Kwit NA, et al. - Researchers here sought to assess risk factors for Lyme arthritis, facial palsy, carditis, and meningitis in patients from high-incidence states. They recognized variation in the risk and manifestations of disseminated Lyme disease (LD) by age and sex. Enhancement in early case recognition and patient management could be achieved with provider education regarding at-risk populations and additional investigations into pathophysiology.

Methods

• Researchers identified patients from high-incidence states treated for LD during 2005–2014 in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations.

Results

• Researchers identified 88,022 unique patients diagnosed with LD.
• Among them, 5,122 (5.8%) patients with 5,333 co-diagnoses were recognized: 2,440 (2.8%) arthritis, 1,853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis.
• Patients with disseminated LD, compared to non-disseminated LD, had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%).
• In this study, greatest differential risks included arthritis in males aged 10–14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0–4.2), facial palsy (OR, 2.1; 95% CI, 1.6–2.7) and carditis (OR, 2.4; 95% CI, 1.6–3.6) in males aged 20–24 years, and meningitis in females aged 10–14 years (OR, 3.4; 95% CI, 2.1–5.5) compared to the 55–59 year referent age group.
• The highest risk for complete heart block, a potentially fatal condition was observed in males aged 15–29 years.