Management and clinical outcomes of Lyme disease in acute care facilities in 2 endemic regions of Quebec, Canada:, 2022, Musonera et al

Full title: Management and clinical outcomes of Lyme disease in acute care facilities in 2 endemic regions of Quebec, Canada: a multicentre retrospective cohort study

Abstract

Background: Despite increases in cases of Lyme disease, little is known about the management and clinical course of the disease in Canada. We aimed to describe the management and clinical course of Lyme disease in patients treated in acute care facilities in Quebec and to assess adherence to the 2006 Infectious Diseases Society of America (IDSA) guideline.

Methods: This retrospective multicentre cohort study included pediatric and adult patients with serologically confirmed Lyme disease treated in acute care facilities (12 community hospitals and 2 tertiary care centres) of 2 endemic regions of Quebec (Estrie and Montérégie), from 2004 to 2017. We considered drug choice, prescribed dose and treatment duration in assessing adherence of prescriptions to the 2006 IDSA guideline. The main outcome was complete resolution of symptoms at 3 months after the initiation of treatment.

Results: We included 272 patients from 14 institutions (age range 3–87 yr). Early disseminated Lyme disease (140 patients [51%]) was predominant. Adherence to the IDSA guideline was observed in 235 (90%) of the 261 cases with complete information, and adherence was stable over time (2004–2013: 57/64 [89%]; 2014–2015: 64/71 [90%]; 2016–2017: 114/126 [90%]; p = 0.8). Non-adherence to the guideline (n = 26) was predominantly due to longer-than-recommended treatment duration (16/26 [62%]). Resolution of objective signs at 3 months after treatment initiation occurred in 265 (99%) of 267 patients, whereas post-treatment Lyme disease syndrome was observed in 27 patients (10%) with increasing incidence over time (2004–2013: 3/65 [5%]; 2014–2015: 4/73 [5%]; 2016–2017: 20/129 [16%]; p = 0.02).

Interpretation: We observed clinical resolution of Lyme disease in 99% of the patients, and most treatments (90%) complied with the 2006 IDSA guideline. The incidence of post-treatment Lyme disease syndrome increased over the study period, warranting further prospective studies.

Open access, https://www.cmajopen.ca/content/10/2/E570

 

I'd have preferred if this attempt to study the clinical course of Lyme disease included more late stage cases. Only 15 percent of this retrospective's cohort were late stage. So 85 percent was either early or early disseminated. Early stage is different, just as it is with Syphilis - not just in terms of presentation, but in ability to treat successfully with conventional protocols.

Regardless, the numbers from this study still reflect what we've known for decades: When you incorporate not just objective symptoms, but subjective as well, people stay sick between 10 and 20 percent of the time. That has been the case stretching back to the 80's. This obsession with, and restriction to, objective signs in Lyme disease limits any accurate discussion of disease prevalence. Apparently for some researchers, if you cannot see it, it really doesn't qualify as a given disease. That is absurd given that for many (most?) Lyme patients, it is subjective symptoms that prove enduring and most disabling.

What's different from studies back in the 80's? Well, first of all, there's a lot more people getting infected now. In the US, some estimates place the number at well over 400,000 case annually. Ten to 20% of 400,000 each year, year after year, will add up and burden any health care system.

Second, from a quick read it would seem to me that this study reflects predominantly early local and early disseminated cases. It's widely acknowledged that late stage Lyme - as with tertiary Syphilis - is more difficult to treat and suffers from higher failure rates. Where's the balance with only 15% purportedly late stage?

Peel back the onion here and these numbers appear grim.