Obstruction to Treatments Meeting International Standards for Lyme and Relapsing Fever Borreliosis Patients
We reviewed how certain institutional policies and practices, as well as questionable research, are creating obstacles to care and informed consent for Lyme and relapsing fever Borreliosis patients. The interference is denying access to treatments that meet the internationally accepted standards as set by the Institute of Medicine. This obstruction to care contributes to significant human suffering, disability and negative economic effect across many nations and in many regions of the world. We note how evidence based medicine emphasizes the importance of clinical experience and patient-centered care and how these patients benefit significantly when their rights to choose among treatment options are upheld.
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 Vector control-Public health importance CHAPTER 4 • BEDBUGS, FLEAS, LICE, TICKS AND MITES Page 268 - Tick-borne relapsing fever, Page 269 - Lyme disease. World Health Organization 1995.
 Patz JA, Githeko AK, McCarty JP, Hussein S, Confalonieri U, de Wet N. Climate change and human health risks and responses. CHAPTER 6 - Climate change and infectious diseases Page 125 - BOX 6.2 Ecological influences and Lyme disease. WHO 2003 (IPCC contribution).
 Lindgren E, Jaenson TGT. Lyme borreliosis in Europe: influences of climate and climate change, epidemiology, ecology and adaptation measures. World Health Organization 2004.
 Vector Biology and Control unit in WHO/EMRO Eastern Global report for Research Infectious diseases of Poverty. WHO publication 2012.
 European Centre for Disease Prevention and Control. ECDC tool for the prioritisation of infectious disease threats – Handbook and manual. Stockholm: ECDC; 2017.
 Luché-Thayer J, Ahern H, DellaSala D, Franklin S, Gilbert L, Horowitz R, Liegner K, McManus M, Meseko C, Miklossy J, Rudenko N, Stuckelberger A, contributing researchers: Beaton J, Blakely J, Freeman P, Garg K, Kraaijeveld H, Lloyd V, Meriläinen L. Updating ICD11 Borreliosis Diagnostic Codes: Edition One, March 29, 2017. ISBN-10: 1978091796 ISBN-13: 978-1978091795 CreateSpace Independent Publishing Platform October 7, 2017.
 Web source: https://botaborrelia.wordpress.com/ Accessed 08.20.2017.
 Schein LA, Harold S. Bernard HS, Henry I. Spitz HI, Philip R. Muskin PR (Editors). Psychosocial Treatment for Medical Conditions: Principles and Techniques 1st Edition. Published by Brunner-Routledge 2003.
 Koch, LC, Rumrill PD. Rehabilitation Counseling and Emerging Disabilities: Medical, Psychosocial, and Vocational Aspects 1st Edition. Published by Springer Publishing LLC, 2017.
 Human rights violations presented on June 7, 2017 to the Special Rapporteur Dr. Dainius Pūras, in addition to those documented in the report to WHO - Luché-Thayer J, Ahern H, DellaSala D, Franklin S, Gilbert L, Horowitz R, Liegner K, McManus M, Meseko C, Miklossy J, Rudenko N, Stuckelberger A, contributing researchers: Beaton J, Blakely J, Freeman P, Garg K, Kraaijeveld H, Lloyd V, Meriläinen L. Updating ICD11 Borreliosis Diagnostic Codes. Technical Report accepted by WHO March 2017.
 Walker AR, Bouattour A, Camicas J, Estrada-Pena A, Horak IG, Latif AA, et al. Ticks of Domestic Animals in Africa: A Guide to Identification of Species. Published by Bioscience Reports, Edinburgh,United Kingdom. 2003.
 DA DellaSala, M Middelveen, KB Liegner, J Luché-Thayer. Lyme Disease Epidemic Increasing Globally Due to Climate Change and Human Activities. Elsevier Inc. 2017.
 Web Source: https/www.publiccartfund.org/view/exhibitions/5735 _women_don’t_get_aids_they_just_die_from_it Accessed 08.20.2017
 Wormser GP, Shapiro ED. Implications of Gender in Chronic Lyme DiseaseJ Womens Health (Larchmt). 2009 Jun; 18(6): 831–834. doi: 10.1089/jwh.2008.1193.
 Presentation by Diane O’Leary. The Gender Principle as a Barrier to Healthcare Access for Women. Visiting Researcher, Kennedy Institute of Ethics, Georgetown University 2017.
 Tasca C, Rapetti M, Carta MG, Fadda B. Women And Hysteria In The History Of Mental Health. Clin Pract Epidemiol Ment Health. 2012; 8: 110–119.Published online 2012 Oct 19. doi: 10.2174/1745017901208010110.
 Barsky AJ, Peekna HM, Borus JF. Somatic Symptom Reporting in Women and Men. J Gen Intern Med. 2001 Apr; 16(4): 266–275. doi: 10.1046/j.1525-1497.2001.00229.x.
 Oxford Textbook of Women and Mental Health, Edited by Dora Kohen. Oxford University Press Print ISBN-13: 9780199214365 Published online: Jul 2011 DOI: 10.1093/med/9780199214365.001.0001.
 Johnson L, Wilcox S, Jennifer Mankoff J, Raphael B. Stricker RB. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. March 27, 2014. PubMed 24749006. https://peerj.com/articles/322/.
 Daszak P, Cunningham AA, Hyatt, AD, Emerging infectious diseases of wildlife--threats to biodiversity and human health. Science; 287.5452:443-9. Jan 21, 2000.
 Food and Agriculture Organization. The pro-Poor Livestock Policy Initiatives: A living from Livestock. Rome; 2004.
 Molyneux D, Hallaj Z, Keusch GT, McManus DP, Ngowi H, Cleaveland S, Ramos-Jimenez P, Gotuzzo E, Kar K, Ana Sanchez A, Garba A, Carabin H, Bassili A,Chaignat CL, Meslin FX,Hind M, Abushama HM, Arve L, Willingham AL, Kioy D. Zoonoses and marginalised infectious diseases of poverty: Where do we stand? Parasit Vectors. 2011; 4: 106.
 Diatta G, Duplantier J-M, Granjon L, et al. Borrelia infection in small mammals in west Africa and its relationship with tick occurrence inside burrows. Acta Tropica. 2015;152:131–140.
 Nordstrand A, Bunikis I, Larsson C, Tsogbe K, Schwan TG, Nilsson M, et al. Tickborne relapsing fever diagnosis obscured by malaria, Togo. Emerg Infect Dis. 2007;13:117–23.
 Goutier S, Ferquel E, Pinel C, Bosseray A, Hoen B, Couetdic G, Bourahoui A, Lapostolle C, Pelloux H, Garnier M, Sertour N, Pelloux I, Pavese P, Cornet M. Borrelia crocidurae Meningoencephalitis, West Africa. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 2, February 2013.
 Mahmoud AAF. The challenge of intracellular pathogens. New England Journal of Medicine 326(11): 761. 1992.
 Georgilis K, Peacocke M, and Klempner MS. Fibroblasts protect the Lyme Disease spirochete, Borrelia burgdorferi, from Ceftriaxone In Vitro. Journal of Infectious Diseases 166: 440–444. 1992.
 Fox M. Three die suddenly from rare Lyme disease complication. NBC News December 12, 2013.
 Liegner KB. In the Crucible of Chronic Lyme Disease – Collected Writings & Associated Materials. Xlibris 2015. Library of Congress Control Number 2015911615.
 Schwarzwalder A, Schneider MF, Lydecker A, Aucott JN. Brief Report Sex Differences in the Clinical and Serologic Presentation of Early Lyme Disease: Results from a Retrospective Review. Gender Medicine Vol. 7, No. 4, 2010.
 Cook MJ, Puri BK. Commercial test kits for detection of Lyme borreliosis: a meta-analysis of test accuracy. International Journal of General Medicine 2016:9 427–440.
 Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336:924–6.
 Editors: Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E. Clinical Practice Guidelines We Can Trust. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Washington (DC): National Academies Press (US); 2011.
 Kavanagh B. The GRADE System for Rating Clinical Guidelines. PLoS Med. 2009 Sep; 6(9): E1000094.
 AGREE, The Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice. guidelines: the AGREE project. Qual Saf Health Care. 2003;12:18–23.
 Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182(18):E839–42.
 Qaseem A, Forland F, Macbeth F, Ollenschläger G, Phillips S, van der Wees P. Guidelines International Network: toward International Standards for Clinical Practice Guidelines. Ann Intern Med. 2012;156(7):525–31.
 Rosen L, Manor O, Engelhard D, Zucker D. In Defense of the Randomized Controlled Trial for Health Promotion Research. Am J Public Health. 2006 July; 96(7): 1181–1186.
 Victora CG, Habicht JP, Bryce J, Ed. Evidence-Based Public Health: Moving Beyond Randomized Trials. Am J Public Health. 2004 March; 94(3): 400–405.
 Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312(7023): 71–72.
 Moses H, Matheson DHM, Cairns-Smith S, George BP, Palisch C, Dorsey ER. The Anatomy of Medical Research US and International Comparisons. JAMA. 2015;313(2):174-189.
 UNESCO Science Report: towards 2030.
 CDC officials who are IDSA members include Rima Khabbaz, Deputy Director for Infectious Diseases and Acting Director of Office of Infectious Diseases; recently retired Beth Bell was Director of the National Center for Emerging and Zoonotic Infectious Diseases, Lyle R. Petersen, Director, Division of Vector-Borne Diseases under National Center for Emerging and Zoonotic Infectious Diseases and CDC Spokesperson; C. Ben Beard, Branch Chief, Bacterial Diseases Branch of Division of Vector-Borne Diseases; and Christina Nelson, Medical Epidemiologist with the Bacterial Diseases Branch.
 Department of Health and Human Services National Institutes of Health - NIH Response to the Conference Report Request for a Plan to Ensure Taxpayers' Interests are Protected. Page 7. July 2001. Web source: https:// www.ott.nih.gov/sites/default/files/documents/policy/wydenrpt.Pdf Accessed 08.20.2017.
 CDC official Barbara Johnson submitted a patent for Lyme diagnostics that would have been in competition to one she publicly dismissed as low quality after the competitor –working closely with the CDC– met all benchmarks for approval. The competitor is Dr. Sin Hang Lee, Sin Hang’s areas of expertise include General pathology, surgical pathology, clinical microbiology, and molecular diagnostics by PCR/direct DNA sequencing. He has over 70 publications from a career that has spanned nearly six decades. He is currently suing the CDC for their anti-competitive practice against using Sanger sequencing for the diagnosis of Lyme borreliosis. According to Sin Hang, all laboratories can use this well-established generic method to diagnose Lyme borreliosis. According to US law, government entities and officials are privileged with a significant degree of immunity –one can only sue for personal damage via an SF-95 form with a specific amount of damage claimed to be listed on the initial Complaint. His filing for a court case is pending and his documents are now on public record.
 Lightfoot RW, Luft BJ, Rahn DW, Steere AC, Sigal LH, Zoschke DC, Gardner P, MD; Britton MC, Kaufman RL. Empirical Parenteral Antibiotic Treatment of Patients with Fibromyalgia and Fatigue and a Positive Serologic Result for Lyme Disease: A Cost-Effectiveness Analysis. Ann Intern Med. 1993;119(6):503-509.
 Web Source: https://on-lyme.org/en/sufferers/lyme-stories/item/253-explaining-human-right-violations-around-lyme-disease Accessed 08.20.2017.
 Luché-Thayer J. CDC's Profile Plummets While 15 Government Authorities Act on Persistent and Disabling Lyme Disease. Technical paper submitted to Senate Budget Committee’s Chief Investigator. July 4, 2017.
 Web Source IDSA Statement on Reintroduction of Home Infusion Legislation, 06/20/2011 http://www.idsociety.org/IDSA_Statement_ on_ Reintroduction_of_Home_Infusion_Legislation/ Accessed 08.20.2017.
 Web source https://botaborrelia.wordpress.com/ Accessed 08.20.2017.
 American Psychiatric Association (APA) Fact Sheet on Somatic Symptom Disorder. 2013 American Psychiatric Association.
 Lantos PM. Chronic Lyme Disease. Infect Dis Clin North Am. 2015 Jun; 29(2): 325–340.
 Lantos PM, Wormser GP. Chronic coinfections in patients diagnosed with chronic Lyme disease: a systematic literature review. Am J Med. 2014 Nov; 127(11): 1105–1110.
 Luché-Thayer J. Lyme Patients Stigmatized and Scapegoated with Federal Support. July 25, 2016. Technical paper for US Congressional record.
 Lantos PM, Shapiro ED, Auwaerter PG, Baker PJ, Halperin JJ, McSweegan E,Wormser GP. Unorthodox Alternative Therapies Marketed to Treat Lyme Disease. Clin Infect Dis. 2015 June 15; 60(12): 1776–1782.
 Auwaerter PG, Bakken JS, Dattwyler RJ, Dumler JS, MD, Halperin JJ, McSweegan E, Nadelman RB, O'Connell S, Shapiro ED, Sood SK, Steere AC, Weinstein A, Wormser GP. Antiscience and Ethical Concerns Associated with Advocacy of Lyme Disease. Volume 11, No. 9, p713–719, September 2011.
 Luché-Thayer J. NIH Grants Used to Claim Lyme Patients are Looney. June 30, 2016. Technical paper for US Congressional record.
 Shapiro ED, Baker PJ, Wormser GP. False and Misleading Information about Lyme Disease. Am J Med., Vol 130, No 7, July 2017.
 Luché-Thayer J. Analysis of False and Misleading Information about Lyme Disease. April 2017. Technical paper for NIH forensic audit of grant misappropriations.
 Web Source: http://www.nationalacademies.org/hmd/Reports/2011/ Clinical-Practice-Guidelines-We-Can-Trust/Standards.aspx. Accessed 08.20.2017.
 Web source: https://patentscope.wipo.int/search/en/detail.jsf?docId =WO2008147879&recNum=1&maxRec=&office=&prevFilter=&sortOption=&queryString=&tab=PCTDescription Patent no. WO/2008/ 147879 filed with the World Intellectual Property Organisation (WIPO) in 2007. Inventor Ryan Golhar states “The present invention provides methods and devices for the identification of bioagents via the presence of their nucleic acids. In the context of the present invention, a "bioagent" is any organism, living or dead, or a nucleic acid derived from such an organism … Bacterial biological warfare bioagents capable of being detected by the present methods include, but are not limited to, Bacillus anthracis (anthrax), Yersinia pestis (pneumonic plague), Franciscella tularensis (tularemia), Brucella suis … Borrelia burgdorferi (Lyme disease).”.
 Web source http://www.idsociety.org/uploadedFiles/IDSA/Policy_and _Advocacy/Current_Topics_and_Issues/Positions_on_Health_Reform/Statements/IDSA%20concerning%20Project%20Bioshield.pdf. Accessed 09.20.2017.
 Web Source http://www.ilads.org/ilads_news/wp-content/uploads/2015/ 09/EvidenceofPersistence-V2.pdf. Accessed 08.20.2017.
 Web source http://www.ohchr.org/Documents/Publications/Factsheet 31. Pdf. Accessed 08.20.2017.
 Web source http://www.ohchr.org/Documents/Issues/ESCR/Health/ RightToHealthWHOFS2.pdf. Accessed 08.20.2017.
 Source is the CDC. (2013) International Conference on Lyme Borreliosis and other Tick-borne Diseases. 18 Aug 2013.
 Web Source https://downloads.globalchange.gov/sap/sap4-6/sap4-6-final -report-all.pdf. Accessed 08.20.2017.
 Adrion ER, Aucott J, Lemke KW, Weiner JP. Health care costs, utilization and patterns of care following Lyme disease. PLOS ONE. 2015;10(2):e0116767.
 The full report on the ICD11 Revision Conference in Tokyo, Japan is available at web source: http://who.int/classifications/network/meeting 2016/ICD-11RevisionConferenceReportTokyo.pdf?ua=1. Accessed 08.20.2017.
 Haut Conseil de la Santé Publique. Borréliose de Lyme. Etat des connaissances. 23 mars 2014. Avis & Rapports. www.hcsp.fr (in French).
 Lee DJ, Vielmeyer O. Analysis of overall level of evidence behind Infectious Diseases Society of America practice guidelines. Arch Intern Med. 2011; 171: 18-22.
 Shadick NA, Phillips CB, Logigian EL et al. The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study. Ann Intern Med. 1994; 121: 905-8.
 Asch ES, Bujak DI, Weiss M et al. Lyme disease: an infectious and postinfectious syndrome. J Rheumatol. 1994; 21: 454-61.
 Skogman BH, Glimaker K, Nordwall M, et al. Long-term clinical outcome after Lyme neuroborreliosis in childhood. Pediatrics. 2012; 130: 262-9.
 Eikeland R, Mygland A, Herlofson K, Ljostad U. European neuroborreliosis: quality of life 30 months after treatment. Acta Neurol Scand. 2011; 124: 349-54.
 Cairns V, Godwin J. Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms. Int J Epidemiol. 2005; 34: 1340-5.
 Fallon BA, Lipkin RB, Corbera KM, Yu S, Nobler MS, Keilp JG, Petkova E, Lisanby SH, Moeller JR, Slavov I, Van Heertum R, Mensh BD, Sackeim HA. Regional cerebral blood flow and metabolic rate in persistent Lyme encephalopathy. Arch Gen Psychiatry. 2009; 66: 554-63.
 Ziska MH, Donta ST, Demarest FC. Physician preferences in the diagnosis and treatment of Lyme disease in the United States. Infection. 1996; 24: 182-6.
 Institute of Medicine (US) Committee on quality of health care in America. Crossing the quality chasm: a new healthsystem for the 21st century. National Academies Press; Washington DC, USA. 2001. P. 360.
 Stricker RB. Counterpoint: long term antibiotic therapy improves persistent symptoms associated with Lyme disease. Clin Infect Dis. 2007; 45: 149-57.
 Sackett D, Straus S., Richardson W, et al. Evidence based-medicine: how to practice and teach EBM. Curchill Livingstone, Edinburgh, London. 2000.
 Pediatrics 2004 Classifying recommendations for clinical practice guidelines. Pediatrics. 2004; 114: 874-7.
 Liegner KB, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, Kong L. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection. J Amer Acad Derm 1993;28:312-4.
 Meriläinen L, Herranen A, Schwarzbach A, Gilbert L. Morphological and biochemical features of Borrelia burgdorferi pleomorphic forms. Microbiology. 2015; 161. 516-27.
 Sharma B, Brown AV, Matluck NE, Hu LT, Lewis K. Borrelia burgdorferi, the causative agent of Lyme disease, forms drug-tolerant persister cells. Antimicrob Agents Chemother. 2015; 59, 4616-24.
 Zhang Y. Persisters, persistent infections and the yin-yang model. Antimicrob Drug Resist. 2013; 3.
 Brorson O, Brorson SH. Transformation of cystic forms of Borrelia burgdorferi to normal, mobile spirochetes, Infection. 1997; 25: 240-6.
 Brorson O, Brorson,S.H. In vitro conversion of Borrelia burgdorferi to cystic forms in spinal fluid, and transformation to mobile spirochetes by incubation in BSK-H medium. Infection 1998; 26: 144–150.
 Brorson O, Brorson SH. A rapid method for generating cystic forms of Borrelia burgdorferi, and their reversal to mobile spirochetes, APMIS. 1998; 106: 1131-41.
 Lewis K. Persister cells, dormancy and infectious disease. Nature. 2007; 5.
 Straubinger RK, Summers BA, Chang YF, Appel MJ. Persistence of Borrelia burgdorferi in experimentally infected dogs after antibiotic treatment. J Clin Microbiol. 1997; 35: 111-6.
 Straubinger RK. PCR-based quantification of Borrelia burgdorferi organisms in canine tissues over a 500-day postinfection period. J Clin Microbiol. 2000; 38: 2191-9.
 Embers ME, Ramamoorthy R, Philipp MT. Survival strategies of Borrelia burgdorferi, the aetiologic agent of Lyme disease. Microbes Infect. 2004; 6: 312-8.
 Hodzic E, Feng S, Holden K, Freet KJ, Barthold SW. Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Antimicrob Agents Chemother. 2008; 52: 1728-36.
 Barthold SW, Hodzic E; Imai DM et al. Ineffectiveness of tigecycline against persistent Borrelia burgdorferi. Antimicrob Agents Chemother. 2010; 54: 643-51.
 Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, Hodzic E, et al. Persistence of Borrelia burgdorferi in Rhesus macaques following antibiotic treatment of disseminated infection. PLoS ONE. 2012; 7: e29914. Erratum: PLoS ONE. 2012; 7.
 Hunfeld KP, Ruzic-Sabljic E, Norris DE, Kraiczy P, Strl F. In vitro susceptibility testing of Borrelia burgdorferi sensu lato isolates cultured from patients with erythema migrans before and after antimicrobial chemotherapy., Antimicrob Agents Chemother. 2005; 49: 1294-301.
 Strle F, Preac-Mursic V, Cimperman J et al. Azithromycine vesus doxycycline for treatment of erythema migrans: clinical and microbiological findings. Infection. 1993; 21: 83-8.
 Weber K, Wilske B, Preac-Mursic VThurmayr R. Azithromycin versus penicillin V for the treatment of early Lyme borreliosis. Infection. 1993; 21: 367-72.
 Haupl T, Hahn G, Rittig M et al. Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis. Arthritis Rheum. 1993; 36: 1621-6.
 Lawrence C, Lipton RB, Lowy FD, Coyle PK. Seronegative chronic relapsing neuroborreliosis. Eur Neurol. 1995; 35: 113-7.
 Lee SH, Vigliotti JS, Vigliotti VS, Jones W, Shearer DM. Detection of Borreliae in archived sera from patients with clinically suspect Lyme disease. Int J Mol Sci. 2014; 15: 4284-98.
 Masters E, Lynxwiler P, Rawlings J. Spirochetemia after continuous high-dose oral amoxicillin therapy. Infect Dis Clin Pract. 1994; 3: 207-8 Murgia R, Cinco M. Induction of cystic forms by different stress conditions in Borrelia burgdorferi. APMIS. 2004; 112: 57-62.
 Oksi J, Nikoskelainen J, Viljanen MK. Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis. Eur J Clin Microbiol Infect Dis. 1998; 17: 715-9.
 Oksi J, Marjamaki M, Nikoskelainen, Viljanen MK. Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Ann Med. 1999; 31: 225-32.
 Pfister HW, Preac-Mursic V, Wilske B, et al. Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. J Infect Dis. 1991; 163: 311-8.
 Phillips SE, Mattman LH, Hulinska D, Moayad H. A proposal for the reliable culture of Borrelia burgdorferi from patients with chronic Lyme disease, even from those previously aggressively treated. Infection. 1998; 26: 364-7.
 Preac-Mursic V, Weber K, Pfister HW. Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borrreliosis. Infection. 1989; 17: 355-9.
 Preac-Mursic V, Pfister HW, Spiegel et al. First isolation of Borrelia burgdorferi from an iris biopsy. J Clin Neuroophthalmol. 1993; 13: 155-61.
 Preac-Mursic V, Pfister HW, Spiegel H, Burk R, Wilske B, Reinhardt S, et al. Formation and cultivation of Borrelia burgdorferi spheroplast-L-form variants. Infection. 1996; 24: 218-26.
 Schmidli J, Hunziker T, Moesli P, Schaad UB. Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis. J Infect Dis. 1988; 158: 905-6.
 Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther. 2014; 12: 1103-35.
 Perronne C. Critical review of studies trying to evaluate the treatment of chronic Lyme disease. Presse Med. 2015.
 Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Infect Dis. 1997; 25: S52-6.
 Donta ST. Macrolide therapy of chronic Lyme disease. Med Sci Monit. 2003; 9: 136-42.
 Clarissou J, Song A, Bernede C, Guillemot D, Dinh A, Ader F, Perronne C, Salomon J. Efficacy of a long-term antibiotic treatment in patients with a chronic tick associated poly-organic syndrome (TAPOS). Med Mal Infect. 2009; 39: 108-15.
 Horowitz RI, Freeman P. The use of dapsone as a novel “persister” drug in the treatment of chronic Lyme disease/post treatment Lyme disease syndrome. J Clin Exp Dermatol Res. 2016.
 Krupp LB, Hyman LG, Grimson R, Coyle PK, Melville P, Ahnn S, et al. Study and treatment of post-Lyme disease (STOP-LD). A randomized double masked clinical trial. Neurology. 2003; 60: 1923-30.
 Fallon BA, Keilp JG, Cordera KM, Petkova E, Britton CB, Dwyer E, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008; 70: 992-1003.
 Klempner MS, Hu LT, Evans J, Schmid CH, Johnson GM, Trevino RP, Norton D, Levy L, Wall D, McCall J, Kosinski M, Weinstein A. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001; 345: 85-92.
 Berende A, Hofstede HJM, Vos FJ, van Midendorp H., Vogelaar ML, Tromp M et al. N Randomized trial of longer-term therapy for symptoms attributed to Lyme disease. Engl J Med. 2016; 374: 1209-20.
 DeLong AK, Blossom B, Maloney EL, Phillips SE. Antibiotic retreatment of Lyme disease in patients with persistent symptoms: a biostatistical review of randomized, placebo-controlled, clinical trials. Contemp Clin Trials. 2012; 33: 1132-42. Front. Med., 14 December 2017 | https://doi.org/10.3389/fmed.2017.00224.
 Rebman A, Bechtold K, Ynag T, Mihm E, Novak C Aucott J. The Clinical, Symptom, and Quality-of-Life Characterization of a Well-Defined Group of Patients with Posttreatment Lyme Disease Syndrome. Front. Med., 14 December 2017.