The Long-Term Clinical Outcomes of Lyme Disease. A Population-Based Retrospective Cohort Study

Ann Intern Med. 1994 Oct 15;121(8):560-7. doi: 10.7326/0003-4819-121-8-199410150-00002.

Abstract

Objective: To ascertain the prevalence of and risk factors for long-term sequelae from acute Lyme disease.

Design: Population-based, retrospective cohort study.

Setting: A coastal region endemic for Lyme disease.

Participants: Patients with a history of Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.

Measurements: A standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.

Results: 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).

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cohort Studies
  • Female
  • Health Status
  • Humans
  • Logistic Models
  • Lyme Disease / blood
  • Lyme Disease / complications*
  • Lyme Disease / psychology
  • Male
  • Mental Disorders / etiology*
  • Middle Aged
  • Musculoskeletal Diseases / etiology*
  • Nervous System Diseases / etiology*
  • Physical Examination
  • Psychometrics
  • Retrospective Studies
  • Risk Factors
  • Silver Staining
  • Surveys and Questionnaires
  • Time Factors