Symptoms may persist long after antibiotic treatment of early Lyme disease. A research team from the Johns Hopkins Division of Rheumatology, led by John Aucott, M.D. and Mark Soloski Ph.D., and Kate Bechtold Ph.D. in the Department of Physical Medicine & Rehabilitation, recently described a large series of patients with early Lyme disease. They found that persistent elevation of CCL19, a protein that acts by recruiting specific inflammatory cells to sites of inflammation, is a risk factor for ongoing symptoms even after initial antibiotic treatment.
Why was this study done?
In most cases, Lyme disease is effectively treated with antibiotics and patients return to baseline health. However, approximately 10% of patients optimally treated with the antibiotics for early Lyme disease develop persistent symptoms of fatigue and pain termed “post-treatment Lyme disease syndrome”. The objective of this study was to investigate associations between post-treatment Lyme disease syndrome and biomarkers of inflammation during early Lyme disease and at several time points following treatment. Our objective was to find blood biomarkers to identify those patients at risk of having persistent symptoms after completion of their initial antibiotic therapy.
How was this study done?
We evaluated and followed seventy-six participants with physician-documented erythema migrans, the classic bulls-eye rash associated with Lyme disease, and 26 healthy controls with no history of Lyme disease. Sixty-four inflammatory markers were measured in blood samples taken at each visit for a total of 6 visits over 1 year. Levels of inflammatory markers in patients with and without persistent post-treatment symptoms were compared to those in healthy controls.
What were the major findings?
Post-treatment levels of the blood protein CCL19 greater than 111.67 pg/mL one month after completion of antibiotic therapy was associated with symptoms that persisted 6 or 12 months later. The level of CCL19 also continued to be elevated in the blood of these patients, above the level of 79.28 observed in healthy controls, even 1 year after treatment with antibiotics. On the other hand, CCL19 levels returned to normal in Lyme disease patients who returned to health after treatment.
What is the impact of this work?
We think that the elevated CCL19 levels among patients with severe persistent symptoms may reflect ongoing inflammation occurring in tissues, even after the active infection has been treated. Our findings suggest that CCL19 levels are important to measure both during early Lyme disease and one month after treatment to identify patients at risk for developing post-treatment Lyme disease syndrome. Identification of a potential biomarker that can predict who will continue to experience symptoms after treatment provides the opportunity to better understand this syndrome and to develop early therapies to treat those patients who remain ill after initial therapy.
This research was supported by:
The Donald B. and Dorothy L. Stabler Foundation and The Johns Hopkins University School of Medicine Synergy Award.
Link to original research article:
CCL19 as a Chemokine Risk Factor for Post-Treatment Lyme Disease Syndrome: A Prospective Clinical Cohort Study. Aucott JN, Soloski MJ, Rebman AW, Crowder LA, Lahey LJ, Wagner CA, Robinson WH, Bechtold KT. Clin Vaccine Immunol. 2016 Jun 29.