Long COVID/Long Lyme Expert Clinician Panel

1.5 CME. This panel aims to equip clinicians with the latest insights and evidence-based strategies for managing two challenging conditions: long COVID and long Lyme disease.

Global Lyme Alliance and Invisible International teamed up to host a Lyme & Tick-borne Disease CME Webinar, which took place on April 6, 2024. The Long COVID/Long Lyme panel from that event can be viewed on this page and taken for CME credit.

To view the other lectures presented at the April 6, 2024 program, please follow these links:

Long Lyme/Co-Infections and Long COVID | What do they have in common?
Instructor: Dr. John Lambert

Neuropsychiatric Symptoms with Lyme Disease & Tick-borne Illness
Instructor: Dr. Shannon Delaney

Invisible is grateful to the Global Lyme Alliance for its sponsorship of this program.

Panel Participants

Christine Green, MD (moderator)
Education Co-director, Invisible International

Shannon Delaney, MD
Private Practice

John Lambert, MD
Full Clinical Professor, University College Dublin School of Medicine
Consultant in Infectious Diseases and Genitourinary Medicine, Mater Misericordiae University Hospital


In this discussion, the expert panelists dive deep into the nuances of long COVID and long Lyme disease, drawing upon clinical experience in the US and Ireland. Participants will gain a comprehensive understanding of the complexities surrounding these conditions, incorporating the latest evidence-based research and clinical experience of the featured experts.

The panel is structured to emphasize the significant mental health aspects associated with Lyme disease, guiding clinicians on how to effectively monitor for mental health sequelae, integrate mental health screening tools into their practice, and make informed referrals to mental health professionals. Furthermore, it offers a concise overview of Lyme disease persistence post-standard treatments, challenging the outdated notion that Lyme disease is always straightforward to treat.

Additionally, the “Long COVID/Long Lyme Expert Clinician Panel” CME course aims to draw parallels between the clinical manifestations of long COVID and long Lyme disease, shedding light on potential treatment options. This segment is particularly designed to enhance clinicians’ diagnostic and therapeutic approaches, potentially accelerating treatment decisions and saving lives.

Learning Objectives

  1. Clinicians will monitor patients with Lyme disease for mental health symptoms, using screening tools to identify those in need of professional mental health referrals.
  2. Clinicians will modify their practices to refer patients showing mental health symptoms to specialized clinicians, ensuring comprehensive care.
  3. Clinicians will explore the similarities between chronic Lyme and long COVID, understanding the role of chronic infection and inflammation, to enhance treatment approaches for both conditions.

This session, Long COVID/Long Lyme Expert Clinician Panel, is approved for 1.5 Enduring AAFP Prescribed credits.

The AAFP has reviewed One Health Medical Education for a Changing Climate, and deemed it acceptable for AAFP credit. Term of approval is from 01/02/2024 to 01/01/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Evidence-based bibliography for further study

Aucott JN, Crowder LA, Yedlin V, Kortte KB. Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans. Dermatol Res Pract. 2012;2012:451727. Epub 2012 Oct 24. 

Aucott JN, Rebman AW, Crowder LA, Kortte KB. Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here? Qual Life Res. 2013 Feb;22(1):75-84

Marques A. Chronic Lyme disease: a review. Infect Dis Clin North Am 2008;22:341– 60 vii–viii. 

Weitzner E, McKenna D, Nowakowski J, Scavarda C, Dornbush R, Bittker S, Cooper D, Nadelman RB, Visintainer P, Schwartz I, Wormser GP. Long-term Assessment of Post-Treatment Symptoms in Patients With Culture-Confirmed Early Lyme Disease. Clin Infect Dis. 2015 Dec 15;61(12):1800-6. 

Shadick NA, Phillips CB, Sangha O, Logigian EL, Kaplan RF, Wright EA, et al.. Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease. Ann Intern Med. (1999) 131:919–26. 

Logigian EL, Kaplan RF, Steere AC. N Engl J Med 1990; 323:1438-1444

Rebman AW, Bechtold KT, Yang T, Mihm EA, Soloski MJ, Novak CB, Aucott JN. Front Med (Lausanne). 2017 Dec 14;4:224.

Mustafiz F, Moeller J, Kuvaldina M, Bennett C, Fallon BA. Persistent Symptoms, Lyme Disease, and Prior Trauma. J Nerv Ment Dis. 2022 May 1;210(5):359-364.

Straubinger RK, Summers BA, Chang YF, Appel MJ. J Clin Microbiol. 1997 Jan;35(1):111-6. 

Hodzic E, Feng S, Holden K, Freet KJ, Barthold SW. Antimicrob Agents Chemother. 2008 May;52(5):1728-36.

Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, Hodzic E, Jacobs MB, Hasenkampf NR, Martin DS, Narasimhan S, Phillippi-Falkenstein KM, Purcell JE, Ratterree MS, Philipp MT. PLoS One. 2012;7(1):e29914.

Hodzic E, Imai D, Feng S, Barthold SW.. PLoS One. 2014 Jan 23;9(1):e86907.

Liegner KB, Duray P, Agricola M, Rosenkilde C, Yannuzzi L, Ziska M, Tilton R, Hulinska D, Hubbard J, Fallon B. Lyme Disease and the Clinical Spectrum of Antibiotic-Responsive Chronic Meningoencephalomyelitides. J Spirochetal and Tick-borne Dis 1997;4:61-73.

Marques A, Telford SR 3rd, Turk SP, Chung E, Williams C, Dardick K, Krause PJ, Brandeburg C, Crowder CD, Carolan HE, Eshoo MW, Shaw PA, Hu LT. Xenodiagnosis to detect Borrelia burgdorferi infection: a first-in-human study. Clin Infect Dis. 2014 Apr;58(7):937-45.

Caine JA, Coburn J. Multifunctional and Redundant Roles of Borrelia burgdorferi Outer Surface Proteins in Tissue Adhesion, Colonization, and Complement Evasion. Front Immunol. 2016 Oct 21;7:442.

Dulipati V, Meri S, Panelius J. Complement evasion strategies of Borrelia burgdorferi sensu lato. FEBS Lett. 2020 Aug;594(16):2645-2656.

Feng J, Auwaerter PG, Zhang Y. Drug combinations against Borrelia burgdorferi persisters in vitro: eradication achieved by using daptomycin, cefoperazone and doxycycline. Plos one. 2015;10(3):e0117207.

Fallon BA, Sotsky J (2018) Conquering Lyme disease: science bridges the great divide. Columbia University Press.

Chandra A, Wormser GP, Klempner MS, Trevino RP, Crow MK, Latov N, Alaedini A. Anti-neural antibody reactivity in patients with a history of Lyme borreliosis and persistent symptoms. Brain Behav Immun. 2010 Aug;24(6):1018-24.

Londoño D, Cadavid D, Drouin EE, Strle K, McHugh G, Aversa JM, Steere AC. Antibodies to endothelial cell growth factor and obliterative microvascular lesions in the synovium of patients with antibiotic-refractory lyme arthritis. Arthritis Rheumatol. 2014 Aug;66(8):2124-33.

Soloski MJ, Crowder LA, Lahey LJ, Wagner CA, Robinson WH, Aucott JN. Serum inflammatory mediators as markers of human Lyme disease activity. PLoS One. 2014 Apr 16;9(4):e93243

Jacek E, Fallon BA, Chandra A, Crow MK, Wormser GP, Alaedini A. Increased IFNα activity and differential antibody response in patients with a history of Lyme disease and persistent cognitive deficits. J Neuroimmunol. 2013 Feb 15;255(1-2):85-91.

Aucott JN, Soloski MJ, Rebman AW, Crowder LA, Lahey LJ, Wagner CA, Robinson WH, Bechtold KT. CCL19 as a Chemokine Risk Factor for Posttreatment Lyme Disease Syndrome: a Prospective Clinical Cohort Study. Clin Vaccine Immunol. 2016 Sep 6;23(9):757-66.

Jutras BL, Lochhead RB, Kloos ZA, Biboy J, Strle K, Booth CJ, Govers SK, Gray J, Schumann P, Vollmer W, Bockenstedt LK, Steere AC, Jacobs-Wagner C. Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis. Proc Natl Acad Sci U S A. 2019 Jul 2;116(27):13498-13507.

Schutzer SE, Angel TE, Liu T, Schepmoes AA, Clauss TR, Adkins JN, Camp DG, Holland BK, Bergquist J, Coyle PK, Smith RD, Fallon BA, Natelson BH. Distinct cerebrospinal fluid proteomes differentiate post-treatment lyme disease from chronic fatigue syndrome. PLoS One. 2011 Feb 23;6(2):e17287.

Fallon BA, Das S, Plutchok JJ, Tager F, Liegner KB, Van Heertum R (1997) Functional brain imaging and neuropsychological testing in Lyme disease. Clin Infect Dis:57–63

Pasareanu AR, Mygland Å, Kristensen Ø. A woman in her 50s with manic psychosis. Tidsskr Nor Laegeforen. 2012 Mar;132(5):537–539. doi: 10.4045/tidsskr.11.0683.

Hess A, Buchmann J, Zettl UK, et al. Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder. Biol Psychiatry. 1999;45(6):795. 

Pachner AR. Borrelia burgdorferi in the nervous system: the new “great imitator”. Ann N Y Acad Sci. 1988;539:56-64.

Hassett AL, Radvanski DC, Buyske S, Savage SV, Gara M, Escobar JI, Sigal LH. Role of psychiatric comorbidity in chronic Lyme disease. Arthritis Rheum. 2008 Dec 15;59(12):1742-9. 

Kalish RA, Kaplan RF, Taylor E, Jones-Woodward L, Workman K, Steere AC. Evaluation of study patients with Lyme disease, 10-20-year follow-up. J Infect Dis. 2001 Feb 1;183(3):453-60.

Dersch R, Sarnes AA, Maul M, Hottenrott T, Baumgartner A, Rauer S, Stich O. Quality of life, fatigue, depression and cognitive impairment in Lyme neuroborreliosis. J Neurol. 2015 Nov;262(11):2572-7.

Bechtold KT, Rebman AW, Crowder LA, Johnson-Greene D, Aucott JN. Standardized Symptom Measurement of Individuals with Early Lyme Disease Over Time. Arch Clin Neuropsychol. 2017 Mar 1;32(2):129-141.

Schmidt H, Djukic M, Jung K, Holzgraefe M, Dechent P, von Steinbüchel N, Blocher J, Eiffert H, Schmidt-Samoa C. Neurocognitive functions and brain atrophy after proven neuroborreliosis: a case-control study. BMC Neurol. 2015 Aug 19;15:139.

Kalish RA, Kaplan RF, Taylor E, Jones-Woodward L, Workman K, Steere AC. Evaluation of study patients with Lyme disease, 10-20-year follow-up. J Infect Dis. 2001 Feb 1;183(3):453-60.

Doshi S, Keilp JG, Strobino B, McElhiney M, Rabkin J, Fallon BA. Depressive symptoms and suicidal ideation among symptomatic patients with a history of Lyme disease vs two comparison groups. Psychosomatics. 2018;59(5):481-489. 

Fallon BA, Madsen T, Erlangsen A, Benros ME. Lyme borreliosis and associations with mental disorders and suicidal behavior: A nationwide Danish cohort study. Am J Psychiatry. 2021;178(10):921-931. 

Fallon BA, Lipkin RB, Corbera KM, Yu S, Nobler MS, Keilp JG, Petkova E, Lisanby SH, Moeller JR, Slavov I, Van Heertum R, Mensh BD, Sackeim HA. Regional cerebral blood flow and metabolic rate in persistent Lyme encephalopathy. Arch Gen Psychiatry. 2009 May;66(5):554-63

Coughlin JM, Yang T, Rebman AW, Bechtold KT, Du Y, Mathews WB, Lesniak WG, Mihm EA, Frey SM, Marshall ES, Rosenthal HB, Reekie TA, Kassiou M, Dannals RF, Soloski MJ, Aucott JN, Pomper MG. Imaging glial activation in patients with post-treatment Lyme disease symptoms: a pilot study using [11C]DPA-713 PET. J Neuroinflammation. 2018 Dec 19;15(1):346.

Stricker et al. Research Journal of Infectious Diseases 2013, http://www.hoajonline.com/journals/pdf/2052-5958-1-2.pdf

Embers ME, et al. Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection. PLoS One. 2012;7(1):e29914. Epub 2012 Jan 11.

Hodzic E, et al. Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in Mice. PLoS ONE 9(1): e86907. doi:10.1371/journal.pone.0086907, 2014

Treib J, Fernandez A, Haass A, Grauer MT, Holzer G, Woessner R. Clinical and serologic follow-up in patients with neuroborreliosis. Neurology. 1998 Nov;51(5):1489-91.  

Oksi J, Nikoskelainen J, Viljanen MK. Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis. Eur J Clin Microbiol Infect Dis. 1998;17(10):715-9.

Strle F, Preac-Mursic V, Cimperman J, Ruzic E, Maraspin V, Jereb M. Azithromycin versus doxycycline for treatment of erythema migrans: clinical and microbiological findings. Infection. 1993 Mar-Apr;21(2):83-8.

Weber K, Wilske B, Preac-Mursic V, Thurmayer R. Azithromycin versus penicillin V for the treatment of early Lyme borreliosis. Infection 1993;21(6):367-72

Schmidli J, Hunziker T, Moesli P, Schaad UB. Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis. J Infect Dis. Oct 1988;158(4):905-906

Preac-Mursic V, Pfister HW, Spiegel H, et al. First isolation of Borrelia burgdorferi from an iris biopsy. J Clin Neuroophthalmol. Sep 1993;13(3):155-161; discussion 162.

Preac-Mursic V, Weber K, Pfister HW, et al. Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection. Nov-Dec 1989;17(6):355-359.

Nocton JJ, Dressler F, Rutledge BJ, Rys PN, Persing DH, Steere AC. Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis.N Engl J Med. 1994 Jan 27;330(4):229-34.

Oksi J, Marjamäki M, Nikoskelainen J, Viljanen MK. Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Ann Med. 1999 Jun;31(3):225-32.

Feng J, et al Identification of novel activity against Borrelia burgdorferi persisters using an FDA approved drug library Emerging Microbes and Infections (2014)3,e49;doi:10.1038/emi.2014.53

Sharma, B., Brown, A., Matluck, N., Hu, L., Lewis, K. (2015) Borrelia burgdorferi, the causative agent of Lyme disease, forms drug-tolerant persister cells. Antimicrob Agents Chemother. 59:4616-24

Steere AC, Schoen RT, Taylor E The clinical evolution of Lyme arthritis Ann Intern Med 1987 Nov;107(5):725-31 (Study Excluded From NICE review, Annals of Internal Medicine 

Coughlin, J.M., Yang, T., Rebman, A.W. et al. Imaging glial activation in patients with post-treatment Lyme disease symptoms: a pilot study using [11C]DPA-713 PET. J Neuroinflammation 15, 346 (2018). https://doi.org/10.1186/s12974-018-1381-4

O’Kelly B, Vidal L, Avramovic G, Broughan J, Connolly SP, Cotter AG, Cullen W, Glaspy S, McHugh T, Woo J, Lambert JS. Assessing the impact of COVID-19 at 1-year using the SF-12 questionnaire: Data from the Anticipate longitudinal cohort study. Int J Infect Dis. 2022 May;118:236-243. doi: 10.1016/j.ijid.2022.03.013. Epub 2022 Mar 14. PMID: 35301101; PMCID: PMC8920113.

Broughan J, McCombe G, O’Kelly B et al. Mental health and alcohol use among patients attending a post-COVID-19 follow-up clinic: a cohort study [version 1; peer review: 1 approved]. HRB Open Res 2022, 5:16 (https://doi.org/10.12688/hrbopenres.13503.1)

Verger A, Kas A, Dudouet P, Goehringer F, Salmon-Ceron D, Guedj E. Visual interpretation of brain hypometabolism related to neurological long COVID: a French multicentric experience. Eur J Nucl Med Mol Imaging. 2022 Jul;49(9):3197-3202. doi: 10.1007/s00259-022-05753-5. Epub 2022 Mar 23. PMID: 35320385; PMCID: PMC8941296.

O’Kelly B, Vidal L, McHugh T, Woo J, Avramovic G, Lambert JS. Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study. Brain Behav Immun Health. 2022 Oct;24:100485. doi: 10.1016/j.bbih.2022.100485. Epub 2022 Jul 3. PMID: 35814187; PMCID: PMC9250701.

Pedro Gutiérrez-Castrellón, Tania Gandara-Martí, Ana T. Abreu Y Abreu, Cesar D. Nieto-Rufino, Eduardo López-Orduña, Irma Jiménez-Escobar, Carlos Jiménez-Gutiérrez, Gabriel López-Velazquez & Jordi Espadaler-Mazo (2022) Probiotic improves symptomatic and viral clearance in Covid19 outpatients: a randomized, quadruple-blinded, placebo-controlled trial, Gut Microbes, 14:1, 2018899, DOI: 10.1080/19490976.2021.2018899

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Course Includes

  • 1 Lesson
  • 2 Quizzes
  • Course Certificate