In clinical practice, it has long been reported that a subset of Lyme disease patients experience a range of symptoms such as exhaustion, cognitive problems, and musculoskeletal pain, which may last for a prolonged period of time. Such symptoms, which may vary from mild to extreme, have been documented in prospective and population-based studies in endemic regions of Lyme disease throughout the literature. After Lyme disease was first described in the late 1970s in the United States, but before the pathogenic bacteria were known, it was noticed that untreated Lyme arthritis patients have often reported recurrent symptoms such as headache, exhaustion, myalgia, and hyperesthesia. In some of the earliest cases series of treated patients it was first reported that these symptoms could persist after antibiotic treatment The etiology of these symptoms is unclear, but several disease-causing mechanisms, including microbial persistence, host immune dysregulation by inflammatory or s...