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Lyme disease surveillance in the United States, 1983-1986
C A Ciesielski1, L E Markowitz, R Horsley
1Epidemiology Section, Centers for Disease Control, Atlanta, Georgia 30333.
Abstract:
During 1983-1986, 5,016 cases of Lyme disease were reported to the Centers for Disease Control. Cases were acquired in 31 states; however, 86% of the cases were acquired in seven states: Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Wisconsin, and Minnesota. For 63% of patients the disease began in summer; 52% recalled a tick bite. Erythema chronicum migrans (ECM) occurred in 91% of the patients; arthritis, in 57%; neurologic complications, in 18%; and cardiac manifestations, in 10%. When serum samples were obtained greater than or equal to 21 days after onset of symptoms, 14% (6 of 42) with ECM alone and 19% (17 of 89) with complicated Lyme disease (ECM plus organ-system involvement) had positive serologic tests. Antimicrobial therapy did not appear to affect serologic response. Lyme disease is now the most commonly reported tick-borne illness in the United States and has been reported from 32 states since 1980. Physicians nationwide need to be familiar with the protean signs and symptoms associated with Lyme disease and with the limitations of current serologic techniques in diagnosing early illness.
Insights
Lyme disease, a common tick-borne illness, presents with varied symptoms like Erythema chronicum migrans (ECM). Early diagnosis is challenging due to limitations in serologic tests, even with symptoms present.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Lyme disease is the most frequently reported tick-borne illness in the U.S.
- Reported cases have been identified in 32 states since 1980.
- The Centers for Disease Control (CDC) documented 5,016 Lyme disease cases between 1983 and 1986.
Purpose of the Study:
- To analyze the epidemiology and clinical manifestations of Lyme disease.
- To highlight the diagnostic challenges posed by early-stage Lyme disease.
- To inform healthcare providers about the protean signs and symptoms of Lyme disease.
Main Methods:
- Retrospective analysis of reported Lyme disease cases (1983-1986).
- Review of clinical presentations, including Erythema chronicum migrans (ECM), arthritis, neurologic, and cardiac complications.
- Evaluation of serologic test sensitivity at different stages of illness.
Main Results:
- 86% of cases were concentrated in seven specific states.
- The majority of cases began in summer, with 52% recalling a tick bite.
- ECM occurred in 91% of patients; arthritis in 57%; neurologic complications in 18%; cardiac manifestations in 10%.
- Serologic tests showed limited sensitivity, with positive results in only 14-19% of cases when drawn ≥21 days post-symptom onset.
- Antimicrobial therapy did not influence serologic response.
Conclusions:
- Lyme disease exhibits diverse clinical presentations, necessitating broad physician awareness.
- Current serologic diagnostic techniques have limitations, particularly in early disease detection.
- Understanding geographic distribution and symptom patterns is crucial for public health surveillance and clinical management.