Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis (original) (raw)
Related papers
BMC Infectious Diseases, 2019
Background: After antibiotic treatment of Lyme borreliosis, a subset of patients report persistent symptoms, also referred to as post-treatment Lyme disease syndrome. The reported prevalence of persistent symptoms varies considerably, and its pathophysiology is under debate. The LymeProspect study has been designed to investigate the prevalence, severity, and a wide range of hypotheses on the etiology of persistent symptoms among patients treated for Lyme borreliosis in the Netherlands. Methods: LymeProspect is a prospective, observational cohort study among adults with proven or probable Lyme borreliosis, either erythema migrans or disseminated manifestations, included at the start of antibiotic treatment. During one year of follow-up, participants are subjected to questionnaires every three months and blood is collected repeatedly during the first three months. The primary outcome is the prevalence of persistent symptoms after treatment, assessed by questionnaires online focusing on fatigue (CIS, subscale fatigue severity), pain (SF-36, subscale pain) and neurocognitive dysfunction (CFQ). Potential microbiological, immunological, genetic, epidemiological and cognitive-behavioral determinants for persistent symptoms are secondary outcome measures. Control cohorts include patients with long-lasting symptoms and unconfirmed Lyme disease, population controls, and subjects having reported a tick bite not followed by Lyme borreliosis.
Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms
International Journal of Epidemiology, 2005
This meta-analysis compares the prevalence of fatigue, musculoskeletal pain, and neurocognitive difficulties in patients who have had Lyme borreliosis (LB) and control subjects without LB. Titles and abstracts in PubMed were reviewed for studies with data on the symptoms listed above that compared patients who had had LB with controls from the general population. Five studies with 504 patients and 530 controls were included in the meta-analysis. The prevalence of symptoms was significantly higher in the LB patients, with P-values between <0.00001 and 0.007 for 8 of the 10 symptoms in the three categories listed above. The higher prevalence of certain neurocognitive symptoms but not others, in the same pattern as reported in the literature, is further confirmation of this syndrome. The pattern of symptoms appears to be different from that seen in fibromyalgia, depression, and chronic fatigue syndrome. This meta-analysis provides strong evidence that some patients with LB have fatigue, musculoskeletal pain, and neurocognitive difficulties that may last for years despite antibiotic treatment.
Response to meta-analysis of Lyme borreliosis symptoms
International Journal of Epidemiology, 2005
Although some Lyme disease patients treated with recommended antibiotic regimens have symptoms post-treatment, the usual course is a slow resolution of these symptoms. 1-3 Subjective symptoms, i.e. fatigue as well as musculoskeletal pain, and certain objective extracutaneous signs, i.e. motor paresis, cognitive difficulties, or joint swelling, tend to resolve over the course of weeks to months rather than days. However, whenever studied, the rate of resolution of symptoms or signs is unrelated to the duration of treatment. 1,2 Cairns and Godwin 4 in their meta-analysis of five selected United States studies 5-9 on the outcome of Lyme borreliosis concluded that the prevalence of the symptoms of persistent fatigue, musculoskeletal pains or neurocognitive difficulties (post-Lyme disease syndrome, chronic post-treatment Lyme disease, or chronic Lyme disease) exceeds that of comparison populations without Lyme disease by >5%. Based on these findings, a conservative estimate of the incidence of this syndrome in the United States would be at least 3000 cases per year (>20 000 reported cases •3; to include unreported cases, •0.05). 10,11 Given the chronic nature of the process, the prevalence of cases should be many times higher. Furthermore, post-Lyme disease symptoms are occurring on a high background rate of indistinguishable symptoms in the general population. Based on the studies cited in the meta-analysis, the frequency of musculoskeletal symptoms alone among the control groups of adults was 25.8%. Thus, more than 30% of adults after treatment for Lyme disease (25.8% 1 .5%) could be regarded as having post-Lyme disease syndrome. This prompts one to wonder why so many difficulties were encountered in enrolling patients in four different controlled treatment trials of Lyme disease patients with post-treatment symptoms. 12-14 Three of the four studies never met their enrollment goals, and the only study 13 to meet its enrollment objective of 55 patients included several patients, that, in retrospect, failed to satisfy entry criteria. Taken together, all four studies managed to recruit ,200 patients during an enrolment period of several years. The findings of this meta-analysis 4 are uninformative and misleading, since the studies upon which it was based have substantive limitations including retrospective study design, lack of timely antimicrobial therapy (or in some instances no treatment at all), use of antimicrobial regimens no longer recommended, 15 lack of 2-stage conditional serologic testing to establish the original diagnosis of Lyme disease, 16 a distorted case
BMC Infectious Diseases, 2022
Background: Patients with Lyme borreliosis (LB) may report persisting non-specific symptoms such as fatigue, widespread musculoskeletal pain or cognitive difficulties. When present for more than 6 months and causing a reduction in daily activities, this is often referred to as post-treatment Lyme disease syndrome (PTLDS). This study aimed to compare the occurrence of symptoms between LB patients and controls, to estimate the proportion of LB patients developing PTLDS and to identify risk factors. Methods: A prospective cohort study was set up including three subpopulations: patients with an erythema migrans (EM) (i) or disseminated/late LB (ii) and a non-LB control group (iii). At 6-and 12-months follow-up, the occurrence of several symptoms, including six symptoms used to define PTLDS, i.e. muscle pain, joint pain, fatigue, memory problems, difficulties concentrating and problems finding words, and impact on daily activities, was compared between LB patients and controls. Finally, the proportion of LB patients developing PTLDS as defined by the Infectious Disease Society of America was estimated, including a time frame for symptoms to be present. Results: Although the risk of presenting PTLDS-related symptoms was significantly higher in EM patients (n = 120) compared to controls (n = 128) at 6 months follow-up, the risk of presenting at least one of these symptoms combined with impact on daily activities was not significantly higher in EM patients, at either 6-or 12-months follow-up. A significant association was found between disseminated/late LB (n = 15) and the occurrence of any PTLDS-symptom with an impact on daily activities at both time points. The proportion of patients with PTLDS was estimated at 5.9% (95% CI 2.7-12.9) in EM patients and 20.9% (95% CI 6.8-64.4) in patients with disseminated/late LB (RR = 3.53, 95% CI 0.98-12.68, p = 0.053). No significant risk factors were identified, which may be explained by small sample sizes. Conclusions: In our study, PTLDS was present in both LB cohorts, yet with a higher percentage in disseminated/late LB patients. Additional research is needed into risk factors for and causes of this syndrome. In addition, development
Healthcare
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, b...
Estimation of cognitive and affective disorders occurrence in patients with lyme borreliosis
Annals of Agricultural and Environmental Medicine, 2016
Introduction and objective. Lyme borreliosis (LB) is a disease caused by the bacteria Borrelia burgdorferi. The most common symptoms are related to the skin, musculo-scelatal system, central and peripheral nervous system, rarely to the heart muscle and the eye, and may occur in the multistage course of the disease. LB may additionally be accompanied by psychopathological symptoms. The aim of the study is estimation of the cognitive and affective disorders occurence in patients with LB. Material and methods. The study was carried out in the group of 121 patients (61 females, 60 males) aged 18-65; mean age 46 years. All patients were diagnosed with late-stage of LB: 46 patients (38%) with Lyme arthritis and 75 patients (62%) with neuroborreliosis. Evaluation of the cognitive and affective functioning of patients was performed on the basis of a standardized interview and test methods: the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT) and the Beck Depression Inventory (BDI). Results. Cognitive disorders occurred statistically significantly more often in patients with neuroborreliosis (14.7%) than in patients with Lyme arthritis (4.3%). A group of females with neuroborreliosis and a group of males with the same diagnosis demonstrated cognitive deficits significantly more often (23.3% and 8.9%, respectively), compared to groups of patients with Lyme arthritis (6.5% in females and no cognitive deficits in males). A significantly higher percentage of depressive disorders was also noted in the group of males and females with neuroborreliosis (50.7%), compared to the group of patients with Lyme arthritis (39.1%). The symptoms of depression were particularly frequent in the females with neuroborreliosis (60%). The severity of depression measured by BDI was mild or moderate in most cases. In the examined groups, more patients with neuroborreliosis (44%), both in females (36.7%) and males (48.9%), demonstrated anxiety disorders. The obtained results showed a higher frequency of affective disorders compared to cognitive deficits, both in patients with Lyme arthritis and neuroborreliosis. Conclusions. An increased frequency of depressive and neurotic disorders was observed in patients with LB, particularly in patients with neuroborreliosis. Neurotic disorders, mainly adaptive, were most common in males with LB, while depressive disorders were more frequent in females. An increased frequency of cognitive deficits was observed in patients with neuroborreliosis, particularly in females.
Neuropsychiatric and Psychological Symptoms in Patients with Lyme Disease: A Study of 252 Patients
Healthcare
This study examined the relationship between neuropsychiatric and psychological symptoms in patients with Lyme borreliosis. We collected data from an experimental group of 252 Lyme disease patients and a control group of 267 healthy individuals. The quality of life and sleep, attention and memory performance were assessed in both groups. Additionally, we investigated depressive symptoms in patients with Lyme disease to examine whether the duration of the disease had an influence on the severity of symptoms shown. Furthermore, various data on the diagnostics and treatment carried out in the patient group were recorded. On average, patients visited almost eight physicians to obtain a diagnosis, and eight years passed between the tick bite and diagnosis (SD ± 7.8); less than half of the sample (46%) received their diagnosis within the first five years after the development of symptoms. It became clear that Lyme disease is often diagnosed very late. It appears that people suffering from...
Healthcare
There is increasing evidence and recognition that Lyme borreliosis (LB) causes mental symptoms. This article draws from databases, search engines and clinical experience to review current information on LB. LB causes immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity which may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a thorough history, comprehensive psychiatric clinical exam, review of systems, m...
The neuropsychiatric manifestations of Lyme borreliosis
Psychiatric Quarterly, 1992
Lyme borreliosis (Lyme disease), a tick-borne spirochetal illness, has multi-systemic involvement and is rapidly increasing in certain areas of the United States. Although its neurologic manifestations are becoming increasingly well recognized, its psychiatric presentations are not well known. The first section of this paper will provide an overview of Lyme borreliosis and a review of the relevant neuropsychiatric literature. The second section will provide clinical descriptions of some common neuropsychiatric symptoms as well as a discussion of the problems typically faced by patients with this illness. Guidelines to assist the clinician in working with these patients will be presented.
Post-treatment Lyme disease symptoms score: Developing a new tool for research
PLOS ONE, 2019
Some patients have residual non-specific symptoms after therapy for Lyme disease, referred to as post-treatment Lyme disease symptoms or syndrome, depending on whether there is functional impairment. A standardized test battery was used to characterize a diverse group of Lyme disease patients with and without residual symptoms. There was a strong correlation between sleep disturbance and certain other symptoms such as fatigue, pain, anxiety, and cognitive complaints. Results were subjected to a Logistic Regression model using the Neuro-QoL Fatigue t-score together with Short Form-36 Physical Functioning scale and Mental Health component scores; and to a Decision Tree model using only the QoL Fatigue t-score. The Logistic Regression model had an accuracy of 97% and Decision Tree model had an accuracy of 93%, when compared with clinical categorization. The Logistic Regression and Decision Tree models were then applied to a separate cohort. Both models performed with high sensitivity (90%), but moderate specificity (62%). The overall accuracy was 74%. Agreement between 2 time points, separated by a mean of 4 months, was 89% using the Decision Tree model and 87% with the Logistic Regression model. These models are simple and can help to quantitate the level of symptom severity in posttreatment Lyme disease symptoms. More research is needed to increase the specificity of the models, exploring additional approaches that could potentially strengthen an operational definition for post-treatment Lyme disease symptoms. Evaluation of how sleep disturbance, fatigue, pain and cognitive complains interrelate can potentially lead to new interventions that will improve the overall health of these patients.