218837 Lyme Disease: A Complex Illness with Distinct Subgroups

Monday, November 8, 2010 : 10:30 AM - 10:45 AM

Cheryl Koopman, PhD , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Tyson Holmes, PhD , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Raphael Stricker, MD , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Daniel Cameron, MD/MPh , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Christine Green, MD , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Yvonne Lin, PA-C , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Adelaida Castillo, MA , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Alexandra Aylward, BA , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Jill Whisnant, MA , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
Casey Brodhead, BA , Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
The diagnosis of Lyme disease merits further study because of the diversity of its manifestations, with infections found in the brain, joints/muscles, and/or heart. Its diagnosis is further complicated by the insensitivity of the two-tier CDC diagnostic criteria requiring positive results on both the ELISA and Western blot. Physicians may rely too heavily on such criteria because of the potentially overwhelming number of symptoms that can accompany Lyme. Therefore, our study aim was to assess if manifestations of Lyme disease could be empirically classified into a small to modest number of symptom constellations. We also sought to identify if medical and demographic characteristics differentiate these clusters. We analyzed medical records of 1059 adult Lyme disease patients from a medical practice specializing in tick-born illnesses. All patients self-reported on the presence or absence of 132 symptoms and provided additional medical and demographic information. Gap statistic analysis identified 10 separable clusters, which differed in symptom frequencies and quantities of patients (3-220). These symptom clusters differed significantly with respect to gender (p ≤ .0005), age (p ≤ .0001), length of time since symptom onset (overall p ≤ .05), and prior use of antibiotic therapy (p ≤ .002). Clusters did not differ significantly with respect to recall of tick bite or bulls-eye rash or to current use of antibiotic therapy. The results of this study may have significant implications for both understanding and treating the complex illness of Lyme disease. Distinct symptom clusters and/or stages of the illness may require different treatment approaches.

Learning Areas:
Basic medical science applied in public health
Epidemiology

Learning Objectives:
Identify separate manifestations of Lyme disease based on symptom constellations. Identify the risk factors associated with specific symptom clusters of Lyme disease, including gender, age, prior use of antibiotic therapy, and length of time since onset of symptoms.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I oversee research on prevention and management of health problems.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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