Diagnosis and treatment in patients with chronic Tick Associated Poly-Organic Syndrome (TAPOS) - a case series

Chronic Lyme borreliosis is often considered as a diagnosis option in patients with long lasting miscellaneous symptoms after tick bites. Despite new codified diagnosis algorithm and treatment, persistent signs and symptoms frequently occur. The aim of the study was to assess the diagnosis of Tick Associated PolyOrganic Syndrome (TAPOS) and to evaluate the treatment’s efficacy. A consecutive case series of patients referred to the Cluj-Napoca University Hospital of Infectious Diseases (January 2006-October 2009) revealed 54 patients with TAPOS. Inclusion criteria consisted of: more than 18 years of age, chronic symptoms, positive Borrelia burgdorferi serology and/or tick bite. Data was collected through chart review and medical observation. We used two clinical scores to classify the probability of chronic TAPOS. All patients were tested for IgM and/or IgG antibodies to B. burgdorferi. The treatment was done with intravenous ceftriaxone, 2 g, daily, for 21-28 days and doxycycline 200 mg, daily, for 21 days. The most frequently reported symptoms were neuropsychological (87%), systemic (81%), muscular and/or articular (33%). The sex ratio was 0.26 (42 women, 12 men), the average age was 43.7. Only eight patients experienced erythema migrans, 20 had tick bite history (51%) and B. burgdorferi serology was positive for IgM (92%) and/or IgG (47%). Chronic TAPOS was diagnosed in 19 patients (35%), the remaining being with “probable” disease.