Clinical characteristics and treatment outcome of early lyme disease in patients with microbiologically confirmed erythema migrans

Robert P. Smith, Robert T. Schoen, Daniel W. Rahn, Vijay K. Sikand, John Nowakowski, Dennis L. Parenti, Mary S. Holman, David H. Persing, Allen C. Steere

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)421-428
Number of pages8
JournalAnnals of internal medicine
Volume136
Issue number6
DOIs
StatePublished - Mar 19 2002
Externally publishedYes

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ASJC Scopus subject areas

  • Internal Medicine

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Smith, R. P., Schoen, R. T., Rahn, D. W., Sikand, V. K., Nowakowski, J., Parenti, D. L., Holman, M. S., Persing, D. H., & Steere, A. C. (2002). Clinical characteristics and treatment outcome of early lyme disease in patients with microbiologically confirmed erythema migrans. Annals of internal medicine, 136(6), 421-428. https://doi.org/10.7326/0003-4819-136-6-200203190-00005