Missed Diagnosis and the Development of Acute and Late Lyme Disease in Dark Skinned Populations of Appalachia

Abstract

Background: Lyme Disease (LD) is the most commonly reported vector-borne disease in the United States, affecting over 300,000 people in the United States each year. If early LD goes undetected or is inadequately treated, the causative spirochete bacteria, Borrelia burgdorferi, can disseminate throughout the body and cause chronic symptoms that will characterize a patient with late LD. The incidence of LD is generally reported at a higher rate in light-skinned patients as compared to dark-skinned patients.Aim: To assess the rate and causative factors of late Lyme Disease in dark-skinned individuals within the Appalachian region and encourage research into the need for early clinical evaluation and testing for at-risk patients.Discussion: Healthcare providers are at risk of missing the diagnosis of acute Borrelia infection in dark-skinned patients based on historically lower reporting frequency and non-traditional early symptoms and clinical presentation. Misdiagnosis, or delayed diagnosis, adversely affects the health outcomes of people of color and risks progression of the infection from early to late LD. Recommendations:We defined the characteristics of darker skin tones as a quantitative score to identify the risk for non-traditional presentation of the early signs of Borrelia infection. Using this score, we recommend determining the association between dark skin color and undiagnosed LD based upon a systematic study on the correlation of patient skin color and positive LD testing. This data should be combined with other risks of exposure. The results of the recommended research would determine whether physicians in Appalachia should incorporate comprehensive treatment plans for LD in dark-skinned patients as preventive medical practice. Lyme Disease DefinedAccording to the Centers for Disease Control and Prevention (CDC) presently, Lyme Disease (LD) is the most commonly reported vector-borne disease in the United States, affecting over 300,000 people in the United States each year [1]. LD is not only of nationwide concern, but also infects people in more than 80 countries worldwide [2]. LD is commonly transmitted by the blacklegged tick, Ixodes scapularis, infected with the spirochete bacteria, Borrelia burgdorferi [1]. However, LD spirochetes are also transmitted globally through minor Borrelia species such as B.

We Need to Stop Failing Our Patients

“…An important example is the early erythema migrans rash that occurs with Lyme disease. It was thought that Lyme disease manifested more aggressively in Black patients, with multiorgan development and worse outcomes, but recent research has shown that these actually result from diagnostic delays because doctors are unable to recognize erythema migrans in darker skin 4 . To overcome these issues, medical schools need to acknowledge limitations in the demographic representation being used for course materials.…”