Outcome of Facial Palsy from Lyme Disease in Prospectively Followed Patients Who Had Received Corticosteroids

Although a short course of corticosteroid therapy has been shown to improve the outcome of idiopathic facial nerve palsy (Bell\u27s palsy), it is unclear whether corticosteroids, in addition to antibiotic therapy, are beneficial, are harmful, or have no impact on the outcome of facial palsy from Lyme disease (LDFP). From 2011 through 2016, 14 patients with LDFP were enrolled into a prospective study to determine the outcome of Lyme disease over the ensuing 12months. Eleven (78.6%) had received corticosteroids in addition to oral antibiotics and entered the study within 24days after onset of the LDFP (median 14days, range 2-24days). Overall, 6 of the corticosteroid-treated patients (54.5%, 95% C.I.: 28.0% to 78.7%) had evidence of residual dysfunction of the facial nerve at the last evaluation, which occurred at a mean of 13.1months after the baseline visit (range 9.6-19.6months). In conclusion, although corticosteroids are frequently prescribed for LDFP, the efficacy of this therapy has not been established. Like another recent report, our study raises concern about the safety of adjunctive corticosteroid treatment for LDFP. A well-designed, prospective clinical trial is needed to determine the risk-to-benefit ratio of corticosteroid therapy for LDFP

A Prospective Study to Characterize Symptoms and Symptom Severity in Adult Patients With Extracutaneous Manifestations of Lyme Disease

BACKGROUND: Systematic assessments of the presence and severity of particular symptoms over time are relatively uncommon for Lyme disease patients in the United States, and especially for Lyme disease patients with extracutaneous manifestations (ECLD). METHODS: Symptoms and symptom severity of 12 particular symptoms were evaluated in a prospective study at baseline and at 12 months for 35 adult Lyme disease patients with ECLD, 91.4% of whom were already started on antibiotic therapy, and compared with 52 adult Lyme disease patients with erythema migrans, who were untreated at study entry. RESULTS: No significant difference in the frequency of having at least 1 symptom of the 12 evaluated was found between the 2 groups at either the baseline visit or the 12-month evaluation. Demographic variables were also similar between the 2 study groups, except that the ECLD patients were significantly less likely to be Caucasian: 24/35 (68.6%) of the ECLD cases vs 48/52 (92.3%) of the erythema migrans cases; P = .008. CONCLUSION: Lyme disease patients with ECLD had a similar frequency of symptoms at baseline compared with patients with erythema migrans. ECLD subjects, however, were significantly less likely to be Caucasian, raising the question of whether a preceding erythema migrans skin lesion may have been missed in persons with a darker skin color. An important limitation of our study, however, is that we did not record skin color per se, which should be considered for future studies

Evaluation of Prospectively Followed Adult Patients with Erythema Migrans Using the Beck Depression Inventory Second Edition

BACKGROUND: The Beck Depression Inventory (BDI-II) may be used to evaluate individuals for symptoms of depression. METHODS: In a 1-year prospective study, 52 adult Lyme disease patients with erythema migrans and 104 matched control subjects were clinically assessed and completed the BDI-II at study entry and approximately 6 and 12 months later following antibiotic treatment. RESULTS: The mean BDI-II score was significantly higher at the baseline visit among Lyme disease patients compared with controls (P=.002), but no significant differences between the groups were observed at either the 6- or 12-month study visits. Over the course of the study, the mean BDI-II scores decreased an average of approximately 0.22 points per month (P \u3c .0005) for Lyme disease patients, whereas the mean scores changed very little for controls (mean change=-0.02 per month, P=.50). The total number of somatic symptoms, of the 12 symptoms evaluated, strongly and directly correlated with the BDI-II scores at the baseline visit for the Lyme disease patients. CONCLUSIONS: The mean BDI-II scores of patients with early Lyme disease significantly exceeded that of matched controls at study entry, but by 6 months the values did not differ significantly. There was a good-to-excellent direct correlation between the BDI-II score and the total number of symptoms, suggesting that the BDI-II scores were reflecting somatic rather than affective depressive symptoms. When using the BDI-II as an assessment tool of patients with Lyme disease, infection-related somatic symptoms per se need to be considered in the interpretation of the results

Efficacy of a 14-Day Course of Amoxicillin for Patients with Erythema Migrans

Although a 14-day treatment course with amoxicillin is in wide clinical usage to treat early Lyme disease, only a few published studies exist to validate its efficacy and safety, with none in the United States. In this study, we reviewed the records of 24 prospectively followed adult patients with erythema migrans who were prescribed a 14-day course of amoxicillin, 500mg 3 times daily. Treatment with amoxicillin was well tolerated and uniformly successful in resolving the erythema migrans skin lesion and in preventing the development of an objective neurologic, cardiac, or rheumatologic manifestation. Although the study was relatively small and only involved a single center, the findings provide additional evidence that a 14-day course of 500mg amoxicillin given 3 times per day is highly effective therapy for patients with early Lyme disease

Assessment of Duration of Tick Feeding by the Scutal Index Reduces Need for Antibiotic Prophylaxis after Ixodes Scapularis Tick Bites

Doxycycline is recommended for persons with Ixodes scapularis tick bites in certain geographic areas, if the tick had fed for at least 36 hours. Based on the scutal index, over 40% of I. scapularis tick bites from patients seen at the Lyme Disease Diagnostic Center did not warrant antibiotic prophylaxis

Evaluation of Selected Variables to Determine if Any Had Predictive Value For, or Correlated with, Residual Symptoms at Approximately 12 Months after Diagnosis and Treatment of Early Lyme Disease

Subjective symptoms may persist after antibiotic treatment of patients with erythema migrans. Selected baseline variables were evaluated to determine if any correlated with symptom persistence to 12 months (PTLDS). Tingling or an abnormal skin sensation were reported by 5 (71.4%) of the 7 PTLDS cases at the baseline visit versus 4 (13.3%) of the 30 initially symptomatic subjects without PTLDS (P= 0.005). The frequency of having a total score of ≥17, when the Beck Depression Inventory score was added to the number of pain sites that the subject reported at the baseline visit, also showed a significant difference: 71.4% versus 10%, P= 0.002. All but 1 of the 7 subjects with possible PTLDS had either a total score of at least 17 on these 2 measures combined or had a score of ≥2 on the stress event questionnaire used. Clinical investigations should be conducted to validate these findings with other patient cohorts

Prospective Evaluation of the Frequency and Severity of Symptoms in Lyme Disease Patients With Erythema Migrans Compared With Matched Controls at Baseline, 6 Months, and 12 Months

BACKGROUND: Erythema migrans is the most common clinical manifestation of Lyme disease. Despite antibiotic therapy, typically at least 10% of adult patients with erythema migrans experience persistence of at least 1 subjective symptom for ≥6 months (posttreatment Lyme disease symptoms [PTLDS]). METHODS: This study was designed to determine whether the frequency and severity (based on a visual analogue scale) of 12 particular symptoms in patients with erythema migrans (n = 52) differed from matched control subjects (n = 104) followed prospectively for 12 months. RESULTS: At baseline, patients with Lyme disease were more likely than controls to have at least 1 symptom (P = .006). Among symptomatic subjects, Lyme disease patients had a higher mean number of symptoms (P \u3c .001) and a higher mean total symptom severity score (P \u3c .001). At both 6 and 12 months, however, there were no significant differences for these variables and no significant differences in the frequency or severity of any of the 12 individual symptoms assessed. However, 10 patients were clinically assessed as having possible PTLDS. CONCLUSIONS: Patients with erythema migrans were more likely than matched control subjects to be symptomatic at baseline with a greater symptom severity score, but this was not found at ≥6 months. Use of symptom survey data alone, however, was less likely to identify patients with possible PTLDS compared with individual clinical assessments. Because it is very challenging to be certain that the presence of long-term symptoms in a particular patient is correctly attributable to having had Lyme disease, an objective biomarker would be highly desirable

Patients with Erythema Migrans: Characterizing the Impact of Initiation of Antibiotic Therapy Prior to Study Enrollment

Erythema migrans is the most common clinical manifestation of Lyme disease, with concomitant subjective symptoms occurring in ∼65% of cases in the United States. We evaluated the impact of having been started on antibiotic treatment before study enrollment on 12 particular symptoms for 38 subjects with erythema migrans versus 52 untreated subjects. There were no significant differences in the frequency of having at least one symptom or in the symptom severity score on study entry. However, the frequency of having at least one symptom was significantly greater for those who had received \u3c7 days of antibiotic treatment than for those who had been treated for ≥7 days (23/24 [95.8%] versus 8/14 [57.1%], P = 0.006). In addition, the percentage of subjects who were males was significantly lower among the group on treatment than among the untreated study subjects (13/38 [34.2%] versus 34/52 [65.4%], P = 0.005). In conclusion, based on these findings, combining untreated and treated groups of patients with erythema migrans for research study analyses may have limitations and, depending on the study objectives, might not be preferred. Additional studies are warranted to better understand the day-to-day impact of antibiotic treatment on the presence, type, and severity of symptoms in patients with early Lyme disease

Co-infections in Persons with Early Lyme Disease, New York, USA

In certain regions of New York state, USA, Ixodes scapularis ticks can potentially transmit 4 pathogens in addition to Borrelia burgdorferi: Anaplasma phagocytophilum, Babesia microti, Borrelia miyamotoi, and the deer tick virus subtype of Powassan virus. In a prospective study, we systematically evaluated 52 adult patients with erythema migrans, the most common clinical manifestation of B. burgdorferi infection (Lyme disease), who had not received treatment for Lyme disease. We used serologic testing to evaluate these patients for evidence of co-infection with any of the 4 other tickborne pathogens. Evidence of co-infection was found for B. microti only; 4–6 patients were co-infected with Babesia microti. Nearly 90% of the patients evaluated had no evidence of co-infection. Our finding of B. microti co-infection documents the increasing clinical relevance of this emerging infection