Clinical features of 705 Borrelia burgdorferi seropositive patients in an endemic area of northern Italy.
http://www.ncbi.nlm.nih.gov/pubmed/24550705
Seven hundred and five patients met the inclusion criteria, 363 males and 342 females.
EM was the most common manifestation and it has been detected in 437 patients (61.99%). There was neither gender difference (M : F = 215 : 222) nor age difference. EM has been found during the visit in 319 patients and it was reported by 118 subjects as an history fact. It appeared from 3 to 25 days after the tick bite (average: after 12 days). Other classical cutaneous manifestations of LB included 58 cases of multiple EM (8.23%), 7 LABC (1%), and 18 ACA (2.55%). Atypical cutaneous manifestations, that is, clinical features not surely linked to LB, were 16 (2.27%), in details: 8 cases of morphoea, 2 Raynaud’s phenomenon, 1 lichen sclerosus and atrophicus, 1 pityriasis lichenoides, 1 Gilbert’s pityriasis rosea, 1 urticaria, 1 anetoderma, and 1 erythema nodosum.
The musculoskeletal system was involved in 511 patients (72.48%): 262 out of 511 presented arthralgias or acute arthritis; they were 119 men and 143 women; 88 had a single episode whereas 174 suffered from several attacks. The evolution to chronic arthritis was seen in 22 cases (8% among the patients with arthralgias/acute arthritis). Muscular hypotonia and/or hypotrophy was observed in 41 patients (5.81%).
Four hundred and sixty patients presented a neurological involvement. Two patients reported Bannwarth’s syndrome, 3 acute encephalopathy and 1 chronic encephalopathy. Two hundred and ninety-three patients (41.56%), 127 males and 166 females, reported cephalea, dizziness, memory and concentration problems, irritability, emotional lability, and sleepiness. As far as the peripheral nervous system is concerned, 161 patients (22.84%) reported paresthesias (115 cases), sensitiveness disorders (47 patients), and motion functionality disorders (19 cases). Out of these 161 patients, 74 suffered from neuritis, polyneuritis, meningoradiculitis and peripheral nerves paralysis, in particular there were 12 cases of the seventh cranial nerve paralysis.
Flu-like symptoms such as fever, arthromyalgia and headache preceded or accompanied or were the only clinical feature in 119 (16.88%) patients. Fever was the only symptom in 11 patients (1.56%) while in 165 (23.4%) cases was accompanied by other manifestations. A reactive regional or generalized lymphadenopathy was recorded in 75 patients (10.64%).
Psychiatric symptoms have been observed in 37 patients (5.25%), 22 men and 15 women. There were 21 cases of anxiety, 10 cases of depression and 6 complex syndromes characterised by panic attacks and phobias.
An intrinsic ocular disease or a disturb deriving from the neuromuscular involvement of the eye has been observed in 71 patients (10.07%), 25 males and 46 females: 28 cases of conjunctivitis, 7 cases of photophobia, 13 cases of visual impairment, 11 of bulbar pain, 4 of diplopia, 1 case of hemianopsia, 1 of orbital muscle tremor, 3 cases of lacrimation and burning and 3 of orbital oedema.
In 57 subjects (8.08%), 26 men and 31 women, there was an involvement of the cardio-vascular system: 14 patients suffered from tachycardia, 3 from bradycardia, and 13 from palpitations. Twenty-four patients presented with the acute onset of varying degrees of intermittent atrioventricular heart block, symptomatic or detected by the ECG. A case of complete atrioventricular block required the implant of a pacemaker. One patient referred angina and 2 patients suffered from a myocarditis.
An involvement of the liver was observed in 41 patients of this survey (5.81) who reported specific alterations of the cytonecrosis enzymes.
With the purpose of better investigating the severity spectrum of LB, an analysis of the summation of the number of symptoms per patient was made. Two hundred and forty-eight (35.1%) patients reported only 1 manifestation. Two different symptoms were observed in 251 (35.6%) patients, 3 clinical features were recorded in 120 (17.0%) subjects, and more than three clinical manifestations assignable to LB were reported for 86 (12.1%) cases.