Long-term Follow-up of Patients With Lyme Disease: Longitudinal Analysis of Clinical and Quality-of-life Measures

Wills, Aprielle B.; Spaulding, Alicen B; Adjemian, Jennifer; Prevots, D. Rebecca; Turk, Siu-Ping; Williams, Carla; Marques, Adriana

doi:10.1093/cid/ciw189

Cited by 46 publications

(23 citation statements)

References 34 publications

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“…The results of this study correspond quite well with the results of a recent US study on QoL among LB patients, in which EM patients had better QoL-scores than other LB patients, and lower QoL scores were associated with comorbidities [43]. …”

Section: Discussionsupporting

confidence: 88%

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

Eliassen

Hjetland

Reiso³

et al. 2017

Scandinavian Journal of Primary Health Care

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ObjectivePromptly treated erythema migrans (EM) has good prognosis. However, some patients report persistent symptoms. Do patients with EM have more symptoms than the general population? We describe individual symptoms and general function in EM-patients at time of diagnosis and one year after treatment.DesignProspective study with 1-year follow up after treatment. Questionnaires included a modified version of the Subjective Health Complaints Inventory, comprising three additional Lyme borreliosis (LB) related symptoms. General function was assessed using a five-point scale modified from the COOP/WONCA charts.SettingNorwegian general practice.SubjectsA total of 188 patients were included in a randomized controlled trial comparing three antibiotic regimens for EM, of whom 139 had complete data for this study.Main outcome measuresIndividual symptoms, symptom load and general function.ResultsMild symptoms were common, reported by 84.9% at baseline and by 85.6% at follow-up. At baseline, patients reported a mean of 5.4 symptoms, compared with 6.2 after one year. Severely bothersome symptoms and severely impaired general function were rare. Tiredness was the most reported symptom both at baseline and at follow-up. Palsy (other than facial) was the least reported symptom, but the only one with a significant increase. However, this was not associated to the EM.ConclusionThe symptom load was comparable to that reported in the general population. We found an increase in symptom load at follow-up that did not significantly affect general function.Implication: Monitoring patients’ symptom loads prior to treatment reduce the probability of attributing follow-up symptoms to LB.Key pointsErythema migrans has a good prognosis.Patients treated for erythema migrans have a slight increase in symptom load one year after treatment.This increase does not affect general function.The levels of subjective health complaints in patients treated for erythema migrans are comparable to the background population.

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Section: Discussionsupporting

confidence: 88%

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

Eliassen

Hjetland

Reiso³

et al. 2017

Scandinavian Journal of Primary Health Care

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“…More severe disease at onset in the form of a higher number of symptoms (37) and/or objective signs (such as Bell's Palsy) or symptoms (such as headache, photophobia, or neck pain) which suggest dissemination to the nervous system may be present and may increase the risk of persistent symptoms following treatment (33,38). One recent study has shown that the presence of pre-existing co-morbidities in Lyme disease was predictive of long-term symptoms and lower quality of life (39), similar to other disease settings (40,41). Delays in diagnosis and initiation of appropriate treatment, which importantly may be driven by patient health insurance status (42), have also been shown to increase risk (31,32).…”

Section: Risk Factorsmentioning

confidence: 99%

“…Currently, there are no commonly agreed-upon symptoms, laboratory, or imaging findings which are sensitive and specific to aid in the clinical evaluation of patients with persistent symptoms in Lyme disease. Therefore, the clinical diagnosis is primarily one of exclusion, and the current illness must be distinguished both from other systemic inflammatory, rheumatic, malignant and infectious conditions, as well as the effects of co-morbid or pre-existing conditions (39). This raises the possibility of anchoring bias, or the misattribution of either symptoms or positive serologies in low-endemic areas to prior Lyme disease, when in fact the symptoms are caused by a new, unrelated illness (67,68).…”

Section: Clinical Presentationsmentioning

confidence: 99%

Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease

2020

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“…Second, immunogenetic mechanisms have been proposed, but prospective observational studies on dysregulated immune responses161162163 and case-control studies on autoimmune processes164165 have been inconclusive. Third, associations of PTDLS have been described with demographic, clinical, and epidemiological patient characteristics, such as advanced age, female sex,166167 comorbidity, and duration of pre-treatment symptoms 168169. Finally, cognitive behavioral characteristics, including depression, anxiety, negative affect, and catastrophizing have been associated with the risk of developing persistent symptoms 170…”

Section: Chronic Symptoms Attributed To Lyme Borreliosismentioning

confidence: 99%

Lyme borreliosis: diagnosis and management

Kullberg

Vrijmoeth

Schoor

et al. 2020

BMJ

109

118

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Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.

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Long-term Follow-up of Patients With Lyme Disease: Longitudinal Analysis of Clinical and Quality-of-life Measures

Abstract: NCT00028080.

Cited by 46 publications

References 34 publications

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease

Lyme borreliosis: diagnosis and management

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