Multidisciplinary management of patients presenting with Lyme disease suspicion

Jacquet, Clémentine; Goehringer, François; Baux, Elisabeth; Conrad, Jason; Devonec, M.O. Ganne; Schmutz, J.‐L.; Mathey, Guillaume; Tronel, H.; Moulinet, T.; Chary‐Valckenaere, Isabelle; May, Thomas

doi:10.1016/j.medmal.2018.06.002

Cited by 22 publications

(31 citation statements)

References 10 publications

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“…The strengths of our study are its population-based approach of disseminated LB, 4-year follow-up and comprehensive access to patient records from several different caregivers. Our patient cohort differed from other recent studies concerning confirmation of LB diagnosis [18,20,27,28]. The proportion of definite, probable and possible LB patients was higher (51%) in our patient cohort than the 13% to 23% reported in those studies.…”

Section: Discussioncontrasting

confidence: 89%

“…The proportion of definite, probable and possible LB patients was higher (51%) in our patient cohort than the 13% to 23% reported in those studies. Furthermore, only 20% of our patients had been prescribed previous antimicrobial treatment effective for LB before referral compared to 50% to 85% in previous studies [18,20,27,28]. This might reflect our local guidelines to refer suspected disseminated LB for an infectious disease specialist consultation.…”

Section: Discussionmentioning

confidence: 71%

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Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

Kortela

Kanerva

Kurkela

et al. 2021

Clinical Microbiology and Infection

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Objective: To evaluate the conditions behind the symptoms in patients with suspected Lyme borreliosis (LB) who were referred to an infectious diseases clinic. Methods: In this retrospective, population-based study, we collected data from the medical records of all patients referred for infectious disease consultations in 2013 due to presumed LB from a population of 1.58 million. The patients were classified according to the certainty of LB on the basis of their symptoms, signs and laboratory results. Data on the outcomes and subsequent alternative diagnoses during the 4year follow-up period were reviewed from all of the available patient records from public, private and occupational healthcare providers. Results: A total of 256 patients (16/100 000) were referred as a result of suspicion of LB; 30 (12%) of 256 were classified with definite, 36 (14%) with probable and 65 (25%) with possible LB. LB was unlikely in 121 (47%) patients. A novel diagnosis was discovered in the background symptoms in 73 (29%) of patients. Previously diagnosed comorbidities caused at least some of the symptoms in 48 (19%) patients. Other explanations for symptoms were found in 81 (67%) of 121 of unlikely and 22 (34%) of 65 of possible LB patients. The spectrum of conditions behind the symptoms was quite broad and most often were musculoskeletal, neurological, psychological or functional disorders. Conclusions: LB was unlikely in half of the patients with presumed LB. In most cases the patients had other conditions that explained their symptoms.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 71%

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

Kortela

Kanerva

Kurkela

et al. 2021

Clinical Microbiology and Infection

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“…Some of these earlier studies were performed when first-generation Lyme disease serologic assays yielded higher false-positive rates than the current 2-tier standardized testing adopted in 1994–1995 [12]. Although one would anticipate improved diagnostic accuracy with improved specificity since the introduction of standardized 2-tier serology, the findings of this study suggest the opposite, with results that fall into a similar range of 9.6%–15.0%, as cited in recent French referral populations [23–25].…”

Section: Discussionmentioning

confidence: 50%

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

Kobayashi

Higgins

Samuels

et al. 2019

Open Forum Infectious Diseases

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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.

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“…Overdiagnosis and overtreatment of Lyme borreliosis is frequent [1]. Recent studies have found that only 10 to 15% of patients consulting with a presumed diagnosis of Lyme borreliosis were actually found with Lyme borreliosis [2][3][4][5]. Psychiatric disorders, including somatic symptom and related disorders as well as depressive disorders, were found in 25% of 301 patients in Paris, France [2], and 42.5 % of 209 patients in Connecticut, USA [6].…”

Section: Introductionmentioning

confidence: 99%

Focus on patients receiving long-term antimicrobial treatments for lyme borreliosis: No lyme but mostly mental disorders

Haddad¹,

Pitron²,

Pichon³

et al. 2021

Infectious Diseases Now

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Multidisciplinary management of patients presenting with Lyme disease suspicion

Cited by 22 publications

References 10 publications

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have?

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

Focus on patients receiving long-term antimicrobial treatments for lyme borreliosis: No lyme but mostly mental disorders

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