Abstract
Introduction. Because patients with a suspicion of Lyme borreliosis (LB) may have experienced difficult care paths, the Tick-Borne Diseases Reference Center (TBD-RC) was started in 2017. The aim of our study was to compare the clinical features of patients according to their final diagnoses, and to determine the factors associated with recovery in the context of multidisciplinary management for suspected LB. Methods. We included all adult patients who were seen at the TBD-RC (2017–2020). Four groups were defined: (i) confirmed LB, (ii) possible LB, (iii) Post-Treatment Lyme Disease Syndrome (PTLDS) or sequelae, and (iv) other diagnoses. Their clinical evolution at 3, 6, and 9–12 months after care was compared. Factors associated with recovery at 3 and at 9–12 months were identified using logistic regression models. Results. Among the 569 patients who consulted, 72 (12.6%) had confirmed LB, 43 (7.6%) possible LB, 58 (10.2%) PTLDS/sequelae, and 396 (69.2%) another diagnosis. A favorable evolution was observed in 389/569 (68.4%) at three months and in 459/569 (80.7%) at 12 months, independent of the final diagnosis. A longer delay between the first symptoms and the first consultation at the TBD-RC (p = 0.001), the multiplicity of the diagnoses (p = 0.004), and the inappropriate prescription of long-term antibiotic therapy (p = 0.023) were negatively associated with recovery, reflecting serial misdiagnoses. Conclusions. A multidisciplinary team dedicated to suspicion of LB may achieve a more precise diagnosis and better patient-centered medical support in the adapted clinical sector with a shorter delay, enabling clinical improvement and avoiding inappropriate antimicrobial prescription.
Highlights
Lyme borreliosis (LB) is the most common tick-borne disease in Europe and the USA, caused by spirochetes of the Borrelia burgdorferi sensu lato complex [1,2]
The aim of our study was to compare the clinical features of patients attending the Tick-Borne Diseases Reference Center (TBD-RC) according to their diagnosis (LB or not), to describe their care paths and outcomes, and to determine the factors associated with recovery in the context of multidisciplinary management for suspected LB
Other diagnoses associated with confirmed LB were found in 36/72 (50%), with possible LB in 30/43 (69.8%), and with post-treatment Lyme disease syndrome (PTLDS)/sequelae in 34/58 (58.6%)
Summary
Lyme borreliosis (LB) is the most common tick-borne disease in Europe and the USA, caused by spirochetes of the Borrelia burgdorferi sensu lato complex [1,2]. Clinical diagnosis of LB may be difficult because of its wide range of clinical pictures, sometimes resembling other pathologies (rheumatological diseases, auto-immune diseases, neurological disorders etc.) The most frequent clinical manifestations in Europe are erythema migrans (EM) and Lyme neuroborreliosis (LNB) [5]. Some functional symptoms may be present at all stages, which can further complicate the diagnosis [6,7]. Such symptoms may persist after a well-conducted treatment following the guidelines [post-treatment Lyme disease syndrome (PTLDS)] [5,6,8]. Rare sequelae causing definitive impairment may occur [5,6,9]. Rare coinfections with LB, transmitted by a tick-bite, are described [10,11]
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