This is bad news for those who use non-scientifically defined terms, but not good enough news for Lyme disease patients suffering from chronic symptoms.
Word has spread that the US Centers for Disease Control and Prevention (CDC) has adopted the term “chronic Lyme disease (borreliosis)”. However, this is not entirely true. In its latest publication from October 2025, Infection-Associated Chronic Conditions and Illnesses (IACCIs), the CDC shared its years of experience with diseases associated with chronic symptoms. This has not yet changed the list of guidelines and recommendations related to Lyme disease.
Among other things, the publication mentions the possible effects of Lyme disease despite treatment or in the long term. These phenomena may be combinations of organ damage, autoimmune diseases and persistent, unexplained systemic symptoms associated with the infection, such as debilitating fatigue, post-exertional malaise, cognitive impairment, musculoskeletal pain and sleep disturbances.
A conceptual shift may be heralded by the discovery of the following possible mechanisms for chronically persistent symptoms: “continuous immune stimulation by antigens or persistent infection in a closed body compartment from which samples cannot be taken, reactivation of latent viruses, autoimmune responses, microbiome dysbiosis, persistent tissue damage, disordered blood clotting, and impaired nerve signal transmission. IACCI causes significant disruption to the patient’s ability to return to work or school or to continue their life as it was before the infection.”
Anyone who has encountered a case of Lyme disease with chronic symptoms will be familiar with these possible causes. What is new is that they can no longer sweep under the carpet the numerous pieces of evidence that confirm the presence of infection after treatment. Direct laboratory tests that detect the presence of the pathogen in body fluids (e.g. culture, PCR, full-genome sequencing, DualDur, etc.) are slowly becoming part of everyday medical practice – at least among specialists. There are numerous publications that not only provide evidence of the continuous, low-concentration presence of the pathogen in the blood, but also explain why it was not found earlier. Borrelia appears in each generation, every 3-4 weeks, with essentially new genetic material, which is beyond the scope of PCR tests designed for a single or a few genetic variants, but it has also been recognised that after centrifugation to separate the plasma, the pathogen was not sought in the right fraction.
Thus, the new reason was outdated from the moment it was born, to be precise, it should be interpreted differently: the term “isolated site” also applies to blood, as Borrelia successfully evades the body’s immune response, so it is completely safe in the blood.
Those who expected this announcement to settle the debate over inadequately defined “technical terms” will have to wait a little longer. Neither PTLDS (a synonym for unsuccessful treatment, a hypocritical, undefined acronym that denies it – more details here) has been removed from the CDC website and dozens of publications, nor has the term “chronic Lyme disease” been added.
But at least now it is no longer possible to deny the continued presence of the pathogen in patients. But if someone prescribes repeat treatment on this basis, will US insurers threaten to terminate their contracts, as they did in the past?
I am also curious to see how long the document available at the link below will remain unchanged in the wake of the great excitement.
The document is available here: https://wwwnc.cdc.gov/eid/article/31/14/25-1187_article
