Risk Factors for Clinician-Diagnosed Lyme Arthritis, Facial Palsy, Carditis, and Meningitis in Patients From High-Incidence States

Abstract

BackgroundClinical features of Lyme disease (LD) range from localized skin lesions to serious disseminated disease. Information on risk factors for Lyme arthritis, facial palsy, carditis, and meningitis is limited but could facilitate disease recognition and elucidate pathophysiology.MethodsPatients from high-incidence states treated for LD during 2005–2014 were identified in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations.ResultsAmong 88022 unique patients diagnosed with LD, 5122 (5.8%) patients with 5333 codiagnoses were identified: 2440 (2.8%) arthritis, 1853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis. Patients with disseminated LD had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%) than nondisseminated LD. Greatest differential risks included arthritis in males aged 10–14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0–4.2), facial palsy (OR, 2.1; 95% CI, 1.6–2.7) and carditis (OR, 2.4; 95% CI, 1.6–3.6) in males aged 20–24 years, and meningitis in females aged 10–14 years (OR, 3.4; 95% CI, 2.1–5.5) compared to the 55–59 year referent age group. Males aged 15–29 years had the highest risk for complete heart block, a potentially fatal condition.ConclusionsThe risk and manifestations of disseminated LD vary by age and sex. Provider education regarding at-risk populations and additional investigations into pathophysiology could enhance early case recognition and improve patient management.

Military veteran residential location and risk for Lyme disease

“…When large forests become fragmented into smaller segments, the number of small vertebrates, such as the white-footed mouse (the primary reservoir for Borrellia species), increases; therefore, more hosts are available for larval tick feeding. As a result, there is a greater chance that these ticks will become carriers of B. burdorferii (62). For military personnel stationed or retired in this location, the risk of exposure to infected ticks is high since routine training drills, other occupational duties, or leisure and recreation often occur in forested areas or short grass prairies (32,34).…”

Epidemiology and cost of Lyme disease‐related hospitalizations among patients with employer‐sponsored health insurance—United States, 2005–2014

“…Symptoms of early Lyme disease typically include erythema migrans, fever, chills and headache (Hu, ; Steere, ). Untreated Lyme disease may lead to severe manifestations such as arthritis, facial palsy, meningitis or carditis (Hu, ; Kwit, Nelson, Max, & Mead, ; Steere, , ). Patients presenting with Lyme carditis often require hospitalization for cardiac monitoring; patients undergoing parenteral antibiotic therapy or those with neurologic or arthritic manifestations may also require hospitalization (Hu, ).…”

“…An estimated 300,000 cases of Lyme disease are diagnosed each year in the United States (Hinckley et al, ; Nelson et al, ). Previous analyses of claims data focused on patterns of disseminated Lyme disease manifestations and found that a higher proportion of patients with disseminated Lyme disease were male compared to patients with non‐disseminated Lyme disease (Kwit et al, ). Other findings included a higher risk of complete heart block among males 15–29 years of age and a higher risk of meningitis among females 10–14 years of age and males 20–24 years of age (Kwit et al, ).…”

“…Previous analyses of claims data focused on patterns of disseminated Lyme disease manifestations and found that a higher proportion of patients with disseminated Lyme disease were male compared to patients with non‐disseminated Lyme disease (Kwit et al, ). Other findings included a higher risk of complete heart block among males 15–29 years of age and a higher risk of meningitis among females 10–14 years of age and males 20–24 years of age (Kwit et al, ). National surveillance data collected by state and local jurisdictions and voluntarily submitted to CDC provide some information on clinical features (Schwartz, Hinckley, Mead, Hook, & Kugeler, ); however, hospitalization information is often unavailable or limited to admission and discharge dates.…”

First case report of inducible heart block in Lyme disease and an update of Lyme carditis

“…Any part of the conducting system could be affected, and conduction blocks of varying degrees (Table 1) are the most common. The incidence of LC varies from 0.2–10% in different reports [2, 17–20]. The actual incidence may be higher.…”