Follow Up of At Least 1 Year Recommended for Lyme Disease Patients

In a new study, researchers in Slovenia have examined how Lyme disease patients with solitary rashes and multiple rashes respond to the same clinical course of treatment.

Lyme disease, or borreliosis, is a tick-borne illness caused by Borrelia burgdorferi bacteria. Symptoms of early localized Lyme disease, also known as stage 1, typically occur within days or weeks of a tick bite and include a telltale rash along with fever, headache, and fatigue. When treated early with antibiotics such as doxycycline, amoxicillin, or cefuroxime axetil for 10 days to 4 weeks, Lyme cases can clear rapidly and fully. When left untreated for weeks or months, individuals can experience early disseminated Lyme disease, stage 2 of infection, which may include symptoms such as numbness, pain, paralysis or weakness of the facial muscles, and heart palpitations. Stage 3 of Lyme disease can include complications such as joint swelling, muscle weakness, or cognitive issues.

The erythema migrans (EM) rashes associated with Lyme disease often present as a solitary circular “bullseye” rash. Multiple erythema migrans (MEM) can be an early sign of stage 2 Lyme disease and may occur in 10% to 20% of patients. Recognizing MEM and other early manifestations of progressing illness and initiating treatment are important for avoiding neurological, ophthalmological, cardiac or rheumatic borreliosis.

In a new study published in the journal JAMA Dermatology, researchers from the University of Ljubljana in Slovenia investigated the potential differences in clinical course and treatment outcomes between Lyme cases with solitary EM and MEM.

The prospective cohort study was conducted from June 1, 2010, to October 31, 2015, and researchers analyzed data from June 1, 2017, to January 3, 2018, from a total of 778 consecutive adult patients with early Lyme borreliosis; of those patients, 200 patients with MEM and 403 patients with solitary EM were enrolled in the study. The researchers compared the clinical course and posttreatment outcomes of patients with MEM to those with solitary EM and assessed outcome at 14 days and at 2, 6, and 12 months after enrollment.

They found that MEM was more common in younger patients and that the greater frequency of Lyme borreliosis—associated constitutional symptoms in patients with MEM could be due to a stronger inflammatory response associated with disseminated infection. In addition, at the 14-day and 6-month follow-ups, patients with MEM more often showed an incomplete response to treatment, represented predominantly by the presence of post–Lyme borreliosis symptoms. However, at 12-month follow up, patients had comparable treatment outcomes, with 10 of 170 (5.9%) patients with MEM and 20 of 308 (6.5%) patients with solitary EM showing an incomplete response.

In an interview with Contagion^®, study author Daša Stupica, MD, said that the reasons why some people present with localized disease (solitary EM) and others with disseminated disease (MEM) are not entirely clear.

“Direct comparison of adult patients with multiple erythema migrans and those with solitary erythema migrans revealed that disseminated disease is accompanied with constitutional symptoms more often than localized disease,” explained Dr Stupica. “Constitutional symptoms persisted longer after antibiotic treatment in disseminated disease, but the frequency of these symptoms merged at 12 months post-treatment in patients with disseminated and in those with localized disease. Thus, patience is needed when assessing the outcome in patients treated for early Lyme borreliosis.”