Clinical course, serologic response, and long-term outcome in elderly patients with early Lyme borreliosis

Boršič, Katarina (author), Blagus, Rok (author), Cerar Kišek, Tjaša (author), Strle, Franc (author), Stupica, Daša (author)

Infected elderly people often present with signs and symptoms that differ from those in younger adults, but data on the association between patient age and presentation of early Lyme borreliosis (LB) are limited. In this study, the association between patient age (18–44 years, young vs. 45–64 years, middle-aged vs. ≥ 65 years, elderly) and disease course, microbiologic characteristics, and the long-term outcome of treatment was investigated prospectively in 1220 adult patients with early LB manifesting as erythema migrans (EM) at a single-center university hospital. Patients were assessed at enrolment and followed-up for 12 months. Age was associated with comorbidities, previous LB, presenting with multiple EM, and seropositivity to borreliae at enrolment. The time to resolution of EM after starting antibiotic treatment was longer in older patients. At 12 months, 59/989 (6.0%) patients showed incomplete response. The odds for incomplete response decreased with time from enrolment (odds ratio (OR) of 0.49, 0.50, and 0.48 for 2-month vs. 14-days, 6-month vs. 2-month, and 12-month vs. 6-month follow-up visits, respectively), but were higher with advancing age (OR 1.57 for middle-aged vs. young, and 1.95 for elderly vs. young), in women (OR 1.41, 95% confidence interval (CI) 1.01–1.96), in patients who reported LB-associated constitutional symptoms at enrolment (OR 7.69, 95% CI 5.39–10.97), and in those who presented with disseminated disease (OR 1.65, 95% CI 1.09–2.51). The long-term outcome of EM was excellent in patients of all age groups. However, older patients had slower resolution of EM and higher odds for an unfavorable outcome of treatment (OR 1.57, 95% CI 1.05–2.34 for middle-aged vs. young; and OR 1.95, 95% CI 1.14–3.32 for elderly vs. young), manifested predominantly as post-LB symptoms. The presence of LB-associated constitutional symptoms at enrolment was the strongest predictor of incomplete response.

• Language: English
• Keywords: erythema migrans, Lyme borreliosis, elderly, post-Lyme symptoms
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2018
• Number of pages: 9 str.
• Numbering: Vol. 7, iss. 12, art. 506
• PID: 20.500.12556/RUL-132010
• UDC: 616.9
• ISSN on article: 2077-0383
• DOI: 10.3390/jcm7120506
• COBISS.SI-ID: 5517740
• Publication date in RUL: 08.10.2021

Record is a part of a journal

• Title: Journal of clinical medicine
• Shortened title: J. clin. med.
• Publisher: MDPI
• ISSN: 2077-0383
• COBISS.SI-ID: 5405759

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
• Licensing start date: 02.12.2018

Projects

• Funder: ARRS - Slovenian Research Agency
• Project number: P3-0296
• Name: Bolezni in povzročitelji, ki jih v Sloveniji prenašajo členonožci

• Funder: ARRS - Slovenian Research Agency
• Project number: J3-6788
• Name: Etiologija, vnetne beljakovine in genski polimorfizem pri bolnikih s solitarnim in multiplim erythema migrans