Comparison of Lyme Disease in the United States and Europe

Adriana R. Marques; Franc Strle; Gary P. Wormser


Emerging Infectious Diseases. 2021;27(8):2017-2024. 

In This Article

Lyme Arthritis

Lyme arthritis will develop in ≈60% of US patients with untreated erythema migrans over a 2-year period[32] and is said to comprise 28% of Lyme disease cases reported to the US Centers for Disease Control and Prevention that have data on symptoms available.[33] Lyme arthritis seems to be less frequent in Europe,[34,35] and for untreated patients in Europe, the interval between onset of erythema migrans and development of Lyme arthritis may be shorter.[1] Of note, B. burgdorferi s.s. was the most prevalent species of Lyme borrelia found in synovial fluid in a study of patients with Lyme arthritis in Europe.[36] An acute manifestation of Lyme arthritis in children in the United States can mimic septic arthritis; this manifestation, however, does not seem to occur in children in Europe with Lyme arthritis.[37]

With regard to demographics, Lyme disease in the United States is more common in male patients (56% of the patients reported during 2001–2018 were male).[38] Indeed, no clinical manifestation has been associated with a female predominance in the United States, whereas in Europe, most cases of erythema migrans and ACA occur in women.[39,40] Many studies (but not all) demonstrated a male predominance for Lyme neuroborreliosis and Lyme arthritis.[22,35,36,41]