Boršič et al. Clinical course, serologic response, and long-term outcome in elderly patients with early Lyme Borreliosis.
J. Clin. Med. 2018, 7, 506; doi:10.3390/jcm7120506
For TBE, it is well known that older patients suffer from more severe clinical symptoms and have more adverse outcomes than younger patients.
For other tick-borne diseases, less is known on the association between patient age and severity of disease and recovery, e.g. Lyme disease (LD). In Slovenia, more than 1220 patients with erythema migrans (EM) were enrolled in clinical studies from 2006 to 2015 and were treated with appropriate antibiotics and treatment guidelines (doxycycline, cefuroxime axetil, amoxicillin or ceftriaxone) and were categorized as young (18 to 44 years), middle-aged (45 to 64 years) or elderly (≥65 years). The long-term outcome of EM was excellent in patients of all age groups. The large majority (≥83%) of patients in all age groups showed complete response from two months onward, returning to their pre-LD health status and treatment failure was documented in only 1.1%. However, the time to resolution of EM after starting antibiotic treatment showed significant prolongation with advancing age, which accords with delayed response to therapy in elderly patients with other types of infection, such as pneumonia. Older patients also had higher odds for an unfavorable outcome of treatment for middle-aged vs. young and for elderly vs. young, predominantly manifested as post-LB symptoms. The results presented here may be applicable to other European countries with similar ratios of Borrelia genospecies causing EM, but may not entirely apply to North America, where LD is caused nearly exclusively by B. burgdorferi sensu stricto (instead of B. afzelii).