Misdiagnosis of early Lyme disease as the summer flu

Abstract

Lyme disease is often identified by the hallmark erythema migrans rash, but not all early cases present with a rash. In other cases the rash may be unseen or unrecognized by a physician. In these situations, Lyme disease is difficult to diagnose because it masquerades as a non-specific viral-like illness. The seasonal peak of Lyme disease ranging from May through September overlaps with that of viral illnesses such as enteroviral infections, West Nile virus, and in rare years such as 2009, early influenza season. We present a case of a patient with Lyme disease who was initially misdiagnosed with influenza A during the summer of 2009. Because of the diagnostic importance of recognizing the erythema migrans rash, physicians in endemic regions should always ask about new rashes or skin lesions and perform a thorough physical examination when patients present over the summer with viral-like symptoms. Even when no rash is evident, Lyme disease should be considered if these symptoms persist or worsen without a specific diagnosis.

Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease

“…Finally, as the presence of symptoms alone cannot currently definitively establish the link to prior Lyme disease, a second key component is grounding the current illness to the initial exposure to B. burgdorferi. This requires a careful, clinical history for clues in the past medical history that may have been missed, such as a misdiagnosed skin lesion or a non-specific, acute, summer, flu-like illness at the onset of the patient's change in health (70,71). Above all, a thorough clinical history must also account for inter-personal variability, the potential implications of initial misdiagnosis, and the diagnostic limitations of two-tier testing.…”

“…For example, a subset of these patients may have experienced initial delays in diagnosis, and/or misdiagnoses of their presenting signs or symptoms (43,71,(176)(177)(178)(179). The particular clinical difficulties in diagnosing EM (180)(181)(182), and/or a lack of EM or acute symptoms, remain on-going issues in community practice and can lead to significant delays in diagnosis and initiation of appropriate treatment.…”

Effectiveness of permethrin-treated clothing to prevent tick exposure in foresters in the central Appalachian region of the USA

“…Tick-borne illnesses such as LB are also underreported due to nondescript flu-like symptoms not always associated with the characteristic bulls-eye rash (e.g. Bacon et al 2008;Aucott and Seifter 2011). There are currently no human vaccines for these vector-borne pathogens available to the general public.…”

Pancytopenia in Lyme disease

“…In order for infection to occur, the tick must typically remain attached to the skin for more than 36–48 h 1 2…”

“…B burgdorferi is the most common vector-borne illness in the USA, with incidence peaking in the summer months of May through August 2––6. Geographically, the predominance of cases occur in northeastern USA, though other coastal areas have reported cases of infection 3 6 7…”