Lyme Disease: Latest Updates, Research, & Treatments

HealthDay News – Lyme disease, otherwise known as Lyme borreliosis, is a prolific, infectious tick-borne disease. Vectors of transmission in the United States include tick bites from Ixodes scapularis tick exposure, also known as black-legged ticks and formerly known as deer ticks (Ixodes dammini).

In the United States and North America, cases of Lyme disease are most often caused by the bacteria Borrelia burgdorferi and Borrelia mayonii. Europe and Asia see cases of Lyme disease caused by Borrelia afzelii, Borrelia garinii, Borrelia spielmanii, and several other bacteria.

Physicians and clinicians, whether of general or specialized practice, should apprise themselves of the most recent research concerning Lyme disease. This is vital for making a diagnosis of Lyme disease, as well as informing patients how Lyme disease is caused. HCPs should know how to:

• Prevent Lyme disease
• Identify early Lyme disease
• List the factors for risk of Lyme disease
• Recognize a patient has had exposure to infected ticks

Treatment for Lyme disease is ever-evolving, as more studies advance medical knowledge of vector-borne diseases. Studies include the following:

Table of Contents

• Biological Sex Tied to Severity, Symptoms of Lyme Disease
• Full Resolution of Symptoms of Lyme Disease Seen in Most Children
• Lyme Disease Often Diagnosed Later Among Black Patients
• Lyme Disease Tied to Higher Risk for Psychiatric Conditions, Suicide
• Global Seroprevalence of Infected Tick-borne Lyme Disease About 14.5 Percent
• Lyme Disease Updates: Key Takeaways

Biological Sex Tied to Severity, Symptoms of Lyme Disease

Biological sex should be included in Lyme disease research, according to a study published online June 17 in the International Journal of General Medicine.

Lyme Disease Patients: Sex-Based Differences

Lorraine Johnson, from MyLymeData in San Ramon, California, and colleagues examined sex-based differences in Lyme disease patients who were clinically diagnosed and reported remaining ill for six or more months after antibiotic treatment.

Self-reported clinical data were analyzed for 2,170 patients in the MyLymeData patient registry. In addition, previous Lyme disease studies were reviewed for the distribution of patients by biological sex.

Symptoms of Lyme Disease in Women

The researchers found that compared with men, women reported more infected tick-borne coinfections, worse Lyme disease symptoms, longer diagnostic delays, more misdiagnoses, and worse functional impairment in MyLymeData.

Antibiotic treatment response and side effects did not differ.

Acute Lyme Disease vs. Persistent

In a review of clinical research trials and data sources, a smaller percentage of women was identified in studies of acute Lyme disease and a larger percentage was identified in studies of persistent illness.

A higher percentage of women was seen in samples and data sources that were more reflective of patients seen in clinical practice than in randomized controlled trials and post-treatment Lyme disease studies.

Lyme Disease and Sex

“Basic and medical research should include biological sex as one of the variables in study design,” the authors write.

“Biological sex can directly impact initial response to pathogens as well as the course of disease progression through different genetic pathways (including the role of X and Y chromosomes), anatomic niches, immunological profiles, and hormonal environments.”

Abstract/Full Text

Full Resolution of Symptoms of Lyme Disease Seen in Most Children

Most children with Lyme disease experience full resolution of Lyme disease symptoms, according to a study published online March 30 in Pediatric Research.

Long-Term Lyme Disease Outcomes

Maureen Monaghan, Ph.D., from The George Washington University School of Medicine and Health Sciences in Washington, D.C., and colleagues characterized long-term outcomes for pediatric patients with Lyme disease.

Post-Treatment Lyme Disease Syndrome Case Definition

They also assessed the case definition of post-treatment Lyme disease (PTLD) syndrome in a sample of 102 children with confirmed Lyme disease diagnosed six months to 10 years before enrollment.

Validated questionnaires were completed assessing health-related quality of life, physical mobility, fatigue, pain, and cognitive impact.

Long-Term Effects of Lyme Disease for Pediatric Patients

The researchers found that although time to full resolution varied, most parents reported their child’s Lyme disease symptoms resolved completely.

Functional Impairment & Lyme Disease

Overall, 22 parents (22 percent) indicated that their child had one or more persistent symptoms of Lyme disease more than six months after treatment: 13 and nine without and with functional impairment (post-treatment Lyme disease symptoms and post-treatment Lyme disease syndrome, respectively).

Post-Treatment Lyme Disease Syndrome: Fatigue

Lower parent-reported Physical Summary scores and greater likelihood of elevated fatigue were seen for children with post-treatment Lyme disease syndrome.

Lyme Disease Treatment Implications for Pediatric Patients

“These findings have important implications for clinicians treating pediatric patients with Lyme disease. Families should be counseled that full recovery is expected, and most patients recover in the first six months post-treatment, regardless of clinical presentation,” the authors write.

Further Research Needed

“For the small number of children who do not experience full recovery, more research is needed to better define the course and pathogenesis of their prolonged [Lyme disease] symptoms, as well as novel targeted therapies to relieve their suffering.”

One author holds a patent related to screening for Lyme disease.

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Lyme Disease Often Diagnosed Later Among Black Patients

Black patients with Lyme disease are often diagnosed later than White patients, according to a study published online Sept. 30 in the Journal of General Internal Medicine.

Lyme Disease Claims Data Analyzed

Dan P. Ly, M.D., Ph.D., from the University of California Los Angeles, used 2015 to 2016 claims data to draw a random nationwide 20 percent sample of traditional Medicare beneficiaries to examine racial differences in the distribution of clinical manifestations of Lyme disease.

Ly identified 6,171 White Medicare patients and 167 Black Medicare patients newly diagnosed with Lyme disease in 2016.

Lyme Disease Manifestations in Black & White Patients

Neurologic manifestations of Lyme disease on initial diagnosis were seen in about 9 percent of White patients and 34 percent of Black patients. There was a significant difference in the distribution of clinical manifestations between Black and White patients.

There was a 20.7 percentage point difference for having disseminated disease for Black versus White patients. For being initially diagnosed outside of the May to August window, the difference was 12.5 percentage points.

Most Patients, Black or White, Seek Clinician Visit

The majority of both White and Black patients with newly diagnosed Lyme disease had a clinician visit in 2016 prior to Lyme disease diagnosis (89 percent and 88 percent, respectively).

Identifying Lyme Disease

“These differences may reflect differential recognition of dermatologic manifestations of Lyme disease by physicians or by patients themselves,” Ly writes.

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Lyme Disease Tied to Higher Risk for Psychiatric Conditions, Suicide

Patients hospitalized with Lyme disease have a higher rate of mental disorders and attempted suicide after infection, according to a study published online July 28 in The American Journal of Psychiatry.

Lyme Disease Data: 1994-2016

Brian A. Fallon, M.D., from Columbia University in New York City, and colleagues used data from the Denmark National Patient Register and the Psychiatric Central Research Register (1994 through 2016) to assess the risk for mental disorders and suicidal behaviors among all individuals diagnosed with Lyme borreliosis in inpatient and outpatient hospital contacts (12,156 patients).

Lyme Disease and Mental Illness

The researchers found that individuals with Lyme borreliosis had higher rates of any mental disorder (incidence rate ratio [IRR], 1.28), affective disorders (IRR, 1.42), suicide attempts (IRR, 2.01), and death by suicide (IRR, 1.75) compared with individuals without Lyme borreliosis.

Rates of Suicide & Mental Disorders

The highest rate of any mental disorder (IRR,1.96) was seen in the six months after diagnosis, while the highest rate of suicide (IRR, 2.41) was seen in the first three years after diagnosis.

Lyme Disease Mental Health Risk Remains Low

“Although the absolute population risk is low, clinicians should be aware of potential psychiatric sequelae of this global disease,” the authors write.

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Global Seroprevalence of Tick-borne Lyme Disease About 14.5 Percent

The estimated global seroprevalence of Borrelia burgdorferi sensu lato (Bb) is 14.5 percent, according to a systematic review and meta-analysis published online June 13 in BMJ Global Health.

Systematic Review of Lyme Disease Global Seroprevalence

Yan Dong, from the Institute for Tropical Medicine at Kunming Medical University in China, and colleagues conducted a systematic review to describe the global seroprevalence and sociodemographic characteristics of Borrelia burgdorferi sensu lato in human populations.

Data were synthesized narratively and stratified by outcome types. A total of 137 studies were eligible for full-text screening, and meta-analyses included 89 studies, with 158,287 participants.

Lyme Disease Top Regions: Central Europe, Eastern Asia, & Western Europe

The researchers found that the reported estimated global seroprevalence of Borrelia burgdorferi sensu lato was 14.5 percent, and Central Europe, Eastern Asia, and Western Europe were the top three regions of Bb seroprevalence (20.7, 15.9, and 13.5 percent, respectively).

After eliminating confounding risk factors, the risk of false-positive Borrelia burgdorferi sensu lato antibody detection was increased with methods lacking western blotting (WB) confirmation compared to methods using WB confirmation (odds ratio, 1.9).

Other Lyme Disease Risk Factors

Other factors associated with Borrelia burgdorferi sensu lato seropositivity were age ≥50 years, male sex, residence in a rural area, and suffering infected tick bites.

Accuracy Needed for Epidemiology of Lyme Borreliosis

“A more accurate characterization of the global distribution of Bb infection would guide the circulating epidemiology of Lyme borreliosis and identify risk factors for the disease, which could inform the development of public health response policies and Lyme borreliosis control programs,” the authors write.

Abstract/Full Text

Lyme Disease Updates: Key Takeaways

Key takeaways for clinicians, physicians, epidemiologists, and healthcare professionals:

1. Women are at risk of Lyme disease, and likelier than men to develop Lyme disease symptoms and greater disease severity.
2. Most children’s Lyme disease symptoms resolve, with incidences of post-treatment fatigue.
3. Black patients have later diagnosis of Lyme disease than White patients.
4. Mental health disorders and suicidal tendencies are comorbidities with, and a risk of, Lyme disease.
5. Lyme disease global seroprevalence is roughly 14.5 percent.

Healthcare personnel should know the latest techniques for the diagnosis of Lyme disease, Lyme disease treatment, and how best to communicate this information with patients. Ideally, this knowledge will better help physicians and clinicians prevent Lyme disease dissemination, and enforce best practices for disease control and prevention.