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Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy

Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy
Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy

This series of serologically confirmed Lyme disease is the largest reported in the UK and represents 508 patients who presented to one hospital in the South of England between 1992 and 2012. The mean rate of borreliosis throughout this period was 9·8/100Â 000 population, much higher than the reported national rate of 1·7/100Â 000. The actual rate increased each year until 2009 when it levelled off. Patients clinically presented with rash (71%), neurological symptoms (16%, of whom half had VII cranial nerve palsies), arthropathy (8%), pyrexia (5%), cardiac abnormalities (1%) or other manifestations (<1%). Twenty percent of patients had additional non-specific symptoms of fatigue, myalgia, and cognitive changes. Serological diagnosis was with a two-tiered system of ELISA and immunoblot. There was a marked seasonal presentation in the summer months and in the first and sixth decades of life. A third of patients gave a clear history of a tick bite. The median interval between tick bite and clinical symptoms was 15 days [interquartile range (IQR) 9-28 days], with a further interval of 14 days to clinical diagnosis/treatment (IQR 2-31 days). Most cases were acquired locally and only 5% abroad. Patients responded to standard antibiotic therapy and recurrence or persistence was extremely rare. A second group of patients, not included in the clinical case series, were those who believed they had Lyme disease based on a probable tick bite but were seronegative by currently available validated tests and presented with subjective symptoms. This condition is often labelled chronic Lyme disease. These patients have a different disease from Lyme disease and therefore an alternative name, chronic arthropod-borne neuropathy (CAN), and case definition for this condition is proposed. We suggest that this chronic condition needs to be distinguished from Lyme disease, as calling the chronic illness 'Lyme disease' causes confusion to patients and physicians. We recommend research initiatives to investigate the aetiology, diagnosis and therapy of CAN.

Borreliosis, chronic arthropod-borne neuropathy, erythema migrans, infection rate, neuroborreliosis, ticks
0950-2688
561-572
Dryden, M.S.
682b2387-d220-45aa-9fbb-2790f5829349
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Ogborn, S.
c99c303e-dcf7-47d2-96cd-d2269910ceae
Swales, P.
f1c88275-d714-4033-bf44-41edb9cb965b
Dryden, M.S.
682b2387-d220-45aa-9fbb-2790f5829349
Saeed, K.
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Ogborn, S.
c99c303e-dcf7-47d2-96cd-d2269910ceae
Swales, P.
f1c88275-d714-4033-bf44-41edb9cb965b

Dryden, M.S., Saeed, K., Ogborn, S. and Swales, P. (2015) Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy. Epidemiology and Infection, 143 (3), 561-572. (doi:10.1017/S0950268814001071).

Record type: Article

Abstract

This series of serologically confirmed Lyme disease is the largest reported in the UK and represents 508 patients who presented to one hospital in the South of England between 1992 and 2012. The mean rate of borreliosis throughout this period was 9·8/100Â 000 population, much higher than the reported national rate of 1·7/100Â 000. The actual rate increased each year until 2009 when it levelled off. Patients clinically presented with rash (71%), neurological symptoms (16%, of whom half had VII cranial nerve palsies), arthropathy (8%), pyrexia (5%), cardiac abnormalities (1%) or other manifestations (<1%). Twenty percent of patients had additional non-specific symptoms of fatigue, myalgia, and cognitive changes. Serological diagnosis was with a two-tiered system of ELISA and immunoblot. There was a marked seasonal presentation in the summer months and in the first and sixth decades of life. A third of patients gave a clear history of a tick bite. The median interval between tick bite and clinical symptoms was 15 days [interquartile range (IQR) 9-28 days], with a further interval of 14 days to clinical diagnosis/treatment (IQR 2-31 days). Most cases were acquired locally and only 5% abroad. Patients responded to standard antibiotic therapy and recurrence or persistence was extremely rare. A second group of patients, not included in the clinical case series, were those who believed they had Lyme disease based on a probable tick bite but were seronegative by currently available validated tests and presented with subjective symptoms. This condition is often labelled chronic Lyme disease. These patients have a different disease from Lyme disease and therefore an alternative name, chronic arthropod-borne neuropathy (CAN), and case definition for this condition is proposed. We suggest that this chronic condition needs to be distinguished from Lyme disease, as calling the chronic illness 'Lyme disease' causes confusion to patients and physicians. We recommend research initiatives to investigate the aetiology, diagnosis and therapy of CAN.

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Accepted/In Press date: 9 April 2014
e-pub ahead of print date: 9 May 2014
Published date: 22 February 2015
Additional Information: Publisher Copyright: © 2014 Cambridge University Press. Copyright: Copyright 2015 Elsevier B.V., All rights reserved.
Keywords: Borreliosis, chronic arthropod-borne neuropathy, erythema migrans, infection rate, neuroborreliosis, ticks

Identifiers

Local EPrints ID: 447326
URI: http://eprints.soton.ac.uk/id/eprint/447326
ISSN: 0950-2688
PURE UUID: a87ae4c0-56e9-424c-b35b-60b5ba3e16f5
ORCID for K. Saeed: ORCID iD orcid.org/0000-0003-0123-0302

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Date deposited: 09 Mar 2021 17:32
Last modified: 17 Mar 2024 03:56

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Contributors

Author: M.S. Dryden
Author: K. Saeed ORCID iD
Author: S. Ogborn
Author: P. Swales

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