Lyme Disease Veterans: Symptoms, Co-Infections, and Missed Diagnoses

In a study examining Lyme disease veterans receiving care through the
Veterans Affairs system, investigators reviewed clinical and laboratory findings to better
understand the presentation of Lyme disease and related tick-borne infections.

The authors found that out of 181 veterans evaluated, 32 presented with an erythema migrans
rash. Confirmed Lyme disease cases were positive on a C6 peptide assay and verified with
Western blot testing.

Clinical Manifestations in Veterans With Lyme Disease

Veterans diagnosed with Lyme disease exhibited a wide range of symptoms, including:

• Joint pain (58 patients)
• Myalgias and fatigue (34)
• Headache and neck pain (27)
• Peripheral neuropathy (14)
• Seventh nerve palsy (5)
• Palpitations (2)

Tick-Borne Co-Infections Identified

Several veterans were also found to have tick-borne co-infections. “Seven patients had
babesiosis with positive smear and parasitemia ranging from 0.1% to 3%,”

writes Psevdos, Chief of Infectious Diseases at the Veterans Affairs Medical Center in
Northport, New York.

“Another patient with babesiosis had a history of splenectomy and required exchange
transfusion,” the authors note.

Additional pathogens were also identified. “Two patients had positive Anaplasma IgM
antibodies, and one had a positive Anaplasma phagocytophilum PCR,” writes Psevdos.

Veterans With Positive C6 Peptide but Negative Western Blot

A key concern raised by this study involves the 228 veterans who tested positive on the C6
peptide assay but were considered not to have Lyme disease because their Western blot tests
were negative.

The authors did not address whether some of these veterans might have had Lyme disease
despite a negative Western blot result.

Reported Diagnoses in Veterans Without Confirmed Lyme Disease

Many of the diagnoses assigned to these 228 veterans overlap with conditions that have been
described in Lyme disease. These included:

• Carpal tunnel syndrome (EMG confirmed)
• Polyneuropathy (EMG confirmed)
• Ulnar neuropathy (EMG confirmed)
• Choroiditis
• Blurry vision
• Uveitis and iritis
• Glaucoma
• Diplopia
• Tinnitus and hearing loss
• Myalgias
• Fibromyalgia
• Headache
• Memory difficulties
• Cellulitis
• Chronic fatigue
• Syncope
• Sick sinus syndrome
• Myasthenia gravis
• Multiple sclerosis
• Delirium
• Seventh nerve palsy
• Joint pain

Long-Term Manifestations of Lyme Disease

The authors acknowledge that their retrospective chart review was not designed to evaluate
the risk of long-term manifestations of Lyme disease.

What Comes Next?

It would be reasonable to follow veterans with positive C6 peptide testing and negative
Western blot results to determine whether any are later diagnosed with Lyme disease.

It would also be reasonable for future studies to prospectively evaluate this veteran
population to better understand the risk of persistent or long-term manifestations of Lyme
disease and associated co-infections.