Long-term follow-up of patients with culture-confirmed Lyme disease

Am J Med. 2003 Aug 1;115(2):91-6. doi: 10.1016/s0002-9343(03)00308-5.


Purpose: 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.

Conclusion: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Bites and Stings
  • Borrelia burgdorferi / isolation & purification*
  • Comorbidity
  • Culture Techniques
  • Endemic Diseases
  • Erythema Chronicum Migrans / diagnosis
  • Erythema Chronicum Migrans / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Lyme Disease / diagnosis*
  • Lyme Disease / drug therapy
  • Lyme Disease / epidemiology
  • Lyme Disease / microbiology*
  • Male
  • Middle Aged
  • New York / epidemiology
  • New York City / epidemiology
  • Prospective Studies
  • Recurrence
  • Skin / pathology
  • Ticks
  • Time
  • Treatment Outcome


  • Anti-Bacterial Agents