title: Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here?
abstract: OBJECTIVE
  A subset of patients treated for Lyme disease report persistent or recurrent symptoms of unknown etiology named post-treatment Lyme disease syndrome (PTLDS). This study aims to describe a cohort of participants with early, untreated Lyme disease, and characterize post-treatment symptomatology and functional impact of PTLDS over time.
  
  
  METHODS
  Sixty-three participants with erythema migrans and systemic symptoms were enrolled in a prospective cohort study. Participants underwent physical exams and clinical assessments, and completed the SF-36 (daily life functioning) and the Beck Depression Inventory, Second Edition (BDI-II) (depression), at each of five visits over a period of 6 months.
  
  
  RESULTS
  Signs of Lyme disease disappeared post-treatment; however, new-onset patient-reported symptoms increased or plateaued over time. At 6 months, 36% of patients reported new-onset fatigue, 20% widespread pain, and 45% neurocognitive difficulties. However, less than 10% reported greater than “minimal” depression across the entire period. Those with PTLDS (36%) did not differ significantly from those without with respect to demographics, pre-treatment SF-36, and BDI-II scores. Statistically significant differences were found over time on the Role Physical, Vitality, Social Functioning, Role Emotional, and Mental Health subscales (with a trend toward significance for the remaining three subscales of Physical Functioning, Bodily Pain, and General Health) of the SF-36 between those with an eventual PTLDS diagnosis and those without when measured at 6 months.
  
  
  CONCLUSIONS
  Unlike clinical signs of Lyme disease, new-onset symptoms are reported by a subset of participants without evidence of depressive symptomatology. Patients who developed PTLDS had significantly lower life functioning compared to those without PTLDS. We propose future avenues for researching infection-triggered symptoms resulting from multiple mechanisms.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, 10755 Falls Road, Suite 200, Lutherville, MD 21093, USA. jaucott2@jhmi.edu
authors.forename: John N
authors.initials: JN
authors.lastname: Aucott
authors.forename: Alison W
authors.initials: AW
authors.lastname: Rebman
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Crowder
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Kortte
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003863:Depression / Q000150:complications / Q000175:diagnosis; D005221:Fatigue / Q000209:etiology*; D005260:Female; D005929:Glossitis, Benign Migratory; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D010555:Personality Inventory; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D018434:Sickness Impact Profile; D012917:Social Adjustment; D013577:Syndrome