Long-term Assessment of Post-Treatment Symptoms in Patients With Culture-Confirmed Early Lyme Disease

Weitzner, Erica; McKenna, Donna; Nowakowski, John; Scavarda, Carol; Dornbush, Rhea L.; Bittker, Susan; Cooper, Denise R.; Nadelman, Robert B.; Visintainer, Paul; Schwartz, Ira; Wormser, Gary P.

doi:10.1093/cid/civ735

Cited by 58 publications

(46 citation statements)

References 14 publications

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“…These symptoms have been shown to continue, at least intermittently, for >10 years in some cases 157 . In an undefined minority of patients with residual subjective symptoms following treatment of Lyme borreliosis, these symptoms are functionally disabling and are referred to as post-treatment Lyme disease syndrome (PTLDS).…”

Section: Managementmentioning

confidence: 99%

“…In ~10% of patients with erythema migrans and perhaps a higher percentage of patients with Lyme neuroborreliosis 157–159 , subjective symptoms such as fatigue, cognitive complaints and musculoskeletal pain can persist for ≥6 months after antibiotic therapy. These symptoms have been shown to continue, at least intermittently, for >10 years in some cases 157 .…”

Section: Managementmentioning

confidence: 99%

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Lyme borreliosis

Steere

Strle

Wormser

et al. 2016

Nat Rev Dis Primers

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644

697

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Lyme borreliosis is a tick-borne disease that predominantly occurs in temperate regions of the northern hemisphere and is primarily caused by the bacterium Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia. Infection usually begins with an expanding skin lesion, known as erythema migrans (referred to as stage 1), which, if untreated, can be followed by early disseminated infection, particularly neurological abnormalities (stage 2), and by late infection, especially arthritis in North America or acrodermatitis chronica atrophicans in Europe (stage 3). However, the disease can present with any of these manifestations. During infection, the bacteria migrate through the host tissues, adhere to certain cells and can evade immune clearance. Yet, these organisms are eventually killed by both innate and adaptive immune responses and most inflammatory manifestations of the infection resolve. Except for patients with erythema migrans, Lyme borreliosis is diagnosed based on a characteristic clinical constellation of signs and symptoms with serological confirmation of infection. All manifestations of the infection can usually be treated with appropriate antibiotic regimens, but the disease can be followed by post-infectious sequelae in some patients. Prevention of Lyme borreliosis primarily involves the avoidance of tick bites by personal protective measures.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Lyme borreliosis

Steere

Strle

Wormser

et al. 2016

Nat Rev Dis Primers

Self Cite

644

697

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“…At the baseline visit, demographic and clinical data were collected, including data on 11 other symptoms in addition to fatigue, such as headache, joint pain, muscle pain, cognitive complaints and others, as described elsewhere [9]. Serologic testing was performed using the C6 Lyme ELISA kit (Immunetics, Inc., Boston, Massachusetts) according to the manufacturer's recommendations.…”

Section: Other Assessmentsmentioning

confidence: 99%

“…Approximately 65% of patients with erythema migrans in the United States have additional non-specific complaints such as fatigue, musculoskeletal pains, headaches, and others [4]. Fatigue is a common symptom in patients with both early and late manifestations of Lyme disease, as well as in patients with post-treatment Lyme disease symptoms (PTLDS) [4-9]. Studies of patients with PTLDS have often employed both an 11-item Fatigue Severity Scale (FSS-11) and a visual analogue scale (VAS) to quantitate the level of fatigue [6-8].…”

mentioning

confidence: 99%

Fatigue in patients with erythema migrans

Wormser

Sudhindra

Lopez

et al. 2016

Diagnostic Microbiology and Infectious Disease

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Background Fatigue is a common symptom in patients with Lyme disease. Objective The purpose of this study was to characterize fatigue in untreated adult patients presenting with erythema migrans. Selected variables were assessed to determine if any correlated with the presence or severity of fatigue. Methods Fatigue was assessed on the day of the evaluation by a visual analogue scale (VAS), over the past 14 days by the 11-item fatigue severity scale (FSS-11) and over the past 28 days based on a question from the 36-item Short Form General Health Survey version 2. Results 51 patients with erythema migrans whose mean age was 49.8 years, and 33 (64.7%) of whom were male, were evaluated in this study. The three measures of fatigue were positively correlated with one another (p ≤ 0.01). 26 (51%) had fatigue based on a VAS score above 0. 10 (19.6%) had severe fatigue based on an FSS-11 score of ≥ 4. The strongest correlate for higher fatigue scores was having a greater number of symptoms in addition to fatigue. Conclusion Based on the FSS-11 assessment tool, approximately 20% of early Lyme patients have severe fatigue. Having a high total number of symptoms was associated with both the presence and severity of fatigue. Since prior studies have demonstrated the presence of elevated levels of pro-inflammatory cytokines and other molecules in the serum of highly symptomatic patients with erythema migrans, the symptom of fatigue in early Lyme disease may be a component of what has been referred to as the acute sickness response.

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“…Lyme disease is a tick‐borne bacterial infection caused by Borrelia burgdorferi sensu lato , endemic in North America and Europe. In Lyme‐endemic areas, controversy exists regarding a post‐treatment syndrome or ‘chronic Lyme disease’ characterised in general by fatigue, cognitive disturbance and joint pain . Several trials show that protracted antibiotic therapy, even in the context of proven and successfully treated Lyme disease, does not offer benefit …”

Section: Introductionmentioning

confidence: 99%