Lantos Paul M, Balamuth Frances, Neville Desiree, Garro Aris C, Levas Michael N, Bennett Jonathan, Thompson Amy D, Kharbanda Anupam B, Branda John A, Nigrovic Lise E
Department of Medicine, Duke University, Durham, North Carolina, USA.
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Vector Borne Zoonotic Dis. 2021 Nov;21(11):839-842. doi: 10.1089/vbz.2021.0030. Epub 2021 Oct 4.
A history of Lyme disease can complicate the interpretation of Lyme disease serology in acutely symptomatic patients. We prospectively enrolled children undergoing evaluation for Lyme disease in the emergency department of one of eight participating Pedi Lyme Net centers. We selected symptomatic children with a Lyme disease history (definite, probable, or none) as well as an available research biosample. We defined a Lyme disease case with either an erythema migrans (EM) lesion or positive two-tier serology with compatible symptoms. Using a generalized estimating equation, we examined the relationship between time from previous Lyme disease diagnosis and current Lyme disease after adjustment for patient demographics and symptoms as well as clustering by center. Of 2501 prospectively enrolled study patients, 126 (5.0%) reported a history of definite or probable Lyme disease. Of these children with previous Lyme disease, 47 met diagnostic criteria for Lyme disease at the time of enrollment (37.3%; 95% confidence interval [CI] 29.1-45.7%); 2 had an EM lesion, and 45 had positive two-tier Lyme disease serology. Over time from the previous Lyme disease diagnosis, the less likely the patient met diagnostic criteria for Lyme disease (adjusted odds ratio 0.62 per time period; 95% CI 0.46-0.84). For children with a history of Lyme disease before enrollment, one-third met the diagnostic criteria for acute Lyme disease with a declining rate over time from previous Lyme disease diagnosis. Novel Lyme disease diagnostics are needed to help distinguish acute from previous Lyme disease.
莱姆病病史会使急性症状患者莱姆病血清学检测结果的解读变得复杂。我们前瞻性地纳入了在八个参与研究的儿科莱姆病网络中心之一的急诊科接受莱姆病评估的儿童。我们选择了有莱姆病病史（确诊、可能或无）且有可用研究生物样本的有症状儿童。我们将伴有游走性红斑（EM）皮损或二级血清学检测呈阳性且伴有相关症状的病例定义为莱姆病病例。使用广义估计方程，在对患者人口统计学特征和症状进行调整以及按中心进行聚类分析后，我们研究了自上次莱姆病诊断以来的时间与当前莱姆病之间的关系。在2501名前瞻性纳入的研究患者中，126名（5.0%）报告有确诊或可能的莱姆病病史。在这些有既往莱姆病病史的儿童中，47名在入组时符合莱姆病诊断标准（37.3%；95%置信区间[CI]29.1 - 45.7%）；2名有EM皮损，45名二级莱姆病血清学检测呈阳性。自上次莱姆病诊断后，患者符合莱姆病诊断标准的可能性越小（每个时间段调整后的优势比为0.62；95%CI 0.46 - 0.84）。对于入组前有莱姆病病史的儿童，三分之一符合急性莱姆病诊断标准，且自上次莱姆病诊断后符合率呈下降趋势。需要新的莱姆病诊断方法来帮助区分急性莱姆病和既往莱姆病。
