Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic

Abstract

Background Although Lyme disease is the most common vector-borne infection in the United States, diagnostic accuracy within community settings is not well characterized. Methods A retrospective observational cohort study of patients referred to an academic center with a presumed diagnosis or concern for Lyme disease between 2000 and 2013 was performed to analyze diagnoses and treatments. Characteristics of those with Lyme disease and those misdiagnosed as having Lyme disease were compared. Results Of 1261 patients, 911 (72.2%) did not have Lyme disease, 184 (14.6%) had active or recent Lyme disease, 150 (11.9%) had a remote history of Lyme disease, and 16 (1.3%) were identified as having possible Lyme disease. Patients without current Lyme disease were more likely to be female (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.08–2.45), to have had symptoms for >3 months (OR, 8.78; 95% CI, 5.87–13.1), to have higher symptom counts (OR per additional symptom, 1.08; 95% CI, 1.02–1.13), to have had more Lyme-related laboratory testing (OR per additional laboratory test, 1.17; 95% CI, 1.03–1.32), and to have been diagnosed with what were regarded as coinfections (OR, 3.13; 95% CI, 1.14–8.57). Of the 911 patients without Lyme disease, 764 (83.9%) had received antimicrobials to treat Lyme disease or their coinfections. The percentage of patients established to have Lyme disease was lower than in earlier studies of referred populations. Conclusions Among patients referred to an academic Infectious Diseases practice for Lyme disease, incorrect diagnoses and unnecessary antibiotic treatment were common, both for Lyme disease and for coinfections.

Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010–2018

“…The estimates we report are influenced by the uncertainties of clinical practice, in which patients are often treated presumptively, inevitably resulting in some degree of overdiagnosis and overtreatment ( 10 ). In contrast, cases reported through national Lyme disease surveillance meet a standardized case definition and are more likely to represent actual infections.…”

Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses, United States, 2010–2018

“…In a recent evaluation of >1,200 persons referred for tertiary evaluation for Lyme disease in a high-incidence area, nearly three quarters lacked clinical or laboratory evidence of Borrelia burgdorferi infection; the majority of these persons referred with a diagnosis of Lyme disease were female and experiencing a long duration of constitutional symptoms ( 18 ). Given the relative scarcity of infected host-seeking ticks in low-incidence areas, the potential for locally acquired Lyme disease is often very low ( 22 , 23 ).…”

“…A larger proportion of Lyme disease diagnoses in MarketScan occurred outside of peak summer months, in female enrollees, and outside high-incidence states, compared with cases reported through surveillance. These characteristics may reflect the inclusion of other medical conditions for which Lyme disease may be considered in a differential diagnosis (18)(19)(20)(21). In addition, given our objective of evaluating MarketScan for use on an annual, routine basis, our analysis treats each year independently.…”

Lyme borreliosis: diagnosis and management

“…These include the pathogens mentioned above, but also other microorganisms, such as Chlamydia , Brucella, or Mycoplasma species, Toxoplasma gondii, Epstein-Barr virus, cytomegalovirus, or human herpes virus-6. However, these patients frequently lack clinical symptoms compatible with such infections 203. A systematic review of patients diagnosed with “chronic Lyme” did not find evidence for chronic anaplasmosis or babesiosis in humans, tick transmission of Bartonella species, or B burgdorferi sl- Bartonella co-infections 159.…”