Objective:

This retrospective study aims to investigate the clinical, laboratory, symptom, and functional impact characteristics of patients with prior neuroborreliosis presenting for evaluation of persistent symptoms. 

Background:

Lyme disease is an illness caused by Borrelia bacteria transmitted through tick bites. Neuroborreliosis describes Lyme disease with neurological manifestations, including cranial nerve palsies, meningitis, and radiculopathy. There is limited data on how neuroborreliosis is associated with other Lyme manifestations and measures of quality of life.

Design/Methods:

Participants presenting to the Johns Hopkins Lyme Disease Research Center for persistent symptoms following confirmed Lyme disease were included in this retrospective study. Clinical data on the patient’s medical, treatment, laboratory results, and symptoms at the onset of Lyme disease were collected via their electronic medical records or clinician encounters at the Lyme center. Surveys assessing quality of life metrics were performed at the Lyme center 6 months following initial visit.

Results:

In our neurological manifestation (NM) cohort consisting of 92 patients, 54.3% had cranial nerve palsies, 30.4% had neuropathy or radiculopathy, and 23.9% had Lyme meningitis. The NM group was less likely to present with diagnostic rash (35.9% vs 47.8%, p= 0.031), flu-like illness at onset (66.3% vs 79.3%, p= 0.005), and early (2.8% vs 19.8%, p<.001) or late (0% vs 7.4%, p= 0.007) Lyme arthritis than the non-NM group. The non-NM groups and the NM group showed no variations in non-Lyme related comorbidities, exposure to inappropriate antibiotic treatment (2.5% vs 2.6%, p = 0.947), or quality of life survey results.

Conclusions:

Our study underscores the need to investigate Lyme disease in patients with new-onset neurological manifestations, particularly in Lyme-endemic regions, irrespective of prior history of Lyme symptoms. Encouragingly, our findings suggest that patients with neurological manifestations and persistent symptoms did not exhibit worse self-assessed indicators of overall health, well-being, or functional capacity compared to the no NM cohort.