A Lyme borreliosis diagnosis probability score – no relation with antibiotic treatment response

Abstract

Objectives: (1) To describe epidemiological and clinical data of patients that present with the suspicion of Lyme borreliosis (LB); (2) to evaluate a previous published score that classifies patients on the probability of having LB, following-up patients’ clinical outcome after antibiotherapy.

Methods: Inclusion criteria: patients with clinical manifestations compatible with LB and Borrelia (B.) burgdorferi positive serology, hospitalized in a Romanian hospital between January 2011 and October 2012. Exclusion criteria: erythema migrans (EM) or suspicion of Lyme neuroborreliosis (LNB) with lumbar puncture performed for diagnosis. A questionnaire was completed for each patient regarding associated diseases, tick bites or EM history and clinical signs/symptoms at admission, end of treatment and 3 months later. Two-tier testing (TTT) used an ELISA followed by a Western Blot kit. The patients were classified in groups, using the LB probability score and were evaluated in a multidisciplinary team. Antibiotherapy followed guidelines’ recommendations.

Results: Sixty-four patients were included, presenting diverse associated comorbidities. Fifty-seven patients presented positive TTT, seven presenting either ELISA or Western Blot test positive. No differences in outcome were found between the groups of patients classified as very probable, probable and little probable LB. Instead, a better post-treatment outcome was described in patients with positive TTT.

Conclusion: The patients investigated for the suspicion of LB present diverse clinical manifestations and comorbidities that complicate differential diagnosis. The LB diagnosis probability score used in our patients did not correlate with the antibiotic treatment response, suggesting that the probability score does not bring any benefit in diagnosis.

Keywords:

• Lyme borreliosis
• differential diagnosis
• probability score

Disclosure statement

The publication of this paper was supported from grant IDEI-PCCE CNCSIS 84, 7/2010, from a project co-financed by E.S.F POSDRU 88/1.5/S/56949. The work of Violeta Tincuţa Briciu and Mihaela Lupşe was done under the frame of EurNegVec COST Action TD1303.

Additional information

Funding

The publication of this paper was supported from grant IDEI-PCCE CNCSIS 84, 7/2010, from a project co-financed by E.S.F POSDRU 88/1.5/S/56949. The work of Violeta Tincu?a Briciu and Mihaela Lup?e was done under the frame of EurNegVec COST Action TD1303.