Prevalence of persistent symptoms after treatment for lyme borreliosis: A prospective observational cohort study.

BACKGROUND

Concerns about long-lasting symptoms attributed to Lyme borreliosis (LB) are widespread in the Western world, while such symptoms are highly prevalent in the general population.

METHODS

In the largest prospective study to date, adults with physician-confirmed LB were included at the start of antibiotic treatment. Primary outcomes, prevalence of persistent symptoms and symptom severity, were assessed using three-monthly standardised questionnaires during one year. Persistent symptoms were defined as impaired scores for fatigue (CIS, subscale fatigue), cognitive impairment (CFQ) or pain (SF-36, subscale bodily pain) ≥6 months, with onset <6 months. Outcomes were compared with a longitudinal general population and a tick-bite cohort without LB as a reference.

FINDINGS

Of 1135 LB patients (94•8% erythema migrans, 5•2% disseminated LB), 1084 fulfilled primary analysis criteria, as well as 1942 population and 1887 tick-bite controls. Overall prevalence of persistent symptoms in LB patients was 27•2% (95%CI, 24•7%-29•7%); 6•0% and 3•9% higher than in population (21•2%, 95%CI, 19•3%-23•1%;

INTERPRETATION

In treated LB patients, persistent symptoms were significantly more prevalent and symptoms were more severe than in individuals without LB, although the background prevalence was substantial. This suggests an association, either direct or indirect, between persistent symptoms and LB in a relatively small subset of patients.

FUNDING

ZonMw; Dutch Ministry of Health, Welfare and Sport.

Informations de copyright

© 2021 The Authors.

Déclaration de conflit d'intérêts

All authors have completed the ICMJE uniform disclosure form and declare: JWH, LABJ, and CCvdW report grants from the Netherlands Organization for Health Research and Development (ZonMw), and the Dutch Ministry of Health, Welfare and Sport (VWS); LABJ has a patent on Lyme diagnosis issued; JWH was supported by the European Union's regional development fund (INTERREG) as part of the NorthTick project; all other authors have no conflicts to declare.