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To determine whether recurrent episodes of appropriately treated Lyme disease are caused by reinfection or relapse, we monitored pertinent clinical manifestations and serology of residents of an endemic site each year for 14 years. Of 253 episodes of early Lyme disease recorded among 213 residents, we observed 40 recurrent episodes. Virtually all included an erythema migrans (EM) rash that appeared at body sites that differed from those of the initial rash, no subjects produced detectable levels of specific antibody between sequential episodes, all episodes occurred a year or more after the initial EM episode, and all occurred during late spring and early summer. People experiencing recurrent episodes tended to have frequent contact with vector ticks. Prompt administration of standard antibiotic therapy for early Lyme disease reliably eliminates persistent infection and prevents relapse.
Received August 7, 2006. Accepted for publication August 18, 2006.
Acknowledgments: We are grateful to Dorothy Dahl and the late Norman Dahl who made possible our studies on Block Island.
Financial support: This study was supported by grants from the National Institutes of Health: AI 32403 (Drs Krause, Persing, Spielman, and Telford and Ms Christianson), AR 41497 (Drs Krause and Persing and Ms Christianson), AI 19693 (Drs Pollack, Telford, and Spielman), and the University of Connecticut Health Center General Clinical Research Center (MO1RR06192).
* Address correspondence to Peter J. Krause, 282 Washington Street, Hartford, CT 06106. E-mail: Pkrause{at}ccmckids.org
Ivo M. Foppa, Raymond Ryan, Peter Baute, Janice Miller, Stephen Wikel, Patricio Tomas, Feliciano Dias, Theresa George, Richard Pollack, and Sam R. Telford III.
Authors’ addresses: Peter J. Krause, Georgine S. Burke, and Diane Christianson, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT 06106, Telephone: 860-545-9490, Fax: 860-545-9371. Daniel T. Foley, Yale University School of Public Health, New Haven, CT, Telephone: 860-208-6061, Fax: 860-530-1339. Linda Closter, Peter Baute, and Janice Miller, Block Island Medical Center, Block Island, RI 02807, Telephone: 401-466-2974, Fax: 401-466-5476. Andrew Spielman, Richard Pollack, and Sam R. Telford III, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, Telephone: 617-432-2058, Fax: 617-432-1796. Ivo Foppa, University of South Carolina, Columbia, SC 29208, Telephone: 803-777-5056, Fax: 803-777-2524. Raymond Ryan, Patricio Tomas, Feliciano Dias, and Theresa George, University of Connecticut Health Center, Farmington, CT, Telephone: 860-679-3132, Fax: 860-679-1401. Stephen Wikel, University of Connecticut Health Center, Farmington, CT, Telephone: 860-679-8129, Fax: 860-679-8130.
Reprint requests: Peter Krause, 282 Washington Street, Hartford, CT 06106. E-mail: Pkrause{at}ccmckids.org.
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