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      The Clinical, Symptom, and Quality-of-Life Characterization of a Well-Defined Group of Patients with Posttreatment Lyme Disease Syndrome

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          Abstract

          Background

          The increased incidence and geographic expansion of Lyme disease has made it the most common vector-borne infection in North America. Posttreatment Lyme disease syndrome (PTLDS) represents a subset of patients who remain ill following standard antibiotic therapy for Lyme disease. The spectrum of symptoms and their impact on quality of life remain largely unexplored among patients with well-documented PTLDS.

          Objective

          To characterize a case series of patients with well-documented PTLDS compared to a sample of healthy controls.

          Methods

          Sixty-one participants met the proposed case definition for PTLDS. Twenty-six healthy controls had neither a clinical history of Lyme disease nor current antibodies to Borrelia burgdorferi. Participants with PTLDS and controls were evaluated by physical exam, clinical laboratory testing, standardized questionnaires, and a 36-item current symptom list.

          Results

          Compared to controls, participants with PTLDS reported significantly greater fatigue, pain, sleep disturbance, and depression (Fatigue Severity Scale: 50.0 ± 10.6 vs. 19.8 ± 8.6; Short-Form McGill Pain Questionnaire: 13.7 ± 8.3 vs. 0.8 ± 1.9; Pittsburgh Sleep Quality Index: 10.1 ± 4.7 vs. 4.1 ± 2.1; Beck Depression Inventory-II: 15.1 ± 7.7 vs. 2.2 ± 3.2; p < 0.001 for each), and significantly lower quality of life (SF-36 Physical Component Score: 33.9 ± 9.7 vs. 55.1 ± 6.2; Mental Component Score: 42.9 ± 10.1 vs. 54.2 ± 5.4; p < 0.001 for each). Nineteen non-PTLDS-defining symptoms were found to be significantly more severe among participants with PTLDS than controls, including sleep difficultly and visual complaints. Initial delayed or misdiagnosis was characterized in 59.0% of participants with PTLDS, and 32.2% had abnormal vibratory sense.

          Conclusion

          Although physical exam and clinical laboratory tests showed few objective abnormalities, standardized symptom questionnaires revealed that patients with PTLDS are highly and clinically significantly symptomatic, with poor health-related quality of life. PTLDS patients exhibited levels of fatigue, musculoskeletal pain, sleep disturbance, and depression which were both clinically relevant and statistically significantly higher than controls. Our study shows that PTLDS can be successfully identified using a systematic approach to diagnosis and symptom measurement. As the prevalence of PTLDS continues to rise, there will be an increased need for physician education to more effectively identify and manage PTLDS as part of integrated patient care.

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          The short-form McGill Pain Questionnaire.

          Ronald Melzack (1987)
          A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
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            Lyme disease-a tick-borne spirochetosis?

            W Burgdorfer, A. Barbour, S. Hayes … (1982)
            Article 0 comments Cited 202 times – based on 0 reviews     Review now
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              Lyme disease.

              A Steere (2001)
              Article 0 comments Cited 173 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Med (Lausanne)
                Journal ID (iso-abbrev): Front Med (Lausanne)
                Journal ID (publisher-id): Front. Med.
                Title: Frontiers in Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2296-858X
                Publication date (Electronic): 14 December 2017
                Publication date Collection: 2017
                Volume: 4
                Electronic Location Identifier: 224
                Affiliations
                [1] 1Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, MD, United States
                [2] 2Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD, United States
                Author notes

                Edited by: Miguel Cacho Teixeira, Universidade de Lisboa, Portugal

                Reviewed by: Dietmar Fuchs, Innsbruck Medical University, Austria; Aleksandra Barac, University of Belgrade, Serbia

                *Correspondence: John N. Aucott, jaucott2@ 123456jhmi.edu

                Specialty section: This article was submitted to Infectious Diseases – Surveillance, Prevention and Treatment, a section of the journal Frontiers in Medicine

                Article
                DOI: 10.3389/fmed.2017.00224
                PMC ID: 5735370
                PubMed ID: 29312942
                SO-VID: a43021a4-0dce-4ab7-8c14-2b91de71c9b3
                Copyright © Copyright © 2017 Rebman, Bechtold, Yang, Mihm, Soloski, Novak and Aucott.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 29 September 2017
                Date accepted : 27 November 2017
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 49, Pages: 10, Words: 7701
                Categories
                Subject: Medicine
                Subject: Original Research

                Keywords: lyme disease,signs and symptoms,quality of life,case series,posttreatment lyme disease syndrome
                Data availability:
                Keywords: lyme disease, signs and symptoms, quality of life, case series, posttreatment lyme disease syndrome

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