- Differential Diagnosis Lyme disease
- Lyme disease Consultations
Choosing A Test
Differential Diagnosis Of Lyme Disease
There is a growing spectrum of Lyme disease cases beyond the oligoarticular arthritis described in children and adults in the index cases of 1977.
Diagnosing Lyme disease
One of the frustrations with the Centers for Disease Control and Prevention (CDC) surveillance case definition has been its failure to include the broad range of manifestations seen with the disease.
Chronic Lyme Disease (CLD) has emerged as an umbrella term for the broad range of chronic manifestations of Lyme disease. The National Institutes of Health (NIH) trials enrolled three categories of individuals with chronic manifestations of Lyme disease: 1) Lyme encephalopathy, 2) persistent symptoms after Lyme disease with negative serologies, and 3) post-Lyme syndrome. The term post-Lyme disease syndrome (PLDS) was coined based on the NIH assumption that Lyme disease has been adequately treated after a 2 to 3 week course of antibiotics. Yet, there are no validated tests to rule out persistent infection in Lyme disease. The term CLD typically does not assume that a short-term course of antibiotics is adequate to cure a patient of Lyme disease.
CDC Surveillance Case Definition
Many physicians will mistakenly defer to the CDC case definition of Lyme disease in making a diagnosis. These clinicians require that patients meet this strict and narrow criteria in order to be diagnosed with the disease.
However, this definition was designed as a surveillance monitoring tool to track the number of Lyme disease cases throughout the country. It was not meant to be used in making a clinical diagnosis. Still, even when patients meet the CDC criteria, there can be a delay in diagnosis. A delay that can have long-lasting consequences for the patient.
Dr. Daniel Cameron & Associates ─ Practice & Research conducted a study which found 32% of Lyme disease patients (who were confirmed by an ELISA and 5 or more positive bands on an IgG Western blot) had an average treatment delay of 1.8 years. Of these, 60% conformed to the CDC surveillance criteria ─ presenting with an EM rash, Bell’s palsy, or arthritis. Yet, there was still a diagnostic delay. And as a result, these patients were significantly more likely to fail their initial antibiotic treatment. 
Lyme disease Consultations
Lyme disease Consultations
Clinically diagnosing Lyme disease is not easy. This is a multi-systemic disease.
The full range of symptoms needed to recognize the disease may not be apparent to a physician during a routine examination. Objective signs (EM rash, Bell’s palsy, etc.) may be absent. Symptoms may be atypical or nonspecific. Clinical presentations may be attributed to other medical conditions, such as Chronic Fatigue Syndrome or Fibromyalgia. Or, some patients may not associate certain symptoms with Lyme disease and fail to report these to their doctor.
Therefore, engaging a patient to obtain a thorough medical history and possible tick exposure is important. Using checklists of symptoms seen in Lyme disease cases and reviewing with a patient may be helpful. Patients may not recognize their symptoms are related to Lyme disease.
Physicians can miss the diagnosis if they don’t look at all of the patient’s symptoms together. Clinicians tend to focus on individual symptoms, such as fatigue or arthritis, and treat only those. It should be a red flag when a patient reports a rash, fever, joint pains and fatigue.
Consultations with appropriate specialists and additional diagnostic testing may become necessary to rule out other illnesses. Laboratory testing typically includes kidney function tests (blood urea nitrogen and creatinine), thyroid, renal, and hepatic panel, serum electrolytes, Antinuclear Antibody (ANA), Rheumatoid Factor (RF), Thyroid Stimulating Hormone (TSH), Erythrocyte Sedimentation Rate (ESR), Rapid Plasma Reagin (RPR), Complete Blood Count (CBC), Electrocardiogram (EKG), and Urinalysis (UA).
“He who knows syphilis knows medicine,” said the Father of Modern Medicine, Sir William Osler, at the turn of the 20th century. Dr. Cameron says, “He who knows Lyme disease knows medicine” at the turn of the 21st century. Both conditions have been characterized as ”The Great Imitator.“
References – Choosing A Test
- Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract, 13(3), 470-472 (2007).
The growing number of infectious diseases carried by ticks; the emergence of new vector-borne diseases; the unreliability of laboratory tests; and the complexity of symptom presentations and variations in each patient make Lyme disease one of the most perplexing and elusive medical conditions to identify. learn more →
Lyme disease should be diagnosed clinically, without reliance on testing. However, all too often, physicians will ignore clinical presentations if laboratory tests are negative. Yet there are numerous scientific articles documenting false negatives and low sensitivity of such tests. learn more →
Lyme disease and syphilis have both been coined “the great imitator.” Lyme disease symptoms may be similar to other medical conditions, making diagnosing a challenge. The Borrelia burgdorferi (Bb) spirochete is an evasive organism which can penetrate virtually any organ or system in the body.learn more →