To determine risk factors for biliary complications of treatment of suspected LD, a case-control study was conducted. Controls were selected randomly from hospitalized patients who had received antimicrobial treatment for LD but who did not develop evidence of gallbladder disease. All had received intravenous ceftriaxone within 90 days preceding the onset of biliary symptoms.
Studies are in progress to identify risk factors for such infections.
Most patients hospitalized for suspected LD in this study lacked documented objective manifestations of disseminated LD or seropositivity to B. burgdorferi. The repeated and often prolonged courses of antimicrobials prescribed in these cases suggest that antimicrobial therapy did not achieve satisfactory remission of symptoms and was associated with biliary complications resulting in cholecystectomy in some patients. Upper abdominal ultrasonography should be considered for patients who develop biliary colic while receiving ceftriaxone. Because new information on LD is rapidly developing, ongoing medical-education programs on this disease are needed. CDC is working with professional societies and others to develop guidelines on diagnosis and management and to provide training materials.