Lyme Disease in Veterans: Symptoms, Co-Infections, and Missed Diagnoses
Lyme disease in veterans may be underrecognized—especially when testing results are incomplete or misleading.
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 associated tick-borne infections.
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:
- Joint pain (58 patients)
- Myalgias and fatigue (34)
- Headache and neck pain (27)
- Peripheral neuropathy (14)
- Seventh nerve palsy (5)
- Palpitations (2)
These findings reflect the multisystem nature of Lyme disease and its overlap with other chronic conditions.
For a broader symptom overview, see Lyme disease symptoms guide.
Tick-Borne Co-Infections Identified
Several veterans were also diagnosed with co-infections.
“Seven patients had babesiosis with positive smear and parasitemia ranging from 0.1% to 3%,” writes Psevdos.
One patient with babesiosis and a history of splenectomy required exchange transfusion.
Additional infections included Anaplasma phagocytophilum, confirmed by antibody and PCR testing.
Learn more about Lyme disease co-infections and how they complicate diagnosis and treatment.
Positive C6 Peptide but Negative Western Blot: A Diagnostic Gap
A key concern in this study was the group of 228 veterans who tested positive on the C6 peptide assay but were classified as not having Lyme disease due to negative Western blot results.
The authors did not address whether some of these patients may have had Lyme disease despite negative confirmatory testing.
This raises ongoing concerns about limitations of Lyme disease testing and the risk of missed diagnoses.
Symptoms Overlapping With Lyme Disease
Many veterans without confirmed Lyme disease were given diagnoses that overlap with known Lyme manifestations, including:
- Peripheral neuropathies (carpal tunnel, ulnar neuropathy, polyneuropathy)
- Visual disorders (uveitis, diplopia, choroiditis)
- Hearing loss and tinnitus
- Chronic fatigue and fibromyalgia
- Memory difficulties and neurologic symptoms
- Syncope and cardiac rhythm disorders
- Multiple sclerosis–like presentations
These overlapping diagnoses highlight the complexity of Lyme disease and the potential for misclassification.
Long-Term Lyme Disease in Veterans
The study was not designed to evaluate long-term outcomes.
However, the findings raise important questions about whether some veterans with incomplete testing may go on to develop persistent symptoms.
Understanding the risk of persistent Lyme disease symptoms remains critical.
Clinical Perspective
This study highlights a broader issue in Lyme disease care: patients may be excluded from diagnosis based on imperfect testing criteria, despite having compatible symptoms and exposure history.
Veterans represent a high-risk population due to outdoor exposure and geographic mobility.
Prospective studies are needed to determine whether patients with positive screening tests and negative confirmatory tests may still have clinically significant Lyme disease.
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References:
- Psevdos G, Khoo T, Chow R, Romano CL, Campbell S. Epidemiology of Lyme disease among US Veterans. Ticks Tick Borne Dis. 2019.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
How is the health of these veterans spouses? Their children and families?
How they are effected by lyme should be noted in any follow up studies.
A friend in the US Army was misdiagnosed with fibromyalgia by Walter Reed Drs, but really had LD. This was confirmed by an IgeneX blood test after 8 years mistreatment for fibro. His wife and 2 sons also have LD. When, if ever, will the CDC wake up and stop the suffering?
I am a native NY veteran of the US Army and a Physician Assistant disabled from tick borne illnesses. I am fed up with an ineffective test being used to tell people they do not have tick borne illness. Why doesn’t someone perform serial PCR tests until we can prove their flawed method?
The PCR works best in the tick prior to a blood meal. The PCR has not performed as well in people or engorged ticks, yet.