Disseminated Lyme Disease in Immunocompromised Patients
Disseminated Lyme disease may occur more frequently in patients with weakened immune systems. A small study examined the risk of disseminated Lyme disease among individuals receiving immunosuppressive therapy. Patients with weakened immune systems may be at greater risk for disseminated infection, raising important questions about Lyme disease in immunocompromised patients.
Disseminated Lyme disease occurs when Borrelia bacteria spread beyond the initial skin infection to the bloodstream, nervous system, heart, or joints. Disseminated infection is one of the mechanisms discussed in our overview of persistent Lyme disease mechanisms.
Researchers evaluated seven patients with erythema migrans (EM) who were diagnosed with Lyme disease while receiving the immunosuppressive medication rituximab. In these patients, the rates of disseminated Lyme disease and bloodstream infection with Borrelia were substantially higher than those typically seen in immunocompetent patients.
Lyme Disease Risk in Patients Taking Rituximab
All seven patients in the study were receiving rituximab for another medical condition. Four patients were also taking additional immunosuppressive medications including corticosteroids, methotrexate, or bortezomib.
Rituximab is an anti-CD20 monoclonal antibody that suppresses B cells and reduces antibody production, weakening the body’s immune response, explain Maraspin and colleagues.
The medication is commonly used to treat conditions such as:
- Non-Hodgkin lymphoma
- Rheumatoid arthritis
- Chronic lymphocytic leukemia
- Granulomatosis with polyangiitis (Wegener granulomatosis)
Signs of Disseminated Lyme Disease
According to the authors, 43% of patients treated with rituximab developed signs of disseminated Lyme disease. In comparison, only about 8% of immunocompetent patients with erythema migrans developed disseminated infection at the same institution.
The isolation rates of Borrelia from blood before antibiotic treatment were also unusually high (40%) when compared with immunocompetent patients (<2%).
“Impaired immunity might be an explanation for the complicated course of Lyme borreliosis present in our patients,” the authors write.
Overall, 57% of the patients experienced either disseminated infection or an unfavorable treatment course.
Antibiotic Treatment and Retreatment
Three of the patients with multiple erythema migrans rashes were treated with intravenous antibiotics. The remaining individuals received oral antibiotics.
One patient, a 65-year-old woman, failed initial treatment. Her skin lesion persisted for more than two months after beginning doxycycline therapy. The lesion eventually resolved after retreatment with amoxicillin and the subsequent clinical course was uneventful.
At their one-year follow-up visit, none of the patients had objective physical signs of Lyme disease. However, the authors did not report whether patients experienced persistent symptoms such as fatigue, pain, or cognitive problems.
Immunosuppressive Therapy and Treatment Failure
A separate study by Maraspin and colleagues found that Lyme disease patients receiving immunosuppressive drugs, including medications such as adalimumab, infliximab, etanercept, and golimumab, experienced higher rates of treatment failure.
Approximately 25% of these patients failed initial Lyme disease treatment, and three of the four required retreatment.
Patients receiving immunosuppressive therapy were also more likely (18.8%) to develop signs of disseminated Lyme disease compared with Lyme disease patients who were immunocompetent.
READ MORE: Lyme disease manifests as autoimmune disorder
Editor’s note: The increased chance of disseminated Lyme disease in patients with impaired immunity needs further study. Future research should also evaluate outcomes such as fatigue, pain, and cognitive problems following treatment.
Related Articles:
People re-infected with Lyme disease may develop strain-specific immunity
References:
- Maraspin V, et al. Erythema Migrans: Course and Outcome in Patients Treated With Rituximab. Open Forum Infect Dis. 2019;6(7):ofz292.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I had undiagnosed Lyme in mid 80′ -`1994 ,5,96
never positive so not treated for years. Dr.s in England wrote all the info, which i followed , first a positive IGG and IGM ( was told by Yale ” what do they know in England, you have fibromyalgia ,” eventually a very positive spinal tap before the first spinal surgery in 1994.
Obviously much more occurred and was observed which I will skip.
other than severe rheumatoid arthritis and erosive and sjogrens syndrome etc
i felt the lyme was more or less gone and the autoimmune situation was actually probably helping with that. Recently i was put on sulfasalazine first and then cimzia
right away after first injection i knew somethng was not right, by the second the arthritis exploded in the only 2 uninvolved joints left , my hips, both knees, Left already replaced, became white hot, swollen etc , left ring finger went ballistic and throbbed unlike other long ago attacks on my hands that had already crippled and deformed them etc. ETC.
I had a new arthritis dr, whom i had never seen, no tests were ever done , and when i finally 5 months later saw the new dr and told her what was happening and what i thought had happened she had me tested and said i was fine. i said exactly what this article says and she was rather unpleasant! After reading this article thank you!
I will never take another drug for this and hope my immune system will kick in and help . I now live in Florida ( having moved from Westport CT) I am writing a synopsis of my experience through all these years for John Hopkins which I hope will help others, including 1 heart attack and 3 TIAs that occurred while it was active.
I am an 80 year old female. Rower , athlete , now having incredible difficulty walking, and unable to row for the last 1 1/2 yr after c2- t2 cervical surgery which caused more problems along with this new explosion. thank you it felt great to read this article and to vent that i was right1
marisol laux
You are not alone