Risk of post-treatment Lyme disease in patients with ideally-treated early Lyme disease: A prospective cohort study.

Debra Powell,Alison W Rebman,John N Aucott,Steven A Geller,Ting Yang,Isaac Yoon

doi:10.1016/j.ijid.2022.01.033

Abstract

PurposePost-treatment Lyme disease (PTLD) is characterized by patient-reported symptoms after treatment for Borrelia burgdorferi infection. The primary aim of this study was to assess whether participants with a history of Lyme disease (LD) would be more likely to meet criteria for PTLD than those without a history of LD. MethodsWe conducted a longitudinal, prospective study among 234 participants with and 49 participants without prior LD. All completed survey metrics for fatigue, pain, sleep, depression, and quality of life. An operationalized PTLD definition was applied to both cohorts, and the distributions of clinical outcomes and symptoms were examined. ResultsIn total, 13·7% of participants with a history of prior LD met criteria for PTLD compared with 4·1% of those without a history of prior LD. Participants with prior LD were approximately 5·28 times as likely to meet PTLD criteria compared with those without prior LD (p = 0·042) and had 8-15 times as high odds of reporting moderate or severe fatigue and muscle pain (p = 0·002, 0·047, respectively). Risk of meeting PTLD criteria was also independently increased among females and those with higher exposure to previous traumatic life events. ConclusionParticipants ideally diagnosed and treated for prior LD reported more symptoms on standardized surveys and were more likely to meet criteria for PTLD than those without prior LD.

Highlights

Lyme disease (LD) is a vector-borne disease caused by various genospecies of the spirochetal bacteria Borrelia burgdorferi sensu lato (Steere et al, 2016)
A total of 293 participants with and 54 without prior LD were enrolled in the study
None were statistically significant by group, participants with prior LD reported a higher percentage of heart disease/hypertension

Summary

Introduction

Lyme disease (LD) is a vector-borne disease caused by various genospecies of the spirochetal bacteria Borrelia burgdorferi sensu lato (Steere et al, 2016). Even fewer prospective cohort studies have included controls unexposed to LD so as to compare symptom prevalence to previously uninfected populations In both our prior work (Bechtold et al, 2017) and in a recent publication by Wormser et al, (Wormser et al, 2020) overall symptom reporting among patients as a whole months to years following treatment for early LD did not differ from unexposed controls. In both studies, a patient subset could be identified as having post-treatment Lyme disease (PTLD), either through standardized symptom surveys (Bechtold et al, 2017) or medical record review by a clinician (Wormser et al, 2020). A recent European study of PTLD showed that in well-defined treated LD patients, persistent symptoms were significantly more prevalent and severe than in patients without LD (Ursinus et al, 2021)

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