Who is more likely to fail Lyme disease treatment?

lyme disease treatment

In a recent article entitled “Risk Factors and Outcomes of Treatment Delays in Lyme Disease: A Population-Based Retrospective Cohort Study,” Hirsch and colleagues described which Lyme disease patients were more likely to fail treatment.¹

 

Investigators reviewed questionnaires from 778 Lyme disease patients treated at the Geisinger Clinic, a health system in Pennsylvania. The authors determined the length of time a patient was ill before seeking medical attention, and the length of time between seeking care for Lyme disease and receiving lyme treatment.

They found that the amount of time between a patient’s initial symptom onset to treatment ranged from 0 days to 15 years.

• Nearly 3 out of 4 patients were treated within 1 month of symptom onset;
• More than 1 in 4 patients were treated more than 1 month after the onset of symptoms;
• 9% were not treated for at least 6 months after symptoms started.

Symptoms misdiagnosed

Some of the Lyme disease patients mistakenly attributed their symptoms to another condition including, the flu or virus, bug bite, allergy, skin problem, muscle or joint strain/injury, arthritis or bursitis, dehydration, overexertion, stress, and old age.

A self-reported diagnosis of chronic fatigue also increased the odds of delay. “Considering the similarity in some symptoms in the two conditions, health care providers may not have initially recognized the onset of Lyme disease symptoms as a new condition, resulting in delayed treatment,” the authors explain.

Some of the Lyme disease patients were diagnosed with other illnesses including, flu or other viral conditions, skin rashes, allergic reactions, shingles, muscle or joint injury, cellulitis or other skin conditions and insect bites.

Socioeconomic status affects treatment

Socioeconomic barriers impacted treatment. “Uninsured individuals in our study were more likely to delay contacting a medical professional for their symptoms than were individuals with private insurance.”

The delayed treatment was more likely to occur when patients were consulting with a primary care doctor versus visiting an urgent care center or emergency room.

Individuals with delayed treatment were more likely to suffer from Post-Treatment Lyme Disease Syndrome (PTLDS). PTLDS patients suffer from pain, impaired cognitive function, fatigue and poor function. The authors stressed the need to reduce the risk of treatment delays to prevent PTLDS.

Editor’s perspective:

Several of the factors associated with treatment failure are amenable to prevention. I remain opposed to the term “PTLDS” until we have a reliable test to exclude a persistent infection.

References:
  1. Hirsch AG, Poulsen MN, Nordberg C, et al. Risk Factors and Outcomes of Treatment Delays in Lyme Disease: A Population-Based Retrospective Cohort Study. Front Med (Lausanne). 2020;7:560018. doi:10.3389/fmed.2020.560018
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12 Replies to "Who is more likely to fail Lyme disease treatment?"

  • Susan Fyten
    04/20/2021 (11:50 am)
    Reply

    My situation is that I’m in the 3rd go-round with Lyme… 1st in 1998, was taking medication within 4 hrs of detection. Next in 2001 when I complained of ankles hurting – did IV antibiotics for 30 days (yuk!) now, in search of a diagnosis for a tooth resorption, I again am testing positive! What should I be taking??? Help!!!

    • Dr. Daniel Cameron
      04/20/2021 (3:31 pm)
      Reply

      I have not read anything helpful on teeth resorption. I typically treat the Lyme disease if it is present.

  • Tibor Szilagyi
    04/03/2021 (2:22 am)
    Reply

    I suffer from neuroborreliosis, with very burning nerve pain in the face and upper dentures. My two feet are also constantly numb. What treatment would help?

    • Dr. Daniel Cameron
      04/03/2021 (10:20 am)
      Reply

      Many of my patients have numbness of the face and legs related to a tick borne illness. They do not have diabetes. The neurologist cannot find an answer. Some of them have been diagnosed with small fiber neuropathy.  I typically recommend including a doctor experienced in treating Lyme disease to come up with a plan for you with followup to determine what treatment works for you.

  • Yvette R Monaco
    04/02/2021 (4:23 pm)
    Reply

    Hi Doctor my lab results just last week came back as Babesia Duncani, how should this be treated ? Thank you

    • Dr. Daniel Cameron
      04/03/2021 (10:06 am)
      Reply

      Babesia duncani was first identified in the Western USA. I typically treat my patients with atovaquone. I also treat Lyme and co-infections if present. You will have to work out a treatment plan with your doctor.

  • Didac Costas
    04/02/2021 (1:25 pm)
    Reply

    Hello Dr Cameron,
    I have symptons for last 2 years and a half. All started in the eyes, pain behind them and a lot of new floaters. I was under a lot of cortisone at the time due to my colitis ulcerosa. After some months I develop that symptom spectrum called visual snow. It took me a year to get a positive WB, and at that time muscle twitching all over the body (as said, initially eyelids, but after the year suddenly mouth, chest, abdomen, limbs..) that started with herbal treatment toguether with amoxicilin. Since then I went for 8 months of 3 antibiotics by month (changing them each 2 months). That just created flares and some remision phases, now I am with herbs and less flares but still no improvement. As I am in Poland and I cant go to set a visit, just this question, do you think I should go for IV antibiotics? Or do you think it might be more due to excesive neurotoxins in my body? My best way to treat symtomps is heat (infrarred sauna, or long summer days).
    Thank you for your answer!!

    • Dr. Daniel Cameron
      04/02/2021 (2:59 pm)
      Reply

      I can’t say if IV ceftriaxone would be helpful for you. You have to work with your doctor to address the question. Were you checked of Babesia as that parasite needs to be treated with a drug such as atovaquone.

      • Didac Costas
        04/03/2021 (5:52 am)
        Reply

        Hi, thank you for your answer. I haven’t been checked foe coinfections, although I believe that I might have bartonella, most of my neuropathy and fasciculations are in calves and feet, as well as some pain in the feet bones. I’ve taken already 5 months of ceftriaxtone, but orally. As said, that medicin lead me to continuous like electric buzz feeling in the legs, as well as dizziness and nause. Anyway, ill check for that babesia and that medicin. Thx

  • Paul Ryan
    04/02/2021 (9:06 am)
    Reply

    My symptoms seem to be here to stay, went 15 years without treatment because of miss diagnosis. It took a fall of 20ft, ending up with broken back and shattered ankle before I was treated. Now again Doctors here have no answers or solutions to ease my symptoms. I know I’m not alone…

  • Debra Cully
    04/02/2021 (7:37 am)
    Reply

    Hi, I got Lyme in 2015 at age 63 I was doing a lot of trail running in Pa. After many treatments with antibiotics and a pic line of Rocephin I still get symptoms every couple of months. When it comes back I get many strange symptoms: neck pain, headaches, brain fog, foot drop, my fingers trigger all at the same time in the middle of the night it’s all been annoying. When I contracted it I was 63 doing IM triathlons winning my age group, running pikes peak marathon, Rachel Carson 34 mile trail race, anyways I was very healthy. I’m still trying to do some of these things. I am going on 68 in April so yes I’m slowing down but these symptoms, will they ever go away.
    Thank you

  • Melinda Rodriguez
    04/02/2021 (4:20 am)
    Reply

    I seriously thought this was going to say, “a person that is more likely to fail Lyme disease treatment is a person who is so forgetful that she/he forgets to order more probiotics for a really long time, and then when they finally are ordered, they arrive, and she/he proceeds to misplace them,
    I actually expected this to be included.

    I guess maybe grossly delayed treatment and this level of forgetfulness may be similar enough, though.


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