Early Disseminated, Early Localized Lyme Borreliosis Show Similar Outcomes

Lyme disease
Lyme disease
At baseline, more symptoms associated with Lyme borreliosis were reported by those with multiple erythema migrans than with solitary erythema migrans.

Early disseminated and early localized Lyme borreliosis show similar and positive long-term outcomes 1 year after treatment, according to a study recently published in JAMA Dermatology.

This study included 403 individuals with solitary erythema migrans and 200 with multiple erythema migrans. Among those with multiple erythema migrans, 106 (53.0%) were female and the median age was 47 (interquartile range [IQR] 35-58) years, while the solitary erythema migrans group was 54.8% (n=221) female with a median age of 55 (IQR 42-62) years. At 14 days, 2 months, 6 months, and 12 months, participants were asked to complete questionnaires dealing with their symptoms. Normal approximation corrected for continuity was used to calculate the rate of incomplete response at 1 year post-treatment and associated 95% confidence intervals (CI).

At baseline, more symptoms associated with Lyme borreliosis were reported by those with multiple erythema migrans (46.5%; 95% CI, 39.4-53.7) than with solitary erythema migrans (23.8%; 95% CI, 19.7-28.3; P <.001). By the 6-month post-treatment mark, more individuals with multiple erythema migrans had shown an incomplete response than those with solitary erythema migrans. 

At 14 days, the respective rates were 32.1% vs 18.4% (P <.001); at 2 months, 19.7% vs 14.0% (P =.28); and at 6 months, 15.9% vs 8.6% (P =.02). By the 12-month mark, however, the two groups showed similar rates of incomplete response: 5.9% vs 6.5% (95% CI, -5.5 to 4.3; P =.95). Nonspecific symptoms were reported at a similar rate to that among controls.

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The researchers reported “that the proportion of patients who reported Lyme borreliosis–associated constitutional symptoms at enrollment and post–Lyme borreliosis symptoms at follow-up was higher in those with [multiple erythema migrans] than in those with solitary [erythema migrans] up until 6 months after treatment; however, the long-term outcome at 12 months after treatment was comparable and excellent, regardless of dissemination. … Follow-up of at least 12 months after treatment is thus recommended for future studies that investigate post-Lyme borreliosis symptoms.”

This study was supported by grants P3-0296 and J3-6788 from the Slovenian Research Agency.


Stupica D, Maraspin V, Bogovič, P, et al. Comparison of clinical course and treatment outcome for patients with early disseminated or early localized Lyme borreliosis [published online August 1, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.2306