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

Published Date
Journal
Annals of Internal Medicine
Citation
Ann Intern Med. 1994 Oct 15;121(8):560-7
DOI
10.7326/0003-4819-121-8-199410150-00002
Authors
Shadick NA
Phillips CB
Logigian EL
Steere AC
Kaplan RF
Berardi VP
Duray PH
Larson MG
Wright EA
Ginsburg KS
Katz JN
Liang MH
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.