PEDIATRICS Vol. 91 No. 2 February 1993, pp. 456-459
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Early Lyme Disease: A Flu-Like Illness Without Erythema Migrans

Henry M. Feder Jr MD1, Michael A. Gerber MD2, Peter J. Krause MD3, Eugene D. Shapiro MD4, and Raymond Ryan PhD5

1 From the Departments of Family Medicine, Pediatrics, University of Connecticut Health Center, Farmington
2 From the Department Pediatrics, University of Connecticut Health Center, Farmington
3 From the Department of Pediatrics, Hartford Hospital, Hartford, CT
4 From the Departments of Pediatrics and of Epidemiology, Yale University School of Medicine, New Haven, CT.
5 From the Department Laboratory Medicine, University of Connecticut Health Center, Farmington

The existence of a form of early Lyme disease characterized by a flu-like illness without erythema migrans is controversial. To confirm the existence and define the clinical characteristics of the flu-like illness without erythema migrans of localized Lyme disease, the authors studied patients from a Lyme disease endemic area of Connecticut who visited their primary care physicians with an undefined flu-like illness. Patients kept a diary of their symptoms. Acute and convalescent sera were obtained. The diagnosis of Lyme disease was based on the appearance of IgM or IgG antibodies to Borrelia burgdorferi as demonstrated by both enzyme-linked immunosorbent assay and immunoblot assay. Twenty-four untreated patients were studied. In five patients acute serologic evidence of Lyme disease developed. The flulike illness in these five patients was characterized by fever and fatigue and resolved spontaneously in 5 to 21 days. Symptoms recurred in three of these five patients. The existence of a flu-like illness without erythema migrans of early Lyme disease has been clearly established. Prospective, controlled studies are needed to better define its incidence, characteristics, and prognosis so that appropriate diagnostic and therapeutic strategies can be developed.

Key Words: Lyme disease • fullike illness

Submitted on May 14, 1992
Accepted on September 30, 1992




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LYME DISEASE MAY MASQUERADE AS A FLU-LIKE ILLNESS
Journal Watch (General), February 16, 1993; 1993(216): 5 - 5.
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