Evaluation and 1-year follow-up of patients presenting at a Lyme borreliosis expertise centre: a prospective cohort study with validated questionnaires

Objectives To describe the course of symptoms reported by patients with symptoms attributed to Lyme borreliosis (LB) without being subsequently diagnosed with LB. Methods We performed a prospective cohort study with patients presenting at the outpatient clinic of two clinical LB centres. The primary...

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Bibliographic Details
Published in:	European journal of clinical microbiology & infectious diseases Vol. 43; no. 5; pp. 937 - 946
Main Authors:	van de Schoor, F. R., Baarsma, M. E., Gauw, S. A., Ursinus, J., Vrijmoeth, H. D., ter Hofstede, H. J. M., Tulen, A. D., Harms, M. G., Wong, A., van den Wijngaard, C. C., Joosten, L. A. B., Hovius, J. W., Kullberg, B. J.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2024 Springer Nature B.V
Subjects:	Adult Aged Arthralgia Arthralgia - epidemiology Arthralgia - etiology Arthralgia - microbiology Biomedical and Life Sciences Biomedicine Borreliosis Cognitive ability Cognitive Dysfunction - epidemiology Cognitive Dysfunction - etiology Cohort analysis Fatigue Fatigue - epidemiology Fatigue - etiology Female Follow-Up Studies Humans Impairment Internal Medicine Lyme Disease - diagnosis Lyme Disease - epidemiology Male Medical Microbiology Middle Aged Myalgia Original Original Article Pain Pain - epidemiology Pain - etiology Patients Prevalence Prospective Studies Surveys and Questionnaires Young Adult Lyme disease Borreliosis PTLDS Erythema migrans PTLBS Borrelia
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Summary:	Objectives To describe the course of symptoms reported by patients with symptoms attributed to Lyme borreliosis (LB) without being subsequently diagnosed with LB. Methods We performed a prospective cohort study with patients presenting at the outpatient clinic of two clinical LB centres. The primary outcome was the prevalence of persistent symptoms, which were defined as clinically relevant fatigue (CIS, subscale fatigue), pain (SF-36, subscale bodily pain), and cognitive impairment (CFQ) for ≥ 6 months and onset < 6 months over the first year of follow-up. Outcomes were compared with a longitudinal cohort of confirmed LB patients and a general population cohort. Prevalences were standardised to the distribution of pre-defined confounders in the confirmed LB cohort. Results Participants ( n = 123) reported mostly fatigue, arthralgia, myalgia, and paraesthesia as symptoms. The primary outcome could be determined for 74.8% (92/123) of participants. The standardised prevalence of persistent symptoms in our participants was 58.6%, which was higher than in patients with confirmed LB at baseline (27.2%, p < 0.0001) and the population cohort (21.2%, p < 0.0001). Participants reported overall improvement of fatigue ( p < 0.0001) and pain ( p < 0.0001) but not for cognitive impairment ( p = 0.062) during the follow-up, though symptom severity at the end of follow-up remained greater compared to confirmed LB patients (various comparisons p < 0.05). Conclusion Patients with symptoms attributed to LB who present at clinical LB centres without physician-confirmed LB more often report persistent symptoms and report more severe symptoms compared to confirmed LB patients and a population cohort.
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ISSN:	0934-9723 1435-4373
DOI:	10.1007/s10096-024-04770-6