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

Abstract

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.

Multidisciplinary Management of Suspected Lyme Borreliosis: Clinical Features of 569 Patients, and Factors Associated with Recovery at 3 and 12 Months, a Prospective Cohort Study

“…Patients seeking care at the TBD-RC presented similar epidemiological and clinical characteristics to those in other studies in other settings describing a multidisciplinary care organization for suspected LB [ 27 , 28 , 29 , 30 ]. As previously found in these studies, ~10–20% of suspected cases had confirmed LB.…”

“…Few patients (9%) had no specific diagnoses compared to other studies varying from 12.1% to 38.5% [ 27 , 28 , 29 , 30 ], probably because they had a regular follow-up in the adapted care sector since the beginning of their management, which allowed for clinical re-evaluations and the confirmation of the diagnosis for a longer period. For patients that have experienced diagnostic delay or serial misdiagnosis, a multidisciplinary approach could be a major answer, helping with acceptance of the diagnosis and offered care [ 23 ].…”

“…The multiplicity of other diagnoses found in all these studies highlights the complexity of diagnosing LB without disregarding other diagnoses [ 27 , 28 , 29 , 30 ]. There is not one disease that presents one picture.…”

“…Patients with LB-associated symptoms were classified as follows [ 5 , 30 , 32 , 33 ]: (i) confirmed LB (tick-exposure, typical clinical signs, and a positive two-tiered serology), (ii) possible LB (tick exposure and/or prior EM, evocative clinical signs, and marked clinical improvement after 21 days of antibiotics), (iii) PTLDS (asthenia/polyalgia/cognitive complaints) or sequelae (objective and definitive impairment after a LNB, an ACA or a Lyme arthritis) persisting for more than six months after proven LB had been treated as recommended [ 15 , 33 ]. Patients not fulfilling these definitions were considered in the group “other diagnoses”.…”

“…Our center was named the Tick-borne Diseases Reference Center (TBD-RC) for Paris and Northern Region in July 2019 by the French Ministry of Health. Other teams in other countries have also created such care organizations [ 27 , 28 , 29 , 30 ], showing a European awareness for the management of complex LB and its differential diagnoses. Several studies have been published to describe these new care organizations, but none have compared the clinical features of patients according to their diagnosis nor have they described patient care paths and outcomes after multidisciplinary and patient-centered medical support.…”