Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans
RP Smith, RT Schoen, DW Rahn… - Annals of internal …, 2002 - acpjournals.org
RP Smith, RT Schoen, DW Rahn, VK Sikand, J Nowakowski, DL Parenti, MS Holman…
Annals of internal medicine, 2002•acpjournals.orgBackground: Lyme disease has a wide spectrum of clinical manifestations. Diagnosis is
usually based on the clinical and serologic picture rather than on microbiological
confirmation. Objective: To examine the clinical presentation and treatment outcome of early
Lyme disease in patients with microbiologically confirmed erythema migrans. Design:
Observational cohort study. Setting: 31 university-based or clinician-practice sites in 10
endemic states. Participants: 10 936 participants enrolled in a phase III trial of Lyme disease …
usually based on the clinical and serologic picture rather than on microbiological
confirmation. Objective: To examine the clinical presentation and treatment outcome of early
Lyme disease in patients with microbiologically confirmed erythema migrans. Design:
Observational cohort study. Setting: 31 university-based or clinician-practice sites in 10
endemic states. Participants: 10 936 participants enrolled in a phase III trial of Lyme disease …
Background
Lyme disease has a wide spectrum of clinical manifestations. Diagnosis is usually based on the clinical and serologic picture rather than on microbiological confirmation.
Objective
To examine the clinical presentation and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans.
Design
Observational cohort study.
Setting
31 university-based or clinician-practice sites in 10 endemic states.
Participants
10 936 participants enrolled in a phase III trial of Lyme disease vaccine; 118 participants had erythema migrans in which Borrelia burgdorferi was detected by culture or polymerase chain reaction.
Measurements
Clinical characteristics and treatment outcome were noted. Skin biopsies of erythema migrans were performed for culture and detection of B. burgdorferi by polymerase chain reaction; serologic responses were determined by Western blot.
Results
The 118 patients with microbiologically confirmed erythema migrans presented a median of 3 days after symptom onset. Early erythema migrans commonly had homogeneous or central redness rather than a peripheral erythema with partial central clearing. The most common associated symptoms were low-grade fever, headache, neck stiffness, arthralgia, myalgia, or fatigue. By convalescence, 65% of patients had positive IgM or IgG antibody responses to B. burgdorferi. Most patients responded promptly to antibiotic treatment.
Conclusions
In major endemic areas in the United States, Lyme disease commonly presents as erythema migrans with homogeneous or central redness and nonspecific flu-like symptoms. Clinical outcome is excellent if antibiotic therapy is administered soon after symptom onset.
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