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Brellier F, Pujades-Rodriguez M, Powell E, Mudie K, Mattos Lacerda E, Nacul L, Wing K. Incidence of Lyme disease in the United Kingdom and association with fatigue: A population-based, historical cohort study. PLoS One 2022; 17:e0265765. [PMID: 35320297 PMCID: PMC8942220 DOI: 10.1371/journal.pone.0265765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Estimations of Lyme disease incidence rates in the United Kingdom vary. There is evidence that this disease is associated with fatigue in its early stage but reports are contradictory as far as long-term fatigue is concerned. Methods and findings A population-based historical cohort study was conducted on patients treated in general practices contributing to IQVIA Medical Research Data: 2,130 patients with a first diagnosis of Lyme disease between 2000 and 2018 and 8,510 randomly-sampled patients matched by age, sex, and general practice, followed-up for a median time of 3 years and 8 months. Main outcome measure was time to consultation for (1) any fatigue-related symptoms or diagnosis; or (2) myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Adjusted hazard ratios (HRs) were estimated from Cox models. Average incidence rate for Lyme disease across the UK was 5.18 per 100,000 person-years, increasing from 2.55 in 2000 to 9.33 in 2018. In total, 929 events of any types of fatigue were observed, leading to an incidence rate of 307.90 per 10,000 person-years in the Lyme cohort (282 events) and 165.60 in the comparator cohort (647 events). Effect of Lyme disease on any subsequent fatigue varied by index season: adjusted HRs were the highest in autumn and winter with 3.14 (95%CI: 1.92–5.13) and 2.23 (1.21–4.11), respectively. For ME/CFS, 17 events were observed in total. Incidence rates were 11.76 per 10,000 person-years in Lyme patients (12 events) and 1.20 in comparators (5 events), corresponding to an adjusted HR of 16.95 (5.17–55.60). Effects were attenuated 6 months after diagnosis but still clearly visible. Conclusions UK primary care records provided strong evidence that Lyme disease was associated with subsequent fatigue and ME/CFS. Albeit weaker on the long-term, these effects persisted beyond 6 months, suggesting patients and healthcare providers should remain alert to fatigue symptoms months to years following Lyme disease diagnosis.
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Affiliation(s)
| | | | - Emma Powell
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathleen Mudie
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eliana Mattos Lacerda
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luis Nacul
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- British Columbia Womens Hospital and Health Centre, Complex Chronic Diseases Program, Vancouver, Canada
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kevin Wing
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Markowicz M, Kundi M, Stanek G, Stockinger H. Nonspecific symptoms following infection with Borrelia burgdorferi sensu lato: A retrospective cohort study. Ticks Tick Borne Dis 2021; 13:101851. [PMID: 34662801 DOI: 10.1016/j.ttbdis.2021.101851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Whether infection with Borrelia burgdorferi sensu lato (sl) can cause nonspecific symptoms is a matter of controversy. We investigated whether individuals infected with B. burgdorferi sl develop unspecific symptoms more frequently than non-infected controls. Eighty-nine persons having presented with B. burgdorferi sl infection between 2015 and 2019 were asked to participate. The infection was defined as erythema migrans diagnosed either in the course of a previous study, during medical visits in the outpatient department, or as seroconversion in asymptomatic subjects. The control group consisted of 85 seronegative individuals without erythema migrans in the past. About two and a half years later, participants were asked to fill out a questionnaire with a list of nonspecific symptoms. The data of 37 persons with previous Borrelia infection and 49 uninfected controls were available for analysis. Muscle pain was significantly (P = 0.040) more frequent in the control group. Fatigue occurred more often in the infected group, but this was not statistically significant (P = 0.109). Likewise, the distribution of other symptoms did not differ considerably. The analysis revealed no difference in the frequency of symptoms of persons who had EM or asymptomatic Borrelia infection 2 years prior assessment in comparison to persons without Borrelia infection.
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Affiliation(s)
- Mateusz Markowicz
- Institute for Hygiene and Applied Immunology; Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Michael Kundi
- Department of Environmental Health, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Gerold Stanek
- Institute for Hygiene and Applied Immunology; Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Hannes Stockinger
- Institute for Hygiene and Applied Immunology; Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
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Heidari Z, Feizi A, Rezaei S, Roohafza H, Adibi P. Psychosomatic symptoms questionnaire (PSQ-39): a psychometric study among general population of Iranian adults. BMC Psychiatry 2021; 21:269. [PMID: 34034698 PMCID: PMC8147044 DOI: 10.1186/s12888-021-03278-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Psychosomatic symptoms, characterized by physical-bodily complaints not fully explained by organic reasons, are highly prevalent. The present study aimed to culturally adapt and evaluate the psychometric properties of Psychosomatic Symptoms Questionnaire 39-item version (PSQ-39) among Iranian general adult population. METHODS This study included 996 Persian-speaking people, living in Isfahan, Iran. The translation of the PSQ-39 was performed using the forward-backward method. Test-retest reliability was evaluated through Intraclass correlation (ICC) coefficient and internal consistency by using Cronbach's α. Construct validity was investigated by using both exploratory (EFA) and confirmatory (CFA) factor analysis. Short Form Health Survey (SF-36) was used to assess divergent validity. Known-group validity was also assessed. RESULTS The Persian version of the PSQ-39 showed excellent test-retest reliability in all domains (ICCs: 0.95-0.99). The computed Cronbach's alpha coefficients for domains of PSQ-39 were in the range good to excellent. The PSQ-39 showed good known-group validity and differentiated patients from the general population (Area under the curve [AUC] of 0.78 (95% CI: 0.73, 0.84). Construct validity evaluated by EFA led to extraction of seven factors (Cardiorespiratory, musculoskeletal, psychological, gastrointestinal, general, body balance and Globus), and the CFA confirmed the adequacy of extracted factors by EFA (CFI = 0.91, TLI = 0.90, PCFI = 0.77, PNFI = 0.71, CMIN = 1413.18 (df = 654), CMIN/DF = 2.16, and RMSEA = 0.06). Significant negative correlations between all domains of PSQ and SF-36 revealed an acceptable divergent Validity. CONCLUSIONS The Persian version of the PSQ-39 is a reliable and valid questionnaire with applicability in a broad range of Persian language populations for assessing common psychosomatic symptoms in research as well as in clinical practice.
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Affiliation(s)
- Zahra Heidari
- grid.411036.10000 0001 1498 685XDepartment of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, P.O. Box 319, Hezar-Jerib Ave, Isfahan, 81746- 73461 Iran ,grid.411036.10000 0001 1498 685XCardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, P.O. Box 319, Hezar-Jerib Ave, Isfahan, 81746- 73461, Iran. .,Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sara Rezaei
- grid.411036.10000 0001 1498 685XDepartment of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, P.O. Box 319, Hezar-Jerib Ave, Isfahan, 81746- 73461 Iran ,grid.411036.10000 0001 1498 685XStudent Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- grid.411036.10000 0001 1498 685XCardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- grid.411036.10000 0001 1498 685XGastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XDepartment of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Thortveit ET, Aase A, Petersen LB, Lorentzen ÅR, Mygland Å, Ljøstad U. Subjective health complaints and exposure to tick-borne infections in southern Norway. Acta Neurol Scand 2020; 142:260-266. [PMID: 32392618 DOI: 10.1111/ane.13263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Whether tick-borne infections can cause chronic subjective health complaints is heavily debated. If such a causal connection exists, one would expect to find more health complaints among individuals exposed to tick-borne infections than among non-exposed. In this study, we aimed to assess if exposure to tick-borne infections earlier in life, evaluated by examination of serum for IgG antibodies to tick-borne microbes, was associated with self-reported somatic symptom load. MATERIALS & METHODS All individuals with residential address in Søgne municipality in southern Norway, aged 18-69 years, were invited to participate in the study. Blood samples were analyzed for IgG antibodies to different tick-borne microbes, and somatic symptom load was charted by the Patient Health Questionnaire-15 (PHQ-15). RESULTS Out of 7424 invited individuals, 2968 (40.0%) were included in the study. We detected IgG antibodies to Borrelia burgdorferi sensu lato (Bb) in 22.9% (95% CI 21.4-24.4). Bb seropositive individuals reported less frequently moderate to severe somatic symptom load (ie, PHQ-15 sum score ≥ 10) than seronegative individuals (12.5% versus 17.7%, difference 5.2% [95% 2.1-8.0]). However, when adjusting for several other variables in a multivariable linear regression model, presence of serum IgG antibodies to Bb was not associated with somatic symptom load. Presence of IgG antibodies to other tick-borne microbes than Bb, or seropositivity to at least two microbes, was also not associated with somatic symptom load. CONCLUSION Presence of serum IgG antibodies to tick-borne microbes was not associated with self-reported somatic symptom load.
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Affiliation(s)
| | - Audun Aase
- Department of Infectious Disease Immunology Norwegian Institute of Public Health Oslo Norway
| | - Lizette Balle Petersen
- Department of Infectious Disease Immunology Norwegian Institute of Public Health Oslo Norway
| | - Åslaug Rudjord Lorentzen
- Department of Neurology Sørlandet Hospital Trust Kristiansand Norway
- The Norwegian National Advisory Unit on Tick‐Borne Diseases Sørlandet Hospital Trust Arendal Norway
| | - Åse Mygland
- Department of Neurology Sørlandet Hospital Trust Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Habilitation Sørlandet Hospital Trust Kristiansand Norway
| | - Unn Ljøstad
- Department of Neurology Sørlandet Hospital Trust Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
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Eikeland R, Ljøstad U, Helgeland G, Sand G, Flemmen HØ, Bø MH, Nordaa L, Owe JF, Mygland Å, Lorentzen ÅR. Patient-reported outcome after treatment for definite Lyme neuroborreliosis. Brain Behav 2020; 10:e01595. [PMID: 32153118 PMCID: PMC7177557 DOI: 10.1002/brb3.1595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To chart patient-reported outcome measures (PROMs) in Norwegian patients treated for definite neuroborreliosis (NB). MATERIAL AND METHODS Adult patients treated for definite NB 1-10 years earlier supplied demographics, symptoms and treatment during NB, and answered validated questionnaires; Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), health-related quality of life questionnaire (RAND-36), and Patient Health Questionnaire (PHQ-15). RESULTS A higher proportion of NB-treated persons reported severe fatigue, defined as FSS score ≥ 5, than in Norwegian normative data, but when removing persons with confounding fatigue associated comorbidities (n = 69) from the analyses, there was no difference between groups. Physical health-related quality of life (RAND-36 PCS), mean FSS score, proportions of persons reporting moderate or severe somatic symptom burden (PHQ-15 score ≥ 10), anxiety (HADS-A ≥ 8), or depression (HADS-D ≥ 8) did not differ between NB-treated persons and reference scores. Mental health-related quality of life (RAND-36 MCS) was poorer than in normative data (47.1 vs. 53.3), but associated with anxiety, depression and current moderate or severe somatic symptom burden, and not with NB characteristics. CONCLUSIONS Results on validated PROM questionnaires measuring fatigue, anxiety, depression, self-reported somatic symptom burden, and physical health-related quality did not differ between persons treated for definite NB 1-10 years earlier and reference scores. NB-treated persons tended to report a slightly poorer mental health-related quality of life than found in normative data, but when adjusting for confounders the causative connection is questionable. Overall, the long-term prognosis of definite NB seems to be good.
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Affiliation(s)
- Randi Eikeland
- Department of Pediatrics, Sørlandet Hospital Trust, Arendal, Norway.,The Norwegian National Advisory Unit on Tick-borne Diseases, Arendal, Norway
| | - Unn Ljøstad
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Helgeland
- Department of Neurology, Møre and Romsdal Hospital Trust, Molde, Norway
| | - Geir Sand
- Department of Infectious Diseases, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Ludmila Nordaa
- Department of Neurology, Helse Fonna Trust, Haugesund, Norway
| | - Jone Furulund Owe
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Åse Mygland
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Rehabilitation, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Åslaug Rudjord Lorentzen
- The Norwegian National Advisory Unit on Tick-borne Diseases, Arendal, Norway.,Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
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