Lyme disease: an infectious and postinfectious syndrome.
OBJECTIVE
To determine chronic morbidity and the variables that influence recovery in patients who had been treated for Lyme disease.


METHODS
Retrospective evaluation of 215 patients from Westchester County, NY, who fulfilled Centers for Disease Control case definition for Lyme disease, were anti-Borrelia antibody positive and were diagnosed and treated at least one year before our examination.


RESULTS
Erythema migrans had occurred in 70% of patients, neurological involvement in 29%, objective cardiac problems in 6%, arthralgia in 78% and arthritis in 41%. Patients were seen at a mean of 3.2 years after initial treatment. A history of relapse with major organ involvement had occurred in 28% and a history of reinfection in 18%. Anti-Borrelia antibodies, initially present in all patients, were still positive in 32%. At followup, 82 (38%) patients were asymptomatic and clinically active Lyme disease was found in 19 (9%). Persistent symptoms of arthralgia, arthritis, cardiac or neurologic involvement with or without fatigue were present in 114 (53%) patients. Persistent symptoms correlated with a history of major organ involvement or relapse but not the continued presence of anti-Borrelial antibodies. Thirty-five of the 114 (31%) patients with persistent symptoms had predominantly arthralgia and fatigue. Antibiotic treatment within 4 weeks of disease onset was more likely to result in complete recovery. Children did not significantly differ from adults in disease manifestations or in the frequency of relapse, reinfection or complete recovery.


CONCLUSIONS
Despite recognition and treatment, Lyme disease is associated with significant infectious and postinfectious sequelae.
Asch
E S
ES
Department of Medicine, New York Medical College, Valhalla 10595.
Bujak
D I
DI
Weiss
M
M
Peterson
M G
MG
Weinstein
A
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000382:microbiology; D015748:Borrelia burgdorferi Group / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008193:Lyme Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000382:microbiology; D009518:New York / Q000453:epidemiology; D012008:Recurrence; D012042:Registries; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial