Study Shows Doctors Can Misdiagnose Lyme Disease in Children
Pediatric Lyme misdiagnosis remains a challenge, particularly in emergency departments where clinicians must make decisions before classic signs or positive tests appear.
The CDC notes that Lyme disease can present with a wide range of symptoms, which can make early diagnosis difficult—especially in children.
Emergency Department Study Highlights Diagnostic Challenges
The study included more than 1,000 children, average age of 9, who underwent evaluation for Lyme disease at 1 of the 5 participating emergency departments. The authors found that 65 out of 554 children (12%) could have been underdiagnosed.
“Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1–3), 65 (12%) had Lyme disease,” according to Nigrovic and colleagues from the Division of Emergency Medicine at Boston Children’s Hospital.
12% of children thought not to have Lyme disease actually had the disease, the study found.
Meanwhile, a significant number of children could have been over-diagnosed. “Of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8–10), 39 (31%) did not have Lyme disease,” writes Nigrovic.
The concerns of under-diagnosing a patient should remind doctors of the importance of follow-up evaluations even if the doctor concludes a child is unlikely to have Lyme disease. But as the study shows, over-diagnosis can be a problem as well and doctors need to be alert in ruling out other illnesses.
It’s worth noting that the 31% of children reportedly over-diagnosed may have been an exaggerated figure since they were required to present with an EM rash or a positive 2-tier test. In actual practice, there are Lyme disease patients who never develop an erythema migrans rash or have a positive 2-tier serologic Lyme disease test.
In this study, the antibiotics prescribed for children who doctors suspected had Lyme disease may have interfered with development of an erythema migrans rash or a positive 2-tier test.
The study reminds us that clinical judgment can be as problematic as relying on an erythema migrans rash or 2-tier serologic test. It is always reasonable to rule out other illnesses if the doctor suspects Lyme disease. It is also reasonable not to rule out Lyme disease even if the doctor thinks the child is unlikely to have it.
Diagnostic uncertainty is common in pediatric cases. Learn more about pediatric Lyme disease diagnostic challenges.
Testing limitations can contribute to diagnostic uncertainty. See this overview of Lyme disease testing and diagnosis.
Children with Lyme disease may present with a wide range of symptoms. For a broader overview see the Lyme disease symptoms guide.
Clinical Takeaway
This study highlights the difficulty of diagnosing Lyme disease in children during early evaluation. Physicians should remain alert to the possibility of Lyme disease and consider follow-up evaluation when symptoms evolve.
Related Articles:
Doctors agree Lyme disease patients at-risk for suicide are under-recognized group
Doctors favor personalized care over IDSA guidelines
CDC advises doctors to consider Lyme disease in emerging states
References:
- Nigrovic LE, Bennett JE, Balamuth F, et al. Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department. Pediatrics. 2017;140(6).
It’s worth noting that the 31% of children reportedly over-diagnosed may have been an exaggerated figure since they were required to present with an EM rash or a positive 2-tier test.
After 6 weeks, 2-tier testing is 85-90% sensitive. Stop spreading the ridiculous myth that serological testing misses Lyme disease in the late stage.
Also, the title of your article is misleading.
The discussion about antibiotic therapy terminating the antibody production in the early phase of Lyme disease was already been held between David J. Volkman and other IDSA members and Volkman was proven wrong.
Stop recycling old outdated views on this disease and start accepting that Lyme disease isn’t the disease you ILADS quacks think it is on the basis of believes.
If I had the “bulls eye” rash, what are the odds for having Lyme? Have had several blood tests turn up negative in the past. Rash was 20 plus years ago.
The risk of Lyme disease is typically 80 to 90% for a physician observed rash. It is harder to know the risk from that rash in high sight without an evaluation