Long-term follow-up of patients with culture-confirmed Lyme disease.
OBJECTIVE
To determine the long-term outcome of patients with culture-confirmed Lyme disease.


METHODS
We analyzed data collected prospectively on adult patients from a highly endemic area in New York State who were diagnosed with early Lyme disease between 1991 and 1994. Patients with culture-confirmed erythema migrans were evaluated at baseline, 7 to 10 days, 21 to 28 days, 3 months, 6 months, 1 year, and annually thereafter. All patients were treated with antibiotics at the time of diagnosis.


RESULTS
We evaluated 96 cases on 709 separate occasions (median, eight evaluations per case). The erythema migrans rash resolved within 3 weeks in all of the 94 evaluable cases, none of whom developed an objective extracutaneous manifestation of Lyme disease. Of the 81 cases who were followed for >/=1 year, all but 8 (10%) were asymptomatic at their last visit, a mean (+/- SD) of 5.6 +/- 2.6 years into follow-up, and only 3 (4%) were symptomatic at every follow-up visit. Intercurrent tick bites were reported by 45 cases (47%), and 14 (15%) developed a second episode of erythema migrans. Four other cases who were asymptomatic seroconverted between years 2 and 5.


CONCLUSIONS
The long-term outcome of patients with erythema migrans after antibiotic therapy was excellent, but patients from a highly endemic area in New York State remained at high risk of re-exposure to ticks and reinfection. Subjective symptoms during follow-up evaluations tended to be mild to moderate, intermittent, and associated with more symptomatic illness at the time of initial diagnosis.
Nowakowski
John
J
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York, USA.
Nadelman
Robert B
RB
Sell
Rebecca
R
McKenna
Donna
D
Cavaliere
L Frank
LF
Holmgren
Diane
D
Gaidici
Adriana
A
Wormser
Gary P
GP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001733:Bites and Stings; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D015897:Comorbidity; D046508:Culture Techniques; D019353:Endemic Diseases; D015787:Erythema Chronicum Migrans / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012867:Skin / Q000473:pathology; D013987:Ticks; D013995:Time; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents