Lyme in UK: chronic arthropod-borne neuropathy

[Aileen]

Epidemiol Infect. 2014 May 9:1-12. [Epub ahead of print]
Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy.
Dryden MS1, Saeed K1, Ogborn S2, Swales P2.
Author information

• 1Department of Microbiology, Royal Hampshire County Hospital, Winchester, UK.
• 2Department of Medicine, Royal Hampshire County Hospital, Winchester, UK.

Abstract
SUMMARY 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 9·8/100 000 population, much higher than the reported national rate of 1·7/100 000. 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.

I hate having yet another name to remember but I think what they are proposing is a really good idea.

 

[Valentijn]

I hate having yet another name to remember but I think what they are proposing is a really good idea.

I'm not so sure ... they seem to be saying there's one group with clear positive blood results for Lyme who recovered after a short bout of antibiotics, and a 2nd group of nutters who think they're sick.

It looks like a proposal to lump them in with "medically unexplained" diagnoses.

 

[alex3619]

They should have a clinical case series for CAN, and then they would find the seropostive patients. Its sounds like they are making an assumption or three here.

I do think however that we need to be investigating what I would call post-Lyme disease, just as we have post-Q fever, post-SARS and post-polio, and the generic post viral fatigue syndrome. In these states the acute infection is typically resolved, but that does not tell us anything about residual pathogens or altered immune states. Blood tests are not reliable for many pathogens anyway, typical blood tests are geared to find acute infection. Further if these patients are immune compromised then the risk of new infection, or the recurrence of old infection, could be expected to be higher.

I agree this does sound like a proposal for a new category of MUPS.

 

[Firestormm]

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

Abstract
SUMMARY

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 9·8/100 000 population, much higher than the reported national rate of 1·7/100 000. 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.

 

[Sushi]

Also, being seronegative means you are seronegative for the strains they tested for--and they generally only test for a few strains whereas there are "legion."

So aside from the problems we might have producing antibodies to an "old infection," there is the question of what strains they tested for.

I have myself as an example: I tested negative by serology for Bartonella. The test only included a few of the 30 some strains. Later I tested positive by PCR (DNA) for Bartonella.

Sushi