Lyme Disease in Veterans: Coinfections and Missed Diagnoses
Symptoms vary widely
Coinfections are common
Testing can be inconsistent
Diagnosis may be missed
Lyme disease in veterans may be underrecognized—especially when testing results are inconsistent. This study highlights the complexity of symptoms, the role of coinfections, and the risk of missed diagnoses.
Study Overview
Researchers evaluated 181 veterans diagnosed with Lyme disease.
Findings included:
- 32 patients presented with an erythema migrans (EM) rash
- Diagnosis was based on a positive C6 peptide test confirmed by Western blot
Many patients did not present with classic early signs.
Common Symptoms in Veterans
- Joint pain (58 patients)
- Myalgias and fatigue (34)
- Headache and neck pain (27)
- Peripheral neuropathy (14)
- Seventh nerve palsy (5)
- Palpitations (2)
This wide range of symptoms reflects the multisystem nature of Lyme disease.
For more, see Lyme disease symptoms guide.
Coinfections Add Complexity
Several patients were diagnosed with additional tick-borne infections:
- 7 patients had babesiosis with parasitemia ranging from 0.1% to 3%
- 1 patient required exchange transfusion following splenectomy
- 2 patients had Anaplasma IgM antibodies
- 1 patient had positive Anaplasma phagocytophilum PCR
Coinfections can complicate diagnosis and worsen symptoms.
For more, see Lyme coinfections.
What About Patients With Negative Western Blot?
The study also evaluated 228 veterans with:
- Positive C6 peptide test
- Negative Western blot
The authors concluded these patients did not have Lyme disease.
However, this raises an important question:
Could some of these patients still have Lyme disease despite negative confirmatory testing?
For more, see Lyme test accuracy.
Symptoms Overlap With Lyme Disease
Many diagnoses in the “non-Lyme” group overlap with known Lyme disease symptoms:
- Carpal tunnel syndrome
- Polyneuropathy
- Ulnar neuropathy
- Vision problems (uveitis, iritis, diplopia)
- Tinnitus and hearing loss
- Fibromyalgia
- Chronic fatigue
- Memory difficulties
- Syncope and cardiac issues
- Multiple sclerosis
- Seventh nerve palsy
- Joint pain
This overlap raises concern that some cases may have been misclassified.
For more, see Lyme disease misdiagnosis.
Long-Term Outcomes Remain Unclear
The study did not evaluate long-term outcomes.
This leaves important unanswered questions about persistent symptoms and recovery.
For more, see persistent Lyme disease.
What Should Be Done Next?
Future research should consider:
- Following patients with negative Western blot results over time
- Assessing whether some later meet criteria for Lyme disease
- Evaluating long-term outcomes and persistent symptoms
Longitudinal follow-up may clarify the true burden of disease.
Clinical Takeaway
Lyme disease in veterans may be more complex than testing alone suggests.
Coinfections are common, symptoms are broad, and diagnostic criteria may miss some cases.
Clinicians should consider Lyme disease in patients with compatible symptoms—even when testing is inconclusive.
Related Reading
Reference
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.