Investigation Open Access

Chronic Lyme Disease: A Working Case Definition

Raphael B. Stricker1 and Melissa C. Fesler1
  • 1 Union Square Medical Associates, United States


Although Lyme disease is the most common tickborne illness in the USA and Eurasia, the pathophysiology and clinical course of chronic Lyme disease (CLD) have not been formally defined. The purpose of this paper is to present a working case definition of CLD based on analysis of more than 700 peer-reviewed publications. According to this definition, CLD is a multisystem illness with diverse musculoskeletal, neuropsychiatric and/or cardiovascular manifestations that result from ongoing infection with pathogenic members of the Borrelia spirochete complex often associated with other tickborne disease (TBD) pathogens. To qualify for the diagnosis of CLD, patients must have Lyme-compatible symptoms and signs that are either consistently or variably present for six or more months. Two subcategories of CLD include untreated chronic Lyme disease (CLD-U) and chronic Lyme disease following a limited course of antibiotic treatment (CLD-T). The symptom patterns and optimal therapy of CLD require further study.

American Journal of Infectious Diseases
Volume 14 No. 1, 2018, 1-44


Submitted On: 10 January 2018 Published On: 16 April 2018

How to Cite: Stricker, R. B. & Fesler, M. C. (2018). Chronic Lyme Disease: A Working Case Definition. American Journal of Infectious Diseases, 14(1), 1-44.

  • 23 Citations



  • Lyme Disease
  • Borrelia burgdorferi
  • Tickborne Disease
  • Chronic Infection