Nutcracker phenomenon

2020-05-12T10:15:33Z

User talk:Cipher

2020-05-02T14:45:55Z

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Nutcracker phenomenon

2020-05-02T14:13:57Z

Cipher:

[[File:Nutcracker Syndrome Anatomy.png|thumb|362x362px|Basic drawing detailing the typical anatomy of nutcracker phenomenon]]
Nutcracker phenomenon, also known as left renal vein entrapment, refers to compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein.<ref name=":0">{{Cite journal|last=Kurklinsky|first=Andrew K.|last2=Rooke|first2=Thom W.|date=2010-6|title=Nutcracker Phenomenon and Nutcracker Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878259/|journal=Mayo Clinic Proceedings|volume=85|issue=6|pages=552–559|doi=10.4065/mcp.2009.0586|issn=0025-6196|pmc=2878259|pmid=20511485}}</ref> Normally, the left renal vein brings blood out of the left kidney and into the inferior vena cava, the body’s largest vein. Compression of the left renal vein can cause blood to flow backward into other nearby veins.

The term ''nutcracker syndrome'' most often refers to the classic symptoms that can arise from the nutcracker phenomenon, e.g. hematuria, abdominal pain (classically left flank or pelvic pain) and orthostatic proteinuria. <ref name=":0" /><ref name=":1">{{Cite journal|last=Scholbach|first=Thomas|date=2007|title=From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs|url=https://www.ncbi.nlm.nih.gov/pubmed/17161550|journal=Medical Hypotheses|volume=68|issue=6|pages=1318–1327|doi=10.1016/j.mehy.2006.10.040|issn=0306-9877|pmid=17161550}}</ref><ref name=":10" /> Some patients with nutcracker phenomenon don't have all of these classic symptoms though (hematuria for example is obligatory in nutcracker syndrome<ref name=":1" />), but still suffers from other symptoms arising from this vein compression disorder.<ref name=":1" /><ref name=":2">{{Cite journal|last=Koshimichi|first=Machiko|last2=Sugimoto|first2=Keisuke|last3=Yanagida|first3=Hidehiko|last4=Fujita|first4=Shinsuke|last5=Miyazawa|first5=Tomoki|last6=Sakata|first6=Naoki|last7=Okada|first7=Mitsuru|last8=Takemura|first8=Tsukasa|date=2012-05|title=Newly-identified symptoms of left renal vein entrapment syndrome mimicking orthostatic disturbance|url=https://www.ncbi.nlm.nih.gov/pubmed/22573421|journal=World journal of pediatrics: WJP|volume=8|issue=2|pages=116–122|doi=10.1007/s12519-012-0349-1|issn=1867-0687|pmid=22573421}}</ref><ref name=":3" /> Hence, both the terms nutcracker syndrome and nutcracker phenomenon can be used to describe symptomatic left renal vein entrapment. There's a wide spectrum of clinical presentations and diagnostic criteria are not well defined, which frequently results in delayed or incorrect diagnosis.<ref name=":0" />

Nutcracker phenomenon has been linked to CFS and dysautonomia in several medical journal articles, both in pediatric and adult patients. Theories regarding the various ways in which nutcracker phenomenon can cause these symptoms include:
# severe congestion in the kidney may cause the expansion of the renal venous bed, which would affect the renin-angiotensin system.<ref name=":3">{{Cite web|url=https://www.dinet.org/info/pots/what-causes-pots-r98/|title=What Causes POTS?|website=Dysautonomia Information Network (DINET)|language=en-US|access-date=2020-05-01}}</ref>
# severe congestion in the adrenal medulla, which is innervated by sympathetic nerves, may disturb a complex set of central neural connections controlling the sympathoadrenal system. <ref name=":3" />
# overproduction or night retention of catecholamines.<ref name=":3" />

== Nutcracker phenomenon's connection to CFS & dysautonomia ==

==== Paper # 1 ====
Hammami et al. published a case-study titled "A Tough Nut to Crack: Chronic Fatigue Syndrome and Abdominal Pain Attributed to Nutcracker Syndrome". The patient, a 24-year-old male had a seven-year history of chronic fatigue syndrome, chronic pelvic pain syndrome, and vague abdominal pain. He also suffered from orthostatic hypotension, and he showed a possible tachycardic response during a tilt table test. He also reported symptoms of “slowed thinking” and an inability to exercise without feeling lightheaded. He underwent surgery to insert a left renal vein stent. His symptoms resolved soon after the intervention. <ref name=":4">{{Cite web|url=https://www.oatext.com/A-Tough-Nut-to-Crack-Chronic-Fatigue-Syndrome-and-Abdominal-Pain-Attributed-to-Nutcracker-Syndrome.php|title=A Tough Nut to Crack: Chronic Fatigue Syndrome and Abdominal Pain Attributed to Nutcracker Syndrome|website=www.oatext.com|language=en|access-date=2020-04-30}}</ref>

==== Paper # 2 ====
This paper was titled "Does severe nutcracker phenomenon cause pediatric chronic fatigue?". According to the abstract, the authors (Takahashi et al.) had 9 pediatric CFS patients at their clinic who were intermittently or persistently absent from school. The patients had been suspected to be burdened with psychosomatic disorders, having orthostatic hypotension, postural tachycardia, or other autonomic dysfunction symptoms. When they investigated the cause of moderate orthostatic proteinuria in some of the patients, they found by chance that they suffered from severe nutcracker phenomenon. Further investigation revealed that nutcracker phenomenon was present in all 9 children complaining of chronic fatigue, even those who did not have orthostatic proteinuria. They conclude in their abstract (NC=nutcracker phenomenon): ''"Their symptoms filled the criteria of chronic fatigue syndrome or idiopathic chronic fatigue (CFS/CF). An association between severe NC and autonomic dysfunction symptoms in children with CFS/CF has been presented."''<ref name=":5">{{Cite journal|last=Takahashi|first=Y.|last2=Ohta|first2=S.|last3=Sano|first3=A.|last4=Kuroda|first4=Y.|last5=Kaji|first5=Y.|last6=Matsuki|first6=M.|last7=Matsuo|first7=M.|date=2000-03|title=Does severe nutcracker phenomenon cause pediatric chronic fatigue?|url=https://www.ncbi.nlm.nih.gov/pubmed/10749295|journal=Clinical Nephrology|volume=53|issue=3|pages=174–181|issn=0301-0430|pmid=10749295}}</ref>

The full-text is hard to find, but some other more details can be found in another paper<ref name=":6">{{Cite journal|last=Shin|first=Jae Il|last2=Lee|first2=Jae Seung|date=2006-05|title=Comment on Gastrointestinal Symptoms Associated with Orthostatic Intolerance|url=https://journals.lww.com/jpgn/Fulltext/2006/05000/Comment_on_Gastrointestinal_Symptoms_Associated.23.aspx|journal=Journal of Pediatric Gastroenterology and Nutrition|language=en-US|volume=42|issue=5|pages=588|doi=10.1097/01.mpg.0000215310.71040.c0|issn=0277-2116}}</ref> referring to this paper and on Dysautonomia Information Network's website<ref name=":3" />. The patients are reported to have suffered from a broad range of symptoms including; chronic fatigue, headache, lightheadedness, dizziness, abdominal pain, unrefreshing sleep, muscle pain, joint pain, sore throat, low-grade fever, afebrile chills in hot summer and depression.

The authors of this study point out that the classic symptom of nutcracker phenomnen is renal bleeding (presenting as micro or macro-hematuria). In their experience, non-CFS patients with nutcracker phenomenon typically had hematuria, but the patients with CFS-associated nutcracker phenimenon had no renal bleeding. Some of these patients did report fibromyalgia type pain. Some patients had proteinuria, others had no urinary abnormalities. The authors of this study had some theories regarding the various ways in which nutcracker phenomenon might affect autonomic function: First, severe congestion in the kidney may cause the expansion of the renal venous bed, which would affect the renin-angiotensin system. Secondly, severe congestion in the adrenal medulla, which is innervated by sympathetic nerves, may disturb a complex set of central neural connections controlling the sympathoadrenal system. On the other hand, overproduction or night retention of catecholamines might be responsible for the various symptoms of pediatric chronic fatigue syndrome.

==== Paper # 3 ====
Another paper from Takahashi et al. was titled "An effective "transluminal balloon angioplasty" therapy for pediatric chronic fatigue syndrome with nutcracker phenomenon"<ref name=":7">{{Cite journal|last=Takahashi|first=Y.|last2=Sano|first2=A.|last3=Matsuo|first3=M.|date=2000-01|title=An effective "transluminal balloon angioplasty" therapy for pediatric chronic fatigue syndrome with nutcracker phenomenon|url=https://www.ncbi.nlm.nih.gov/pubmed/10661488|journal=Clinical Nephrology|volume=53|issue=1|pages=77–78|issn=0301-0430|pmid=10661488}}</ref>. Unfortunately, the abstract and full-text are not easily found, but another paper<ref name=":6" /> describes the findings in this paper.

It's about a 13 year old girl who suffered from orthostatic hypotension, tachycardia and chronic fatigue syndrome. The patient was also diagnosed with nutcracker phenomenon, and was successfully treated with transluminal balloon angioplasty of the compressed left renal vein between the aorta and superior mesenteric artery. Both her dysautonomia and CFS improved after the intervention.

==== Paper # 4 ====
A third paper from Takahashi et al. was titled "An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon". They tested 93 pediatric patients for nutcracker phenomenon (56 with idiopathic renal bleeding, 14 with massive orthostatic proteinuria and 23 with severe orthostatic intolerance). Left renal vein occlusion (nutcracker phenomenon) was observed in 70% of the patients with severe orthostatic intolerance, and in contrast in 18% and 14% for idiopathic renal bleeding and massive orthostatic proteinuria, respectively. <ref name=":8">{{Cite journal|last=Takahashi|first=Y.|last2=Sano|first2=A.|last3=Matsuo|first3=M.|date=2005-07|title=An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon|url=https://www.ncbi.nlm.nih.gov/pubmed/16047645|journal=Clinical Nephrology|volume=64|issue=1|pages=47–54|doi=10.5414/cnp64047|issn=0301-0430|pmid=16047645}}</ref>

==== Paper # 5 ====
Takemura et al. published a paper describing four adolescents diagnosed with nutcracker syndrome. Three of these patients had previously been diagnosed with orthostatic disturbance and suffered from various symptoms including fainting, tachycardia, headache and abdominal pain.<ref name=":9">{{Cite journal|last=Takemura|first=T.|last2=Iwasa|first2=H.|last3=Yamamoto|first3=S.|last4=Hino|first4=S.|last5=Fukushima|first5=K.|last6=Isokawa|first6=S.|last7=Okada|first7=M.|last8=Yoshioka|first8=K.|date=2000-09|title=Clinical and radiological features in four adolescents with nutcracker syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10975316|journal=Pediatric Nephrology (Berlin, Germany)|volume=14|issue=10-11|pages=1002–1005|doi=10.1007/s004670050062|issn=0931-041X|pmid=10975316}}</ref>

==== Paper # 6 ====
A case-report from Daily et al. titled "Nutcracker syndrome: symptoms of syncope and hypotension improved following endovascular stenting" describes a 19-year-old woman diagnosed with nutcracker syndrome. She suffered from syncope, sometimes multiple episodes in one day. Her other symptoms included unilateral hematuria, nausea, lower abdominal pain and weight loss. After she was treated with stenting of her left renal vein, her symptoms improved drastically and she had no episodes of syncope and her blood pressure normalized.<ref>{{Cite journal|last=Daily|first=Ryan|last2=Matteo|first2=Jerry|last3=Loper|first3=Todd|last4=Northup|first4=Martin|date=2012-12|title=Nutcracker syndrome: symptoms of syncope and hypotension improved following endovascular stenting|url=https://www.ncbi.nlm.nih.gov/pubmed/22734085|journal=Vascular|volume=20|issue=6|pages=337–341|doi=10.1258/vasc.2011.cr0320|issn=1708-5381|pmid=22734085}}</ref>

==== Paper # 7 ====
In a paper titled "Newly-identified symptoms of left renal vein entrapment syndrome mimicking orthostatic disturbance"<ref name=":2" />, Koshimichi et al. describes the symptoms of 53 pediatric patients diagnosed with left renal vein entrapment syndrom (another term for nutcracker phenomenon). 22 of these 53 patients (42%) suffered from orthostatic disturbance. 15 of these 22 patients suffered from general malaise and fatigue, palpitation or shortness of breath in 14, severe abdominal pain in 10, increased pulse (21 beats per minute or more) on standing in 2 patients.

There was an absence of micro/macro-hematuria 11 of these 22 patients. 13 of 22 patients had no proteinuria. 4 of 22 patients had neither micro/macro-hematuria or proteinuria.

Treatment with midodrine significantly decreased orthostasis scores. The most severe patients (6 of 22) had either low urinary cortisol or plasma cortisol, persistent in some and intermittent in some. These patients improved after being given a low oral dose of fludrocortisone acetate to maintain sufficient blood cortisol.

== Epidemiology ==
Nutcracker syndrome/phenomenon is often described as "rare" in the medical literature, even though there's research indicating that it's a severely under-diagnosed condition.<ref name=":0" /><ref name=":1" /><ref>{{Cite web|url=https://rarediseases.info.nih.gov/diseases/11971/renal-nutcracker-syndrome|title=Renal nutcracker syndrome {{!}} Genetic and Rare Diseases Information Center (GARD) – an NCATS Program|website=rarediseases.info.nih.gov|access-date=2020-05-01}}</ref><ref name=":10">{{Cite journal|last=Poyraz|first=Ahmet K|last2=Firdolas|first2=Fatih|last3=Onur|first3=Mehmet R|last4=Kocakoc|first4=Ercan|date=2013-03|title=Evaluation of left renal vein entrapment using multidetector computed tomography|url=https://journals.sagepub.com/doi/10.1258/ar.2012.120355|journal=Acta Radiologica|language=en-US|volume=54|issue=2|pages=144–148|doi=10.1258/ar.2012.120355|issn=0284-1851}}</ref>

[[wikipedia:Varicocele|Varicocele]] is a known complication of nutcracker phenomenon<ref name=":0" />. Between 9.5%<ref name=":0" /> and 15%<ref>{{Cite journal|last=Kupis|first=Łukasz|last2=Dobroński|first2=Piotr Artur|last3=Radziszewski|first3=Piotr|date=2015|title=Varicocele as a source of male infertility – current treatment techniques|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643713/|journal=Central European Journal of Urology|volume=68|issue=3|pages=365–370|doi=10.5173/ceju.2015.642|issn=2080-4806|pmc=4643713|pmid=26568883}}</ref> of all men globally are affected by varicocele. According to two separate studies, 30%<ref>{{Cite journal|last=Mohamadi|first=Afshin|last2=Ghasemi-Rad|first2=Mohammad|last3=Mladkova|first3=Nikol|last4=Masudi|first4=Sima|date=2010|title=Varicocele and Nutcracker Syndrome|url=https://onlinelibrary.wiley.com/doi/abs/10.7863/jum.2010.29.8.1153|journal=Journal of Ultrasound in Medicine|language=en|volume=29|issue=8|pages=1153–1160|doi=10.7863/jum.2010.29.8.1153|issn=1550-9613}}</ref> to 100%<ref>{{Cite journal|last=Unlu|first=Murat|last2=Orguc|first2=Sebnem|last3=Serter|first3=Selim|last4=Pekindil|first4=Gokhan|last5=Pabuscu|first5=Yuksel|date=2007|title=Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/17366101/|journal=Scandinavian Journal of Urology and Nephrology|volume=41|issue=1|pages=42–46|doi=10.1080/00365590600796659|issn=0036-5599|pmid=17366101}}</ref> of varicocele patients have nutcracker phenomenon. If one extrapolates these numbers, between 2.9-15% of all men suffer from nutcracker phenomenon. A minuscule percentage of these patients are ever diagnosed with nutcracker phenomenon.

There might be several reasons behind this under-diagnosing, including:
# wide spectrum of symptoms<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref name=":4" /><ref name=":5" /><ref name=":7" /><ref name=":8" /><ref name=":9" />, many of which are not well known in the medical community to be linked to nutcracker phenomenon.
# not all patients experience classic nutcracker syndrome symptoms like hematuria, abdominal pain, proteinuria<ref name=":2" /><ref name=":7" /><ref name=":5" />
# diagnostic criteria are not well defined<ref name=":0" />
# nutcracker phenomenon is not easily detectable using conventional means<ref>{{Cite journal|last=Matsukura|first=Hiro|last2=Arai|first2=Miwako|last3=Miyawaki|first3=Toshio|date=2005-02|title=Nutcracker phenomenon in two siblings of a Japanese family|url=https://www.ncbi.nlm.nih.gov/pubmed/15599773|journal=Pediatric Nephrology (Berlin, Germany)|volume=20|issue=2|pages=237–238|doi=10.1007/s00467-004-1682-y|issn=0931-041X|pmid=15599773}}</ref><ref name=":0" />. Standard CT is for example insufficient to diagnose nutcracker phenomenon.<ref name=":0" />

== Diagnosis ==
This quote is from Dysautonomia Information Network's website<ref name=":3" />, where Dr. Takahashi (the author of some of the studies linking nutcracker phenomenon to CFS & orthostatic intolerance) explains the methods used to diagnose nutcracker phenomenon:

''"The methods used to diagnose nutcracker phenomenon include Doppler US, MRI and three-dimensional helical computed tomography. Dr. Takahashi (personal communication, September 8, 2002) explains the procedures for testing as follows: Conventional ultrasound requires patients to be examined for left renal vein obstruction in 4 positions: supine, semisitting, upright and prone. Nonvisualization of the left renal vein lumen or absence of the left renal vein wall between the aorta and superior mesenteric artery is regarded as signifying left renal vein obstruction. Doppler color flow imaging can be used to locate a blue-colored blood stream flowing to the dorsal direction. This is a collateral vein flowing from the left renal vein into the paravertebral vein. With MRI, oblique coronal images along the left renal vein, and also axial images, are recommended to visualize the collateral veins around the left renal vein."''

== Learn more ==
[https://rarediseases.info.nih.gov/diseases/11971/renal-nutcracker-syndrome Renal nutcracker syndrome - Genetic and Rare Diseases Information Center]

[[wikipedia:Nutcracker_syndrome|Nutcracker Syndrome - Wikipedia]]

==References==
{{reflist}}


[[Category:Diagnoses]]

2020-04-28T00:25:44Z

Cipher:

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[[File:Borrelia burgdorferi-cropped.jpg|225px|thumb|right|Spirochete, or “corkscrew-shaped” bacteria known as Borrelia burgdorferi]]
== Symptoms ==
== Treatment and management ==
== Notable research ==
*2013, [http://www.sciencedaily.com/releases/2013/03/130321205712.htm Quirky Lyme disease bacteria: Unlike most organisms, they don't need iron, but crave manganese]<ref>{{Cite news|url=http://www.sciencedaily.com/releases/2013/03/130321205712.htm|title=Quirky Lyme disease bacteria: Unlike most organisms, they don't need iron, but crave manganese|last=|first=|date=21 Mar 2013|work=ScienceDaily|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|publisher=Woods Hole Oceanographic Institution|language=en}}</ref>

*2016, [http://www.sciencedaily.com/releases/2016/01/160118102524.htm Ticks that transmit Lyme disease reported in nearly half of all US counties.]<ref>{{Cite news|url=http://www.sciencedaily.com/releases/2016/01/160118102524.htm|title=Ticks that transmit Lyme disease reported in nearly half of all US counties|last=|first=|date=18 Jan 2016|work=ScienceDaily|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|publisher=Entomological Society of America|language=en}}</ref>

*2016, [https://www.ucsf.edu/news/2016/02/401581/gene-signature-could-lead-new-way-diagnosing-lyme? Gene Signature Could Lead To A New Way Of Diagnosing Lyme]<ref>{{Cite web|url=https://www.ucsf.edu/news/2016/02/401581/gene-signature-could-lead-new-way-diagnosing-lyme?|title=Gene Signature Could Lead To A New Way Of Diagnosing Lyme|last=Kurtzman|first=Laura|date=12 Feb 2016|website=UC San Francisco|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-09-03}}</ref>

=== Multiple Pathogens ===
*2016, [http://www.sciencedaily.com/releases/2016/02/160208135440.htm Researchers identify new Borrelia species that causes Lyme disease]<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2016/02/160208135440.htm|title=Researchers identify new Borrelia species that causes Lyme disease: Until now, Borrelia burgdorferi was only species believed to cause Lyme disease in North America|last=|first=|date=Feb 8, 2016|work=ScienceDaily|access-date=2018-08-13|archive-url=|archive-date=|dead-url=|publisher=|language=en}}</ref>
====Pathobiome Paradigm====
* 2015, Some future research will focus on a spectrum of pathogens instead of a "one pathogen-one disease" vision.<ref name="VayssierT20152">{{citation
| last1 = Vayssier-Taussat | first1 = M | authorlink1 =
| last2 = Kazimirova | first2 = M | authorlink2 =
| last3 = Hubalek | first3 = Z | authorlink3 =
| last4 = Hornok | first4 = S | authorlink4 =
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| title = Emerging horizons for tick-borne pathogens: from the 'one pathogen-one disease' vision to the pathobiome paradigm
| journal = Future Microbiol | volume = 10 | issue = 12 | page = 2033-43
| date = 19 Nov 2015
| pmid = 26610021 | doi = 10.2217/fmb.15.114
| url = http://www.futuremedicine.com/doi/abs/10.2217/fmb.15.114
}}</ref>

=== United States Congressional Report ===
* 2018, [https://drive.google.com/viewerng/viewer?url=https://www.hhs.gov/sites/default/files/tbdwg-report-to-congress-2018.pdf Tick-Borne Disease Working Group - 2018 Report to Congress]<ref>{{Cite web|title=Tick-Borne Disease Working Group - 2018 Report to Congress|url=https://drive.google.com/viewerng/viewer?url=https://www.hhs.gov/sites/default/files/tbdwg-report-to-congress-2018.pdf|website=drive.google.com|access-date=2018-11-26|language=en|date=2018|last=Aucott|first=John N|archive-url=|archive-date=|dead-url=|last2=Honey|first2=Kristen T|last3=Adams|first3=Wendy|last4=Beard|first4=Charles Benjamin|last5=Cooper|first5=Captain Scott|last6=Dixon|first6=Dennis|last7=Horowitz|first7=Richard|last8=Jones|first8=Captain Estella|last9=Nigrovic|first9=Lisa E|others=Allen Richards; Robert Sabatino; Vanila Singh; Patricia Smith; Robert Smith}}</ref>

== Blood and other laboratory tests ==

===United States===

*[http://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html Two-step Laboratory Testing Process]<ref>{{Cite web|url=http://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html|title=Two-step Laboratory Testing Process{{!}} Lyme Disease {{!}} CDC|website=www.cdc.gov|language=en-us|access-date=2018-09-03}}</ref>
*[http://lymediseaseguide.org/types-of-lyme-disease-tests Types of Lyme Disease Tests]<ref>{{Cite web|url=http://lymediseaseguide.org/types-of-lyme-disease-tests|title=Types of Lyme Disease Tests|last=|first=|date=May 27, 2011|website=lymediseaseguide.org|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2018-09-03}}</ref>
*[http://www.cdc.gov/lyme/diagnosistesting/LabTest/OtherLab/index.html Laboratory tests that are not recommended]<ref>{{Cite web|url=http://www.cdc.gov/lyme/diagnosistesting/LabTest/OtherLab/index.html|title=Laboratory tests that are not recommended{{!}} Lyme Disease {{!}} CDC|website=www.cdc.gov|language=en-us|access-date=2018-09-03}}</ref>

=== United Kingdom ===

*BBC1 Lyme Disease Discussion - Some patients have waited up to 30 years for a correct diagnosis. [[National Health Service]] (NHS) services have only correctly identified the disease in a quarter of the patients. The blood tests are unreliable and often come back negative. The development of an accurate blood test is in need of research funding.<ref>{{Cite web|url=https://www.youtube.com/watch?v=R1-a8kowVkE&app=desktop&utm_content=buffer99c3a&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer|title=BBC1 Lyme Disease 27.02.2016|last=Loukas|first=Demetrios|date=Feb 27, 2016|website=YouTube|publisher=Katherine Allman|via=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

*[[Department of Health and Social Care (UK)]] [http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_106528.pdf Testing for Lyme Disease]<ref name=":0">{{Cite web|url=http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_106528.pdf|title=Testing for Lyme Disease|last=Donaldson|first=Liam|date=2009|website=webarchive.nationalarchives.gov.uk|page=4|type=PDF|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

===False positives===
Several herpesviruses including [[varicella zoster virus]]<ref name="Feder1991" /><ref name="Woelfle1998" />, [[cytomegalovirus]], [[Epstein-Barr virus]],<ref name="Goossens1999" /> and [[HSV-2]]<ref name="Strasfeld2005" /> may cause false positives on Lyme Disease tests.

=== News media on unapproved tests ===

*2005, [http://www.nytimes.com/2005/08/23/health/policy/unproved-lyme-disease-tests-prompt-warnings.html?_r=0 Unproved Lyme Disease Tests Prompt Warnings]<ref>{{Cite news|url=http://www.nytimes.com/2005/08/23/health/policy/unproved-lyme-disease-tests-prompt-warnings.html?_r=0|title=Unproved Lyme Disease Tests Prompt Warnings|last=Santora|first=Dan Hurley and Marc|access-date=2018-09-03|language=en}}</ref>

*2013, [https://www.bostonglobe.com/lifestyle/health-wellness/2013/10/20/many-tests-diagnose-lyme-but-proof-they/ISjAcxmZxkk2disi94ENfI/story.html Many tests to diagnose Lyme, but no proof they work]<ref>{{Cite news|url=https://www.bostonglobe.com/lifestyle/health-wellness/2013/10/20/many-tests-diagnose-lyme-but-proof-they/ISjAcxmZxkk2disi94ENfI/story.html|title=Many tests to diagnose Lyme, but no proof they do - The Boston Globe|last=Daley|first=Beth|date=21 Oct 2013|work=BostonGlobe.com|access-date=2018-09-03|archive-url=|archive-date=|dead-url=}}</ref>

*2013, [http://www.medscape.com/viewarticle/778482 Lyme Culture Test Causes Uproar]<ref>{{Cite web|url=http://www.medscape.com/viewarticle/778482|title=Medscape Log In|last=Lyme Culture Test Causes Uproar|first=|date=|website=www.medscape.com|format=Login Needed|archive-url=|archive-date=|dead-url=|access-date=2018-09-03}}</ref>

*2014, [http://news.wgbh.org/post/federal-loopholes-compromise-lyme-disease-testing Federal Loopholes Compromise Lyme Disease Testing]<ref>{{Cite news|url=http://news.wgbh.org/post/federal-loopholes-compromise-lyme-disease-testing|title=Federal Loopholes Compromise Lyme Disease Testing|last=Daley|first=Beth|date=2014-06-17|work=WGBH 89.7|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|language=en}}</ref>

==Co-infections==

===Herpesviruses===

Lyme may cause reactivation of latent [[herpesvirus]]es. At the same time, several herpesviruses including [[varicella zoster virus]],<ref name="Feder1991" /><ref name="Woelfle1998" /> [[cytomegalovirus]], [[Epstein-Barr virus|epstein-barr virus]],<ref name="Goossens1999" /> and [[HSV-2]]<ref name="Strasfeld2005" /> may cause false positives on lyme disease tests.

=== Pathobiome paradigm ===
Some future research will focus on a spectrum of pathogens instead of a "one pathogen-one disease" vision.<ref name="VayssierT2015" />

== Lyme Disease vs Chronic Fatigue Syndrome ==

*2009, "The [[Department of Health and Social Care (UK)]] remains concerned about the growing number of patients, particularly those suffering from chronic conditions such as myalgic encephalopathy ([[ME]]) or chronic fatigue syndrome, who receive a false diagnosis of Lyme disease from private laboratories offering unvalidated tests that lack the sensitivity and specificity to detect B. burgdorferi. A report of the Department’s investigation into the use of such tests in the diagnosis of Lyme disease is available at [http://webarchive.nationalarchives.gov.uk/20130107105354/http://dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4138917.pdf ''Report on Lyme Disease'': Unorthodox and Unvalidated Laboratory Tests in the Diagnosis of Lyme Borreliosis and in Relation to Medically Unexplained Symptoms]. Misinformation about Lyme disease is readily available to patients via the internet and can lead them to seek inappropriate diagnosis and treatment." <ref name=":0" />
*2011, Lyme Disease and [[Chronic Fatigue Syndrome]] are different diseases. Research is published on cerebrospinal fluid, and distinct differences were found.<ref name="Schutzer2011" />
*2016, [http://simmaronresearch.com/2016/08/post-lyme-disease-and-chronic-fatigue-syndrome-mecfs-are-they-the-same/ Post Lyme Disease and Chronic Fatigue Syndrome (ME/CFS) – Are They The Same?]<ref>{{Cite news|url=http://simmaronresearch.com/2016/08/post-lyme-disease-and-chronic-fatigue-syndrome-mecfs-are-they-the-same/|title=Post Lyme Disease and Chronic Fatigue Syndrome (ME/CFS) - Are They The Same? - Simmaron Research|last=Johnson|first=Cort|date=2016-08-06|work=Simmaron Research|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>

*There are [[many historical outbreaks]] of [[Myalgic Encephalomyelitis]] and [[Chronic Fatigue Syndrome]] that do not correlate with a tick-borne pathogen.

==See also==
* [[Alpha-gal allergy]]

*[https://www.nationalgeographic.com/animals/invertebrates/d/deer-tick/ About the Deer Tick]<ref>{{Cite news|url=https://www.nationalgeographic.com/animals/invertebrates/d/deer-tick/|title=Deer Tick {{!}} National Geographic|date=2010-04-11|access-date=2018-09-03}}</ref>
* [[Borrelia burgdorferi]]
* [[Lyme disease]]

* [[Vagus nerve infection hypothesis]]

==Learn more==
* [http://www.columbia-lyme.org/ Lyme and Tick-Borne Diseases Research Center]<ref>{{Cite web|url=https://www.columbia-lyme.org|title=Lyme Disease|last=|first=|date=|website=Columbia-lyme.org|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-08-13}}</ref>

* [https://blausen.com/en/video/lyme-disease/ Lyme Disease]<ref>{{Cite web|url=https://blausen.com/en/video/lyme-disease/|title=Lyme Disease|last=|first=|date=|website=blausen.com|publisher=Blausen|archive-url=|archive-date=|dead-url=|access-date=}}</ref> Video Short
* [https://www.nejm.org/doi/full/10.1056/NEJMp1807870#.W4x74fVA80g.twitter Tickborne Diseases - Confronting a Growing Threat]<ref>{{Cite journal|last=Paules|first=Catharine I.|last2=Marston|first2=Hilary D.|last3=Bloom|first3=Marshall E.|last4=Fauci|first4=Anthony S.|date=2018-07-25|title=Tickborne Diseases — Confronting a Growing Threat {{!}} NEJM|url=https://www.nejm.org/doi/full/10.1056/NEJMp1807870#.W4x74fVA80g.twitter|journal=New England Journal of Medicine|language=en|doi=10.1056/nejmp1807870#.w4x74fva80g.twitter}}</ref>

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</references>

[[Category:Diagnoses]]
[[Category:Potential comorbidities]]
[[Category:Disease names]]

Chronic Lyme disease

2020-04-28T00:19:58Z

Cipher:The summary that was before this edit was copied from the wikipedia-page covering this topic. Wikipedia pages aren't always reflective of the truth and reality, like the CFS-page for example saying that CBT&GET is beneficial for ME, which isn't true.

'''Chronic Lyme disease''' is a controversial diagnosis regarding the concept of a chronic ''borrelia burgdorferi'' infection in humans. There's an overwhelming amount of research, both in vitro and in vivo, that B. burgdorferi can persist in the human body, not only in the spirochetal but also in the antibiotic-resistant biofilm form, even after long-term antibiotic treatment.<ref>{{Cite web|url=https://www.dovepress.com/review-of-evidence-for-immune-evasion-and-persistent-infection-in-lyme-peer-reviewed-article-IJGM|title=Review of evidence for immune evasion and persistent infection in Lyme disease|last=Berndtson|first=Keith|date=2013-04-23|website=International Journal of General Medicine|language=English|doi=10.2147/ijgm.s44114|pmc=PMC3636972|pmid=23637552|access-date=2020-04-28}}</ref><ref name=":4">{{Cite journal|last=Stricker|first=Raphael B.|last2=Johnson|first2=Lorraine|date=2013-04-22|title=Persistent infection in chronic lyme disease: does form matter?|url=http://www.hoajonline.com/infectdis/2052-5958/1/2|journal=Research Journal of Infectious Diseases|language=en|volume=1|issue=1|pages=2|doi=10.7243/2052-5958-1-2|issn=2052-5958}}</ref><ref>{{Cite journal|last=Sapi|first=Eva|last2=Bastian|first2=Scott L.|last3=Mpoy|first3=Cedric M.|last4=Scott|first4=Shernea|last5=Rattelle|first5=Amy|last6=Pabbati|first6=Namrata|last7=Poruri|first7=Akhila|last8=Burugu|first8=Divya|last9=Theophilus|first9=Priyanka A. S.|date=2012-10-24|title=Characterization of Biofilm Formation by Borrelia burgdorferi In Vitro|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0048277|journal=PLOS ONE|language=en|volume=7|issue=10|pages=e48277|doi=10.1371/journal.pone.0048277|issn=1932-6203|pmc=PMC3480481|pmid=23110225}}</ref><ref>{{Cite journal|last=Caskey|first=John R.|last2=Hasenkampf|first2=Nicole R.|last3=Martin|first3=Dale S.|last4=Chouljenko|first4=Vladimir N.|last5=Subramanian|first5=Ramesh|last6=Cheslock|first6=Mercedes A.|last7=Embers|first7=Monica E.|date=2019|title=The Functional and Molecular Effects of Doxycycline Treatment on Borrelia burgdorferi Phenotype|url=https://www.frontiersin.org/articles/10.3389/fmicb.2019.00690/full|journal=Frontiers in Microbiology|language=English|volume=10|doi=10.3389/fmicb.2019.00690|issn=1664-302X|pmc=PMC6482230|pmid=31057493}}</ref><ref>{{Cite journal|last=Lacout|first=Alexis|last2=Hajjam|first2=Mostafa El|last3=Marcy|first3=Pierre-Yves|last4=Perronne|first4=Christian|date=2018-07-01|title=The Persistent Lyme Disease: “True Chronic Lyme Disease” rather than “Post-treatment Lyme Disease Syndrome”|url=http://www.jgid.org/article.asp?issn=0974-777X;year=2018;volume=10;issue=3;spage=170;epage=171;aulast=Lacout;type=0|journal=Journal of Global Infectious Diseases|language=en|volume=10|issue=3|pages=170|doi=10.4103/jgid.jgid_152_17|issn=0974-777X|pmc=PMC6100330|pmid=30166820}}</ref><ref>{{Cite journal|last=Middelveen|first=Marianne J.|last2=Sapi|first2=Eva|last3=Burke|first3=Jennie|last4=Filush|first4=Katherine R.|last5=Franco|first5=Agustin|last6=Fesler|first6=Melissa C.|last7=Stricker|first7=Raphael B.|date=2018/6|title=Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease|url=https://www.mdpi.com/2227-9032/6/2/33|journal=Healthcare|language=en|volume=6|issue=2|pages=33|doi=10.3390/healthcare6020033|pmc=PMC6023324|pmid=29662016}}</ref><ref>{{Cite journal|last=Sharma|first=Bijaya|last2=Brown|first2=Autumn V.|last3=Matluck|first3=Nicole E.|last4=Hu|first4=Linden T.|last5=Lewis|first5=Kim|date=2015-08-01|title=Borrelia burgdorferi, the Causative Agent of Lyme Disease, Forms Drug-Tolerant Persister Cells|url=https://aac.asm.org/content/59/8/4616|journal=Antimicrobial Agents and Chemotherapy|language=en|volume=59|issue=8|pages=4616–4624|doi=10.1128/AAC.00864-15|issn=0066-4804|pmid=26014929}}</ref><ref>{{Cite journal|last=Feng|first=Jie|last2=Auwaerter|first2=Paul G.|last3=Zhang|first3=Ying|date=2015-03-25|title=Drug Combinations against Borrelia burgdorferi Persisters In Vitro: Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0117207|journal=PLOS ONE|language=en|volume=10|issue=3|pages=e0117207|doi=10.1371/journal.pone.0117207|issn=1932-6203|pmc=PMC4373819|pmid=25806811}}</ref><ref>{{Cite journal|last=Locke|first=Jonathan W.|date=2019/6|title=Complement Evasion in Borrelia spirochetes: Mechanisms and Opportunities for Intervention|url=https://www.mdpi.com/2079-6382/8/2/80|journal=Antibiotics|language=en|volume=8|issue=2|pages=80|doi=10.3390/antibiotics8020080|pmc=PMC6627623|pmid=31200570}}</ref><ref>{{Cite journal|last=Wagemakers|first=A.|last2=Visser|first2=M. C.|last3=de Wever|first3=B.|last4=Hovius|first4=J. W.|last5=van de Donk|first5=N. W. C. J.|last6=Hendriks|first6=E. J.|last7=Peferoen|first7=L.|last8=Muller|first8=F. F.|last9=Ang|first9=C. W.|date=2018-08-02|title=Case report: persistently seronegative neuroborreliosis in an immunocompromised patient|url=https://doi.org/10.1186/s12879-018-3273-8|journal=BMC Infectious Diseases|volume=18|issue=1|pages=362|doi=10.1186/s12879-018-3273-8|issn=1471-2334|pmc=PMC6090844|pmid=30071836}}</ref><ref>{{Cite journal|last=Rudenko|first=Natalie|last2=Golovchenko|first2=Maryna|last3=Kybicova|first3=Katerina|last4=Vancova|first4=Marie|date=2019-05-16|title=Metamorphoses of Lyme disease spirochetes: phenomenon of Borrelia persisters|url=https://doi.org/10.1186/s13071-019-3495-7|journal=Parasites & Vectors|volume=12|issue=1|pages=237|doi=10.1186/s13071-019-3495-7|issn=1756-3305|pmc=PMC6521364|pmid=31097026}}</ref><ref>{{Cite journal|last=Aslam|first=Bilal|last2=Nisar|first2=Muhammad Atif|last3=Khurshid|first3=Mohsin|last4=Farooq Salamat|first4=Muhammad Khalid|date=2017-09-15|title=Immune escape strategies of Borrelia burgdorferi|url=https://www.futuremedicine.com/doi/10.2217/fmb-2017-0013|journal=Future Microbiology|volume=12|issue=13|pages=1219–1237|doi=10.2217/fmb-2017-0013|issn=1746-0913}}</ref><ref>{{Cite journal|last=Maloney|first=Elizabeth L.|date=2016-11|title=Controversies in Persistent (Chronic) Lyme Disease|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102277/|journal=Journal of Infusion Nursing|volume=39|issue=6|pages=369–375|doi=10.1097/NAN.0000000000000195|issn=1533-1458|pmc=5102277|pmid=27755213}}</ref><ref>{{Cite journal|last=Cabello|first=Felipe C.|last2=Godfrey|first2=Henry P.|last3=Bugrysheva|first3=Julia V.|last4=Newman|first4=Stuart A.|date=2017|title=Sleeper cells: the stringent response and persistence in the Borreliella (Borrelia) burgdorferi enzootic cycle|url=https://sfamjournals.onlinelibrary.wiley.com/doi/abs/10.1111/1462-2920.13897|journal=Environmental Microbiology|language=en|volume=19|issue=10|pages=3846–3862|doi=10.1111/1462-2920.13897|issn=1462-2920|pmc=PMC5794220|pmid=28836724}}</ref><ref>{{Cite journal|last=DeLong|first=Allison K.|last2=Blossom|first2=Barbara|last3=Maloney|first3=Elizabeth L.|last4=Phillips|first4=Steven E.|date=2012-11|title=Antibiotic retreatment of Lyme disease in patients with persistent symptoms: A biostatistical review of randomized, placebo-controlled, clinical trials|url=https://doi.org/10.1016/j.cct.2012.08.009|journal=Contemporary Clinical Trials|volume=33|issue=6|pages=1132–1142|doi=10.1016/j.cct.2012.08.009|issn=1551-7144}}</ref><ref>{{Cite journal|last=Sapi|first=Eva|last2=Kasliwala|first2=Rumanah S.|last3=Ismail|first3=Hebo|last4=Torres|first4=Jason P.|last5=Oldakowski|first5=Michael|last6=Markland|first6=Sarah|last7=Gaur|first7=Gauri|last8=Melillo|first8=Anthony|last9=Eisendle|first9=Klaus|date=2019/12|title=The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease|url=https://www.mdpi.com/2079-6382/8/4/183|journal=Antibiotics|language=en|volume=8|issue=4|pages=183|doi=10.3390/antibiotics8040183|pmc=PMC6963883|pmid=31614557}}</ref> Despite this, a large part of the medical community discard this disease in conflict with science.<ref name=":4" />

[[Lyme disease]] is caused by the bacterium [[borrelia burgdorferi]] and transmitted through the bite of a [https://en.wikipedia.org/wiki/Ixodes_scapularis deer tick or black legged tick].<ref>{{Cite web|url=http://www.cdc.gov/lyme/index.html|title=Lyme Disease {{!}} Lyme Disease {{!}} CDC|date=2018-01-19|website=www.cdc.gov|language=en-us|access-date=2018-09-03}}</ref>
A bulls-eye rash can appear at the site of a deer tick bite but can be in different forms<ref>{{Cite news|url=http://www.bayarealyme.org/blog/lyme-disease-bullseye-rash/|title=Does Everyone Get the Telltale Bullseye Rash? {{!}} Bay Area Lyme Foundation|date=2014-09-12|work=Bay Area Lyme Foundation|access-date=2018-09-03|language=en-US}}</ref> while some people never recall having a rash.

== Symptoms ==
The signs and symptoms of lyme disease vary and usually appear in stages.<ref name=":1">{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/lyme-disease/basics/symptoms/CON-20019701|title=Lyme disease - Symptoms and causes|work=Mayo Clinic|access-date=2018-09-03|language=en}}</ref>
[[File:Lyme Rash.jpg|300px|thumb|right|A bulls-eye rash from the bite of a deer tick]]
'''Early Signs and Symptoms'''

*Bull's eye rash (Rash can be in other forms and 30% of the time no rash is present.)<ref name=":2">{{Cite news|url=http://www.bayarealyme.org/blog/lyme-disease-bullseye-rash/|title=Does Everyone Get the Telltale Bullseye Rash? {{!}} Bay Area Lyme Foundation|date=2014-09-12|work=Bay Area Lyme Foundation|access-date=2018-09-03|language=en-US}}</ref><ref>{{Cite news|url=https://www.webmd.com/rheumatoid-arthritis/arthritis-lyme-disease|title=Lyme Disease: Symptoms, Causes, Diagnosis, Treatment, Prevention|work=WebMD|access-date=2018-09-06|language=en-US}}</ref>
*Flu-like symptoms

'''Later Signs and Symptoms'''

*[https://en.wikipedia.org/wiki/Erythema_chronicum_migrans Erythema migrans]<ref>{{Cite news|url=http://www.medicinenet.com/image-collection/lyme_disease_erythema-migrans_picture/picture.htm|title=Lyme Disease (Erythema-Migrans) Picture Image on MedicineNet.com|work=MedicineNet|access-date=2018-09-03|language=en}}</ref>
*[[Joint pain]]
*[[Neurological]] problems

'''Signs and symptoms may also include'''
*[[Nausea]] and [[vomiting]]
*Diffuse rashes (rather than a single bull's-eye rash commonly associated with Lyme disease)<ref name=":2" /> ''See:'' [https://www.bayarealyme.org/blog/lyme-disease-bullseye-rash/ Images]

'''Less Common Signs and Symptoms'''

*Heart problems, such as irregular heartbeat.
*Eye inflammation
*Liver inflammation (hepatitis).
*Severe [[fatigue]]<ref name=":1" />

== Treatment and management ==

*2018, [http://emedicine.medscape.com/article/330178-treatment Lyme Disease Treatment & Management - Approach Considerations]<ref>{{Cite journal|last=Meyerhoff|first=John O.|date=17 May 2018|editor-last=Diamond|editor-first=Herbert S.|title=Lyme Disease Treatment & Management: Approach Considerations, Treatment of Early Lyme Disease, Lyme Arthritis|url=https://emedicine.medscape.com/article/330178-treatment|journal=Medscape|volume=|pages=|via=|at=Approach Considerations}}</ref>
*2018, [http://emedicine.medscape.com/article/330178-treatment#d7 Lyme Disease Treatment & Management - Treatment of Early Lyme Disease]<ref>{{Cite journal|last=Meyerhoff|first=John O.|date=17 May 2018|editor-last=Diamond|editor-first=Herbert S.|title=Lyme Disease Treatment & Management: Approach Considerations, Treatment of Early Lyme Disease, Lyme Arthritis|url=https://emedicine.medscape.com/article/330178-treatment|journal=Medscape|volume=|pages=|via=|at=Treatment of Early Lyme Disease}}</ref>
*2018, [http://emedicine.medscape.com/article/330178-treatment#d13 Lyme Disease Treatment & Management - Post-Treatment Lyme Disease Syndrome]<ref>{{Cite journal|last=Meyerhoff|first=John O.|date=17 May 2018|editor-last=Meyerhoff|editor-first=Herbert S.|title=Lyme Disease Treatment & Management: Approach Considerations, Treatment of Early Lyme Disease, Lyme Arthritis|url=https://emedicine.medscape.com/article/330178-treatment|journal=Medscape|volume=|pages=|via=|at=Post-Treatment Lyme Disease Syndrome}}</ref>

*[https://www.cdc.gov/lyme/postlds/index.html Post-Treatment Lyme Disease Syndrome]<ref name=":3">{{Cite web|url=https://www.cdc.gov/lyme/postlds/index.html|title=Post-Treatment Lyme Disease Syndrome {{!}} Lyme Disease {{!}} CDC|date=2017-12-01|website=www.cdc.gov|language=en-us|access-date=2018-09-19}}</ref>
== Notable research ==
[[File:Borrelia burgdorferi-cropped.jpg|225px|thumb|right|Spirochete, or “corkscrew-shaped” bacteria known as Borrelia burgdorferi]]

*2013, [http://www.sciencedaily.com/releases/2013/03/130321205712.htm Quirky Lyme disease bacteria: Unlike most organisms, they don't need iron, but crave manganese]<ref>{{Cite news|url=http://www.sciencedaily.com/releases/2013/03/130321205712.htm|title=Quirky Lyme disease bacteria: Unlike most organisms, they don't need iron, but crave manganese|last=|first=|date=21 Mar 2013|work=ScienceDaily|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|publisher=Woods Hole Oceanographic Institution|language=en}}</ref>

*2016, [http://www.sciencedaily.com/releases/2016/01/160118102524.htm Ticks that transmit Lyme disease reported in nearly half of all US counties.]<ref>{{Cite news|url=http://www.sciencedaily.com/releases/2016/01/160118102524.htm|title=Ticks that transmit Lyme disease reported in nearly half of all US counties|last=|first=|date=18 Jan 2016|work=ScienceDaily|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|publisher=Entomological Society of America|language=en}}</ref>

*2016, [https://www.ucsf.edu/news/2016/02/401581/gene-signature-could-lead-new-way-diagnosing-lyme? Gene Signature Could Lead To A New Way Of Diagnosing Lyme]<ref>{{Cite web|url=https://www.ucsf.edu/news/2016/02/401581/gene-signature-could-lead-new-way-diagnosing-lyme?|title=Gene Signature Could Lead To A New Way Of Diagnosing Lyme|last=Kurtzman|first=Laura|date=12 Feb 2016|website=UC San Francisco|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-09-03}}</ref>

=== Multiple Pathogens ===
*2016, [http://www.sciencedaily.com/releases/2016/02/160208135440.htm Researchers identify new Borrelia species that causes Lyme disease]<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2016/02/160208135440.htm|title=Researchers identify new Borrelia species that causes Lyme disease: Until now, Borrelia burgdorferi was only species believed to cause Lyme disease in North America|last=|first=|date=Feb 8, 2016|work=ScienceDaily|access-date=2018-08-13|archive-url=|archive-date=|dead-url=|publisher=|language=en}}</ref>
====Pathobiome Paradigm====
* 2015, Some future research will focus on a spectrum of pathogens instead of a "one pathogen-one disease" vision.<ref name="VayssierT20152">{{citation
| last1 = Vayssier-Taussat | first1 = M | authorlink1 =
| last2 = Kazimirova | first2 = M | authorlink2 =
| last3 = Hubalek | first3 = Z | authorlink3 =
| last4 = Hornok | first4 = S | authorlink4 =
| last5 = Farkas | first5 = R | authorlink5 =
| last6 = Cosson | first6 = JF | authorlink6 =
| last7 = Bonnet | first7 = S | authorlink7 =
| last8 = Vourch | first8 = G | authorlink8 =
| last9 = Gasqui | first9 = P | authorlink9 =
| last10 = Mihalca | first10= AD | authorlink10=
| last11 = Plantard | first11= O | authorlink11=
| last12 = Silaghi | first12= C | authorlink12=
| last13 = Cutler | first13= S | authorlink13=
| last14 = Rizzlo | first14= A | authorlink14=
| title = Emerging horizons for tick-borne pathogens: from the 'one pathogen-one disease' vision to the pathobiome paradigm
| journal = Future Microbiol | volume = 10 | issue = 12 | page = 2033-43
| date = 19 Nov 2015
| pmid = 26610021 | doi = 10.2217/fmb.15.114
| url = http://www.futuremedicine.com/doi/abs/10.2217/fmb.15.114
}}</ref>

=== United States Congressional Report ===
* 2018, [https://drive.google.com/viewerng/viewer?url=https://www.hhs.gov/sites/default/files/tbdwg-report-to-congress-2018.pdf Tick-Borne Disease Working Group - 2018 Report to Congress]<ref>{{Cite web|title=Tick-Borne Disease Working Group - 2018 Report to Congress|url=https://drive.google.com/viewerng/viewer?url=https://www.hhs.gov/sites/default/files/tbdwg-report-to-congress-2018.pdf|website=drive.google.com|access-date=2018-11-26|language=en|date=2018|last=Aucott|first=John N|archive-url=|archive-date=|dead-url=|last2=Honey|first2=Kristen T|last3=Adams|first3=Wendy|last4=Beard|first4=Charles Benjamin|last5=Cooper|first5=Captain Scott|last6=Dixon|first6=Dennis|last7=Horowitz|first7=Richard|last8=Jones|first8=Captain Estella|last9=Nigrovic|first9=Lisa E|others=Allen Richards; Robert Sabatino; Vanila Singh; Patricia Smith; Robert Smith}}</ref>

== Blood and other laboratory tests ==

===United States===

*[http://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html Two-step Laboratory Testing Process]<ref>{{Cite web|url=http://www.cdc.gov/lyme/diagnosistesting/labtest/twostep/index.html|title=Two-step Laboratory Testing Process{{!}} Lyme Disease {{!}} CDC|website=www.cdc.gov|language=en-us|access-date=2018-09-03}}</ref>
*[http://lymediseaseguide.org/types-of-lyme-disease-tests Types of Lyme Disease Tests]<ref>{{Cite web|url=http://lymediseaseguide.org/types-of-lyme-disease-tests|title=Types of Lyme Disease Tests|last=|first=|date=May 27, 2011|website=lymediseaseguide.org|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2018-09-03}}</ref>
*[http://www.cdc.gov/lyme/diagnosistesting/LabTest/OtherLab/index.html Laboratory tests that are not recommended]<ref>{{Cite web|url=http://www.cdc.gov/lyme/diagnosistesting/LabTest/OtherLab/index.html|title=Laboratory tests that are not recommended{{!}} Lyme Disease {{!}} CDC|website=www.cdc.gov|language=en-us|access-date=2018-09-03}}</ref>

=== United Kingdom ===

*BBC1 Lyme Disease Discussion - Some patients have waited up to 30 years for a correct diagnosis. [[National Health Service]] (NHS) services have only correctly identified the disease in a quarter of the patients. The blood tests are unreliable and often come back negative. The development of an accurate blood test is in need of research funding.<ref>{{Cite web|url=https://www.youtube.com/watch?v=R1-a8kowVkE&app=desktop&utm_content=buffer99c3a&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer|title=BBC1 Lyme Disease 27.02.2016|last=Loukas|first=Demetrios|date=Feb 27, 2016|website=YouTube|publisher=Katherine Allman|via=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

*[[Department of Health and Social Care (UK)]] [http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_106528.pdf Testing for Lyme Disease]<ref name=":0">{{Cite web|url=http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_106528.pdf|title=Testing for Lyme Disease|last=Donaldson|first=Liam|date=2009|website=webarchive.nationalarchives.gov.uk|page=4|type=PDF|archive-url=|archive-date=|dead-url=|access-date=}}</ref>

===False positives===
Several herpesviruses including [[varicella zoster virus]]<ref name="Feder1991" /><ref name="Woelfle1998" />, [[cytomegalovirus]], [[Epstein-Barr virus]],<ref name="Goossens1999" /> and [[HSV-2]]<ref name="Strasfeld2005" /> may cause false positives on Lyme Disease tests.

=== News media on unapproved tests ===

*2005, [http://www.nytimes.com/2005/08/23/health/policy/unproved-lyme-disease-tests-prompt-warnings.html?_r=0 Unproved Lyme Disease Tests Prompt Warnings]<ref>{{Cite news|url=http://www.nytimes.com/2005/08/23/health/policy/unproved-lyme-disease-tests-prompt-warnings.html?_r=0|title=Unproved Lyme Disease Tests Prompt Warnings|last=Santora|first=Dan Hurley and Marc|access-date=2018-09-03|language=en}}</ref>

*2013, [https://www.bostonglobe.com/lifestyle/health-wellness/2013/10/20/many-tests-diagnose-lyme-but-proof-they/ISjAcxmZxkk2disi94ENfI/story.html Many tests to diagnose Lyme, but no proof they work]<ref>{{Cite news|url=https://www.bostonglobe.com/lifestyle/health-wellness/2013/10/20/many-tests-diagnose-lyme-but-proof-they/ISjAcxmZxkk2disi94ENfI/story.html|title=Many tests to diagnose Lyme, but no proof they do - The Boston Globe|last=Daley|first=Beth|date=21 Oct 2013|work=BostonGlobe.com|access-date=2018-09-03|archive-url=|archive-date=|dead-url=}}</ref>

*2013, [http://www.medscape.com/viewarticle/778482 Lyme Culture Test Causes Uproar]<ref>{{Cite web|url=http://www.medscape.com/viewarticle/778482|title=Medscape Log In|last=Lyme Culture Test Causes Uproar|first=|date=|website=www.medscape.com|format=Login Needed|archive-url=|archive-date=|dead-url=|access-date=2018-09-03}}</ref>

*2014, [http://news.wgbh.org/post/federal-loopholes-compromise-lyme-disease-testing Federal Loopholes Compromise Lyme Disease Testing]<ref>{{Cite news|url=http://news.wgbh.org/post/federal-loopholes-compromise-lyme-disease-testing|title=Federal Loopholes Compromise Lyme Disease Testing|last=Daley|first=Beth|date=2014-06-17|work=WGBH 89.7|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|language=en}}</ref>

==Co-infections==

===Herpesviruses===

Lyme may cause reactivation of latent [[herpesvirus]]es. At the same time, several herpesviruses including [[varicella zoster virus]],<ref name="Feder1991" /><ref name="Woelfle1998" /> [[cytomegalovirus]], [[Epstein-Barr virus|epstein-barr virus]],<ref name="Goossens1999" /> and [[HSV-2]]<ref name="Strasfeld2005" /> may cause false positives on lyme disease tests.

=== Pathobiome paradigm ===
Some future research will focus on a spectrum of pathogens instead of a "one pathogen-one disease" vision.<ref name="VayssierT2015" />

== Lyme Disease vs Chronic Fatigue Syndrome ==

*2009, "The [[Department of Health and Social Care (UK)]] remains concerned about the growing number of patients, particularly those suffering from chronic conditions such as myalgic encephalopathy ([[ME]]) or chronic fatigue syndrome, who receive a false diagnosis of Lyme disease from private laboratories offering unvalidated tests that lack the sensitivity and specificity to detect B. burgdorferi. A report of the Department’s investigation into the use of such tests in the diagnosis of Lyme disease is available at [http://webarchive.nationalarchives.gov.uk/20130107105354/http://dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4138917.pdf ''Report on Lyme Disease'': Unorthodox and Unvalidated Laboratory Tests in the Diagnosis of Lyme Borreliosis and in Relation to Medically Unexplained Symptoms]. Misinformation about Lyme disease is readily available to patients via the internet and can lead them to seek inappropriate diagnosis and treatment." <ref name=":0" />
*2011, Lyme Disease and [[Chronic Fatigue Syndrome]] are different diseases. Research is published on cerebrospinal fluid, and distinct differences were found.<ref name="Schutzer2011" />
*2016, [http://simmaronresearch.com/2016/08/post-lyme-disease-and-chronic-fatigue-syndrome-mecfs-are-they-the-same/ Post Lyme Disease and Chronic Fatigue Syndrome (ME/CFS) – Are They The Same?]<ref>{{Cite news|url=http://simmaronresearch.com/2016/08/post-lyme-disease-and-chronic-fatigue-syndrome-mecfs-are-they-the-same/|title=Post Lyme Disease and Chronic Fatigue Syndrome (ME/CFS) - Are They The Same? - Simmaron Research|last=Johnson|first=Cort|date=2016-08-06|work=Simmaron Research|access-date=2018-09-03|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>

*There are [[many historical outbreaks]] of [[Myalgic Encephalomyelitis]] and [[Chronic Fatigue Syndrome]] that do not correlate with a tick-borne pathogen.

==See also==
* [[Alpha-gal allergy]]

*[https://www.nationalgeographic.com/animals/invertebrates/d/deer-tick/ About the Deer Tick]<ref>{{Cite news|url=https://www.nationalgeographic.com/animals/invertebrates/d/deer-tick/|title=Deer Tick {{!}} National Geographic|date=2010-04-11|access-date=2018-09-03}}</ref>
* [[Borrelia burgdorferi]]
* [[Lyme disease]]

* [[Vagus nerve infection hypothesis]]

==Learn more==
* [http://www.columbia-lyme.org/ Lyme and Tick-Borne Diseases Research Center]<ref>{{Cite web|url=https://www.columbia-lyme.org|title=Lyme Disease|last=|first=|date=|website=Columbia-lyme.org|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-08-13}}</ref>

* [https://blausen.com/en/video/lyme-disease/ Lyme Disease]<ref>{{Cite web|url=https://blausen.com/en/video/lyme-disease/|title=Lyme Disease|last=|first=|date=|website=blausen.com|publisher=Blausen|archive-url=|archive-date=|dead-url=|access-date=}}</ref> Video Short
* [https://www.nejm.org/doi/full/10.1056/NEJMp1807870#.W4x74fVA80g.twitter Tickborne Diseases - Confronting a Growing Threat]<ref>{{Cite journal|last=Paules|first=Catharine I.|last2=Marston|first2=Hilary D.|last3=Bloom|first3=Marshall E.|last4=Fauci|first4=Anthony S.|date=2018-07-25|title=Tickborne Diseases — Confronting a Growing Threat {{!}} NEJM|url=https://www.nejm.org/doi/full/10.1056/NEJMp1807870#.W4x74fVA80g.twitter|journal=New England Journal of Medicine|language=en|doi=10.1056/nejmp1807870#.w4x74fva80g.twitter}}</ref>

== References ==
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[[Category:Diagnoses]]
[[Category:Potential comorbidities]]
[[Category:Disease names]]