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However, it has long been observed in clinical practice and in research settings that a subset of patients continue to report a constellation of largely patient reported, so-called subjective symptoms which may last for a significant period of time following treatment ( Estimated Frequency After Lyme disease was first identified in the United States in the late 1970's, but before the pathogenic bacteria was recognized, it was noted that untreated patients with Lyme arthritis often also reported concurrent symptoms such as headache, fatigue, myalgia, and hyperesthesia ( As more effective antibiotic treatments and drug regimens were tested and identified in prospective studies and clinical treatment trials, other investigators reported estimates of 0 to 35% for persistent, non-specific symptoms following treatment ( While Lyme disease has been a nationally notifiable disease in the United States since 1991, the CDC does not track disease outcomes or cases of persistent symptoms ( Risk Factors Several clinical factors surrounding the initial onset of Lyme disease have been found to increase risk for persistent symptoms after treatment