Chronic Lyme disease and co-infections: inpatient treatment in Germany

1. Diagnostics

The programme starts with a medical history, a physical and neurological examination and laboratory tests. The laboratory tests include a Borrelia ELISpot, a Western blot with expanded band analysis, a CD57 natural killer cell analysis, a co-infection panel and an assessment of immune function. These tests go beyond the standard two-step test (ELISA and Western blot). Lyme disease remains a clinical diagnosis that laboratory tests support. How the hospital diagnoses Lyme disease

2. Core Lyme module (2 weeks, inpatient)

The core Lyme module combines two sessions of whole-body hyperthermia with antibiotic therapy. The hospital calls this protocol antibiotic-augmented thermoeradication (AAT). This term is the name of the protocol and does not describe a guaranteed result. Each session of whole-body hyperthermia reaches 41.6 to 41.8 °C (106.9 to 107.2 °F) for 120 minutes. The minimum target temperature of the AAT protocol is 41.6 °C. The protocol sets this minimum because laboratory studies show that Borrelia bacteria are sensitive to heat. The sessions are performed under sedation. The hospital offers whole-body hyperthermia only within the inpatient programme. Medical staff monitor core temperature, heart rate, oxygen level and blood pressure during the whole session. The antibiotic therapy uses individually selected combinations, given intravenously and orally, for 2 weeks. Supportive infusions and daily physical therapy accompany the module. The Lyme treatment protocol in detail and what a session of whole-body hyperthermia involves

3. Co-infection module (2 additional weeks, only if co-infections are confirmed)

The co-infection panel tests for Bartonella, Babesia, Ehrlichia, Anaplasma, Rickettsia, Chlamydia pneumoniae, Mycoplasma pneumoniae and Yersinia. If a co-infection is confirmed, the co-infection module adds 10 sessions of intravenous laser therapy, apheresis and antimicrobial agents that the physician selects for the identified pathogen. Co-infections that the hospital tests for and what intravenous laser therapy involves

4. Apheresis, if indicated

Apheresis is a group of procedures that filter the blood outside the body. In the Lyme programme the physician may recommend H.E.L.P. apheresis. For patients with elevated autoantibody levels the physician may recommend immunoadsorption. The decision depends on your laboratory findings. What H.E.L.P. apheresis involves and what immunoadsorption involves

5. Microbiome restore week (1 additional week, optional)

Antibiotic therapy over several weeks disrupts the bacteria in the gut. The third module addresses the gut after the antibiotic therapy. It includes a gastroscopy and a colonoscopy with a microbiome transfer. The physician discusses with you whether this module is appropriate for you. What microbiome transfer involves

6. One coordinated plan

The programme is comprehensive. It addresses the different domains of Lyme disease in one plan: the Borrelia infection and the co-infections, inflammation, the immune system, detoxification, the gut microbiome, mobility and pain, mental health and nutrition. All therapies belong to one plan, and one team plans them. The treatment team reviews your findings and your response every day and adjusts the plan. How the Lyme therapies combine

The term. Physicians use the term "chronic Lyme disease" in different ways, and many medical societies do not use it. These societies speak of "post-treatment Lyme disease syndrome" when symptoms continue after antibiotic therapy. On this page, chronic Lyme disease means persistent symptoms in connection with a Borrelia infection, with or without co-infections.

Diagnosis. No single laboratory test can confirm or exclude a chronic Borrelia infection. The physicians combine your history, the examination and the results of several laboratory tests. The diagnosis page lists the published studies that the hospital refers to.

Whole-body hyperthermia. Laboratory studies show that temperatures above 41 °C reduce the viability of Borrelia bacteria. The AAT protocol is built on this finding and sets 41.6 °C as its minimum temperature.

Experience. The hospital has treated more than 12,000 patients with Lyme disease since 1995. The hospital has performed more than 30,000 sessions of whole-body hyperthermia.

Individual concept. The programme is not part of guideline care. The physicians create an individual treatment concept for each patient after the diagnostics. The hospital performs therapies outside guideline care as an individual treatment attempt. Your physician explains the procedure and the current state of knowledge to you before you consent.

What the programme cannot do. The hospital does not promise results. The response depends on the duration of the illness, on co-infections and on individual factors. Treatment of chronic Lyme disease is a process. Most patients need continued care at home after discharge, and some patients return for a further treatment cycle. The physicians record laboratory values and standardised symptom scores before and after treatment, so that you and your home physician can see the course.

Side effects. Some patients have a Herxheimer reaction during treatment. A Herxheimer reaction is a temporary worsening of symptoms. The team monitors and treats this reaction. After a session of whole-body hyperthermia you will be tired for the rest of the day.