A critical appraisal of "chronic Lyme disease".

Department of Family Medicine and Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA.
New England Journal of Medicine (Impact Factor: 54.42). 11/2007; 357(14):1422-30. DOI: 10.1056/NEJMra072023
Source: PubMed
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome - a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization.
    PLoS ONE 02/2015; 10(2):e0116767. DOI:10.1371/journal.pone.0116767 · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient's condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.
    Infectious disease reports 11/2014; 6(4):5496. DOI:10.4081/idr.2014.5496
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Whether or not Borrelia burgdorferi can persist after conventional treatment with antimicrobials has been a very controversial issue. Two recent studies took different approaches to try to answer this question. In one, investigators showed that, in each of 22 instances in 17 patients with two consecutive episodes of culture-proved erythema migrans, the strains of B. burgdorferi were different based on their genotypes. This indicated that the repeat episodes were due to new infections rather than recrudescence of the original infection. In another study, in which persistence of B. burgdorferi was assessed by using xenodiagnosis, no viable B. burgdorferi were cultured from ticks fed on any of the patients. There continues to be no evidence that viable B. burgdorferi persist in humans after conventional treatment with antimicrobials.
    01/2015; 7:11. DOI:10.12703/P7-11

Full-text (2 Sources)

Available from
Jun 1, 2014