I think I may have pinpointed the source of your confusion!
They've systematically listed everything people suspect they got as a result of their Lyme disease infection (past or present) as an exclusion factor in Post-Lyme Disease Syndrome.
This accomplishes two things:
it pushes anybody with what they consider "real problems" out of the PLDS realm so that only people who think they're having real problems (but in Wormser's real unrealistic reality, they're not, really) are left. This is evidenced in this particular line of inclusion:
People who complain about having cognitive difficulties are included in PLDS, whereas people who actually have cognitive difficulties are excluded as evidenced here:Complaints of cognitive difficulties
Even though this is an extremely important point, it has been seemingly hidden away behind another totally different extremely important point, refractory Lyme arthritis.For example, a patient with antibiotic refractory Lyme arthritis would be excluded. A patient with late neuroborreliosis associated with encephalopathy, who has recurrent or refractory objective cognitive dysfunction, would be excluded.
it slaps everyone without an objective measure for his or her pain and disability (not that there isn't an objective measure, just that no one will be given a test to measure it - such as the Two-Day PEM test) with a new and improved PLDS label. This new label no longer even means "Post-Lyme Disease Syndrome"! It now means "Crazy People Who Think They Have PLDS" or CPWTTHPLDS.
Otherwise, I don't see how having a diagnosis of Schizophrenia in a person's lifetime, for example, can exclude that person from having problems after Lyme treatment a.k.a. Post-Lyme Disease Syndrome???
But what I think they have unwittingly accomplished is that anybody with objective problems stemming from their Lyme disease infection who has already been treated with either short- or long-term antibiotics will now be considered to still have the Lyme disease infection, thus perpetuating the "Chronic Lyme Disease" label they have tried so hard to crush out of existence.
I'll bet this clears things right up for you, doesn't it?
You see, they have really out-done themselves this time. They've out-done themselves so well that they have actually out-witted themselves!