A category of herbs — Ashwagandha, Rhodiola, Cordyceps among them — used to help the body handle physical and emotional stress more resiliently, generally supporting adrenal and immune function rather than targeting a specific pathogen.

When the immune system, confused by a chronic infection, begins attacking the body’s own tissue. Chronic Lyme is sometimes misdiagnosed as a primary autoimmune condition (lupus, MS, rheumatoid arthritis) because of this symptom overlap.

A protective colony structure microorganisms build together, encased in a self-secreted slime layer that shields them from both antimicrobials and the immune system.

A subset of natural killer immune cells. Chronically low CD57+ counts are sometimes used as a supportive — not definitive — marker in chronic Lyme, since Borrelia is documented to suppress this cell population.

The US public health agency whose Lyme disease case-reporting criteria are often referenced, and sometimes contested, in diagnostic discussions.

A second (or third) tick-borne infection present alongside Borrelia, such as Bartonella or Babesia. A major reason Lyme treatment can fail if only Borrelia is addressed while a co-infection goes untreated.

A protective, rounded state Borrelia can shift into under stress, including antibiotic exposure — allowing it to ‘wait out’ treatment before reverting to its active spirochete form later.

A signaling protein the immune system uses to coordinate its response to infection. Necessary in the right amount, but chronically excessive cytokine production drives much of the pain, fatigue and brain fog seen in chronic Lyme.

The initial standard screening blood test for Lyme antibodies. Prone to false negatives, especially early in infection, before the body has mounted a full antibody response.

The classic ‘bullseye’ rash sometimes seen after a tick bite. A reliable diagnostic sign on its own when present, but appears in fewer than half of confirmed cases.

A cluster of bacteria — notably Babesia and Bartonella — shielded by fibrin, the same protein responsible for blood clotting, which physically blocks antimicrobials and immune cells from reaching them.

An enzyme that protects red blood cells from oxidative damage. Deficiency in this enzyme makes certain drugs — Dapsone, Methylene Blue, Tafenoquine — dangerous, since they can trigger severe hemolysis.

The destruction of red blood cells. This is the specific danger G6PD testing is meant to screen for before starting certain medications.

A temporary flare-up of symptoms that can occur when a large number of pathogens die off at once, releasing inflammatory toxins faster than the body can clear them. Often mistaken for the illness getting worse, rather than treatment actually working.

A medical society whose Lyme guidelines are narrower and more conservative than ILADS, generally not recognizing ‘chronic Lyme’ as a distinct diagnosis requiring extended treatment.

A specialty laboratory frequently used in Lyme-literate medicine, offering expanded Western Blot testing across more Borrelia strains than standard commercial labs.

A cytokine that generally dampens immune activity. Some herbs, Ashwagandha in particular, are used specifically to help lower IL-10 in chronic Lyme.

A medical society whose guidelines support extended treatment for chronic or persistent Lyme symptoms and recognize the limitations of standard testing, in contrast to IDSA’s stricter criteria.

A cell-wall-deficient form of Borrelia that can live inside host cells, evading antibiotics that specifically target bacterial cell walls.

A physician with additional training and clinical experience in diagnosing and treating chronic Lyme and tick-borne co-infections, often practicing outside standard IDSA guidelines.

A condition where mast cells release excessive inflammatory chemicals in response to normally harmless triggers. Can be caused or worsened by chronic infection and often complicates treatment tolerance.

Dr. Horowitz’s clinical framework describing Lyme as one of several overlapping factors — co-infections, toxicity, inflammation, hormone dysfunction and more — that together keep a person chronically ill, rather than treating it as a single isolated infection.

Borrelia infection that has spread to, or is actively affecting, the central nervous system, producing neurological symptoms.

A DNA-based test that looks for genetic material from the pathogen itself, rather than antibodies. Can still be falsely negative if the pathogen isn’t actively circulating in the specific sample taken.

A dormant, low-metabolism state some Borrelia and Bartonella cells enter to survive antibiotic or antimicrobial pressure. Standard treatments that target actively growing cells often miss this form entirely.

A form of autonomic nervous system dysfunction causing an abnormal heart rate increase on standing. Documented as one of the symptom clusters that can appear within MSIDS.

The chemical communication process bacteria within a biofilm use to coordinate behavior, including when to form or reinforce the biofilm structure.

Testing negative for antibodies despite having an active infection. A recognized limitation of standard Lyme testing, since antibody response can be suppressed, delayed, or simply missed by the specific test used.

A potentially life-threatening reaction caused by excess serotonin activity in the nervous system, typically from combining two or more serotonin-affecting substances — for example, Methylene Blue with an SNRI antidepressant.

The corkscrew-shaped bacterial form of Borrelia. Its shape allows it to burrow through tissue that would stop most other bacteria.

Two branches of the adaptive immune response. Chronic infection can skew the balance between them, and some herbs — Astragalus, for example — are specifically used or avoided depending on which direction that skew has gone.

A liquid herbal extract, typically alcohol-based (though alcohol-free versions exist), used to deliver a concentrated dose of a herb’s active compounds.

Describes how concentrated a tincture is. A 1:5 tincture uses 1 part herb to 5 parts liquid — more dilute, so a larger dose is needed — while a 1:2 is more concentrated, needing a smaller dose for the same effect.

Gradually increasing a dose over time, often starting at just a few drops, to find the highest amount a person tolerates well — rather than starting at a full target dose immediately.

A follow-up antibody test that looks for specific protein ‘bands’ associated with Borrelia exposure. More specific than ELISA, but still not perfectly sensitive on its own.