OBJECTIVE To investigate the potential differences in clinical course and treatment outcome between multiple erythema migrans (MEM) and solitary erythema migrans (EM). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted from June 1, 2010, to October 31, 2015, at the University Medical Center Ljubljana, Slovenia. Of the 778 consecutive adult patients with early Lyme borreliosis (LB) evaluated, 200 patients with MEM and 403 patients with solitary EM were enrolled. Patients were asked to refer a family member or a friend of similar age (±5 years) without a history of LB to serve as a control participant. Clinical course and posttreatment outcome of MEM were compared with those of solitary EM. Outcome was assessed at 14 days and at 2, 6, and 12 months after enrollment. At each visit, patients completed a written questionnaire about their symptoms; controls completed the same questionnaire. Nonspecific symptoms reported by patients and controls without a history of Lyme borreliosis were compared. MAIN OUTCOMES AND MEASURES The proportion of patients with incomplete response at 12 months after enrollment and the associated 2-sided 95%CI for the difference between MEM and solitary EM were estimated using the normal approximation with continuity correction. RESULTS A total of 200 patients with MEM and 403 patients with solitary EM were included. Patients with MEM reported LB–associated constitutional symptoms at enrollment more often than those with solitary EM (93 [46.5%]; 95%CI, 39.4-53.7 vs 96 [23.8%]; 95%CI, 19.7-28.3; P(.001). During the initial 6 months after treatment, the proportion of patients with incomplete response was higher in the MEM group than in the solitary EM group (14 days: 62/193 [32.1%] vs 72/391 [18.4%]; P(.001; 2 months: 38/193 [19.7%] vs 55/394 [14.0%]; P=.28; 6 months: 29/182 [15.9%] vs 31/359 [8.6%]; P=.02). However, at the 12-month visit, the outcome was comparable: 10/ 170 (5.9%) patients with MEM vs 20/308 (6.5%) patients with solitary EM showed incomplete response (-0.6; 95%CI, –5.5 to 4.3; P=.95). The frequency of nonspecific symptoms in patients was similar to that in controls. CONCLUSIONS AND RELEVANCE The long-term outcome at 12 months after treatment was comparable, regardless of dissemination. Follow-up of at least 12 months after treatment is thus recommended for future studies that investigate post–LB symptoms.
COBISS.SI-ID: 5060780
Background. Information on the course and outcome of early European Lyme neuroborreliosis is limited. Methods. The study comprised 77 patients (38 males, 39 females; median age 58 years) diagnosed with painful meningoradiculitis (Bannwarth’s syndrome) who were followed-up for one year at a single center. Results. Duration of neurological symptoms before diagnosis was 30 (IQR 14–50) days. The most frequent symptoms/signs were radicular pain (100%), sleep disturbances (75.3%), erythema migrans (59.7%), headache (46.8%), fatigue (44.2%), malaise (39%), paresthesias (32.5%), peripheral facial palsy (36.4%), meningeal signs (19.5%), and pareses (7.8%). Cerebrospinal fluid (CSF) analysis revealed lymphocytic/monocytic pleocytosis, elevated protein concentration, and intrathecal synthesis of borrelial IgM and IgG antibody in 100%, 81.1%, 63%, and 88.7% of patients, respectively. Borreliae (predominantly Borrelia garinii) were isolated from CSF, skin, and blood in 15.6%, 40.6%, and 2.7% of patients, respectively. The outcome after 14-day treatment with ceftriaxone was favorable in 87.8% of patients. Control CSF examination at three months showed decreased leukocyte counts in all patients; however, 23.3% still had pleocytosis ()10x106 cells/L). A model based on pretreatment data and the findings at the end of 14-day antibiotic treatment accurately predicted which patients would have an unfavorable outcome 6 or 12 months after treatment. Conclusions. Our patients had fewer pretreatment neurological complications (peripheral facial palsy, pareses) than reported for Bannwarth’s syndrome decades ago, probably as the result of earlier recognition and prompt antibiotic treatment. Unfavorable outcome was rare and was predicted by the continued presence of symptoms 14 days after commencement of treatment.
COBISS.SI-ID: 32671193
Lyme borreliosis is caused by certain genospecies of the Borrelia burgdorferi sensu lato complex, which are transmitted by hard ticks of the genus Ixodes. The most common clinical manifestation is erythema migrans, an expanding skin redness that usually develops at the site of a tick bite and eventually resolves even without antibiotic treatment. The infecting pathogens can spread to other tissues and organs, resulting in manifestations that can involve the nervous system, joints, heart and skin. Fatal outcome is extremely rare and is due to severe heart involvement; fetal involvement is not reliably ascertained. Laboratory support— mainly by serology—is essential for diagnosis, except in the case of typical erythema migrans. Treatment is usually with antibiotics for 2 to 4 weeks; most patients recover uneventfully. There is no convincing evidence for antibiotic treatment longer than 4 weeks and there is no reliable evidence for survival of borreliae in adequately treated patients. European Lyme borreliosis is a frequent disease with increasing incidence. However, numerous scientifically questionable ideas on its clinical presentation, diagnosis and treatment may confuse physicians and lay people. Since diagnosis of Lyme borreliosis should be based on appropriate clinical signs, solid knowledge of clinical manifestations is essential.
COBISS.SI-ID: 4721580