Comparison of Clinical Course and Treatment Outcome for Patients With Early Disseminated or Early Localized Lyme Borreliosis

Stupica, Daša; Maraspin, Vera; Bogovič, Petra; Ogrinc, Katarina; Blagus, Rok; Cerar, Tjaša; Strle, Franc

doi:10.1001/jamadermatol.2018.2306

Cited by 29 publications

(39 citation statements)

References 25 publications

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“…Our study has shown that the majority of basic clinical and epidemiologic characteristics of EM before treatment with antibiotics were analogous in the two groups of women and consonant with previous findings in Slovenian patients with EM [35][36][37][38][39][40][41][42] and that the outcome after antibiotic treatment was excellent regardless of pregnancy. No subsequent objective manifestations of LB were established in either of the two groups, and the proportion of patients with symptoms at follow-up visits was even lower than found in other recent studies from Slovenia [37][38][39][40][41][42], possibly because only young, previously healthy patients were included in the present study.…”

Section: Discussionsupporting

confidence: 91%

“…We do not have a reliable explanation for the observation that the pregnant women less often had ring-like EM despite similar duration of the skin lesion before treatment, but we stress that the findings in our control group are in agreement with previous reports in Slovenian patients with EM [35][36][37][38][39][40][41][42]. Furthermore, the proportion of reported constitutional symptoms accompanying EM was lower in the pregnant women, indicating that the course of EM during pregnancy was milder than in the age-matched non-pregnant women (Table 1, Figure 1), as also shown in previous reports on EM from the same region [35][36][37][38][39][40][41][42]. Our results indicate that the probability of reporting constitutional symptoms systematically decreases with gestation week at diagnosis of EM (EM was diagnosed a median 7 days after the appearance of the skin lesion) and that women infected during the later stages of pregnancy report fewer constitutional symptoms compared with those infected during the early phases of pregnancy, who are more similar to non-pregnant women.…”

Section: Discussionsupporting

confidence: 82%

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Course and Outcome of Erythema Migrans in Pregnant Women

Maraspin

Lusa

Blejec

et al. 2020

JCM

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Information on Lyme borreliosis (LB) during pregnancy is limited. In the present study, the course and outcome of erythema migrans (EM) in 304 pregnant women, diagnosed in the period 1990–2015, was assessed and compared with that in age-matched non-pregnant women. The frequency of unfavorable outcome of pregnancies was also evaluated. The pregnant women reported constitutional symptoms less frequently than the non-pregnant women (22.4% vs. 37.2%, p < 0.001). Pregnant women diagnosed with EM later during pregnancy had a lower probability of reporting constitutional symptoms (odds ratio = 0.97 for 1-week difference in gestation week at diagnosis of EM, 95% CI: 0.94–0.99, p = 0.02). The outcome of pregnancy was unfavorable in 42/304 (13.8%) patients: preterm birth in 22/42 (52.4%), fetal/perinatal death in 10/42 (23.8%), and/or anomalies in 15/42 (35.7%). Several patients had potential explanation(s) for the unfavorable outcome. In conclusion, the course of early LB during pregnancy is milder than in age-matched non-pregnant women. The outcome of pregnancy with the treatment approach used in the present study (i.v. ceftriaxone 2 g once daily for 14 days) is favorable.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 82%

Course and Outcome of Erythema Migrans in Pregnant Women

Maraspin

Lusa

Blejec

et al. 2020

JCM

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“…The 1220 patients included in this study were ≥18 years of age with EM defined according to European criteria [8], and were enrolled prospectively in five clinical trials between June 2006 and October 2015 at the Lyme borreliosis outpatient clinic, University Medical Center Ljubljana, Slovenia [2,4,9,10,11]. Patients were referred by their general practitioners, and only exceptionally by other specialists.…”

Section: Methodsmentioning

confidence: 99%

“…Multiple EM is defined as the presence of two or more erythemas, at least one of which must fulfil the size criterion for solitary EM [12]. Patients with multiple EM were over-represented in our sample because they were enrolled preferentially in two of the clinical trials in the present analysis [10,11]; patients with previous LB were under-represented because such patients were excluded from two of the eligible trials [2,9]. Patients were categorized as young (18–44 years), middle-aged (45–64 years), or elderly (≥65 years) [13].…”

Section: Methodsmentioning

confidence: 99%

“…Thus, patients with solitary EM were treated with doxycycline for 10 days (107 patients, 8.8%), 14 days (400 patients, 32.8%), or 15 days (259 patients, 21.2%); or with cefuroxime axetil for 15 days (199 patients, 16.3%); or with amoxicillin for 15 days (60 patients, 4.9%). Patients with multiple EM received intravenous ceftriaxone (96 patients, 7.9%) or doxycycline (99 patients, 8.1%) for 14 days [2,4,9,10,11].…”

Section: Methodsmentioning

confidence: 99%

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Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis

Boršič

Blagus²,

Cerar

et al. 2018

JCM

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Infected elderly people often present with signs and symptoms that differ from those in younger adults, but data on the association between patient age and presentation of early Lyme borreliosis (LB) are limited. In this study, the association between patient age (18–44 years, young vs. 45–64 years, middle-aged vs. ≥ 65 years, elderly) and disease course, microbiologic characteristics, and the long-term outcome of treatment was investigated prospectively in 1220 adult patients with early LB manifesting as erythema migrans (EM) at a single-center university hospital. Patients were assessed at enrolment and followed-up for 12 months. Age was associated with comorbidities, previous LB, presenting with multiple EM, and seropositivity to borreliae at enrolment. The time to resolution of EM after starting antibiotic treatment was longer in older patients. At 12 months, 59/989 (6.0%) patients showed incomplete response. The odds for incomplete response decreased with time from enrolment (odds ratio (OR) of 0.49, 0.50, and 0.48 for 2-month vs. 14-days, 6-month vs. 2-month, and 12-month vs. 6-month follow-up visits, respectively), but were higher with advancing age (OR 1.57 for middle-aged vs. young, and 1.95 for elderly vs. young), in women (OR 1.41, 95% confidence interval (CI) 1.01–1.96), in patients who reported LB-associated constitutional symptoms at enrolment (OR 7.69, 95% CI 5.39–10.97), and in those who presented with disseminated disease (OR 1.65, 95% CI 1.09–2.51). The long-term outcome of EM was excellent in patients of all age groups. However, older patients had slower resolution of EM and higher odds for an unfavorable outcome of treatment (OR 1.57, 95% CI 1.05–2.34 for middle-aged vs. young; and OR 1.95, 95% CI 1.14–3.32 for elderly vs. young), manifested predominantly as post-LB symptoms. The presence of LB-associated constitutional symptoms at enrolment was the strongest predictor of incomplete response.

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Systemic immune responses in patients with early localized or early disseminated Borrelia afzelii lyme borreliosis

Kišek¹,

Blagus

Ružić‐Sabljić³

et al. 2020

Immunity Inflam & Disease

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Introduction The role of host immune responses in the pathogenesis of borrelial dissemination in early Lyme borreliosis (LB) in the form of multiple erythema migrans (MEM) or LB‐associated symptoms is incompletely understood. Methods In this study, fifteen cytokine or chemokine levels, representative of innate, Th1, and Th17 immune responses, were assessed using a bead‐based Luminex multiplex assay in acute sera from 76 adult patients with skin culture‐positive Borrelia afzelii solitary erythema migrans (SEM) and 58 patients with MEM at a single‐center university hospital. Differences between the groups were tested by modeling each cytokine or chemokine concentration by means of left‐censored regression using the classic Tobit model. Results Mean serum cytokine or chemokine levels were low. When taking into account the proportion of patients with cytokine or chemokine concentrations below the lowest detectable limit, only levels of CXCL10 (p = .03) and CCL19 (p = .02), representatives of the Th1 immune response, differed between patients with SEM and those with MEM; however, the differences did not reach statistical significance when adjusted for multiple comparisons. In addition, we did not find differences in systemic inflammatory responses when comparing patients with and those without LB‐associated constitutional symptoms. Conclusion No significant differences in systemic immune responses represented by selected cytokines or chemokines in serum samples of patients with EM infected with B. afzelii suggest that systemic mediators are not pivotal in the pathogenesis of dissemination of early infection in the form of MEM or LB‐associated symptoms. Localized immune responses in the skin or other pathogenetic mechanisms may be more important in this regard.

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Comparison of Clinical Course and Treatment Outcome for Patients With Early Disseminated or Early Localized Lyme Borreliosis

Cited by 29 publications

References 25 publications

Course and Outcome of Erythema Migrans in Pregnant Women

Course and Outcome of Erythema Migrans in Pregnant Women

Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis

Systemic immune responses in patients with early localized or early disseminated Borrelia afzelii lyme borreliosis

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