Lyme disease: an infectious and postinfectious syndrome.

 J Rheumatol. 1994 Mar;21,3:454-61. Lyme disease: an infectious and postinfectious
syndrome.Asch ES, Bujak DI, Weiss M, Peterson MG, Weinstein A.
Department of Medicine, New York Medical College, Valhalla 10595.
OBJECTIVE. To determine chronic morbidity and the variables that influence recovery in
patients who had been treated for Lyme disease. METHODS. Retrospective evaluation of 215
patients from Westchester County, NY, who fulfilled Centers for Disease Control case definition
33for Lyme disease, were anti-Borrelia antibody positive and were diagnosed and treated at least
one year before our examination. RESULTS. Erythema migrans had occurred in 70% of patients,
neurological involvement in 29%, objective cardiac problems in 6%, arthralgia in 78% and
arthritis in 41%. Patients were seen at a mean of 3.2 years after initial treatment. A history of
relapse with major organ involvement had occurred in 28% and a history of reinfection in 18%.
Anti-Borrelia antibodies, initially present in all patients, were still positive in 32%. At followup,
82, 38%, patients were asymptomatic and clinically active Lyme disease was found in 19, 9%.
Persistent symptoms of arthralgia, arthritis, cardiac or neurologic involvement with or
without fatigue were present in 114, 53%, patients. Persistent symptoms correlated with a
history of major organ involvement or relapse but not the continued presence of
anti-Borrelial antibodies. Thirty-five of the 114, 31%, patients with persistent symptoms had
predomina ntly arthralgia and fatigue. Antibiotic treatment within 4 weeks of disease onset was
more likely to result in complete recovery. Children did not significantly differ from adults in
disease manifestations or in the frequency of relapse, reinfection or complete recovery.
CONCLUSION. Despite recognition and treatment, Lyme disease is associated with significant
infectious and postinfectious sequelae




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