Full spectrum of clinical, serological, and epidemiological features of complicated forms of Lyme borreliosis in the Paris, France, area

The aim of this study was to report the clinical, serological and epidemiol ogical features of a homogeneous cohort of patients with various forms of L yme borreliosis, based on recent European case-definition guidelines. Compl ete clinical and epidemiological reports were requested from the patients' physicians for case definition. Enzyme immunoassay IgG and IgM screening te sts were performed. A total of 170 patients (141 adults and 29 children) wi th the following forms of Lyme borreliosis were included between 1989 and 1 997: erythema migrans alone (n =38), early neuroborreliosis (n = 76), arthr itis (n = 34), acrodermatitis chronica atrophicans (n = 12), carditis (n =2 ), lymphocytoma (n = 3), chronic neuroborreliosis (n = 2), and miscellaneou s disorders (n = 3). On the basis of the occurrence and course of the full spectrum of complicated forms of Lyme borreliosis, the specificity of the c linical and biological presentation of the complicated forms (age, ratio of children/adults, sex ratio, incubation period, time to diagnosis, and sero logical profiles) was demonstrated, as was the absence of overlap between t he clinical presentations. Using these data, an alternative scheme for the natural history of Lyme borreliosis is suggested.