Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 146 No. 4950 (2016)

Update of the Swiss guidelines on post-treatment Lyme disease syndrome

  • Johannes Nemeth
  • Enos Bernasconi
  • Ulrich Heininger
  • Mohamed Abbas
  • David Nadal
  • Carol Strahm
  • Stefan Erb
  • Stefan Zimmerli
  • Hansjakob Furrer
  • Julie Delaloye
  • Thierry Kuntzer
  • Ekkehard Altpeter
  • Mathias Sturzenegger
  • Rainer Weber
  • for the Swiss Society for Infectious Diseases and the Swiss Society for Neurology
Cite this as:
Swiss Med Wkly. 2016;146:w14353


Lyme borreliosis is caused by Borrelia burgdorferi sensu lato infection, which responds well to antibiotic therapy in the overwhelming majority of cases. However, despite adequate antibiotic treatment some patients report persisting symptoms which are commonly summarised as post-treatment Lyme disease syndrome (PTLDS). In 2005, the Swiss Society of Infectious Diseases published a case definition for PTLDS. We aimed to review the scientific literature with a special emphasis on the last 10 years, questioning whether the definitions from 2005 are still valid in the light of current knowledge. Furthermore, we describe the clinical history of infection with Borrelia burgdorferi sensu lato, the estimated prevalence of PTLDS, the possible pathogenesis of PTLDS, and treatment options with an emphasis on clinical studies.

In summary, we were unable to find a scientific reason for modification of the PTLDS definitions published in 2005. Thus, the diagnostic criteria remain unchanged, namely documented clinical and laboratory evidence of previous infection with B. burgdorferi, a completed course of appropriate antibiotic therapy, symptoms including fatigue, arthralgia, myalgia, cognitive dysfunction or radicular pain persisting for >6 months, a plausible timely association between documented B. burgdorferi infection and onset of symptoms (i.e., persistent or recurrent symptoms that began within 6 months of completion of a recommended antibiotic therapy for early or late Lyme borreliosis), and exclusion of other somatic or psychiatric causes of symptoms. The main therapeutic options remain cognitive behavioural therapy and low-impact aerobic exercise programmes. Growing and unequivocal evidence confirms that prolonged or repeated antibiotic therapy for PTLDS is not beneficial, but potentially harmful and therefore contraindicated.

The Guidelines of the Swiss Society of Infectious Diseases offer an evidence based, diagnostic and therapeutic framework for physicians caring for patients suffering from presumptive PTLDS in Switzerland.


  1. Asch ES, Bujak DI, Weiss M, Peterson MG, Weinstein A. Lyme disease: an infectious and postinfectious syndrome. J Rheumatol. 1994;21(3):454–61.
  2. Shadick NA, Phillips CB, Logigian EL, Steere AC, Kaplan RF, Berardi VP, et al. The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study. Ann Intern Med. 1994;121(8):560–7.
  3. Bujak DI, Weinstein A, Dornbush RL. Clinical and neurocognitive features of the post Lyme syndrome. J Rheumatol. 1996;23(8):1392–7.
  4. Dattwyler RJ, Luft BJ, Kunkel MJ, Finkel MF, Wormser GP, Rush TJ, et al. Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease. N Engl J Med. 1997;337(5):289–95.
  5. Shadick NA, Phillips CB, Sangha O, Logigian EL, Kaplan RF, Wright EA, et al. Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease. Ann Intern Med. 1999;131(12):919-26.
  6. Seltzer EG, Gerber MA, Cartter ML, Freudigman K, Shapiro ED. Long-term outcomes of persons with Lyme disease. JAMA. 2000;283(5):609–16.
  7. Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, et al. Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans. Ann Intern Med. 2002;136(6):421–8.
  8. Wormser GP, Ramanathan R, Nowakowski J, McKenna D, Holmgren D, Visintainer P, et al. Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003;138(9):697–704.
  9. Hassett AL, Radvanski DC, Buyske S, Savage SV, Sigal LH. Psychiatric comorbidity and other psychological factors in patients with “chronic Lyme disease”. Am J Med. 2009;122(9):843–50.
  10. Evison J, Aebi C, Francioli P, Péter O, Bassetti S, Gervaix A, Zimmerli S, Weber R. Abklärung und Therapie der Lyme-Borreliose bei Erwachsenen und Kindern. Teil 1. Schweiz Arzteztg. 2005;86.
  11. Evison J, Aebi C, Francioli P, Péter O, Bassetti S, Gervaix A, Zimmerli S, Weber R. Abklärung und Therapie der Lyme-Borreliose bei Erwachsenen und Kindern. Teil 2. Schweiz Arzteztg. 2005;86:2375–84.
  12. Evison J Aebi C, Francioli P, Péter O, Bassetti S, Gervaix A, Zimmerli S, Weber R. Abklärung und Therapie der Lyme-Borreliose bei Erwachsenen und Kindern. Teil 3. Schweiz Arzteztg. 2005;86:2422–8.
  13. Evison J, Aebi C, Francioli P, Peter O, Bassetti S, Gervaix A, et al. Lyme disease Part I: epidemiology and diagnosis. Rev Med Suisse. 2006;2(60):919–24.
  14. Evison J, Aebi C, Francioli P, Peter O, Bassetti S, Gervaix A, et al. Lyme disease Part 2: clinic and treatment. Rev Med Suisse. 2006;2(60):925–34.
  15. Evison J, Aebi C, Francioli P, Peter O, Bassetti S, Gervaix A, et al. Lyme disease Part 3: prevention, pregnancy, immunodeficient state, post-Lyme disease syndrome. Rev Med Suisse. 2006;2(60):935–40.
  16. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089–134.
  17. Grann D. Stalking Dr. Steere Over Lyme Disease. The New York Times [Internet]. 2001 20.03.2014. Available from:
  18. Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2011;17(1):69–79.
  19. Mygland A, Ljostad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol. 2010;17(1):8–16, e1–4.
  20. Ljostad U, Mygland A. Remaining complaints 1 year after treatment for acute Lyme neuroborreliosis; frequency, pattern and risk factors. Eur J Neurol. 2010;17(1):118–23.
  21. British Infection Association. The epidemiology, prevention, investigation and treatment of Lyme borreliosis in United Kingdom patients: a position statement by the British Infection Association. J Infect. 2011;62(5):329–38.
  22. Feder HM, Jr., Johnson BJ, O'Connell S, Shapiro ED, Steere AC, Wormser GP, et al. A critical appraisal of "chronic Lyme disease". N Engl J Med. 2007;357(14):1422–30. Corrected in: N Engl J Med. 2008 Mar 6;358(10):1084.
  23. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379(9814):461–73.
  24. Stanek G, Strle F. Lyme borreliosis: a European perspective on diagnosis and clinical management. Curr Opin Infect Dis. 2009;22(5):450–4.
  25. Stanek G, O'Connell S, Cimmino M, Aberer E, Kristoferitsch W, Granstrom M, et al. European Union Concerted Action on Risk Assessment in Lyme Borreliosis: clinical case definitions for Lyme borreliosis. Wien Klin Wochenschr. 1996;108(23):741–7.
  26. Strle K, Stupica D, Drouin EE, Steere AC, Strle F. Elevated levels of IL-23 in a subset of patients with post-lyme disease symptoms following erythema migrans. Clin Infect Dis. 2014;58(3):372–80.
  27. Sigal LH. Summary of the first 100 patients seen at a Lyme disease referral center. Am J Med. 1990;88(6):577–81.
  28. Dinerman H, Steere AC. Lyme disease associated with fibromyalgia. Ann Intern Med. 1992;117(4):281–5.
  29. Klempner MS, Hu LT, Evans J, Schmid CH, Johnson GM, Trevino RP, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001;345(2):85–92.
  30. 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(12):1923–30.
  31. Fallon BA, Keilp JG, Corbera 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(13):992–1003.
  32. Cerar D, Cerar T, Ruzic-Sabljic E, Wormser GP, Strle F. Subjective symptoms after treatment of early Lyme disease. Am J Med. 2010;123(1):79–86.
  33. Stupica D, Lusa L, Ruzic-Sabljic E, Cerar T, Strle F. Treatment of erythema migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis. 2012;55(3):343–50.
  34. Skogman BH, Croner S, Nordwall M, Eknefelt M, Ernerudh J, Forsberg P. Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome. Pediatr Infect Dis J. 2008;27(12):1089–94.
  35. Pachner AR, Steiner I. Lyme neuroborreliosis: infection, immunity, and inflammation. Lancet Neurol. 2007;6(6):544–52.
  36. Ljostad U, Skogvoll E, Eikeland R, Midgard R, Skarpaas T, Berg A, et al. Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial. Lancet Neurol. 2008;7(8):690–5.
  37. Benke T, Gasse T, Hittmair-Delazer M, Schmutzhard E. Lyme encephalopathy: long-term neuropsychological deficits years after acute neuroborreliosis. Acta Neurol Scand. 1995;91(5):353–7.
  38. Dersch R, Freitag MH, Schmidt S, Sommer H, Rauer S, Meerpohl JJ. Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis – a systematic review. Eur J Neurol. 2015;22(9):1249–59.
  39. Steere AC, Schoen RT, Taylor E. The clinical evolution of Lyme arthritis. Ann Intern Me. 1987;107(5):725–31.
  40. Herzer P. Rheumatic manifestations in Lyme borreliosis. Clin Dermatol. 1993;11(3):401–6.
  41. Herzer P. Joint manifestations of Lyme borreliosis in Europe. Scand J Infect Dis Suppl. 1991;77:55–63.
  42. Herzer P. Lyme arthritis in Europe: comparisons with reports from North America. Ann Rheum Dis. 1988;47(9):789–90.
  43. Huppertz HI, Bohme M, Standaert SM, Karch H, Plotkin SA. Incidence of Lyme borreliosis in the Wurzburg region of Germany. Eur J Clin Microbiol Infect Dis. 1999;18(10):697–703.
  44. Wilking H, Fingerle V, Klier C, Thamm M, Stark K. Antibodies against Borrelia burgdorferi sensu lato among Adults, Germany, 2008-2011. Emerg Infect Dis. 2015;21(1):107–10.
  45. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MR, et al. An epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum. 1977;20(1):7–17.
  46. Steere AC, Angelis SM. Therapy for Lyme arthritis: strategies for the treatment of antibiotic-refractory arthritis. Arthritis Rheum. 2006;54(10):3079–86.
  47. Drouin EE, Seward RJ, Strle K, McHugh G, Katchar K, Londono D, et al. A novel human autoantigen, endothelial cell growth factor, is a target of T and B cell responses in patients with Lyme disease. Arthritis Rheum. 2013;65(1):186–96.
  48. Centers for Disease Control and Prevention. Three sudden cardiac deaths associated with Lyme carditis – United States, November 2012–July 2013. MMWR Morb Mortal Wkly Rep. 2013;62(49):993–6.
  49. Zajkowska J, Czupryna P, Pancewicz SA, Kondrusik M, Moniuszko A. Acrodermatitis chronica atrophicans. The Lancet Infect Dis. 2011;11(10):800.
  50. Weitzner E, McKenna D, Nowakowski J, Scavarda C, Dornbush R, Bittker S, et al. Long-term Assessment of Post-Treatment Symptoms in Patients With Culture-Confirmed Early Lyme Disease. Clin Infect Dis. 2015;61(12):1800–6.
  51. Dersch R, Sommer H, Rauer S, Meerpohl JJ. Prevalence and spectrum of residual symptoms in Lyme neuroborreliosis after pharmacological treatment: a systematic review. J Neurol. 2016;263(1):17–24.
  52. Edlow JA. Bull's Eye: Unraveling the Medical Mystery of Lyme Disease Yale University Press; 2004.
  53. Halperin JJ. Nervous system Lyme disease. Handb Clin Neurol. 2014;121:1473–83.
  54. Halperin JJ. Lyme disease: neurology, neurobiology, and behavior. Clin Infect Dis. 2014;58(9):1267–72.
  55. Klempner MS, Baker PJ, Shapiro ED, Marques A, Dattwyler RJ, Halperin JJ, et al. Treatment trials for post-Lyme disease symptoms revisited. Am J Med. 2013;126(8):665–9.
  56. Berende A, ter Hofstede HJ, Donders AR, van Middendorp H, Kessels RP, Adang EM, et al. Persistent Lyme Empiric Antibiotic Study Europe (PLEASE)-design of a randomized controlled trial of prolonged antibiotic treatment in patients with persistent symptoms attributed to Lyme borreliosis. BMC Infect Dis. 2014;14:543.
  57. Berende A, ter Hofstede HJ, Vos FJ, van Middendorp H, Vogelaar ML, Tromp M, et al. Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease. N Engl J Med. 2016;374(13):1209–20.
  58. Cameron DJ. Insufficient evidence to deny antibiotic treatment to chronic Lyme disease patients. Med Hypotheses. 2009;72(6):688–91.
  59. Cameron DJ. Clinical trials validate the severity of persistent Lyme disease symptoms. Med Hypotheses. 2009;72(2):153–6.
  60. Lantos PM, Shapiro ED, Auwaerter PG, Baker PJ, Halperin JJ, McSweegan E, et al. Unorthodox alternative therapies marketed to treat lyme disease. Clin Infect Dis. 2015;60(12):1776–82.
  61. Parvu M, Parvu V. Statistical issues when searching for predictors of post-Lyme disease symptoms. Clin Infect Dis. 2014;58(8):1199–200.
  62. Tang KS, Klempner MS, Wormser GP, Marques AR, Alaedini A. Association of Immune Response to Endothelial Cell Growth Factor With Early Disseminated and Late Manifestations of Lyme Disease but Not Posttreatment Lyme Disease Syndrome. Clin Infect Dis. 2015;61(11):1703–6.
  63. Aucott JN. Posttreatment Lyme disease syndrome. Infect Dis Clin North Am. 2015;29(2):309–23.
  64. Batheja S, Nields JA, Landa A, Fallon BA. Post-treatment lyme syndrome and central sensitization. J Neuropsychiatry Clin Neurosci. 2013;25(3):176–86.
  65. Solomon SP, Hilton E, Weinschel BS, Pollack S, Grolnick E. Psychological factors in the prediction of Lyme disease course. Arthritis Care Res. 1998;11(5):419–26.
  66. Morgenstern RG. Chronic Lyme disease: it's not all in our heads. Environ Health Perspect. 2003;111(2):A77; author reply A.
  67. Reid MC, Schoen RT, Evans J, Rosenberg JC, Horwitz RI. The consequences of overdiagnosis and overtreatment of Lyme disease: an observational study. Ann Intern Med. 1998;128(5):354–62.
  68. Kaplan RF, Jones-Woodward L, Workman K, Steere AC, Logigian EL, Meadows ME. Neuropsychological deficits in Lyme disease patients with and without other evidence of central nervous system pathology. Applied Neuropsychol. 1999;6(1):3–11.
  69. Barr WB, Rastogi R, Ravdin L, Hilton E. Relations among indexes of memory disturbance and depression in patients with Lyme borreliosis. Applied Neuropsychol. 1999;6(1):12–8.
  70. Gaudino EA, Coyle PK, Krupp LB. Post-Lyme syndrome and chronic fatigue syndrome. Neuropsychiatric similarities and differences. Arch Neurol. 1997;54(11):1372–6.
  71. Hassett A, Sigal LH. The Psychology of “Post-Lyme Disease Syndrome” and “Not Lyme”. In: Halperin JJ, editor. Lyme disease: An Evidence-based Approach: CAB International 2011;2011:p.232–47.
  72. Hassett AL, Radvanski DC, Buyske S, Savage SV, Gara M, Escobar JI, et al. Role of psychiatric comorbidity in chronic Lyme disease. Arthritis and rheumatism. 2008;59(12):1742–9.
  73. Lantos PM, Wormser GP. Chronic coinfections in patients diagnosed with chronic Lyme disease: a systematic review. Am J Med. 2014;127(11):1105–10.
  74. Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord. 2007;8:27.
  75. Wormser GP, Weitzner E, McKenna D, Nadelman RB, Scavarda C, Nowakowski J. Long-term assessment of fatigue in patients with culture-confirmed Lyme disease. Am J Med. 2015;128(2):181–4.
  76. Cohen S, Doyle WJ, Turner RB, Alper CM, Skoner DP. Emotional style and susceptibility to the common cold. Psychosom Med. 2003;65(4):652–7.
  77. Hickie I, Davenport T, Wakefield D, Vollmer-Conna U, Cameron B, Vernon SD, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. Bmj. 2006;333(7568):575.
  78. Sigal LH. Misconceptions about Lyme disease: confusions hiding behind ill-chosen terminology. Ann Intern Med. 2002;136(5):413–9.
  79. Sigal LH, Hassett AL. Commentary: “What’s in a name? That which we call a rose by any other name would smell as sweet.” Shakespeare W. Romeo and Juliet, II, ii(47-48). Int J Epidemiol. 2005;34(6):1345–7.
  80. Sigal LH, Hassett AL. Contributions of societal and geographical environments to “chronic Lyme disease”: the psychopathogenesis and aporology of a new “medically unexplained symptoms” syndrome. Environ Health Perspect. 2002;110 Suppl 4:607–11.
  81. Steere AC, Taylor E, McHugh GL, Logigian EL. The overdiagnosis of Lyme disease. JAMA. 1993;269(14):1812–6.
  82. Moynihan R, Smith R. Too much medicine? BMJ. 2002;324(7342):859–60.
  83. Cooper JD, Feder HM, Jr. Inaccurate information about lyme disease on the internet. Pediatr Infect Dis J. 2004;23(12):1105–8.
  84. Sood SK. Effective retrieval of Lyme disease information on the Web. Clin Infect Dis. 2002;35(4):451–64.
  85. Sen A. Health: perception versus observation. BMJ. 2002;324(7342):860–1.
  86. Johnson M, Feder HM, Jr. Chronic Lyme disease: a survey of Connecticut primary care physicians. J Pediatr. 2010;157(6):1025–9 e1–2.
  87. Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008(3):CD001027.
  88. Steere AC, Arvikar SL. Editorial commentary: what constitutes appropriate treatment of post-Lyme disease symptoms and other pain and fatigue syndromes? Clin Infect Dis. 2015;60(12):1783–5.
  89. 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(6):1132–42.
  90. Fallon BA, Petkova E, Keilp JG, Britton CB. A reappraisal of the U.S.Clinical trials of post-treatment Lyme disease syndrome. Neurology. 2012;6:79–87.
  91. Holzbauer SM, Kemperman MM, Lynfield R. Death due to community-associated Clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected lyme disease. Clin Infect Dis. 2010;51(3):369–70.
  92. Patel R, Grogg KL, Edwards WD, Wright AJ, Schwenk NM. Death from inappropriate therapy for Lyme disease. Clin Infect Dis. 2000;31(4):1107–9.
  93. Ettestad PJ, Campbell GL, Welbel SF, Genese CA, Spitalny KC, Marchetti CM, et al. Biliary complications in the treatment of unsubstantiated Lyme disease. J Infect Dis. 1995;171(2):356–61.
  94. Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin North Am. 2009;35(2):393–407.
  95. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep. 1997;46(RR-10):1–55.
  96. Centers for Disease Control and Prevention. Lyme disease (Borrelia burgdorferi), 2011 Case Definition. http://wwwncdcgov/nndss/conditions/lyme-disease/case-definition/2011/. 2011.
  97. Nadelman RB, Luger SW, Frank E, Wisniewski M, Collins JJ, Wormser GP. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease. Ann Intern Med. 1992;117(4):273–80.
  98. Strle F, Ruzic E, Cimperman J. Erythema migrans: comparison of treatment with azithromycin, doxycycline and phenoxymethylpenicillin. J Antimicrob Chemother. 1992;30(4):543–50.
  99. Strle F, Preac-Mursic V, Cimperman J, Ruzic E, Maraspin V, Jereb M. Azithromycin versus doxycycline for treatment of erythema migrans: clinical and microbiological findings. Infection. 1993;21(2):83–8.
  100. Luger SW, Paparone P, Wormser GP, Nadelman RB, Grunwaldt E, Gomez G, et al. Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans. Antimicrob Agents Chemother. 1995;39(3):661–7.
  101. Luft BJ, Dattwyler RJ, Johnson RC, Luger SW, Bosler EM, Rahn DW, et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial. Ann Intern Med. 1996;124(9):785–91.
  102. Hammers-Berggren S, Hansen K, Lebech AM, Karlsson M. Borrelia burgdorferi-specific intrathecal antibody production in neuroborreliosis: a follow-up study. Neurology. 1993;43(1, part 1):169–75.
  103. Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. N Engl J Med. 1996;335(17):1270–4.
  104. Berglund J, Stjernberg L, Ornstein K, Tykesson-Joelsson K, Walter H. 5-y Follow-up study of patients with neuroborreliosis. Scand J Infect Dis. 2002;34(6):421–5.
  105. Nowakowski J, Nadelman RB, Sell R, McKenna D, Cavaliere LF, Holmgren D, et al. Long-term follow-up of patients with culture-confirmed Lyme disease. Am J Med. 2003;115(2):91–6.
  106. Hammers-Berggren S, Lebech AM, Karlsson M, Svenungsson B, Hansen K, Stiernstedt G. Serological follow-up after treatment of patients with erythema migrans and neuroborreliosis. J Clin Microbiol. 1994;32(6):1519–25.
  107. Hammers-Berggren S, Lebech AM, Karlsson M, Andersson U, Hansen K, Stiernstedt G. Serological follow-up after treatment of Borrelia arthritis and acrodermatitis chronica atrophicans. Scand J Infect Dis. 1994;26(3):339–47.
  108. Centers for Disease Control and Prevention. Fibromyalgia Case definition. Available from:

Most read articles by the same author(s)

1 2 3 > >>