Brief observationSystemic symptoms without erythema migrans as the presenting picture of early Lyme disease☆
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.
References (26)
- et al.
Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis
Lancet
(1990) - et al.
Treatment of early Lyme disease
Am J Med
(1992) Lyme disease
N Engl J Med
(2001)- et al.
Early Lyme diseasea flu-like illness without erythema migrans
Pediatrics
(1993) - et al.
Human granulocytic ehrlichiosisa case series from a medical center in New York State
Ann Intern Med
(1996) - et al.
Direct cultivation of the causative agent of human granulocytic ehrlichiosis
N Engl J Med
(1996) - 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) - et al.
Human babesiosis on Nantucket Island. Evidence for self-limited and subclinical infections
N Engl J Med
(1977) - 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)
Immunoblot interpretation criteria for serodiagnosis of early Lyme disease
J Clin Microbiol
Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis
Am J Clin Pathol
The antibody response in Lyme diseaseevaluation of diagnostic tests
J Infect Dis
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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.