| dc.description.abstract | The question of whether Lyme disease can become a persistent infection in the form of chronic Lyme disease has caused heated debates, public protests, litigation, harassment and even death threats over the last decades. Against the established view of Lyme disease as an acute infection that is easily treated with few complications once recognized, a vocal dissenting minority of scientists maintains the existence of an unrecognized epidemic of chronic bacterial infestation caused by the tick-borne Borrelia spirochetes. We aim to review interpretations of continued reporting of symptoms despite antibiotic treatment as per standard of care; while the term chronic Lyme disease implies an unsuccessfully eradicated infection, Post-Lyme disease syndrome accounts for this as post-infectious sequelae. In addition, we also examine diagnostic strategies, summarize the contenting recommendations given by the two sides, and briefly asses some of the more controversial laboratory tests being used for chronic Lyme Disease in the private market. We find that chronic Lyme disease is defined as a very vague diagnosis based on symptoms and clinical findings, of which several are present in more than 10% of the general population, regardless of exposure indicators such as a recognized tick-bite or Borrelia being endemic in the area or not, and supported by a myriad of unvalidated diagnostic tests. However, we also find that existing test strategies suffer from potential selection bias and high variability, and conclude further research towards better discriminatory tests is warranted. | eng |