Nancy A. Shadick, MD, MPOH; Charlotte B. Phillips, MPH; Eric L. Logigian, MD; Allen C. Steere, MD; Richard F. Kaplan, PhD; Victor P. Berardi, AB; Paul H. Duray, MD; Martin G. Larson, ScD; Elizabeth A. Wright, PhD; Katherine S. Ginsburg*, MD, MPH; Jeffrey N. Katz, MD, MS; Matthew H. Liang, MD, MPH
Shadick NA, Phillips CB, Logigian EL, Steere AC, Kaplan RF, Berardi VP, et al. The Long-Term Clinical Outcomes of Lyme Disease: A Population-Based Retrospective Cohort Study. Ann Intern Med. 1994;121:560-567. doi: 10.7326/0003-4819-121-8-199410150-00002
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Published: Ann Intern Med. 1994;121(8):560-567.
To ascertain the prevalence of and risk factors for long-term sequelae from acute Lyme disease.
Population-based, retrospective cohort study.
A coastal region endemic for Lyme disease.
Patients with a history of Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.
A standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.
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).
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.
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