Long-term Assessment of Post-Treatment Symptoms in Patients With Culture-Confirmed Early Lyme Disease

Clin Infect Dis. 2015 Dec 15;61(12):1800-6. doi: 10.1093/cid/civ735. Epub 2015 Sep 18.


Background: Lyme disease patients with erythema migrans are said to have post-treatment Lyme disease symptoms (PTLDS) if there is persistence of subjective symptoms for at least 6 months following antibiotic treatment and resolution of the skin lesion. The purpose of this study was to characterize PTLDS in patients with culture-confirmed early Lyme disease followed for >10 years.

Methods: Adult patients with erythema migrans with a positive skin or blood culture for Borrelia burgdorferi were enrolled in a prospective study beginning in 1991 and followed up at 6 months and annually thereafter to determine the long-term outcome of this infection. The genotype of the infecting strain of B. burgdorferi was evaluated in subjects with PTLDS.

Results: One hundred twenty-eight subjects with culture-confirmed early Lyme disease, of whom 55% were male, were followed for a mean ± SD of 14.98 ± 2.71 years (median = 15 years; range = 11-20 years). Fourteen (10.9%) were regarded as having possible PTLDS, but only 6 (4.7%) had PTLDS documented at their last study visit. Nine (64.3%) had only a single symptom. None of the 6 with PTLDS at their last visit was considered to be functionally impaired by the symptom(s). PTLDS was not associated with a particular genotype of B. burgdorferi.

Conclusions: PTLDS may persist for >10 years in some patients with culture-confirmed early Lyme disease. Such long-standing symptoms were not associated with functional impairment or a particular strain of B. burgdorferi.

Keywords: Borrelia burgdorferi; Lyme; Lyme disease; erythema migrans; post-treatment Lyme disease symptoms.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Blood / microbiology
  • Borrelia burgdorferi / classification
  • Borrelia burgdorferi / genetics
  • Borrelia burgdorferi / isolation & purification*
  • Erythema / etiology*
  • Erythema / pathology*
  • Female
  • Genotype
  • Humans
  • Lyme Disease / drug therapy*
  • Lyme Disease / microbiology
  • Lyme Disease / pathology*
  • Male
  • Middle Aged
  • Prospective Studies
  • Skin / microbiology
  • Time Factors
  • Treatment Outcome