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Probable late lyme disease: a variant manifestation of untreated Borrelia burgdorferi infection.

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Lyme disease, a bacterial infection with the tick-borne spirochete Borrelia burgdorferi, can cause early and late manifestations. The category of probable
Lyme disease was recently added to the CDC surveillance case definition to describe patients with serologic evidence of exposure and physician-diagnosed
disease in the absence of objective signs. We present a retrospective case series of 13 untreated patients with persistent symptoms of greater than 12 weeks duration who meet these criteria and suggest a label of ‘probable late
Lyme disease‘ for this presentation.


The sample for this analysis draws from a retrospective chart review of consecutive, adult patients presenting between August 2002 and August 2007 to the author (JA), an infectious
disease specialist. Patients were included in the analysis if their current illness had lasted greater than or equal to 12 weeks duration at the time of evaluation.


Probable late
Lyme patients with positive IgG serology but no history of previous physician-documented
Lyme disease or appropriate
Lyme treatment were found to represent 6% of our heterogeneous sample presenting with ? 12 weeks of symptom duration. Patients experienced a range of symptoms including fatigue, widespread pain, and cognitive complaints. Approximately one-third of this subset reported a patient-observed rash at illness onset, with a similar proportion having been exposed to non-recommended antibiotics or glucocorticosteroid treatment for their initial
disease. A clinically significant response to antibiotics treatment was noted in the majority of patients with probable late
Lyme disease, although post-treatment symptom recurrence was common.


We suggest that patients with probable late
Lyme disease share features with both confirmed late
Lyme disease and post-treatment
Lyme disease syndrome. Physicians should consider the recent inclusion of probable
Lyme disease in the CDC
Lyme disease surveillance criteria when evaluating patients, especially in patients with a history suggestive of misdiagnosed or inadequately treated early
Lyme disease. Further studies are warranted to delineate later manifestations of
Lyme disease and to quantify treatment benefit in this population.

BMC Infect Dis. 2012 Aug 1;12:173. Research Support, Non-U.S. Gov’t

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