Abstract
Many late-stage chronic Lyme disease clinical findings are neuropsychiatric. A total clinical assessment is critical in diagnosis, especially since controversy surrounds the reliability of laboratory testing. The clinical findings of one hundred Lyme disease patients with chronic neuropsychiatric symptoms were entered into a database. The prevalence of each clinical finding pre-infection and post-infection was compared and calculated within the 95% confidence interval. Patients had minimal symptoms pre-infection, but a high post-infection prevalence of a broad spectrum of acquired multisystem symptoms. These findings included impairments of attention span, memory, processing, executive functioning, emotional functioning, behavior, psychiatric syndromes, vegetative functioning, neurological, musculoskeletal, cardiovascular, upper respiratory, dental, pulmonary, gastrointestinal, genitourinary, and other symptoms. The most prevalent symptoms included sustained attention impairments, brain fog, unfocused concentration, joint symptoms, distraction by frustration, depression, working memory impairments, decreased school/job performance, recent memory impairments, difficulty prioritizing multiple tasks, fatigue, non-restorative sleep, multitasking difficulties, sudden mood swings, hypersomnia, mental apathy, decreased social functioning, insomnia, tingling, word finding difficulties, name retrieval, headaches, sound hypersensitivity, paresis, anhedonia, depersonalization, cold intolerance, body temperature fluctuations, light sensitivity and dysfluent speech. The average patient had five symptoms pre-infection and 82 post-infection. Pattern recognition is critical in making a diagnosis. This study was used to develop three clinical assessment forms.
Highlights
Called Lyme disease, is a tick-borne disease caused by an infection with
Borrelia burgdorferi sensu lato complex, a spirochete that is more complex and more difficult to treat than syphilis [1,2]
The objective of this study is to describe the clinical presentation of Lyme borreliosis patients with chronic, late-stage, psychiatric symptoms from a retrospective review of 100 charts, and to develop a clinical assessment system from these findings
Summary
Other tick-borne diseases and opportunistic infections may accompany the Borrelia infection and contribute to a complex interactive infectious process [3]. It has been called by many different names throughout the past 100 years including acrodermatitis chronicum atrophicans in Europe for a characteristic late-stage rash. A large number of symptoms associated with Lyme disease have been documented, there is wide variability of specific symptoms present in a given patient. This makes it difficult to establish clearly defined diagnostic criteria, especially for late-stage disease. A number of definitions for the late-stage, chronic, manifestations have been proposed [4,5,6]
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