Objectives

To describe the course of symptoms reported by patients with symptoms attributed to Lyme borreliosis (LB) without being subsequently diagnosed with LB.

Methods

We performed a prospective cohort study with patients presenting at the outpatient clinic of two clinical LB centres. The primary outcome was the prevalence of persistent symptoms, which were defined as clinically relevant fatigue (CIS, subscale fatigue), pain (SF-36, subscale bodily pain), and cognitive impairment (CFQ) for ≥ 6 months and onset < 6 months over the first year of follow-up. Outcomes were compared with a longitudinal cohort of confirmed LB patients and a general population cohort. Prevalences were standardised to the distribution of pre-defined confounders in the confirmed LB cohort.

Results

Participants (n = 123) reported mostly fatigue, arthralgia, myalgia, and paraesthesia as symptoms. The primary outcome could be determined for 74.8% (92/123) of participants. The standardised prevalence of persistent symptoms in our participants was 58.6%, which was higher than in patients with confirmed LB at baseline (27.2%, p < 0.0001) and the population cohort (21.2%, p < 0.0001). Participants reported overall improvement of fatigue (p < 0.0001) and pain (p < 0.0001) but not for cognitive impairment (p = 0.062) during the follow-up, though symptom severity at the end of follow-up remained greater compared to confirmed LB patients (various comparisons p < 0.05).

Conclusion

Patients with symptoms attributed to LB who present at clinical LB centres without physician-confirmed LB more often report persistent symptoms and report more severe symptoms compared to confirmed LB patients and a population cohort.

中文翻译：

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对莱姆疏螺旋体病专业中心就诊的患者进行评估和一年随访：一项采用经过验证的问卷的前瞻性队列研究

目标

描述具有莱姆疏螺旋体病 (LB) 症状但随后未被诊断为 LB 的患者报告的症状过程。

方法

我们对两个临床 LB 中心门诊就诊的患者进行了一项前瞻性队列研究。主要结局是持续症状的患病率，这些症状被定义为临床相关疲劳（CIS，次级疲劳）、疼痛（SF-36，次级身体疼痛）和认知障碍（CFQ），持续时间≥6个月且发病时间<6个月在随访的第一年。将结果与确诊 LB 患者的纵向队列和一般人群队列进行比较。将患病率标准化为已确认的 LB 队列中预定义混杂因素的分布。

结果

参与者 ( n  = 123) 报告的症状大多为疲劳、关节痛、肌痛和感觉异常。74.8% (92/123) 的参与者可以确定主要结局。我们的参与者中持续症状的标准化患病率为 58.6%，高于基线时确诊 LB 的患者 (27.2%，p  < 0.0001) 和人群队列 (21.2%，p  < 0.0001)。参与者报告随访期间疲劳 ( p  < 0.0001) 和疼痛 ( p < 0.0001)总体改善，但认知障碍 ( p = 0.062) 没有改善 ，但随访结束时症状严重程度仍高于确诊的 LB患者（各种比较p  < 0.05）。

结论

与确诊的 LB 患者和人群相比，在临床 LB 中心就诊但未得到医生确认的 LB 的患有 LB 症状的患者更常报告持续症状，并且报告更严重的症状。