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The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study.

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Abstract

OBJECTIVE:

To ascertain the prevalence of and risk factors for long-term sequelae from acute
Lyme disease.

DESIGN:

Population-based, retrospective cohort study.

SETTING:

A coastal region endemic for
Lyme disease.

PARTICIPANTS:

Patients with a history of
Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.

MEASUREMENTS:

A standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.

RESULTS:

Compared with the control group (n = 43), the
Lyme group (n = 38; mean duration from
disease onset to study evaluation, 6.2 years) had more arthralgias (61% compared with 16%; P < 0.0001); distal paresthesias (16% compared with 2%; P = 0.03); concentration difficulties (16% compared with 2%; P = 0.03); and fatigue (26% compared with 9%; P = 0.04), and they had poorer global health status scores (P = 0.04). The
Lyme group also had more abnormal joints (P = 0.02) and more verbal memory deficits (P = 0.01) than did the control group. Overall, 13 patients (34%; 95% CI, 19% to 49%) had long-term sequelae from
Lyme disease (arthritis or recurrent arthralgias [n = 6], neurocognitive impairment [n = 4], and neuropathy or myelopathy [n = 3]). Compared with controls, patients who had long-term sequelae had higher IgG antibody titers to the spirochete (P = 0.03) and received treatment later (34.5 months compared with 2.7 months; P < 0.0001).

CONCLUSIONS:

Persons with a history of
Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal memory impairment when compared with those without a history of
Lyme disease. Our findings suggest that disseminated
Lyme disease may be associated with long-term morbidity.

Ann Intern Med. 1994 Oct 15;121(8):560-7. Research Support, Non-U.S. Gov’t; Research Support, U.S. Gov’t, P.H.S.

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