Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study

Abstract

ObjectivesTo identify underlying subgroups with distinct symptom profiles, and to characterise and compare these subgroups across a range of demographic, clinical and psychosocial factors, within a heterogeneous group of patients with well-defined post-treatment Lyme disease (PTLD).DesignA clinical case series of patents.SettingParticipants were recruited from a single-site, Lyme disease referral clinic patient population and were evaluated by physical exam, clinical laboratory testing and standardised questionnaires.ParticipantsTwo hundred and twelve participants met study criteria for PTLD, with medical record-confirmed prior Lyme disease as well as current symptoms and functional impact.ResultsExploratory factor analysis classified 30 self-reported symptoms into 6 factors: ‘Fatigue Cognitive’, ‘Ocular Disequilibrium’, ‘Infection-Type’, ‘Mood-Related’, ‘Musculoskeletal Pain’ and ‘Neurologic’. A final latent profile analysis was conducted using ‘Fatigue Cognitive’, ‘Musculoskeletal Pain’ and ‘Mood-Related’ factor-based scores, which produced three emergent symptom profiles, and participants were classified into corresponding subgroups with 59.0%, 18.9% and 22.2% of the sample, respectively. Compared with the other two groups, subgroup 1 had similarly low levels across all factors relative to the sample as a whole, and reported lower rates of disability (1.6% vs 10.0%, 12.8%; q=0.126, 0.035) and higher self-efficacy (median: 7.5 vs 6.0, 5.3; q=0.068,<0.001). Subgroup 2 had the highest ‘Musculoskeletal Pain’ factor-based scores (q≤0.001). Subgroup 3 was characterised overall by higher symptom factor-based scores, and reported higher depression (q≤0.001).ConclusionsThis analysis identified six symptom factors and three potentially clinically relevant subgroups among patients with well-characterised PTLD. We found that these subgroups were differentiated not only by symptom phenotype, but also by a range of other factors. This may serve as an initial step towards engaging with the symptom heterogeneity that has long been observed among patients with this condition.

A multimodal neuroimaging study of brain abnormalities and clinical correlates in post treatment Lyme disease

“…Participants were asked to complete a self-administered 36-item post-Lyme questionnaire of symptoms (PLQS) which was developed based on prior clinical and research experience among patients with PTLD. The list of individual symptom items has been previously published [ 22 ]. For each item, participants indicated severity over the past 2 weeks (0 = absent, 1 = mild, 2 = moderate, 3 = severe), and a binary response was created (absent/mild = 0 vs. moderate/severe = 1).…”

Lyme Borreliosis as a Trigger for Autoimmune Disease

“…Although spirochetal infection itself may be a trigger, disruptions in the microbiome resulting from antibiotic treatment of B. burgdorferi infection may also be an underlying mechanism [ 20 ]. There is evidence in a person with a genetic predisposition to autoimmune diseases (such as SLE or rheumatoid arthritis), infection with B. burgdorferi can trigger their development [ 21 ]. Further research on HLA-DR and dendritic cell response to B. burgdorferi may help develop new treatments for LD and contribute to a better understanding of the mechanism of causation of autoimmune diseases.…”

Recent Progress in Lyme Disease and Remaining Challenges

“…These studies provide evidence that PTLD is an infection-associated condition with a distinct biology. Here and throughout, we adopt the terminology PTLD, as previously proposed (44,118), to describe this condition.…”