1. Precision Medicine Approach to Post Treatment Lyme Disease Syndrome: Building A Case for Personalized Care
in Invisible Illness
Nevena Zubcevik1
and Mykol Larvie2
1
Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Department of Physical Medicine and
Rehabilitation; Harvard Medical School, Boston, MA
2
Massachusetts General Hospital, Department of Radiology; Harvard Medical School and Harvard-MIT Division
of Health Sciences and Technology, Boston, MA, USA
Introduction: Post-Treatment Lyme Disease Syndrome (PTLDS) is a complex disorder in which symptoms such
as joint pain, fatigue, cognitive difficulties and myalgia might persist for months to years after completing
standard antibiotic therapy for Lyme Disease. The reason for this syndrome is currently unknown. It is speculated
in literature that it might be due to autoimmunity, tissue damage, chronic inflammation or persistent infection as
evidenced by animal studies. Further complicating factors could be presence of other infections including but not
limited to other genospecies of Borrelia, Babesiosis, Bartonella, Anaplasmosis, Ehrlichiosis, and Rickettsia.
Patients may also present with clinical and imaging features of autoimmune encephalopathy as well as chronic
pain with elevated inflammatory markers. All of these factors are key in our pipeline to deciphering the full
clinical picture of this complex chronic illness. To better understand the role of these various factors we have
honed in on integrating clinical presentation and innovative diagnostics. Guided by our data we are able to design
an individualized pipeline to recovery.
Materials and Methods: Symptom questionnaires, neuropsychological testing, collaborative microbial
laboratory platform combining research and clinical approaches, FDG brain PET imaging, anti-neuronal antibody
panels, cytokine profiles and genetic testing are utilized for a complete longitudinal data set.
Results and Discussion: By analyzing our longitudinal data set we are starting to be able to decipher patterns of
clinical presentation and predict most likely responses to treatment. Our findings are that patients who present
with more infections other then Borrelia alone, tend to have a more complex clinical profile. These patients have a
more difficult recovery path and frequently require several treatment approaches. Patients with elevated
antineuronal antibodies present with increased cognitive deficits, neuropsychological difficulties and
neuropathies. Patients with abnormal metabolism in the brain tend to respond well to repeat of medication
therapy.
Conclusions: We report that with the use of our precision medicine model we can hone in on a personalized care
approach. This approach leads to better quantification of symptoms and ultimatelly, to improved diagnostic,
therapeutic and rehabilitation strategies in a complex chronic illness such as PTLDS. We hypothesize that these
findings may help streamiline the process of properly discovering the etiologies of chonic illness related to tick
borne disease and reduce suffering, morbidity and disability.