Abstract
Context: Persistent fatigue, pain, and neurocognitive impairment are common in individuals following treatment for Lyme borreliosis (LB). Poor sleep, depression, visual disturbance, and sensory neuropathies have also been reported. The cause of these symptoms is unclear, and widely accepted effective treatment strategies are lacking.Objectives: To identify symptom clusters in people with persistent symptoms previously treated for LB and to examine the relationship between symptom severity and perceived disability.Methods: This was a retrospective chart review of individuals with a history of treatment of LB referred to The Dean Center for Tick-Borne Illness at Spaulding Rehabilitation Hospital between 2015 and 2018 (n = 270) because of persistent symptoms. Symptoms and functional impairment were collected using the General Symptom Questionnaire-30 (GSQ-30), and the Sheehan Disability Scale. Clinical tests were conducted to evaluate for tick-borne co-infections and to rule out medical disorders that could mimic LB symptomatology. Exploratory factor analysis was performed to identify symptom clusters.Results: Five symptom clusters were identified. Each cluster was assigned a name to reflect the possible underlying etiology and was based on the majority of the symptoms in the cluster: the neuropathy symptom cluster, sleep-fatigue symptom cluster, migraine symptom cluster, cognitive symptom cluster, and mood symptom cluster. Symptom severity for each symptom cluster was positively associated with global functional impairment (p < 0.001).Conclusion: Identifying the interrelationship between symptoms in post-treatment LB in a cluster can aid in the identification of the etiological basis of these symptoms and could lead to more effective symptom management strategies.Key Message: This article describes symptom clusters in individuals with a history of Lyme borreliosis. Five clusters were identified: sleep-fatigue, neuropathy, migraine-like, cognition, and mood clusters. Identifying the interrelationship between symptoms in each of the identified clusters could aid in more effective symptom management through identifying triggering symptoms or an underlying etiology.
Highlights
Lyme borreliosis (LB) is caused by various tick-borne genospecies of the spirochete bacteria Borrelia burgdorferi sensu lato [1, 2] and is a multisystem, multi-stage disease
All patients underwent a complete blood count (CBC) and chemistry, tests of kidney, liver, thyroid function, and HgBA1c to rule out disorders that could mimic post-treatment Lyme borreliosis symptomatology
12.7% were on disability or unemployed, 8.5% were retired, 6.8% were students, 2.5% were homemakers, and 69.6% were employed
Summary
Lyme borreliosis (LB) is caused by various tick-borne genospecies of the spirochete bacteria Borrelia burgdorferi sensu lato [1, 2] and is a multisystem, multi-stage disease. If erythema migrans is absent at the onset of infection and the flu-like symptoms are presumed to be related to non-specific viral infection [9], LB can go undiagnosed and untreated for weeks, months, or even years. A subset of individuals with Lyme borreliosis go on to experience persistent or relapsing-remitting symptoms including fatigue, pain, and neurocognitive difficulties after treatment; an illness referred to as post-treatment Lyme disease syndrome (PTLDS). These chronic symptoms are of sufficient severity to impact quality of life and physical functioning [15, 19,20,21,22,23]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
