Brief observation
Systemic symptoms without erythema migrans as the presenting picture of early Lyme disease

https://doi.org/10.1016/S0002-9343(02)01440-7Get rights and content

Section snippets

Patients and methods

In 1995, 10,936 people (aged 15 to 70 years) were enrolled in a Lyme disease vaccine trial that involved 31 different centers in 10 states where the infection is endemic (14). During the 20-month study, which included two summer transmission seasons of Lyme disease, systemic or influenza-like symptoms accompanied by IgM or IgG seroconversion to B. burgdorferi were reported in 63 participants. The reporting study investigators, and often the patients, were contacted for additional clinical

Results

Of the 1917 participants who were evaluated for suspected Lyme disease during the study (14), 269 met prospectively defined criteria for definite, possible, or asymptomatic Lyme disease. Forty-two of these patients (16%) had systemic symptoms without erythema migrans, accompanied by IgM or IgG seroconversion to whole B. burgdorferi sonicate, which was defined in the original study as possible Lyme disease. For this post hoc analysis in which the more sensitive and specific VlsE peptide ELISA

Discussion

Among the patients with definite Lyme disease, oligoarticular or migratory arthralgias and pain in the back of the head with mild neck stiffness were common symptoms. This clinical picture, which may be suggestive of meningitis, is often seen in patients with erythema migrans during the early, disseminated phase of Lyme disease (17). In a previous report (18), 8 of 12 patients who had such symptoms associated with erythema migrans had a positive test for B. burgdorferi DNA in cerebrospinal

Acknowledgements

The authors thank Dr. David S. Krause at GlaxoSmithKline Pharmaceuticals and Dr. Dennis L. Parenti at American Home Products for guidance and support and the members of the Lyme Disease Vaccine Study Group for providing information and observations.

First page preview

First page preview
Click to open first page preview

References (26)

  • R.J. Dattwyler et al.

    Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis

    Lancet

    (1990)
  • E.M. Massarotti et al.

    Treatment of early Lyme disease

    Am J Med

    (1992)
  • A.C. Steere

    Lyme disease

    N Engl J Med

    (2001)
  • H.M. Feder et al.

    Early Lyme diseasea flu-like illness without erythema migrans

    Pediatrics

    (1993)
  • M.E. Aguero-Rosenfeld et al.

    Human granulocytic ehrlichiosisa case series from a medical center in New York State

    Ann Intern Med

    (1996)
  • J.L. Goodman et al.

    Direct cultivation of the causative agent of human granulocytic ehrlichiosis

    N Engl J Med

    (1996)
  • J.S. Dumler et al.

    Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsialesunification of some species of Ehrlichia with Anaplasma, Cowdria with Ehrlichia and Ehrlichia with Neorickettsia, descriptions of six new species combinations and designation of Ehrlichia equi and ‘HGE agent’ as subjective synonyms of Ehrlichia phagocytophila

    Int J Syst Evol Microbiol

    (2001)
  • T.K.D. Ruebush et al.

    Human babesiosis on Nantucket Island. Evidence for self-limited and subclinical infections

    N Engl J Med

    (1977)
  • A. Spielman et al.

    Human babesiosis on Nantucket Island, USAdescription of the vector, Ixodes (Ixodes) dammini, n. sp. (Acarina: Ixodidae)

    J Med Entomol

    (1979)
  • Recommendations for test performance and interpretation from the Second International Conference on serologic diagnosis of Lyme disease

    MMWR Morb Mortal Wkly Rep

    (1995)
  • S.M. Engstrom et al.

    Immunoblot interpretation criteria for serodiagnosis of early Lyme disease

    J Clin Microbiol

    (1995)
  • G.P. Wormser et al.

    Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis

    Am J Clin Pathol

    (1997)
  • J.E. Craft et al.

    The antibody response in Lyme diseaseevaluation of diagnostic tests

    J Infect Dis

    (1984)
  • Cited by (69)

    • Documentation of a false positive Lyme disease serologic test in a patient with untreated Babesia microti infection carries implications for accurately determining the frequency of Lyme disease coinfections

      2021, Diagnostic Microbiology and Infectious Disease
      Citation Excerpt :

      This potential use of the C6 test has been reported previously (Steere et al. 2003). Of interest, in that previous study (Steere et al. 2003), out of the 14 cases that were IgM seroreactive for B. burgdorferi antibodies on immunoblot but were C6 negative, 5 were PCR positive for Anaplasma phagocytophilum, and 1 additional subject was PCR positive for B. microti. Thus, arguably, at least 1 subject of the 14 had a false positive IgM Lyme disease antibody test because of active babesiosis.

    • Migrating Swollen Joint and Lyme Disease: A Case Report

      2021, Journal of Emergency Nursing
      Citation Excerpt :

      The most common sign and presenting symptom of Lyme disease is a rash called erythema migrans, which is also known as a bull's-eye rash owing to its appearance on the skin. This is the presenting feature in approximately 70% to 80% of those affected by Lyme disease.4,6 The rash itself does not tend to be pruritic or painful in nature and does not develop associated vesicles or bullae.

    • Lyme Disease

      2018, Integrative Medicine: Fourth Edition
    • Lyme Disease Vaccines

      2017, Plotkin's Vaccines
    View all citing articles on Scopus

    The study was supported in part by SmithKline Beecham Pharmaceuticals, Philadelphia, Pennsylvania, and by a grant (Cooperative agreement No. CCU110291) from the Centers for Disease Control and Prevention, Atlanta, Georgia. Dr. Dhar received support from the Lincoln Financial Group Foundation.

    View full text