{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T01:19:29Z","timestamp":1789262369878,"version":"build-2803163510"},"reference-count":75,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T00:00:00Z","timestamp":1721865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mater Foundation"},{"name":"Sorbonne Universit\u00e9"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Tick-borne illnesses (TBIs), especially those caused by Borrelia, are increasingly prevalent worldwide. These diseases progress through stages of initial localization, early spread, and late dissemination. The final stage often leads to post-treatment Lyme disease syndrome (PTLDS) or chronic Lyme disease (CLD), characterized by persistent and non-specific multisystem symptoms affecting multiple systems, lasting over six months after antibiotic therapy. PTLDS significantly reduces functional ability, with 82\u201396% of patients experiencing pain, including arthritis, arthralgia, and myalgia. Inflammatory markers like CRP and TNF-alpha indicate ongoing inflammation, but the link between chronic pain and other biomarkers is underexplored. This study examined the relationship between pain and biomarkers in TBI patients from an Irish hospital and their response to antibiotic treatment. Pain ratings significantly decreased after antibiotic treatment, with median pain scores dropping from 7 to 5 (U = 27215.50, p &lt; 0.001). This suggests a persistent infection responsive to antibiotics. Age and gender did not influence pain ratings before and after treatment. The study found correlations between pain ratings and biomarkers such as transferrin, CD4%, platelets, and neutrophils. However, variations in these biomarkers did not significantly predict pain changes when considering biomarkers outside the study. These findings imply that included biomarkers do not directly predict pain changes, possibly indicating allostatic load in symptom variability among long-term TBI patients. The study emphasizes the need for appropriate antibiotic treatment for TBIs, highlighting human rights issues related to withholding pain relief.<\/jats:p>","DOI":"10.3390\/antibiotics13080693","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T06:11:36Z","timestamp":1721887896000},"page":"693","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Biomarker-Based Analysis of Pain in Patients with Tick-Borne Infections before and after Antibiotic Treatment"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4346-027X","authenticated-orcid":false,"given":"Kunal","family":"Garg","sequence":"first","affiliation":[{"name":"Te?ted Oy, 40100 Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbie","family":"Thoma","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Catherine Mc Auley Education & Research Centre, Mater Misericordiae University Hospital, 21 Nelson Street, Dublin 7, D07 A8NN Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9610-6472","authenticated-orcid":false,"given":"Gordana","family":"Avramovic","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Catherine Mc Auley Education & Research Centre, Mater Misericordiae University Hospital, 21 Nelson Street, Dublin 7, D07 A8NN Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7470-5770","authenticated-orcid":false,"given":"Leona","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Te?ted Oy, 40100 Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Shawky","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Technologie de Compi\u00e8gne, Costech Laboratory, Alliance Sorbonne Universit\u00e9, Centre de Recherches, 60203 Compi\u00e8gne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minha Rajput","family":"Ray","sequence":"additional","affiliation":[{"name":"Curaidh Clinic: Innovative Solutions for Pain, Chronic Disease and Work Health, Perth PH2 8EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Shearer","family":"Lambert","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Catherine Mc Auley Education & Research Centre, Mater Misericordiae University Hospital, 21 Nelson Street, Dublin 7, D07 A8NN Dublin, Ireland"},{"name":"Catherine Mc Auley Education & Research Centre, University College Dublin, 21 Nelson Street, Dublin 7, D07 A8NN Dublin, Ireland"},{"name":"Infectious Diseases Department, The Rotunda Hospital, D01 P5W9 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"641","DOI":"10.3201\/eid2604.191629","article-title":"Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States","volume":"26","author":"Eisen","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.3201\/eid2708.204763","article-title":"Comparison of Lyme Disease in the United States and Europe","volume":"27","author":"Marques","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_3","first-page":"649","article-title":"Clinical aspects of Borrelia burgdorferi infections","volume":"64","author":"Neubert","year":"1989","journal-title":"Z. Hautkrankh."},{"key":"ref_4","first-page":"87","article-title":"Lyme borreliosis: Review of present knowledge","volume":"42","year":"1993","journal-title":"Ceskoslovenska Epidemiol. Mikrobiol. Imunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciaa1215","article-title":"Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease","volume":"72","author":"Lantos","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","first-page":"138016","article-title":"Relevance of Chronic Lyme Disease to Family Medicine as a Complex Multidimensional Chronic Disease Construct: A Systematic Review","volume":"2014","author":"Borgermans","year":"2014","journal-title":"Int. J. Fam. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5114\/reum.2015.50557","article-title":"Post-Lyme disease syndrome","volume":"53","year":"2015","journal-title":"Rheumatology"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chung, M.K., Caboni, M., Strandwitz, P., D\u2019Onofrio, A., Lewis, K., and Patel, C.J. (2023). Systematic comparisons between Lyme disease and post- treatment Lyme disease syndrome in the U.S. with administrative claims data. EBioMedicine, 90.","DOI":"10.1016\/j.ebiom.2023.104524"},{"key":"ref_9","first-page":"301","article-title":"CNS manifestations of third stage lyme disease","volume":"263","author":"Pachner","year":"1987","journal-title":"Zentralblatt Bakteriol. Mikrobiol. Hyg. Ser. A M\u00e9d. Microbiol. Infect. Dis. Virol. Parasitol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.idc.2007.12.011","article-title":"Chronic Lyme Disease: A Review","volume":"22","author":"Marques","year":"2008","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11136-012-0126-6","article-title":"Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: Is there something here?","volume":"22","author":"Aucott","year":"2013","journal-title":"Qual. Life Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100142","DOI":"10.1016\/j.lanepe.2021.100142","article-title":"Prevalence of persistent symptoms after treatment for lyme borreliosis: A prospective observational cohort study","volume":"6","author":"Ursinus","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Xi, D., Thoma, A., Rajput-Ray, M., Madigan, A., Avramovic, G., Garg, K., Gilbert, L., and Lambert, J.S. (2023). A Longitudinal Study of a Large Clinical Cohort of Patients with Lyme Disease and Tick-Borne Co-Infections Treated with Combination Antibiotics. Microorganisms, 11.","DOI":"10.3390\/microorganisms11092152"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1038\/s41390-023-02577-3","article-title":"Pediatric Lyme disease: Systematic assessment of post-treatment symptoms and quality of life","volume":"95","author":"Monaghan","year":"2024","journal-title":"Pediatr. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1056\/NEJMcp1314325","article-title":"Lyme Disease","volume":"370","author":"Shapiro","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"158","DOI":"10.2174\/1874205X01206010158","article-title":"Chronic Lyme Disease and Co-infections: Differential Diagnosis","volume":"6","author":"Berghoff","year":"2012","journal-title":"Open Neurol. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.mehy.2004.10.004","article-title":"Is Gulf War Syndrome actually chronic Lyme disease?","volume":"64","author":"Owen","year":"2005","journal-title":"Med. Hypotheses"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1038\/s41591-022-01810-6","article-title":"Unexplained post-acute infection syndromes","volume":"28","author":"Choutka","year":"2022","journal-title":"Nat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1586\/14787210.2014.940900","article-title":"Evidence assessments and guideline recommendations in Lyme disease: The clinical management of known tick bites, erythema migrans rashes and persistent disease","volume":"12","author":"Cameron","year":"2014","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Rebman, A.W., and Aucott, J.N. (2020). Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease. Front. Med., 7.","DOI":"10.3389\/fmed.2020.00057"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zhang, X., Jiang, Y., Chen, Y., Yang, J., Xing, L., Liu, A., and Bao, F. (2023). Efficacy and safety of antibiotic therapy for post-Lyme disease? A systematic review and network meta-analysis. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-07989-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e443","DOI":"10.1016\/j.ijid.2013.01.008","article-title":"Development of a foundation for a case definition of post-treatment Lyme disease syndrome","volume":"17","author":"Aucott","year":"2013","journal-title":"Int. J. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Rebman, A.W., Bechtold, K.T., Yang, T., Mihm, E.A., Soloski, M.J., Novak, C.B., and Aucott, J.N. (2017). The Clinical, Symptom, and Quality-of-Life Characterization of a Well-Defined Group of Patients with Posttreatment Lyme Disease Syndrome. Front. Med., 4.","DOI":"10.3389\/fmed.2017.00224"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"44S","DOI":"10.1016\/S0002-9343(99)80043-6","article-title":"Musculoskeletal manifestations of Lyme disease","volume":"98","author":"Steere","year":"1995","journal-title":"Am. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1056\/NEJM200107123450207","article-title":"Lyme Disease","volume":"345","author":"Steere","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_26","unstructured":"International Association for the Study of Pain (IASP) (2024, July 14). Definitions of Chronic Pain Syndromes. Available online: https:\/\/www.iasp-pain.org\/advocacy\/definitions-of-chronic-pain-syndromes\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1016\/j.pain.2014.04.024","article-title":"Acute and chronic pain associated with Lyme borreliosis: Clinical characteristics and pathophysiologic mechanisms","volume":"155","author":"Zimering","year":"2014","journal-title":"Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1093\/bja\/aet127","article-title":"Sex differences in pain: A brief review of clinical and experimental findings","volume":"111","author":"Bartley","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.pnpbp.2019.04.006","article-title":"The silent epidemic of chronic pain in older adults","volume":"93","author":"Domenichiello","year":"2019","journal-title":"Prog. Neuro-Psychopharmacol. Biol. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/pm\/pny062","article-title":"Pain Intensity, Disability, and Quality of Life in Patients with Chronic Low Back Pain: Does Age Matter?","volume":"20","author":"Wettstein","year":"2019","journal-title":"Pain Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1526-5900(00)90101-9","article-title":"The stages of pain processing across the adult lifespan","volume":"1","author":"Riley","year":"2000","journal-title":"J. Pain"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/01.ajp.0000146217.31780.ef","article-title":"Age and the Experience of Chronic Pain","volume":"21","author":"Wahl","year":"2005","journal-title":"Clin. J. Pain"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1093\/cid\/ciw599","article-title":"Expression of C-Reactive Protein and Serum Amyloid A in Early to Late Manifestations of Lyme Disease","volume":"63","author":"Uhde","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1046\/j.1365-2567.2002.01500.x","article-title":"Cytokines in Lyme borreliosis: Lack of early tumour necrosis factor-\u03b1 and transforming growth factor-\u03b21 responses are associated with chronic neuroborreliosis","volume":"107","author":"Widhe","year":"2002","journal-title":"Immunology"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Laumet, G., Ma, J., Robison, A.J., Kumari, S., Heijnen, C.J., and Kavelaars, A. (2019). T Cells as an Emerging Target for Chronic Pain Therapy. Front. Mol. Neurosci., 12.","DOI":"10.3389\/fnmol.2019.00216"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0165-2478(00)00316-3","article-title":"Decreased CD57 lymphocyte subset in patients with chronic Lyme disease","volume":"76","author":"Stricker","year":"2001","journal-title":"Immunol. Lett."},{"key":"ref_37","first-page":"111","article-title":"Longterm decrease in the CD57 lymphocyte subset in a patient with chronic Lyme disease","volume":"9","author":"Stricker","year":"2002","journal-title":"Ann. Agric. Environ. Med.  AAEM"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1128\/CVI.00260-09","article-title":"Natural Killer Cells in Chronic Lyme Disease","volume":"16","author":"Stricker","year":"2009","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Saeidi, A., Zandi, K., Cheok, Y.Y., Saeidi, H., Wong, W.F., Lee, C.Y.Q., Cheong, H.C., Yong, Y.K., Larsson, M., and Shankar, E.M. (2018). T-Cell Exhaustion in Chronic Infections: Reversing the State of Exhaustion and Reinvigorating Optimal Protective Immune Responses. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.02569"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1176\/appi.neuropsych.12090223","article-title":"Post-Treatment Lyme Syndrome and Central Sensitization","volume":"25","author":"Batheja","year":"2013","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Xi, D., Garg, K., Lambert, J.S., Rajput-Ray, M., Madigan, A., Avramovic, G., and Gilbert, L. (2024). Scrutinizing Clinical Biomarkers in a Large Cohort of Patients with Lyme Disease and Other Tick-Borne Infections. Microorganisms, 12.","DOI":"10.3390\/microorganisms12020380"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/zph.13073","article-title":"Demographic patterns in Lyme borreliosis seasonality over 25 years","volume":"70","author":"Goren","year":"2023","journal-title":"Zoonoses Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Thompson, A.E., Anisimowicz, Y., Miedema, B., Hogg, W., Wodchis, W.P., and Aubrey-Bassler, K. (2016). The influence of gender and other patient characteristics on health care-seeking behaviour: A QUALICOPC study. BMC Fam. Pract., 17.","DOI":"10.1186\/s12875-016-0440-0"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.2147\/IJGM.S406466","article-title":"Does Biological Sex Matter in Lyme Disease? The Need for Sex-Disaggregated Data in Persistent Illness","volume":"16","author":"Johnson","year":"2023","journal-title":"Int. J. Gen. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Woudenberg, T., B\u00f6hm, S., B\u00f6hmer, M., Katz, K., Willrich, N., Stark, K., Kuhnert, R., Fingerle, V., and Wilking, H. (2020). Dynamics of Borrelia burgdorferi-Specific Antibodies: Seroconversion and Seroreversion between Two Population-Based, Cross-Sectional Surveys among Adults in Germany. Microorganisms, 8.","DOI":"10.3390\/microorganisms8121859"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1109\/MPULS.2022.3145628","article-title":"The Search for Pain Biomarkers","volume":"13","author":"Allen","year":"2022","journal-title":"IEEE Pulse"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Diaz, M.M., Caylor, J., Strigo, I., Lerman, I., Henry, B., Lopez, E., Wallace, M.S., Ellis, R.J., Simmons, A.N., and Keltner, J.R. (2022). Toward Composite Pain Biomarkers of Neuropathic Pain\u2014Focus on Peripheral Neuropathic Pain. Front. Pain Res., 3.","DOI":"10.3389\/fpain.2022.869215"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3230","DOI":"10.1007\/s00586-023-07717-1","article-title":"The importance of inflammatory biomarkers in non-specific acute and chronic low back pain: A systematic review","volume":"32","author":"Pinto","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"293","DOI":"10.2174\/1381612826666201102103520","article-title":"Pain Biomarkers in Cancer: An Overview","volume":"27","author":"Calapai","year":"2020","journal-title":"Curr. Pharm. Des."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/00325481.2017.1270155","article-title":"Patterns of chronic inflammation in extensively treated patients with arachnoiditis and chronic intractable pain","volume":"129","author":"Bilello","year":"2017","journal-title":"Postgrad. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e000108","DOI":"10.1136\/bmjmed-2021-000108","article-title":"Chronic pain and infection: Mechanisms, causes, conditions, treatments, and controversies","volume":"1","author":"Cohen","year":"2022","journal-title":"BMJ Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1086\/651275","article-title":"Host-Pathogen Interactions Mediating Pain of Urinary Tract Infection","volume":"201","author":"Rudick","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1097\/j.pain.0000000000000559","article-title":"Pain and infection","volume":"157","author":"Chiu","year":"2016","journal-title":"Pain"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/iju.12309","article-title":"Mechanisms of pain from urinary tract infection","volume":"21","author":"Rosen","year":"2014","journal-title":"Int. J. Urol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3344\/kjp.23129","article-title":"Antimicrobial therapies for chronic pain (part 1): Analgesic mechanisms","volume":"36","author":"Wang","year":"2023","journal-title":"Korean J. Pain"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"299","DOI":"10.3344\/kjp.23130","article-title":"Antimicrobial therapies for chronic pain (part 2): The prevention and treatment of chronic pain","volume":"36","author":"Wang","year":"2023","journal-title":"Korean J. Pain"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000510696","article-title":"Allostatic Load and Its Impact on Health: A Systematic Review","volume":"90","author":"Guidi","year":"2020","journal-title":"Psychother. Psychosom."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.exger.2016.12.013","article-title":"Allostatic load and pain severity in older adults: Results from the English Longitudinal Study of Ageing","volume":"88","author":"Sibille","year":"2017","journal-title":"Exp. Gerontol."},{"key":"ref_59","first-page":"e16847","article-title":"Assessment of Functional Pain Score by Comparing to Traditional Pain Scores","volume":"13","author":"Adeboye","year":"2021","journal-title":"Cureus"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Sarzi-Puttini, P., Fiorini, T., Panni, B., Turiel, M., Cazzola, M., and Atzeni, F. (2002). Correlation of the score for subjective pain with physical disability, clinical and radiographic scores in recent onset rheumatoid arthritis. BMC Musculoskelet. Disord., 3.","DOI":"10.1186\/1471-2474-3-18"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Fagen, J.L., Shelton, J.A., and Luch\u00e9-Thayer, J. (2023). Medical Gaslighting and Lyme Disease: The Patient Experience. Healthcare, 12.","DOI":"10.3390\/healthcare12010078"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1212\/01.WNL.0000284604.61160.2d","article-title":"A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy","volume":"70","author":"Fallon","year":"2008","journal-title":"Neurology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1212\/01.WNL.0000071227.23769.9E","article-title":"Study and Treatment of Post Lyme Disease (STOP-LD): A Randomized Double Masked Clinical Trial","volume":"60","author":"Krupp","year":"2003","journal-title":"Neurology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1089\/153036602321653842","article-title":"Controlled Trials of Antibiotic Treatment in Patients with Post-Treatment Chronic Lyme Disease","volume":"2","author":"Klempner","year":"2002","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1016\/j.cct.2012.08.009","article-title":"Antibiotic retreatment of Lyme disease in patients with persistent symptoms: A biostatistical review of randomized, placebo-controlled, clinical trials","volume":"33","author":"DeLong","year":"2012","journal-title":"Contemp. Clin. Trials"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1136\/emj.20.1.54","article-title":"Observational research methods. Research design II: Cohort, cross sectional, and case-control studies","volume":"20","author":"Mann","year":"2003","journal-title":"Emerg. Med. J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1097\/PRS.0b013e3181f44abc","article-title":"Observational Studies: Cohort and Case-Control Studies","volume":"126","author":"Song","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Cohen, J. (2013). Statistical Power Analysis for the Behavioral Sciences, Taylor & Francis Group.","DOI":"10.4324\/9780203771587"},{"key":"ref_69","unstructured":"Pandas Development Team (2023). Pandas-Dev\/Pandas: Pandas, Zenodo."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1038\/s41586-020-2649-2","article-title":"Array programming with NumPy","volume":"585","author":"Harris","year":"2020","journal-title":"Nature"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1109\/MCSE.2007.55","article-title":"Matplotlib: A 2D graphics environment","volume":"9","author":"Hunter","year":"2007","journal-title":"Comput. Sci. Eng."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.21105\/joss.03021","article-title":"seaborn: Statistical data visualization","volume":"6","author":"Waskom","year":"2021","journal-title":"J. Open Source Softw."},{"key":"ref_73","unstructured":"Field, A. (2009). Discovering Statistics Using SPSS, Sage Publications."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/j.1365-2648.2007.04270_1.x","article-title":"Discovering Statistics Using SPSS. Second Edition","volume":"58","author":"Gigliotti","year":"2007","journal-title":"J. Adv. Nurs."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Hastie, T., Tibshirani, R., and Friedman, J. (2009). The Elements of Statistical Learning, Springer. [2nd ed.].","DOI":"10.1007\/978-0-387-84858-7"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/8\/693\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:22:57Z","timestamp":1760109777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/8\/693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,25]]},"references-count":75,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["antibiotics13080693"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13080693","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,25]]}}}