as the outcome adjusted for age and Lyme disease duration, males had higher odds of being in a higher disease severity score category (OR = 1.94 [1.20,3.15], p = 0.028); again, particularly in comparison to pre-menopausal females (OR = 2.26 [1.13,4.58], p = 0.044). Heart palpitations (p = 0.023), vomiting (p = 0.007), and photophobia (p = 0.057) trended towards higher reporting among females, while sleep difficulty (p = 0.010) was higher among males. No differences were found on non-dermatologic components of the physical exam. We found sex and menopausal status to be relevant in accounting for variability in two-tier serologic status and severity of early Lyme disease in a well-characterized group of patients. Lower rates of seroreactivity among females is unexpected but may be consistent with lower acute severity of disease. Our clinical findings underscore the need for additional research to understand possible contributing biologic and/or social behavioral factors, as well as their impact on timely diagnosis and post-treatment conditions. Lyme disease is a bacterial infection obtained through a tick bite. The goal of this study was to look at whether male and female patients with early Lyme disease show up to the doctor with different signs of their disease in terms of the symptoms they report, their physical exams, and the results of their laboratory tests. We also examined whether females who had gone through menopause would be different on these factors compared to those who had not. We studied data from 243 adults (118 females and 125 males) with early Lyme disease before and after treatment. We found that at diagnosis, males were more likely to have a positive test and more obvious findings of severe disease, yet there were no differences in how long males and females had been sick. For both of these findings, the male group was more similar to females who had undergone menopause and was more different than females who had not. We found a small number of Lyme disease symptoms that were reported more frequently among females (heart palpitations, vomiting, eyes sensitive to light, neck pain, nausea) and two symptoms (sleep difficulty and irritability) reported more frequently among males. These findings suggest that sex and menopause status are important to consider in understanding early Lyme disease. More research is needed to determine the cause of these differences and their impact on time to diagnosis and risk of later conditions after treatment.", "url": "https://pubmed.ncbi.nlm.nih.gov/41653328/" }, { "pmid": "41648077", "title": "Distinct Clinico-pathogenic Subgroups in Pediatric Lyme Neuroborreliosis.", "pub_date": "2026-02-06", "journal": "Open forum infectious diseases", "authors": "Sidorov, Semjon, Greiter, Beat M, Osuna, Ester, Hackenberg, Annette et al.", "abstract": "Lyme neuroborreliosis (LNB) is a common manifestation of Lyme disease in children. It is caused by the bacterium We performed a large retrospective cohort study of children diagnosed with LNB at the University Children's Hospital Zurich from 1 January 2006 to 31 December 2020. A total of 190 children diagnosed with LNB were included (median age, 7.6 years). Meningitis was the most frequent manifestation of LNB ( Lyme neuroborreliosis in children presents with a broad clinical spectrum, with meningitis and iCN being the most common manifestations. We observed distinct clinico-pathogenic subgroups of LNB: iCN reflects a more localized, PNS-restricted disease, whereas meningitis and meningoradiculitis represent a more systemic involvement of both PNS and CNS. These findings may improve diagnostic accuracy and guide the management of children with LNB.", "url": "https://pubmed.ncbi.nlm.nih.gov/41648077/" }, { "pmid": "41602096", "title": "A lethal combination: fulminant liver failure due to", "pub_date": "2026-01-28", "journal": "Therapeutic advances in infectious disease", "authors": "Elalfy, Aya, Grahovac, Danilo, Dumic, Igor, Gavrancic, Tatjana", "abstract": "Babesiosis and Lyme disease are tick-borne infections endemic to the northeastern and upper Midwestern United States. Although both diseases can involve multiple organ systems, acute liver failure (ALF) is exceedingly uncommon. Co-infection with A rare and severe case of liver failure caused by babesiosis and Lyme disease without typical symptoms Babesiosis and Lyme disease are tick-bourne infections transmitted by Ixodes ticks and are increasingly prevalent in the northeastern and upper midwestern U.S. While each pathogen independently can cause systemic illness, co-infection is not uncommon and may present with overlapping or atypical features, complicating timely diagnosis and treatment. We present a case of a 70 year old man who presented to the hospital with dyspnea, dry cough and leg edema. Initial workup supported acute decompensated heart failure and cardiorenal syndrome. Despite appropriate diuresis and supportive care, the patient rapidly developed oliguric renal failure requiring dialysis, hepatic encephalopathy and fulminant acute liver failure (ALF) with severe coagulopathy and shock. Notably, he lacked classic features of tick-bourne illness during presentation, such as fever, rash, hemolysis. Broad spectrum empiric antibiotics were initiated, including doxycycline, but the patient deteriorated and died on hospital day five. Postmortem testing revealed Babesia microti (2, 4% parasitemia) and Borrelia Burgdorferi by PCP testing, confirming tick-bourne co-infection. This case highlights the diagnostic challenge of atypical presentations of endemic zoonoses. Although hepatic involvement in babesiosis is recognized, fulminant ALF remains rare. Lyme disease is typically associated with mild, transient LFT elevations and has not been linked to ALF. The patient’s clinical decline may reflect the additive effect of Babesia induced multiorgan failure. Clinicians should maintain a high index of suspicion for tick-bourne infections, even in the absence of hallmark features in endemic regions, particularly when faced with unexplained multiorgan failure. Early recognition and empiric therapy is imperative to improve outcome in similar cases.", "url": "https://pubmed.ncbi.nlm.nih.gov/41602096/" }, { "pmid": "41582366", "title": "Long-Term Cardiac Sequelae in Lyme Carditis: A Review.", "pub_date": "2026-01-26", "journal": "Current cardiology reviews", "authors": "Badheeb, Mohamed, Ahmed, Ashraf, Stolear, Anton, Wadan, Al-Hassan Soliman et al.", "abstract": "Lyme disease, primarily caused by Borrelia burgdorferi in North America, is a common spirochetal infection transmitted via tick bites. The dissemination of Lyme spirochetes can result in multisystem complications, including Lyme carditis. This review incorporated data from observational studies, retrospective analyses, systematic reviews, and case reports involving patients with confirmed or presumed Lyme carditis. Key outcomes included prevalence, reversibility, and chronicity of cardiac involvement, as well as diagnostic and prognostic implications. Atrioventricular block represents the most prevalent conduction abnormality in Lyme carditis, occurring in up to 90% of cases, with high-degree of persistent blocks potentially necessitating temporary or permanent pacing. While the majority of conduction abnormalities resolve with appropriate antimicrobial therapy, a subset of patients experience persistent dysfunction. Structural complications, including myocarditis, pericarditis, and, less frequently, endocarditis and dilated cardiomyopathy, have been documented. Emerging evidence suggests that persistent myocardial inflammation and autoimmune mechanisms may contribute to the development of long-term cardiac remodeling and dysfunction. Reports of coronary artery involvement and aneurysmal changes, though rare, raise further concern regarding chronic cardiovascular risk. This review highlights several cardiovascular complications of Lyme carditis that can persist despite medical therapy. While permanent conduction abnormalities, fulminant myocarditis, and subsequent ventricular dysfunction have been reported, studies on chronic heart failure are limited, and coronary artery involvement remains underrecognized, necessitating further research. While Lyme carditis is generally self-limited with timely therapy, accumulating evidence indicates the potential for lasting cardiac sequelae. Further longitudinal studies are warranted to delineate risk factors, pathophysiologic mechanisms, and optimal strategies for longterm surveillance and management.", "url": "https://pubmed.ncbi.nlm.nih.gov/41582366/" }, { "pmid": "41570190", "title": "Nonspecific Symptoms Attributable to Lyme Disease in High-Incidence Areas, United States, 2017-2021.", "pub_date": "2026-01-22", "journal": "Emerging infectious diseases", "authors": "Nawrocki, Courtney C, Delorey, Mark J, Earley, Austin R, Hook, Sarah A et al.", "abstract": "For some patients who have Lyme disease (LD), nonspecific symptoms can persist after treatment and impair quality of life. Estimating the frequency and duration of such symptoms is challenging. Using commercial insurance claims data from 2017-2021 for enrollees residing in states where LD is common, we identified 24,503 case-patients with LD and matched them (1:5) with 122,095 control-patients with other diagnoses by demographics, medical service date, and inpatient/outpatient setting. We compared relative frequencies of diagnosis codes for pain, fatigue, and cognitive difficulties between case-patients and control-patients in the year after diagnosis. Those symptom codes occurred 5.0% more frequently among case-patients than among control-patients and comprised »11.0% of the total symptom codes among case-patients. Symptom code frequency among case-patients declined significantly in the 6-12 months after LD diagnosis and reached levels similar to control-patients by the end of the year, with the exception of fatigue.", "url": "https://pubmed.ncbi.nlm.nih.gov/41570190/" }, { "pmid": "41563653", "title": "Borrelia burgdorferi-Induced Neuroinflammation in Lyme Disease: A Potential Driver of Alzheimer's Disease Pathology?", "pub_date": "2026-01-21", "journal": "Molecular neurobiology", "authors": "Ahuja, Ria, Shaban, Ayleen, Chawla, Jyotsna, Parmar, Mayur S", "abstract": "Emerging evidence suggests that chronic infections may contribute to neurodegenerative diseases such as Alzheimer's disease (AD). One such infection is caused by Borrelia burgdorferi sensu lato (Bbsl), the spirochete complex responsible for Lyme disease, which can invade the central nervous system (CNS) and trigger Lyme neuroborreliosis (LNB). Bbsl infection is associated with persistent neuroinflammatory responses and immune evasion mechanisms, which may contribute to long-term neurological sequelae in a subset of patients. Neuroinflammation is increasingly recognized as a contributing factor in AD pathogenesis. This review examines proposed mechanistic overlaps between LNB and AD, focusing on the role of Bbsl-induced neuroinflammation driving amyloid-beta (Aβ) accumulation and tau pathology. We summarize evidence from in vitro, in vivo, and postmortem studies reporting assay-dependent co-localization of Borrelia with hallmark AD pathology in selected cases, alongside epidemiological studies that yield mixed results. While some studies suggest an association between Bbsl exposure and neurodegenerative risk, others report no clear correlation. Overall, current evidence indicates only an association, and a causal relationship between Bbsl infection and AD has not been established. Understanding this potential link may inform future mechanistic studies, biomarker development, and preventive strategies targeting chronic infection-driven neuroinflammation to address the hypothesis.", "url": "https://pubmed.ncbi.nlm.nih.gov/41563653/" }, { "pmid": "41563326", "title": "Xenodiagnosis to search for Borrelia burgdorferi after antibiotic treatment of Lyme disease: a prospective cohort study.", "pub_date": "2026-01-21", "journal": "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America", "authors": "Marques, Adriana R, Ng, Siu-Ping, McCarthy, Julie E, Telford, Sam R et al.", "abstract": "Some patients report non-specific symptoms after antibiotic therapy for Lyme disease (LD), raising questions about ongoing infection, despite no compelling evidence. We investigated whether xenodiagnosis could detect Borrelia burgdorferi in such patients, and if positive results correlated with symptoms. Participants were adults who completed antibiotic treatment for LD 3-12 months earlier (post-therapy, n=40) or had persistent symptoms for ≥ 12 months after treatment, (post-treatment LD symptoms [PTLDS], n=20). Controls included one patient with erythema migrans (EM), one patient with untreated Lyme arthritis (LA), and 9 healthy volunteers (HV). Participants had 25-30 larval Ixodes scapularis ticks placed; ticks were collected 3-6 days later and tested for B. burgdorferi. The primary analysis evaluated if B. burgdorferi detection by xenodiagnosis was associated with persistence of symptoms in patients during the first year after treatment. This trial is registered with ClinicalTrials.gov, NCT02446626. Recovered ticks included 402 from post-therapy, 314 from PTLDS, 30 from the EM patient, 11 from the LA patient, and 80 from HV. All ticks tested negative for B. burgdorferi except for 1 tick from a recovered patient. An unplanned interim analysis led to the early termination of the study for futility. Xenodiagnosis with larval I. scapularis ticks showed no evidence of B. burgdorferi in most patients after treatment, irrespective of symptoms. This may be due to absence of bacteria or to the low sensitivity of the technique in humans. This method is unlikely to detect persistent B. burgdorferi infection in humans and further research on the use of xenodiagnosis is unwarranted.", "url": "https://pubmed.ncbi.nlm.nih.gov/41563326/" }, { "pmid": "41552140", "title": "Seropositive Myasthenia Gravis Triggered by Lyme Disease: A Case Study of Molecular Mimicry.", "pub_date": "2026-01-19", "journal": "Cureus", "authors": "Sardana, Sahil, Grieco, Emily, MacGavin, Samantha, Shakeel, Hassan Abdullah et al.", "abstract": "Lyme disease, caused by Borrelia burgdorferi, is a multisystem infection that rarely produces neuromuscular complications beyond classic neuroborreliosis. Myasthenia gravis (MG) is an autoimmune disorder characterized by fatigable weakness due to acetylcholine receptor (AChR) antibodies. We describe a 74-year-old man with coronary artery disease, chronic kidney disease, and prostate cancer who developed progressive dysphagia, dysphonia, ptosis, and neck weakness. Initial attribution to medication-related angioedema delayed recognition. Neurological examination revealed bulbar weakness and fatigable ptosis. Electrodiagnostic testing confirmed post-synaptic neuromuscular junction dysfunction, and AChR antibody assays were strongly positive across binding, blocking, and modulating subtypes. Concurrent Lyme serologies were positive for immunoglobulin G and immunoglobulin M. The patient required intensive care monitoring and was treated with plasma exchange, intravenous ceftriaxone, prednisone, and pyridostigmine, with marked improvement. This case illustrates a rare coexistence of neuroborreliosis and seropositive MG, highlighting potential molecular mimicry between Borrelia antigens and AChR epitopes.", "url": "https://pubmed.ncbi.nlm.nih.gov/41552140/" }, { "pmid": "41498020", "title": "A Unique Case of Squamous Cell Carcinoma on the Palm in a Patient with Lyme Disease.", "pub_date": "2026-01-07", "journal": "The Journal of clinical and aesthetic dermatology", "authors": "Mukarram, Mahnoor, Rashid, Zaina, Shuker, Sarah", "abstract": "Squamous cell carcinoma (SCC) is the second most common type of skin cancer following basal cell carcinoma (BCC). Risk factors for the development of SCC include exposure to ultraviolet light (UV) and non-UV-related risk factors, such as chronic wounds, Marjolin ulcers, and human papillomavirus (HPV) infection. In this case report, we report an interesting case of the development of SCC in the palm of a patient with an extensive history of Lyme disease.", "url": "https://pubmed.ncbi.nlm.nih.gov/41498020/" }, { "pmid": "41450978", "title": "Early brain changes in Lyme disease are associated with clinical outcomes.", "pub_date": "2025-12-26", "journal": "Brain, behavior, & immunity - health", "authors": "Marvel, Cherie L, Rebman, Alison W, Alm, Kylie H, Touradji, Pegah et al.", "abstract": "In Lyme disease (LD), 10-20 % of patients develop persistent symptoms following antibiotic treatment (i.e., post-treatment Lyme disease (PTLD)), which often includes neurological symptoms. This study tested the hypothesis that physiological brain changes occur early in LD and influence outcomes. Task-based functional MRI (fMRI) and health surveys were administered to patients with acute LD (n = 20) after treatment and six months later. Demographically matched healthy controls (HC; n = 19) were also assessed six months apart. The LD group was categorized at six months into those who had returned to health (RTH, n = 11) or reported persistent symptoms (sPTLD, n = 9). FMRI data from both LD subgroups were compared to each other and HC at both time points. FMRI-guided regions of interest (ROI) values were compared to health surveys. Baseline brain activity in RTH was elevated in fronto-parietal regions relative to sPTLD (p < .0025) and HC (p < .001). Notably, 64 % of activation clusters in RTH were in white matter, confirmed by segmentation analysis. FMRI-guided ROI values from RTH vs. HC correlated with higher health survey scores. At 6-months, few group differences remained. By contrast, sPTLD vs. HC fMRI comparisons yielded few activation differences at either time point or correlations with health survey scores. Robust brain activity in early LD was associated with future RTH. By contrast, the absence of early brain activity was associated with persistent symptoms, suggesting that failure to mount an early response contributes to PTLD. Understanding how brain activity relates to recovery in LD can aid prognosis and guide treatment.", "url": "https://pubmed.ncbi.nlm.nih.gov/41450978/" }, { "pmid": "41441042", "title": "Metabolomics-Based Machine Learning Diagnostics of Post-Acute Sequelae of SARS-CoV-2 Infection.", "pub_date": "2025-12-24", "journal": "Metabolites", "authors": "Cai, Ethan, Kouznetsova, Valentina L, Tsigelny, Igor F", "abstract": "No abstract available.", "url": "https://pubmed.ncbi.nlm.nih.gov/41441042/" }, { "pmid": "41438359", "title": "Skin ulcer and maculopapular rash with inguinal lymph node enlargement: a case report of a 46-year-old female patient from north-eastern Poland with", "pub_date": "2025-12-24", "journal": "Central-European journal of immunology", "authors": "Borawski, Karol, Lebensztejn, Anna, Czupryna, Piotr, Kondrusik, Maciej et al.", "abstract": "North-eastern Poland is an endemic region for tick-borne diseases, especially Lyme disease and tick-borne encephalitis. However, less common diseases such as rickettsiosis and tularemia may occur after a tick bite. In this paper we present a rare case of Rickettsia spp. and Francisella tularensis co-infection in a 46-year-old female patient with no history of travel and no chronic diseases, confirmed by serological and molecular tests. The symptoms appeared 5-7 days after the tick bite and lasted for 2 weeks. On physical examination, a maculopapular rash over the entire body, an ulcer on the left lower extremity, and an enlarged inguinal lymph node were noted. We concluded that rare diseases such as rickettsiosis and tularemia should be included in differential diagnosis of fever, lymphadenopathy and skin changes after a tick bite. Co-infection with Rickettsia spp. and F. tularensis is possible in patients after a tick bite. Quick diagnosis allows proper treatment (with doxycycline) and complete recovery.", "url": "https://pubmed.ncbi.nlm.nih.gov/41438359/" }, { "pmid": "41427440", "title": "Autonomic Symptoms in Post-Treatment Lyme Disease: Insights From the COMPASS-31 and the 10-Minute Active Stand Test.", "pub_date": "2025-12-22", "journal": "Mayo Clinic proceedings. Innovations, quality & outcomes", "authors": "Adler, Brittany L, Rebman, Alison W, Chung, Tae, Miller, John B et al.", "abstract": "To determine the prevalence of autonomic symptoms in post-treatment Lyme disease (PTLD) and identify clinical factors that associate with abnormal hemodynamics on the 10-minute active stand test. We administered the Composite Autonomic Symptom Score-31 survey to 37 patients with PTLD and compared them with a cohort of patients with postural orthostatic tachycardia syndrome (POTS) without a known history of Lyme disease. We also report the 10-minute active stand test performed in 210 patients with PTLD recruited from July 1, 2016 through October 31, 2024. Patients with PTLD had higher total Composite Autonomic Symptom Survey 31 scores than healthy controls and reported similar vasomotor, urinary, and pupillomotor symptom burden as patients with POTS. On the 10-minute active stand test, 9 of the 210 (4.29%) patients with PTLD had orthostatic tachycardia. Although the prevalence of orthostatic tachycardia in patients was not significantly different from that of healthy controls, those with orthostatic tachycardia were more likely to be earlier in their disease course and had higher rates of steroid use ( Autonomic symptoms are common in PTLD. The 10-minute active stand test identified a subgroup of patients with orthostatic tachycardia that associated with distinct clinical features of Lyme disease.", "url": "https://pubmed.ncbi.nlm.nih.gov/41427440/" }, { "pmid": "41421419", "title": "Methemoglobinemia induced by dapsone, hydroxychloroquine, and rifampin combination for post-treatment Lyme disease syndrome: A case report.", "pub_date": "2025-12-21", "journal": "Journal of the American Pharmacists Association : JAPhA", "authors": "Worden, Jarett, Baumeister, Tyler, Stogner, Sarah, Henin, Nancy et al.", "abstract": "A patient presented to the emergency department with drug-induced methemoglobinemia due to a combination of medications prescribed for post-treatment Lyme disease syndrome (PTLDS). This case highlights the potential risks of dapsone, hydroxychloroquine (HCQ), and rifampin for the management of PTLDS. A 62-year-old female presented to the hospital with shortness of breath and low oxygen saturation. Past medical history included a diagnosis of PTLDS, for which she was prescribed a combination of dapsone, HCQ, doxycycline, rifampin, and ivermectin at home. The patient had an oxygen saturation of 88% on room air but was otherwise clinically stable. Arterial blood gas was obtained and demonstrated an elevated methemoglobin level (11.2%). Analysis of peripheral blood smear revealed oxidative hemolysis, indicating medication-induced methemoglobinemia. Glucose-6-phosphate-dehydrogenase (G6PD) testing was ordered to assess for G6PD deficiency, as this is a known risk factor for methemoglobinemia and had not previously been evaluated for this patient. Testing did not demonstrate a G6PD deficiency for this patient. A negative Lyme total antibody test confirmed no active infection. Both dapsone and HCQ are known to induce methemoglobinemia and the addition of rifampin may enhance this effect. Patient improved on supplemental oxygen, ascorbic acid, and discontinuation of dapsone, HCQ, ivermectin, doxycycline, and rifampin therapy. There is no strong evidence for any anti-infectives used for the treatment of PTLDS, with either short- or long-term use. Dapsone and HCQ can each cause methemoglobinemia. That effect may be increased when used together, especially in combination with rifampin. Appropriate risk assessment and monitoring should be considered when utilizing this combination.", "url": "https://pubmed.ncbi.nlm.nih.gov/41421419/" }, { "pmid": "41350176", "title": "The lingering shadow of epidemics: post-acute sequelae across history.", "pub_date": "2025-12-06", "journal": "Trends in immunology", "authors": "Miller, Christine M, Moen, Janna K, Iwasaki, Akiko", "abstract": "The SARS-CoV-2 pandemic has drawn global attention to post-acute infection syndromes (PAIS), with millions affected by post-acute sequelae of COVID-19 (PASC, or Long COVID). While Long COVID is newly defined, PAIS have been described for over a century following epidemic infections. Multiple pathogens - including influenza, Epstein-Barr virus, and Borrelia burgdorferi, among others - can precipitate persistent, poorly understood symptoms. Chronic illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have long been linked to infectious triggers. This recurring association highlights critical knowledge gaps and underscores the need for systematic investigation. Unlike prior pandemics, the current era offers advanced technologies and analytic tools to address these gaps. Defining the biology of Long COVID may yield broader insights into host-pathogen interactions and mechanisms of chronic illness.", "url": "https://pubmed.ncbi.nlm.nih.gov/41350176/" }, { "pmid": "41314472", "title": "Guidelines for Lyme borreliosis: post-treatment Lyme disease syndrome (PTLDS).", "pub_date": "2025-11-29", "journal": "Infectious diseases now", "authors": "Arias, P, Gocko, X, Roblot, F, Hansmann, Y et al.", "abstract": "Persistent symptoms following appropriate treatment of confirmed Lyme borreliosis (LB) require a systematic clinical reassessment. The diagnostic approach should verify the accuracy of the initial diagnosis, adherence to and adequacy of antibiotic therapy, and consider potential sequelae or differential diagnoses such as new-onset diseases or comorbidities. When no alternative explanation is found, symptoms may correspond to Post-Treatment Lyme Disease Syndrome (PTLDS), as defined by the French National Authority for Health (HAS). PTLDS is characterized by fatigue, diffuse pain, and cognitive dysfunction lasting more than six months after a documented and adequately treated LB episode. The syndrome significantly impairs daily functioning and quality of life and is not attributable to persistent infection or other identifiable causes. Management relies on long-term, multidisciplinary, and personalized care coordinated between reference centers and primary physicians, focusing on physical rehabilitation and psychological support. Additional antibiotic or immunomodulatory therapies are not recommended due to lack of efficacy and potential adverse effects. Future research should prioritize high-quality clinical studies to clarify therapeutic indications, integrate social science perspectives to better understand the illness and its controversies, and actively involve patients to ensure that research and care strategies align with their lived experiences.", "url": "https://pubmed.ncbi.nlm.nih.gov/41314472/" }, { "pmid": "41305452", "title": "The Relationship Between Hemodynamic Responses During Head-Up Tilt Testing and Parameters of Infection in Post-COVID Syndrome, Chronic Fatigue Syndrome, and Late-Stage Lyme Disease.", "pub_date": "2025-11-27", "journal": "Viruses", "authors": "Milovanovic, Branislav, Markovic, Nikola, Petrovic, Masa, Stojanovic, Smiljana et al.", "abstract": "Autonomic nervous system (ANS) dysfunction has emerged as a central feature of post-infectious syndromes, including post-COVID syndrome (PCS), chronic fatigue syndrome (CFS), and late-stage Lyme disease. This cross-sectional study included 1036 patients evaluated in the Neurocardiological Laboratory of the Institute for Cardiovascular Diseases \"Dedinje,\" divided into four groups: PCS, CFS after COVID-19, CFS of insidious onset, and Lyme disease. All patients underwent head-up tilt testing (HUTT), and serological testing was performed in accredited institutions. The Lyme disease group demonstrated the highest prevalence of positive HUTT responses and a significantly greater frequency of orthostatic hypotension and syncope. Approximately 50-65% of patients in the PCS and Lyme groups were positive for IgM antibodies against at least one microorganism, with more than 10% showing positivity for three or more pathogens. Logistic regression analysis revealed that, beyond classical hemodynamic parameters, antibody status served as a significant predictor of HUTT outcomes, with specific associations identified for HSV-1, HHV-6,", "url": "https://pubmed.ncbi.nlm.nih.gov/41305452/" }, { "pmid": "41281778", "title": "Investigating the frequency of tick-borne infections in a case series of 37 youth diagnosed with pediatric bipolar disorder.", "pub_date": "2025-11-24", "journal": "Frontiers in child and adolescent psychiatry", "authors": "Greenberg, Rosalie", "abstract": "This retrospective chart review examined 37 youth with pediatric bipolar disorder from a private practice in the Lyme-endemic state of New Jersey, expanding on findings from 27 previously reported cases to explore the potential contribution of tick-borne infections to disease etiology. Diagnoses were based on DSM-IV-TR and DSM-V criteria using parent and child interviews, questionnaires, and school reports. Initial screening evaluated for possible PANDAS/PANS, with testing for Group A beta-hemolytic streptococcus, More than three-quarters of the cohort demonstrated confirmed tick-borne infections. Overlaps between bipolar disorder and tick-borne illness-such as immune dysregulation, chronic symptomatology, and responsiveness to treatments like minocycline and anti-inflammatory agents-support further exploration of infectious contributors to pediatric bipolar disorder. While limited by its single-practice retrospective design, these findings suggest that tick-borne pathogens may play a role in the pathogenesis of bipolar symptoms in youth, warranting larger, controlled studies.", "url": "https://pubmed.ncbi.nlm.nih.gov/41281778/" }, { "pmid": "41234161", "title": "Home Testing for Contagious Illness: Historical Context and Modern Caveats.", "pub_date": "2025-11-14", "journal": "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America", "authors": "Zuger, Abigail", "abstract": "Dozens of over-the-counter tests offer to evaluate users for an array of contagious illnesses, including sexually transmitted infections, acute respiratory infections like coronavirus disease 2019 (COVID-19) and influenza, and complicated chronic infections like Lyme disease, tuberculosis, and human immunodeficiency virus (HIV). Diagnosing any of these conditions in a home setting raises both logistical and ethical issues that may prevent home testing from becoming the public health benefit its advocates envision. Over the last century, early home tests such as the first urine glucose screening tests for diabetes and the first home pregnancy tests generated very similar expectations of substantial public health benefits. These tests helped many individual patients, but neither proved to be a particularly effective public health tool. Home testing for contagious illness raises additional issues of quarantine, contact tracing, and treatment that are yet to be addressed in any systematic way. The widespread enthusiasm for patching suboptimal healthcare systems with home testing seems premature.", "url": "https://pubmed.ncbi.nlm.nih.gov/41234161/" }, { "pmid": "41201149", "title": "[Isolated Sixth Cranial Nerve Palsy as a Clinical Presentation of Neuroborreliosis].", "pub_date": "2025-11-07", "journal": "Revista de neurologia", "authors": "Moreno de la Bandera, Antonio José, Vives Crook, Marian, Ballivian Abaroa, Alejandro", "abstract": "Lyme disease is a zoonosis caused by spirochetes of the genus Borrelia, presenting with a broad spectrum of clinical manifestations. This heterogeneity may hinder diagnosis, particularly in regions with low prevalence. We present the case of a 65-year-old woman who attended the emergency department with a 24-hour history of diplopia upon awakening, without other neurological focal signs. Neuroborreliosis was diagnosed after identifying a history of travel to an endemic area and compatible cutaneous manifestations. Clinical progression, together with serological confirmation, enabled early diagnosis and initiation of appropriate antibiotic therapy, resulting in complete resolution of symptoms. This case highlights the importance of including Lyme disease in the differential diagnosis of patients with any neurological focal signs and a history of travel to endemic regions, even in the absence of recalled tick bites or classical manifestations. Early detection and timely treatment are crucial to prevent chronic and disabling complications. Introducción: La enfermedad de Lyme es una zoonosis causada por espiroquetas del género Borrelia, que presenta un amplio espectro de manifestaciones clínicas. Esto puede dificultar su diagnóstico, especialmente en regiones con baja prevalencia. Caso Clínico: Presentamos el caso de una mujer de 65 años que acudió a urgencias por diplopía de 24 horas de evolución desde el despertar, sin otra focalidad neurológica. Fue diagnosticada de neuroborreliosis tras identificar antecedentes de viaje a una zona endémica y manifestaciones cutáneas compatibles. La evolución clínica, junto con la confirmación serológica, permitió un diagnóstico precoz y la instauración de tratamiento antibiótico adecuado, con resolución completa de los síntomas. Conclusiones: Este caso resalta la necesidad de incluir la enfermedad de Lyme en el diagnóstico diferencial de pacientes con focalidad neurológica y antecedentes de viaje a áreas endémicas, incluso en ausencia de picaduras recordadas o manifestaciones clásicas. La detección precoz y el tratamiento oportuno son fundamentales para prevenir complicaciones crónicas e invalidantes.", "url": "https://pubmed.ncbi.nlm.nih.gov/41201149/" }, { "pmid": "41195425", "title": "Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis.", "pub_date": "2025-11-06", "journal": "German medical science : GMS e-journal", "authors": "Rauer, Sebastian, Kastenbauer, Stefan, Dersch, Rick, Hofmann, Heidelore et al.", "abstract": "Lyme disease is the most common tick-borne infectious disease in Europe. Neurological manifestations occur in 3-15% of infections and can present as polyradiculitis, meningitis, and rarely as encephalomyelitis. The disease is treatable with antibiotics. The S3 guideline \"Neuroborreliosis\" has been updated in accordance with the methodological standards of the \"Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.\" (AWMF register number 030/071). Eighteen AWMF member societies, the Robert Koch Institute, the \"Paul-Ehrlich-Gesellschaft für Infektionstherapie\", the \"Schweizerische Neurologische Gesellschaft\", the \"Österreichische Gesellschaft für Neurologie\", the \"Deutsche Borreliose-Gesellschaft\" and two patient organizations were involved in the update. The guideline aimed at physicians in practice and hospital settings who are involved in the treatment of neuroborreliosis in children and adults. For the first time, there is Class Ia evidence that a 14-day course of antibiotics is therapeutically sufficient in early neuroborreliosis. Additionally, it is now recommended that the administration of steroids alongside antibiotic therapy is not advised in cases of facial palsy within the context of a neuroborreliosis that is probable or confirmed according to diagnostic criteria. The age limit for doxycycline in the treatment of neuroborreliosis in children under 8 years has been removed. There are still no valid study data on the effectiveness of combination antibiotic treatments. A systematic review on the therapy of so-called Post-Treatment Lyme Disease Syndrome (PTLDS) showed that parameters such as quality of life, fatigue, depression, and cognition do not respond to antibiotic therapy. Die Lyme-Borreliose ist die häufigste durch Zecken übertragene Infektionskrankheit in Europa. Eine neurologische Manifestation kommt bei 3–15% der Infektionen vor und kann sich als Polyradikulitis, Meningitis sowie selten als Enzephalomyelitis manifestieren. Die Erkrankung ist durch Antibiotika behandelbar. Die bisher gültige S3-Leitlinie „Neuroborreliose“ wurde entsprechend den methodischen Vorgaben der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF-Registernr. 030/071) aktualisiert. An der Aktualisierung waren 18 AWMF-Mitgliedsgesellschaften, das Robert Koch-Institut, die Paul-Ehrlich-Gesellschaft für Infektionstherapie, die Schweizerische Neurologische Gesellschaft, die Österreichische Gesellschaft für Neurologie, die Deutsche Borreliose-Gesellschaft und 2 Patientenorganisationen beteiligt. Die Leitlinie richtet sich an Ärzte in Praxis und Klinik, die mit der Behandlung der Neuroborreliose bei Kindern und Erwachsenen befasst sind. Erstmals liegt jetzt eine Klasse-Ia-Evidenz vor, dass eine 14-tägige Dauer der Antibiotikagabe bei früher Neuroborreliose therapeutisch ausreichend ist. Neu ist außerdem, dass eine Steroidgabe zusätzlich zur Antibiotikatherapie bei Fazialisparese im Rahmen einer entsprechend den Diagnosekriterien wahrscheinlichen oder gesicherten Neuroborreliose nicht empfohlen wird und dass die Altersbegrenzung für Doxycyclin bei Kindern unter 8 Jahren zur Therapie der Neuroborreliose entfällt. Über die Wirksamkeit von Antibiotika-Kombinationsbehandlungen liegen weiterhin keine validen Studiendaten vor. Im Rahmen eines systematischen Reviews zur Therapie des sogenannten Post-Treatment Lyme Disease Syndrome (PTLDS) zeigte sich, dass die untersuchten Parameter Lebensqualität, Fatigue, Depression und Kognition nicht auf eine antibiotische Therapie ansprechen. Für die Wirksamkeit anderer Therapieverfahren fanden sich keine aussagekräftigen Studien.", "url": "https://pubmed.ncbi.nlm.nih.gov/41195425/" }, { "pmid": "41172651", "title": "Trends in incidence of tick bites and physician-reported early and late Lyme borreliosis in the Netherlands.", "pub_date": "2025-11-01", "journal": "Ticks and tick-borne diseases", "authors": "van den Berg, Oda E, Harms, Margriet G, Tulen, Anna D, Brown, Vanessa D et al.", "abstract": "Lyme borreliosis (LB) is a prevalent vector-borne disease in Europe. Untreated, it can cause severe complications, with some patients experiencing persistent symptoms post-treatment. In the Netherlands, tick bite consultations and erythema migrans (EM) diagnoses tripled from 1994 to 2009, but tick bite consultations declined and EM diagnoses stabilized in 2014. This study examines trends in tick bite consultations, EM diagnoses, and other LB manifestations in the Netherlands from 2014 onward. In 2017 and 2021, questionnaires were sent to Dutch GPs to collect data on tick bite consultations and EM diagnoses. The 2021 survey additionally addressed disseminated LB and persistent symptoms attributed to LB. Data were analyzed using a negative binomial distribution, with bootstrapping applied to account for uncertainty. The population coverage was 51 % in 2017 and 32 % in 2021. The incidence of tick bite consultations per 100,000 was 534 (518-551) in 2017 and 447 (426-470) in 2021. The incidence of EM diagnoses per 100,000 was 150 (145-155) in 2017 and 147 (140-154) in 2021. In 2021, the incidence was 5.0 (4.2-5.9) per 100,000 for disseminated LB and 5.0 (4.4-5.5) per 100,000 for persisting symptoms attributed to LB. Compared to 2014, GP consultations for tick bites and EM diagnoses had increased in 2017. In 2021, tick bite consultations were lower than in 2017, likely due to COVID-19 restrictions. EM diagnoses were similar to 2017. Disseminated LB was lower in 2021 compared to 2010, whilst persisting symptoms attributed to LB remained stable.", "url": "https://pubmed.ncbi.nlm.nih.gov/41172651/" }, { "pmid": "41136524", "title": "HLA and pathogens in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and other post-infection conditions.", "pub_date": "2025-10-25", "journal": "Scientific reports", "authors": "Georgopoulos, Apostolos P, James, Lisa M, Peterson, Philip K", "abstract": "Viral infections have been widely implicated in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) pathogenesis. Recent evidence has also identified certain Human Leukocyte Antigen (HLA) alleles that are significantly associated with ME/CFS risk/protection. Here we tested the hypothesis that ME/CFS risk or protection conferred from those HLA alleles is associated with binding affinity to antigens of HHV viruses, a critical step in initiating the adaptive immune system response to foreign antigens. Specifically, we determined in silico the predicted binding affinity of two susceptibility alleles (C*07:04, DQB1*03:03) and two protective alleles (B*08:01, DPB1*02:01) to > 10,000 antigens of the 9 Human Herpes Viruses (HHV1, HHV2, HHV3, HHV4, HHV5, HHV6A, HHV6B, HHV7, HHV8) which have been implicated in the etiology of ME/CFS. We found that the binding affinity of all HHV antigens to the susceptibility alleles was significantly weaker than the binding affinity to the protective alleles (P < 0.001). In fact, none of the HHV antigens showed strong binding to the susceptibility alleles, in contrast to the strong bindings showed by the protective alleles. These findings are in keeping with the hypothesis that the effect of a putative HHV insult in contributing to ME/CFS is modulated by the host's HLA immunogenetic makeup. We speculate that strong HLA-antigen binding likely protects against ME/CFS via elimination of virus antigens; conversely, weak HLA-antigen binding may permit persistence of foreign antigens, contributing to ME/CFS and other chronic conditions. Finally, with respect to the latter, we determined the binding affinities to the 4 HLA alleles above to pathogens causing two chronic diseases with very similar symptomatology to ME/CFS, namely Long COVID and post-treatment Lyme disease syndrome (PTLDS). We found that the 2 ME/CFS susceptibility HLA alleles above had very weak binding with SARS-CoV-2 virus glycoprotein (involved in Long COVID) and 5 proteins of Borrelia burgdorferi (involved in PTLDS), in contrast to the ME/CFS protective alleles that showed strong bindings. These findings support the hypothesis that ME/CFS, long COVID and PTLDS are caused by persistent pathogenic antigens that could not be eliminated due to inadequate protection by the patient's HLA makeup.", "url": "https://pubmed.ncbi.nlm.nih.gov/41136524/" }, { "pmid": "41065377", "title": "The multiplexed single-tier InBios Lyme Detect Multiplex ELISA is more sensitive than standard two-tier tests in the early stages of Lyme disease.", "pub_date": "2025-10-09", "journal": "Journal of clinical microbiology", "authors": "Hickman, Anna F, Weber, Allison F, Horn, Elizabeth J, Gwynne, Peter J", "abstract": "There are nearly 500,000 cases of Lyme disease each year in the United States; 10%-20% of them result in the development of a debilitating chronic disease known as post-treatment Lyme disease. Existing standardized and modified two-tier tests (STT/MTT) suffer from poor detection rates in the first weeks of infection, where the antibody response, the basis of diagnosis, is developing but is not robust enough for detection. During this early window, false negative results are common, which leads to delayed treatment and increases the likelihood of developing severe symptoms. The InBios Lyme Detect Multiplex ELISA is a microarray-based assay designed to capture a set of commonly used diagnostic antibodies specific to During initial Lyme disease infection, existing diagnostic tests have poor sensitivity, resulting in a high number of false-negative tests. This is due to the lag between infection and a robust immune response capable of being detected by such tests. With a multiplexed array of nine unique antibody targets specific for", "url": "https://pubmed.ncbi.nlm.nih.gov/41065377/" }, { "pmid": "41060581", "title": "Burkitt in disguise: clonal transformation of incidentally detected gallbladder diffuse large B-cell lymphoma in a liver transplant recipient.", "pub_date": "2025-10-08", "journal": "International journal of hematology", "authors": "Miyawaki, Kohta, Nakagaki, Hidetaka, Mori, Yasuo, Semba, Yuichiro et al.", "abstract": "Post-transplant lymphoproliferative disorders (PTLDs) typically arise months to years after solid-organ transplantation and are frequently driven by Epstein-Barr virus (EBV). However, EBV-negative monomorphic PTLDs are increasingly recognized as an alternative pathogenesis. We report a case of a 64-year-old man who underwent liver transplantation and was found to have a minute focus of diffuse large B-cell lymphoma (DLBCL) in the resected gallbladder. Given the absence of residual disease and the patient's postoperative frailty, close observation was chosen. Three months later, the patient developed an aggressive clinical relapse characterized by Burkitt-like features, including massive effusions and gastric wall thickening. Retrospective analysis using a 398-gene panel (DISCAVar) revealed that both the initial and recurrent lesions shared an IGH::MYC rearrangement, while the recurrent tumor acquired additional Burkitt lymphoma (BL)-associated mutations (TP53, TCF3, CCND3, DDX3X) absent in the original lesion. These alterations spanned all three molecular subgroups of BL and suggest rapid clonal evolution from a pre-existing MYC-positive clone under post-transplant immunosuppression. Despite treatment with dose-modified EPOCH, the patient's condition deteriorated, and he died 108 days after treatment initiation. This case underscores the value of longitudinal molecular analysis in understanding the pathogenesis of EBV-negative PTLD and identifying high-risk clones before clinical transformation.", "url": "https://pubmed.ncbi.nlm.nih.gov/41060581/" }, { "pmid": "41046949", "title": "Hypercholesterolemia enhances early dissemination and Borrelia burgdorferi burden in a mouse model.", "pub_date": "2025-10-06", "journal": "Microbial pathogenesis", "authors": "González, Julia, Hinger, Lauren, Parveen, Nikhat, Toledo, Alvaro", "abstract": "The Lyme disease spirochete, Borrelia burgdorferi, requires cholesterol to grow. The spirochete acquires cholesterol from the host to form cholesterol glycolipids, which are then incorporated into the spirochete's membrane. This study aimed to determine whether higher levels of serum cholesterol could facilitate the infection and contribute to the pathogenesis of Lyme disease. We investigated the effect of acute and chronic hypercholesterolemia on spirochetal infection in C3H/HeJ mice fed a high-fat diet (HF) compared to mice fed a control diet. The course of infection in mice was followed for 3 weeks (short-term effects) and 16 weeks post-infection (long-term effects) by measuring spirochete bioluminescence in vivo. At the endpoint, bacterial burden was measured in tissues by real-time PCR, and histology was performed to assess differences in the inflammatory response. Between days 10 and 14 post-infection, live imaging showed that mice on a HF diet presented a significantly higher spirochetal burden and greater dissemination than the controls. These differences were transient and restricted to the first two weeks of infection, without long-term effect observed. Histology showed no significant differences in inflammation between HF and control mice. However, qPCR showed that mice fed with HF diet had a higher B. burgdorferi burden in tissues, including heart, visceral, and subcutaneous fat. These findings revealed that high cholesterol levels resulting from a HF diet led to increases in spirochetal burden and dissemination early in the infection, suggesting that cholesterol may contribute to spirochete persistence and associated Lyme disease symptoms.", "url": "https://pubmed.ncbi.nlm.nih.gov/41046949/" }, { "pmid": "41042957", "title": "Assessment of the accuracy of initial diagnoses and the frequency of clinical forms of Lyme disease among hospitalized patients: a single-center study.", "pub_date": "2025-10-03", "journal": "Przeglad epidemiologiczny", "authors": "Kazberuk, Małgorzata, Kondrat, Ada, Nienałtowski, Michał, Czupryna, Piotr et al.", "abstract": "Lyme borreliosis (LB) is one of the most commonly diagnosed tick-borne diseases globally, caused by Borrelia spirochetes. Despite advances in laboratory diagnostics, both overdiagnosis and underdiagnosis of LB remain significant issues. Nonspecific symptoms such as chronic fatigue or musculoskeletal complaints are often misattributed to LB, creating controversy and delaying appropriate diagnosis and treatment. To analyze clinical data and diagnostic results of patients referred to the Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, with suspected LB, and to assess the frequency of its clinical forms. A retrospective analysis was conducted on medical records of patients hospitalized with suspected early or late LB at the Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, from January 2018 to June 2023. Diagnostics included ELISA and Western blot tests for IgM and IgG antibodies against Borrelia. Initial diagnoses were based on tick exposure and clinical presentation. Records of 819 hospitalized patients were analyzed: 497 (60.7%) men and 322 (39.3%) women, mean age 55.7 ± 14.8 years. LB was diagnosed in 426 (52%) patients, including 24 (5.6%) with neuroborreliosis and 7 (1.7%) with erythema migrans. In 395 cases, symptoms and results did not clearly confirm LB, yet antibiotics were used to assess response. In 393 patients (48%), LB was excluded; the most common alternative diagnoses were osteoarthritis (31.3%) and other musculoskeletal disorders (25.1%). Overdiagnosis of LB may result in unwarranted antibiotic use, while delayed treatment can lead to late-stage disease. A key issue is the lack of differential diagnostics, delaying proper management of serious conditions like MS, rheumatoid arthritis, or cancer. Notably, many patients received empirical antibiotics despite not meeting clinical-serological criteria, distorting disease incidence. The current LB reporting system also requires revision, as it promotes overdiagnosis. Borelioza jest jedną z najczęściej diagnozowanych chorób przenoszonych przez kleszcze na świecie. Pomimo znaczących postępów rozwoju metod diagnostyki laboratoryjnej, problem klinicznej nadrozpoznawalności, a z drugiej strony niedoropoznawalności boreliozy wciąż narasta. Niecharakterystyczne objawy, jak przewlekłe zmęczenie czy dolegliwości mięśniowo-stawowe przypisywane boreliozie są źródłem wielu kontrowersji i często opóźniają właściwą diagnostykę i leczenie choroby zasadniczej. Analiza danych klinicznych i badań pacjentów kierowanych do Kliniki Chorób Zakaźnych i Neuroinfekcji, Uniwersytetu Medycznego w Białymstoku z podejrzeniem boreliozy z Lyme i ocena częstości form klinicznych. Retrospektywnej analizie poddano dokumentację pacjentów hospitalizowanych z powodu podejrzenia boreliozy wczesnej lub późnej w Klinice Chorób Zakaźnych i Neuroinfekcji Uniwersytetu Medycznego w Białymstoku w okresie styczeń 2018r.–czerwiec 2023r.Diagnostykę oparto na testach ELISA i Western blot w kierunku przeciwciał IgM i IgG przeciwko krętkom Borrelia, a wstępne rozpoznanie uwzględniało wywiad narażenia na kleszcze oraz obraz kliniczny. Przeanalizowano dokumentację 819 hospitalizowanych pacjentów, w tym 497 (60,7%) mężczyzn i 322 (39,3%) kobiety. Średnia wieku badanej populacji wyniosła 55,7 ± 14,8 lat. Boreliozę rozpoznano u 426 (52%) osób, w tym u 24 osób (5,6%) rozpoznano neuroboreliozę a u 7 (1,7%) rozpoznano rumień wędrujący. U 395 pacjentów objawy kliniczne oraz wyniki badań laboratoryjnych nie pozwoliły jednoznacznie wykluczyć boreliozy, co przy braku alternatywnej diagnozy było przyczyną zastosowania antybiotykoterapii, celem oceny poprawy klinicznej. U 48% pacjentów (n=393) wykluczono boreliozę. Wśród pacjentów bez zdiagnozowanej boreliozy najczęstszymi schorzeniami naśladującymi objawy boreliozy była choroba zwyrodnieniowa stawów (31,3%) i schorzenia układu mięśniowo-kostnego (25,1%). Nadrozpoznawalność boreliozy może skutkować narażeniem pacjentów na bezzasadne stosowanie antybiotykoterapii. Niezwykle istotnym problemem jest zaniechanie diagnostyki różnicowej, które może prowadzić do opóźnionego leczenia chorób takich jak SM, RZS, choroby nowotworowe. Szczególnej uwagi wymaga duża grupa pacjentów, którzy nie spełniali kryteriów kliniczno-serologicznych, u których mimo to zastosowano antybiotykoterapię empiryczną - grupa ta może istotnie zaburzać ogólną ocenę zapadalności. Zweryfikować należy formę raportowania rozpoznań boreliozy, co wpływa na nadrozpoznawalność.", "url": "https://pubmed.ncbi.nlm.nih.gov/41042957/" }, { "pmid": "41024925", "title": "Reassessing Chronic Lyme Disease and Post-Treatment Lyme Disease Syndrome as Focal Infections.", "pub_date": "2025-09-30", "journal": "Cureus", "authors": "Lakos, András, Nagy, Gyöngyi, Varga, Zoltán, Rásonyi-Kovács, Péter et al.", "abstract": "The complete clinical spectrum of Lyme borreliosis has been recognized for nearly 50 years, yet its diagnosis remains challenging due to the heterogeneity of symptoms. While many symptoms are likely nonspecific, a recurring cluster, including severe fatigue, brain fog, cognitive decline, memory impairment, joint and muscle pain, limb numbness, headaches, and low-grade fever, is often labeled in the scientific literature as post-treatment Lyme disease syndrome (PTLDS), and in the popular media as \"chronic Lyme disease.\" Based on clinical experience and retrospective case analysis, this study hypothesizes that in many such cases, these persistent symptoms are not sequelae of Lyme borreliosis but manifestations of an undiagnosed focal infection, most commonly chronic tonsillitis or periodontal disease. The hypothesis is supported by the observation that the symptom profile of PTLDS is remarkably similar to that seen in focal infections, and by documented patient outcomes following treatment of these localized infections. This study compiles and analyzes clinical data to support the reinterpretation of PTLDS and \"chronic Lyme disease\" as misattributed focal infections in a subset of patients.", "url": "https://pubmed.ncbi.nlm.nih.gov/41024925/" }, { "pmid": "40985958", "title": "Evidence-Based Clinical Effectiveness of Kundalini Yoga: Systematic Review of RCTs Across Multiple Health Conditions.", "pub_date": "2025-09-23", "journal": "Alternative therapies in health and medicine", "authors": "Roy, Sharmistha, Biswas, Ashis Kumar, Sharma, Manoj", "abstract": "Kundalini Yoga (KY) integrates breathwork, meditation, dynamic movement, and chanting, and has gained recognition as a therapeutic intervention. Despite promising results from individual randomized controlled trials (RCTs), to our knowledge, no systematic review has exclusively synthesized RCT evidence on KY across health domains. To critically assess the clinical effectiveness and safety of KY interventions across diverse cognitive, psychological, emotional, sleep-related, and physical health outcomes. PRISMA-guided systematic review of RCTs evaluating KY was conducted from January 2015 to December 2024. Databases included MEDLINE (PubMed), Scopus, CENTRAL (Cochrane Library), Embase, PsycINFO, and CINAHL. Risk of bias was independently assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Studies were conducted worldwide, across multiple sites. Approximately 1370 participants ranging from healthy adults to those diagnosed with conditions such as Mild Cognitive Impairment (MCI), Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), insomnia, chronic pain, and post-treatment Lyme disease syndrome. No serious adverse events were reported. KY protocols (pranayama, asana/kriya, meditation, chanting) delivered in person, online, or hybrid formats; duration 6 weeks-12 months (most 8-12 weeks) with practice from once weekly to daily. Pre-specified validated measures assessed cognitive function, psychological symptoms (e.g., anxiety, depression), sleep quality, emotional regulation, and physical health outcomes (e.g., hippocampal metrics, absenteeism, blood pressure). This systematic review included 15 studies, among which 13 demonstrated a low risk of bias. The findings suggest that KY significantly improves memory, executive functioning, and hippocampal structure, reduces symptoms of anxiety, PTSD, OCD, and depression, enhances sleep quality and emotional regulation, and modestly improves fatigue, blood pressure, and functional outcomes. KY appears safe and shows benefits for a wide range of cognitive, psychological, and physical health conditions. However, larger, standardized RCTs with active comparators, biomarkers, and longer follow-up are needed. Kundalini Yoga, randomized controlled trials, cognitive function, mental health, sleep, PTSD, hypertension, complementary therapy, mind-body intervention.", "url": "https://pubmed.ncbi.nlm.nih.gov/40985958/" }, { "pmid": "40946755", "title": "Case report: Recipient-derived, late-onset post-transplant lymphoproliferative disorder involving a transplanted liver.", "pub_date": "2025-09-15", "journal": "Transplant immunology", "authors": "Zou, Dongmei, Ma, Qiang, Wang, Dandan, Lin, Dongdong et al.", "abstract": "Post-transplant lymphoproliferative disorders (PTLD) are severe complications of transplantation associated with poor outcomes. Compared to early-onset PTLDs, late-onset PTLDs are much less associated with allograft localization. Herein, we report a case of Epstein-Barr virus (EBV)-negative lymphoma involving a graft 7 years after liver transplantation. A 45-year-old man presented with hepatomegaly 7 years after liver transplantation. Liver puncture biopsy revealed B-cell lymphoma with a high proliferation index and a germinal center B-cell-like subtype. Tissue and other donor information were unavailable. Next-generation sequencing was performed on the tumor and recipient tissues, and the single nucleotide polymorphism (SNP) sites were identical, thereby confirming the recipient origin. The patient received a reduction in immunosuppression and six cycles of rituximab, reduced doses of cyclophosphamide, doxorubicin, vincristine, and prednisone, and achieved complete remission after the fourth cycle of treatment. The patient remained in good condition for 7 months after the last chemotherapy dose. This rare case report describes a late-onset EBV-negative recipient-derived PTLD involving a transplanted liver. SNP analysis is a useful method for determining tumor origin in situations where donor tissue is unavailable.", "url": "https://pubmed.ncbi.nlm.nih.gov/40946755/" }, { "pmid": "40842981", "title": "Pre-existing oncohematological disease in kidney transplant recipients: impact on graft survival, acute rejection, and long-term clinical outcomes.", "pub_date": "2025-08-22", "journal": "Frontiers in immunology", "authors": "Mella, Alberto, Clari, Roberta, Deiana, Valeria, Giraudi, Roberta et al.", "abstract": "Oncohematological disorders are heterogeneous conditions that present significant challenges in management prior to transplantation. Data about rejection risk, disease recurrence, eligibility criteria, and requested remission time before kidney transplant (KT) are still lacking. All KTRs between January 1, 2000, and March 31, 2023 (n = 2871) were analyzed. All patients with an oncohematological disease (hematological cohort, including plasma cell dyscrasias [PCDs], acute leukemia, high-grade lymphoma/post-transplant lymphoproliferative disorders [PTLDs], myeloproliferative neoplasms [MPNs], myelodysplastic/myeloproliferative neoplasms [MDS/MPNs], and genetic/AA amyloidosis) were matched 1:2 by age at transplant, gender, type of dialysis, and eGFR at transplant with KTRs without a history of hematological disease (control cohort). Primary endpoints were death-censored graft survival and the risk of rejection. Secondary endpoints included the risk of hematological disease recurrence and infection, patient survival rates, and graft function. Thirty out of 2871 patients (1.04%) receiving 31/3019 KTs have a pre-existing oncohematological disease (hematological cohort): 7/30 (23.3%) PCDs, 4/30 (13.3%) acute leukemia, 8/30 (26.7%) high-grade lymphomas/PTLDs, 4/30 (13.3%) MPNs, 2/30 (6.7%) MDS/MPNs, and 5/30 (16.7%) AA/familiar amyloidosis. Patients were transplanted at a median time of 5 (PCDs), 11.8 (acute leukemia), 12.3 (high-grade lymphomas/PTLDs), 8.5 (MPNs), 3.6 (MDS/MPNs), and 3.5 years (amyloidosis) after achieving disease remission (or stable disease in smoldering myeloma, MPNs, and MDS/MPNs). Comparing hematological and control cohorts, no differences were observed in patient and graft survival or post-transplant complications, including acute rejections. Results are superimposable also without considering the three patients who underwent living KTs from the same donor as the bone marrow transplant. Hematological disease relapses were observed in 2/30 (6.6%), including a light-chain deposition and a Castleman disease, both of which were successfully treated with chemotherapy without allograft dysfunction. Favorable long-term transplant and clinical outcomes were achieved in patients with various pre-existing oncological and hematological disorders. These patients should not be denied KT after a well-documented stable disease. In this context, a multidisciplinary approach is crucial for establishing standardized pre- and post-transplant monitoring protocols and achieving optimal graft and patient outcomes.", "url": "https://pubmed.ncbi.nlm.nih.gov/40842981/" }, { "pmid": "40811832", "title": "Non-DLBCL monomorphic and Hodgkin lymphoma PTLD: clinical insights and treatment strategies.", "pub_date": "2025-08-14", "journal": "Blood advances", "authors": "Atallah-Yunes, Suheil Albert, Khurana, Arushi, Habermann, Thomas M", "abstract": "Monomorphic posttransplant lymphoproliferative disorders (PTLDs) beyond diffuse large B-cell lymphoma (DLBCL) are rare, biologically heterogeneous entities with limited prospective data to guide treatment. DLBCL-PTLD, which comprises most cases, is managed using approaches informed by prospective phase 2 studies, including reduction in immunosuppression and a risk-adapted sequential immunochemotherapy approach. In contrast, non-DLBCL subtypes such as Burkitt lymphoma, PTLDs of T/NK-cell origin, and plasmacytic variants are less common and are typically treated using strategies extrapolated from established treatment algorithms used in immunocompetent patients and sporadic case reports. Classic Hodgkin lymphoma PTLD, although not classified as monomorphic, represents another distinct and clinically relevant subtype. This review summarizes the epidemiology, clinical features, treatment strategies, and outcomes associated with these less common PTLDs, aiming to provide a practical framework for their management.", "url": "https://pubmed.ncbi.nlm.nih.gov/40811832/" }, { "pmid": "40733058", "title": "Development of Low-Dose Disulfiram Rectal Suppository Intended for Application in Post-Treatment Lyme Disease Syndrome.", "pub_date": "2025-07-30", "journal": "Pharmaceutics", "authors": "Benkő, Beáta-Mária, Szabó, Bálint-Imre, Kádár, Szabina, Szabó, Edina et al.", "abstract": "No abstract available.", "url": "https://pubmed.ncbi.nlm.nih.gov/40733058/" }, { "pmid": "40703523", "title": "Aberrant T-cell phenotypes in a cohort of patients with post-treatment Lyme disease.", "pub_date": "2025-07-24", "journal": "Frontiers in immunology", "authors": "Girgis, Alexander A, Cimbro, Raffaello, Yang, Ting, Rebman, Alison W et al.", "abstract": "Post-treatment Lyme Disease (PTLD) is a poorly understood complication of", "url": "https://pubmed.ncbi.nlm.nih.gov/40703523/" }, { "pmid": "40671857", "title": "Understanding the Perspectives, Experiences, Beliefs, and Knowledge of Health Care Practitioners on the Diagnosis and Treatment of Lyme Disease in Canada.", "pub_date": "2025-07-17", "journal": "Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada", "authors": "Robertson, Madison, Norris-Roozmon, Emilie, Egan, Rylan", "abstract": "Lyme disease (LD) is a multisystemic disease without a current approved human vaccine. Increasing infection rates have created pressure to improve the diagnosis and treatment of LD in Canada. This study aims to inform LD care through the exploration of health care practitioner (HCP) perspectives, experiences, beliefs, and knowledge of LD diagnosis and treatment. Canadian HCPs took part in bilingual (English and French) semi-structured interviews to explore their experiences and perspectives related to LD diagnosis and treatment. Major themes within and between participants were identified using inductive thematic analysis and axial coding. A total of 43 HCPs working in LD-related fields participated in this study. Four major themes were identified; HCPs have: 1) Similar perspectives regarding antibiotic use, regional influences, and physician referral; 2) diverse perspectives on the use of serology testing and barriers for LD diagnosis and treatment between endemic and nonendemic regions; 3) challenges and disagreement toward diagnosing and treating chronic LD; and 4) trust in one (among several) LD guidelines, yet consult a variety of secondary sources for additional LD knowledge. The findings reveal a pressing need for greater consistency among HCPs regarding the diagnosis and treatment of LD in Canada. Variation can be attributed to diverse beliefs, perspectives, and approaches within LD practitioners generally, but is particularly evident when addressing, acknowledging, and defining chronic LD. La maladie de Lyme (MD) est une affection multisystémique pour laquelle il n'existe pas de vaccin humain homologué. Les taux d'infection croissants ont suscité des pressions pour améliorer le diagnostic et le traitement de la ML au Canada. Cette étude contribue à éclairer les soins de la ML par l'exploration des points de vue, des expériences, des croyances et des connaissances des professionnels de la santé à l’égard du diagnostic et du traitement de la ML. Les professionnels de la santé canadiens ont participé à des entrevues semi-structurées bilingues (français et anglais) pour explorer leurs expériences et leurs points de vue à l’égard du diagnostic et du traitement de la ML. Des thèmes majeurs ont été extraits chez les participants et entre eux au moyen d'une analyse thématique inductive et d'un codage axial. Au total, 43 professionnels de la santé qui travaillaient dans des secteurs liés à la ML ont participé à la présente étude. Quatre thèmes importants en sont ressortis; les professionnels de la santé ont 1) des points de vue semblables sur l'utilisation des antibiotiques, les influences régionales et l'orientation vers un autre médecin; 2) des points de vue diversifiés sur l'utilisation des tests de sérologie et des obstacles au diagnostic et au traitement de la ML dans les régions endémiques et non endémiques; 3) des difficultés et des divergences quant au diagnostic et au traitement de la ML chronique et 4) confiance en une série de directives sur la ML (parmi d'autres), mais consultent des sources secondaires pour accroître leurs connaissances sur le sujet. Les résultats révèlent un besoin pressant de cohérence entre les professionnels de la santé au sujet du diagnostic et du traitement de la ML au Canada. Les variations peuvent être attribuées à des convictions, des points de vue et des approches variés chez les praticiens de la ML en général, mais sont particulièrement évidents lorsqu'il est question de prendre en compte, de confirmer et de définir la ML chronique.", "url": "https://pubmed.ncbi.nlm.nih.gov/40671857/" }, { "pmid": "40662763", "title": "Class and isotype of VlsE-specific antibody differentiates Lyme disease stage.", "pub_date": "2025-07-15", "journal": "Journal of clinical microbiology", "authors": "Nair, Nisha, Marques, Adriana, Horn, Elizabeth J, Brown, Grant et al.", "abstract": "Establishment of immunoglobulin diversity is contingent on recombination that occurs both at the Fab and at the Fc regions of the immunoglobulin, and this process is time dependent. Based on this principle, we questioned whether Lyme disease stage can be distinguished by quantification of immunoglobulin class and IgG isotype specific to VlsE in serum from clinically characterized patients. We used an enzyme immunoassay to categorize serologic antibodies to VlsE antigen as well as machine-learning techniques to train and integrate multiple predictors to identify likely disease stage. We found that IgM/IgG3/IgG1/IgA1 was enriched in serum obtained in the earliest stages, whereas IgG3/IgG1/IgG4 was enriched in Lyme arthritis. IgG2 detection was unremarkable across all disease stages. Post-Treatment Lyme Disease Syndrome (PTLDS) serum was enriched in IgG3/IgG1/IgA1 but lacked IgM. The multivariable models showed better predictive accuracy than any single immunoglobulin model, with more than half of panels perfectly identified by random forest under cross validation (56%) vs a maximum of 38% for a model using IgG1 alone. The findings suggest a characteristic succession of VlsE-specific antibody switching between immunoglobulin class and IgG isotype as Lyme disease progresses from early to late stages. The data also suggest that immunoglobulin class and IgG isotyping are likely more helpful to distinguish early Lyme disease cases. Comprehensive evaluation of immunoglobulin class (M, G, A) and IgG isotypes (1/2/3/4) provides time-dependent pathogen-induced host response information to current Lyme disease antibody detection and may be useful for differentiation of disease stage. The order of switching between the immunoglobulin heavy chain (Fc) is time dependent, progressing from IgM/D to IgG3/IgG1/IgA1/IgG2/IgG4 and later to IgE/IgA2. In this study, we show that", "url": "https://pubmed.ncbi.nlm.nih.gov/40662763/" }, { "pmid": "40511782", "title": "Cycles of (Dis)engagement: A Qualitative Meta-Synthesis of the (Health)Care-Seeking Experiences of Patients with Chronic Symptoms Following Lyme Disease.", "pub_date": "2025-06-13", "journal": "Health communication", "authors": "Gunning, Jacqueline N", "abstract": "(Chronic) Lyme disease/post-treatment Lyme disease syndrome ([C]LD/PTLDS) is a post-infection illness that remains contested, resulting in a divergent epistemological landscape (i.e., biomedicine versus alternative medicine). Consequently, (C)LD/PTLDS patients exhaust their (health)care options in their search for symptom relief, falling into cycles of starting and stopping (health)care-seeking. This meta-synthesis reviewed 13 qualitative interview studies representing the (health)care-seeking experiences of 216 (C)LD/PTLDS patients across five countries (i.e., United States, Canada, Netherlands, Australia, France) to examine how communication catalyzes patients' (health)care-seeking behaviors. This study proposes a model of (health)care (dis)engagement, identifying communication as a motor moving patients through (health)care-seeking both within and outside of biomedical models of care. This model extends our understanding of communicative (dis)enfranchisement processes and understandings of why patients disengage and reengage in healthcare-seeking behaviors. Theoretical and practical implications and future directions are discussed.", "url": "https://pubmed.ncbi.nlm.nih.gov/40511782/" }, { "pmid": "40485158", "title": "Long COVID as an Infection-Associated Chronic Condition: Implications.", "pub_date": "2025-06-09", "journal": "American journal of health promotion : AJHP", "authors": "Unger, Elizabeth R", "abstract": "A link between infection and chronic illness has been recognized, along with the complexities of interactions between pathogen, environment, host genetics, route of exposure, and timing of outcomes. The COVID-19 pandemic has brought this issue to the forefront and Long COVID is recognized to be an infection associated chronic condition. However, given the wide range of Long COVID presentations, the singular expression gives a false sense of simplicity. Long COVID is best considered as a group of infection associated conditions requiring developing research studies and treatment trials that address the inherent heterogeneity.", "url": "https://pubmed.ncbi.nlm.nih.gov/40485158/" }, { "pmid": "40385877", "title": "Prevalence of Rheumatoid Factor and Anti-citrullinated Protein Antibodies in Patients With Post-treatment Lyme Disease.", "pub_date": "2025-05-19", "journal": "Cureus", "authors": "Miller, John B, Rebman, Alison, Yang, Ting, Aucott, John", "abstract": "Post-treatment Lyme disease (PTLD) occurs in a portion of patients after initial antibiotic treatment of Lyme disease (LD) and is often characterized by arthralgia without synovitis. Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) are often used to assess joint pain in this setting; however, their clinical utility remains unknown. Our objective was to define the frequency of these autoantibodies in a large cohort of carefully characterized patients with PTLD meeting a research case definition and to determine the clinical implications of these tests. RF and ACPA were tested as indicated clinically and abstracted by chart review. The prevalence of antibodies and their relationship to symptoms were examined. Of the 167 patients included in the analysis, RF status was documented at least once for 78.4% (131 of 167), and ACPA status was available at least once for 88.0% (147 of 167). RF was positive in 3.8% (five of 131), and ACPA was positive in 4.8% (seven of 147) at least at one time point. A total of 7.2% (12 of 167) patients were found to have a positive RF or ACPA test at least at one time point. There was no difference in the proportion of patients with RF and/or ACPA based on the initial presenting manifestations of their LD, nor the symptoms of PTLD at later evaluation; however, the small sample size may limit our ability to detect these clinical differences. We found a low prevalence of RF and ACPA in this study, similar to the known rates in the general population. This reflects the lack of inflammatory arthritis in this population with clinically defined PTLD and arthralgia only.", "url": "https://pubmed.ncbi.nlm.nih.gov/40385877/" }, { "pmid": "40373880", "title": "Soluble CD95L is a prognostic marker in central nervous system posttransplant lymphoproliferative disorders.", "pub_date": "2025-05-16", "journal": "American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons", "authors": "Tichadou, Antoine, Lebrault, Eden, Samri, Assia, Baron, Marine et al.", "abstract": "CD95L is a transmembrane cytokine mainly expressed by activated T and natural killer cells to contract the immune response through cell-cell contact. Conversely, after cleavage by metalloproteases, this ligand releases a soluble CD95L (sCD95L) that stimulates the immune response and its antitumor activity. In posttransplant lymphoproliferative disorders (PTLDs), we hypothesized that the concentration of sCD95L could exert a biological function and affect clinical outcomes by modulating the immune response. Using the K-VIROGREF biobank, we quantified sCD95L in 163 patients with PTLD, 16 transplant controls, and 28 healthy donors. Transplant recipients had higher plasma levels of sCD95L than healthy donors. More interestingly, patients with PTLD and high concentration of sCD95L had better clinical outcomes than patients with lower concentration, particularly those with central nervous system (CNS) involvement, who are known to have poor survival. At the cellular level, only natural killer and natural killer T-like cell fractions were reduced in the blood of patients with CNS-PTLD and high concentration of sCD95L, suggesting that sCD95L may either promote the trafficking of these cells within tumors or modulate their differentiation/survival. In conclusion, we showed in this exploratory analysis that plasma concentration of sCD95L might be a prognostic marker in patients with PTLD, particularly in those with CNS involvement.", "url": "https://pubmed.ncbi.nlm.nih.gov/40373880/" }, { "pmid": "40371616", "title": "Supplementary management of chronic Lyme disease with Pycnogenol®.", "pub_date": "2025-05-15", "journal": "Minerva medica", "authors": "Cesarone, Maria R, Hu, Shu, Belcaro, Gianni, Cornelli, Umberto et al.", "abstract": "The aim of this pilot supplement registry study was to investigate the efficacy of the anti-inflammatory supplement Pycnogenol The subjects were divided into two groups: one group received 150 mg/day of Pycnogenol Forty subjects with history of Lyme Disease and persistent symptoms completed the study: 20 in the Pycnogenol In conclusion, the present registry study showed that Pycnogenol", "url": "https://pubmed.ncbi.nlm.nih.gov/40371616/" }, { "pmid": "40339728", "title": "Presumptive Lyme disease-associated eosinophilic synovitis in a horse.", "pub_date": "2025-05-09", "journal": "Journal of equine veterinary science", "authors": "Serpa, P B S, Bogers, S, Byron, C, Cardona, G et al.", "abstract": "A 1-year-old American Quarter horse was presented with acute onset of right hind lameness. On physical examination, there was synovial effusion of the right tarsocrural joint. Synovial fluid cytology revealed a marked eosinophilic synovitis. Serology indicated evidence of acute and chronic infection with Borrelia burgdorferi, although PCR of the synovial fluid was negative. The filly was treated with phenylbutazone and oxytetracycline, and repeated synovial cytology indicated improvement. The filly was discharged with a prescription of minocycline for 30 days. Despite initial improvement, recurrent lameness with bilateral tarsocrural effusion without radiographic abnormalities occurred 8 months later. Repeated synovial cytology showed macrophagic synovitis without an eosinophilic component. The filly was discharged with instructions to complete a 14-day course of minocycline, resulting in complete recovery. Based on the serology results and response to therapy, this report describes a possible naturally occurring eosinophilic synovitis with likely involvement of B. burgdorferi, a condition previously unreported in horses.", "url": "https://pubmed.ncbi.nlm.nih.gov/40339728/" }, { "pmid": "40330647", "title": "Case Report: The intersection of psychiatry and medicine: diagnostic and ethical insights from case studies.", "pub_date": "2025-05-07", "journal": "Frontiers in psychiatry", "authors": "Monaco, Francesco, Vignapiano, Annarita, D'Angelo, Martina, Raffone, Fabiola et al.", "abstract": "The intersection of psychiatry and medicine presents unique diagnostic and ethical challenges, particularly for conditions involving significant brain-body interactions, such as psychosomatic, somatopsychic, and complex systemic disorders. This article explores the historical and contemporary issues in diagnosing such conditions, emphasizing the fragmentation of medical and psychiatric knowledge, biases in clinical guidelines, and the mismanagement of complex illnesses. Diagnostic errors often arise from insufficient integration between general medicine and psychiatry, compounded by the reliance on population-based guidelines that neglect individual patient needs. Misclassification of conditions like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Lyme disease, and fibromyalgia as psychosomatic or psychogenic has led to stigmatization and delayed care. While these conditions are referenced as emblematic examples of misclassified and poorly understood disorders, the five clinical cases discussed in this article do not directly illustrate these diseases. Instead, they exemplify shared diagnostic and ethical dilemmas at the medicine-psychiatry interface, including uncertainty, fragmentation, and the risk of epistemic injustice. The article critically examines terms like medically unexplained symptoms and functional disorders, highlighting their limitations and potential for misuse. Case examples underscore the consequences of diagnostic inaccuracies and the urgent need for improved approaches. Ethical considerations are also explored, emphasizing respecting patient experiences, promoting individualized care, and acknowledging the inherent uncertainties in medical diagnosis. Advances in technologies such as brain imaging and molecular diagnostics offer hope for bridging the gap between psychiatry and medicine, enabling more accurate assessments and better patient outcomes. The article concludes by advocating comprehensive training at the medicine-psychiatry interface and a patient-centered approach that integrates clinical observation, research insights, and a nuanced understanding of mind-body dynamics.", "url": "https://pubmed.ncbi.nlm.nih.gov/40330647/" }, { "pmid": "40291359", "title": "Isolated Muscular NK/T Cell Lymphoma: A Rare Presentation of Post-Transplant Lymphoproliferative Disorders.", "pub_date": "2025-04-28", "journal": "Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India", "authors": "Srivastava, Srishti, Jilhare, Parag, Nazar, Aftab Hasan, Ora, Manish et al.", "abstract": "Posttransplant lymphoproliferative disorders (PTLDs) represent a spectrum of malignancies occurring in transplant recipients under immunosuppression, often linked with Epstein-Barr Virus infection. PTLD has a varied presentation, and isolated muscular involvement is infrequent. Here, we present the case of a 47-year-old female renal transplant recipient presenting with acute left knee joint swelling, initially suggestive of an infective or inflammatory etiology. Biopsy revealed high-grade non-Hodgkin lymphoma of natural killer/T-cell lymphoma. F-18 Fluorodeoxyglucose positron emission tomography-computed tomography scan revealed metabolically active soft tissue mass lesions isolated to thigh muscles. The patient was on a modified chemotherapy regimen tailored to accommodate renal function. This case underscores the necessity for heightened vigilance in diagnosing PTLD, particularly considering its atypical presentations.", "url": "https://pubmed.ncbi.nlm.nih.gov/40291359/" }, { "pmid": "40674535", "title": "Charting a Path Toward New Treatments for Lyme Infection-Associated Chronic Illnesses", "pub_date": "2025-01", "journal": "Unknown Journal", "authors": "March, Andrew, Liao, Julie, Kester, Kent", "abstract": "Around 10-20% of people who contract Lyme disease, the most common tickborne disease in the U.S., develop persistent, often debilitating symptoms such as chronic pain, fatigue, and cognitive dysfunction. Lyme infection-associated chronic illnesses (IACI) share symptoms common to other IACI such as Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome. Despite the chronic impact on the quality of life for many people, there are currently no validated interventions to treat Lyme IACI. In response to this unmet need, the Steven & Alexandra Cohen Foundation asked the National Academies to convene a committee of experts to assess the evidence for disease mechanisms, diagnoses, and treatments of Lyme IACI and illuminate a pathway for the development of new treatments. The resulting report, Charting a Path Toward New Treatments for Lyme Infection-Associated Chronic Illnesses, makes recommendations around developing treatments that improve function and quality of life based on currently available evidence, while continuing research to identify root causes and mechanisms of the disease.", "url": "https://pubmed.ncbi.nlm.nih.gov/40674535/" } ] }