Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
Institute of Health and Society (IRSS), Université Catholique de Louvain, Woluwe-Saint-Lambert, Belgium.
BMC Infect Dis. 2022 Sep 28;22(1):756. doi: 10.1186/s12879-022-07686-8.
Patients with Lyme borreliosis (LB) may report persisting non-specific symptoms such as fatigue, widespread musculoskeletal pain or cognitive difficulties. When present for more than 6 months and causing a reduction in daily activities, this is often referred to as post-treatment Lyme disease syndrome (PTLDS). This study aimed to compare the occurrence of symptoms between LB patients and controls, to estimate the proportion of LB patients developing PTLDS and to identify risk factors.
A prospective cohort study was set up including three subpopulations: patients with an erythema migrans (EM) (i) or disseminated/late LB (ii) and a non-LB control group (iii). At 6- and 12-months follow-up, the occurrence of several symptoms, including six symptoms used to define PTLDS, i.e. muscle pain, joint pain, fatigue, memory problems, difficulties concentrating and problems finding words, and impact on daily activities, was compared between LB patients and controls. Finally, the proportion of LB patients developing PTLDS as defined by the Infectious Disease Society of America was estimated, including a time frame for symptoms to be present.
Although the risk of presenting PTLDS-related symptoms was significantly higher in EM patients (n = 120) compared to controls (n = 128) at 6 months follow-up, the risk of presenting at least one of these symptoms combined with impact on daily activities was not significantly higher in EM patients, at either 6- or 12-months follow-up. A significant association was found between disseminated/late LB (n = 15) and the occurrence of any PTLDS-symptom with an impact on daily activities at both time points. The proportion of patients with PTLDS was estimated at 5.9% (95% CI 2.7-12.9) in EM patients and 20.9% (95% CI 6.8-64.4) in patients with disseminated/late LB (RR = 3.53, 95% CI 0.98-12.68, p = 0.053). No significant risk factors were identified, which may be explained by small sample sizes.
In our study, PTLDS was present in both LB cohorts, yet with a higher percentage in disseminated/late LB patients. Additional research is needed into risk factors for and causes of this syndrome. In addition, development and validation of standardized methods to assess the PTLDS case definition, easily applicable in practice, is of great importance.
莱姆病（LB）患者可能会报告持续存在的非特异性症状，如疲劳、广泛的肌肉骨骼疼痛或认知困难。当这些症状持续 6 个月以上并导致日常活动减少时，通常被称为治疗后莱姆病综合征（PTLDS）。本研究旨在比较 LB 患者和对照组之间症状的发生情况，估计 LB 患者发生 PTLDS 的比例，并确定风险因素。
本研究建立了一项前瞻性队列研究，包括三个亚人群：患有游走性红斑（EM）（i）或播散性/晚期 LB（ii）的患者和非 LB 对照组（iii）。在 6 个月和 12 个月的随访中，比较 LB 患者和对照组之间出现的多种症状，包括用于定义 PTLDS 的六种症状，即肌肉疼痛、关节疼痛、疲劳、记忆问题、注意力集中困难和找词困难，以及对日常生活的影响。最后，根据美国传染病学会的标准，估计出现 PTLDS 的 LB 患者的比例，包括出现症状的时间框架。
尽管 EM 患者（n=120）在 6 个月随访时出现 PTLDS 相关症状的风险明显高于对照组（n=128），但 EM 患者在 6 个月或 12 个月随访时，出现至少一种这些症状并伴有日常生活影响的风险并不明显更高。在两个时间点均发现播散性/晚期 LB（n=15）与任何 PTLDS 症状的发生及其对日常生活的影响之间存在显著关联。EM 患者中 PTLDS 的比例估计为 5.9%（95%CI 2.7-12.9），播散性/晚期 LB 患者为 20.9%（95%CI 6.8-64.4）（RR=3.53，95%CI 0.98-12.68，p=0.053）。未发现显著的风险因素，这可能是由于样本量较小所致。
在本研究中，LB 两个队列中均存在 PTLDS，但播散性/晚期 LB 患者的比例更高。需要进一步研究该综合征的风险因素和病因。此外，制定和验证用于评估 PTLDS 病例定义的标准化方法，以及在实践中易于应用的方法非常重要。
