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Lyme Disease

Lyme Disease

Differential Diagnosis

Diagnosing 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. 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.

Diagnosing Chronic Lyme 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 Lyme disease diagnosis

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.

Stay informed
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. 1
─ Dr. Daniel Cameron & Associates Practice & Research

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”
─ the Father of Modern Medicine, Sir William Oslerat the turn of the 20th century

"He who knows Lyme disease knows medicine”
─ Dr. Daniel Cameron at the turn of the 21st century

Both conditions have been characterized as "The Great Imitator"

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