USE THIS ONE!
Statements Proven False or Counterproductive
However, because young age reduces the probability of infection with B burgdorferi, the likelihood that these 11 youngpatients had acquired an asymptomatic infectionwith B burgdorferi can be estimated to be atmost 10%, not 100%.
CDC- The majority of patients with Lyme disease develop a characteristic rash, erythema migrans (EM), accompanied by symptoms of fever, malaise, fatigue, headache, myalgia, or arthralgia. Other manifestations of infection can include arthritis, carditis, and neurologic deficits. Lyme disease can be treated successfully with standard antibiotic regimens.
CDC- A single dose of doxycycline should be considered for prophylaxis of Lyme disease in persons aged >8 years who have been bitten by a nymph or adult I. scapularis or I. pacificus tick in an area in which at least 20% of ticks are thought to be infected with B. burgdorferi (8). The tick must have been attached for >36 hours and prophylactic antibiotic administered within 72 hours of tick removal (8).
CDC- During 1991--1996, a case of Lyme disease was defined for national surveillance purposes as 1) physician-diagnosed EM of >5 cm in diameter or 2) at least one objective late manifestation (i.e. musculoskeletal, cardiovascular, or neurologic) with laboratory confirmation of infection with B. burgdorferi(18). Laboratory confirmation required 1) isolation of B. burgdorferi from clinical specimens, 2) demonstration of diagnostic levels of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies to B. burgdorferi in serum or cerebrospinal fluid (CSF), or 3) significant change in IgM or IgG antibody response in paired serum samples.
CDC- In 1997, CSTE and CDC implemented a revised surveillance case definition on the basis of the availability of improved serologic testing (20). Clinical criteria were not changed; however, laboratory confirmation was modified to require 1) isolation of B. burgdorferi from a clinical specimen or 2) demonstration of diagnostic levels of IgM or IgG antibodies to B. burgdorferi in serum or CSF. A two-test approach (a sensitive enzyme immunoassay or immunofluorescence antibody assay followed by Western blot) was recommended but not required (10).
Although B. burgdorferi can develop into cystlike forms in vitro under certain conditions that can be created in the laboratory,50 there is no evidence that this phenomenon has any clinical relevance.
Each of the 3 stages of the disease is associated with specific clinical features: early localized infection, with erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias; early disseminated infection (occurring days to weeks later), with neurologic, musculoskeletal, or cardiovascular symptoms and multiple erythema migrans lesions; and late disseminated infection, with intermittent swelling and pain of 1 or more joints (especially knees).
A positive ELISA IgM result very likely represents a false-positive result and should always be confirmed by WB assay and objective clinical signs of borreliosis before implementing the appropriate antimicrobial therapy.
Alfred I. duPont Hospital for Children- Patients were considered to have Lyme disease only if they met Centers for Disease Control and Prevention criteria (documented erythema migrans and/or positive Lyme serology).
Recurrent, brief attacks (lasting weeks or months) of objective joint swelling in one or a few joints, sometimes followed by chronic arthritis in one or a few joints; manifestations not considered criteria for diagnosis include chronic progressive arthritis, not preceded by brief attacks, and chronic symmetrical polyarthritis; arthralgia, myalgia, or fibromyalgia syndromes alone are not criteria for musculoskeletal involvement
Acute-onset, high-grade (2 or 3) atrioventricular conduction defects that resolve in days to weeks and are sometimes associated with myocarditis; palpitations, bradycardia, bundle branch block, or myocarditis are not criteria for cardiovascular involvement
Boston Children's Hospital- It’s not a chronic disease (Lyme), and when discovered early, is easily treated with antibiotics.
Boston Children's Hospital- The disease is transmitted to humans from contact with the tick—not spread from one human to another.
Boston Children's Hospital- Neurological symptoms of late-stage Lyme disease appear to be rare in children.
Boston Children's Hospital- The risk of developing Lyme disease after being bitten by a tick is only about 1 percent to 3 percent.
Boston Children's Hospital- It can take up to 48 hours for a tick to transmit Lyme disease.
Boston Children's Hospital- It's not necessary to take your child to a doctor after a tick bite.
Boston Children's Hospital- Lyme disease cannot be spread from human to human.
Boston Children's Hospital- In the vast majority of cases, the arthritis eventually goes away on its own.
Boston Children's Hospital- You can only get Lyme disease from being bitten from a tick that is carrying the bacteria.
Boston Children's Hospital- Since post-infectious syndrome is not itself caused by an infectious agent (it follows an infection caused by an infectious agent), doctors generally don’t prescribe antibiotics.
Boston Children's Hospital- Each child is different, but it’s not uncommon for symptoms of post-infectious syndrome to linger for months, or even years. They may seem to come and go, and can be influenced by stress or any other infections or illnesses your child experiences. But most children do make a full recovery.
Washington Hospital Center- There was no evidence of Borrelial infection in these patients by culture or detection of Bb DNA in blood or spinal fluid. Furthermore, there was no difference in responsiveness of these patients to a 3-month course of antibiotic compared with placebo treatment. Thus, LA [Lyme arthritis] caused by active Bb infection, post-treatment LA with persistent knee synovitis and post-LD syndrome are distinct and distinguishable clinical entities.
Alfred I. Dupont Hospital for Children- At the completion of treatment, there was total resolution of erythema migrans in 67% of the amoxicillin group, 92% of the low-dose cefuroxime group, and 87% of the high-dose cefuroxime group, and resolution of constitutional symptoms occurred in 100%, 69%, and 87%, respectively. All patients had a good outcome, with no long-term problems associated with LD.
Patients were re-examined 6 weeks later and a telephone interview was performed in summer 2000 to evaluate the long-term outcome.... Therefore, a complete clinical examination is sufficient as an initial evaluation and long-term follow-up is not necessary.
Children's Hospital of Philadelphia- Misdiagnosis- Lyme disease with clinical features resembling brown recluse spider bites, with a necrotic skin wound. Brown recluse spider bites may be overdiagnosed in some geographic regions.
YALE/SHAPIRO- Although there still is much to learn about Lyme disease, many aspects are well understood. Conventional treatment with antimicrobials is usually effective, and the long-term prognosis for children with Lyme disease is excellent.
YALE/SHAPIRO- The risk of transmission from ticks (for which the duration of feeding could be assessed) to humans was 25% for nymphal ticks that fed for 72 hours or more and O% for those that fed for fewer than 72 hours.
YALE/SHAPIRO- The most common manifestation of late Lyme disease, which occurs weeks to months after the initial infection, is arthritis. This is usually monoarticular or oligoarticular and affects the large joints, particularly the knees.
YALE/SHAPIRO- Lyme urine antigen test is inaccurate.
YALE/SHAPIRO- Unfortunately, because many lay persons have the erroneous belief that chronic, nonspecific symptoms alone (eg, fatigue or arthralgia) may be manifestations of Lyme disease, parents of children with these symptoms frequently demand that their child be tested for Lyme disease. In truth, Lyme disease is the cause of nonspecific symptoms in few such children, if any.
YALE/SHAPIRO- The specificity of even the best antibody tests for Lyme disease rarely exceeds 90% to 95%, some testresults for children with nonspecific signs or symptoms are positive; most of these are false positive results. Unfortunately, an erroneous diagnosis of Lyme disease is often made based on the results of these tests, and such children are often treated unnecessarily with antimicrobials.
YALE/SHAPIRO- Physicians should realize that although a symptomatic patient has a positive serologic test result for B. burgdorferi, it is possible that Lyme disease may not be the cause of that patient's symptoms. In addition to the possibility that the test result is falsely positive (a common occurrence ), the patient may have been infected with B. burgdorferi previously, and the patient's symptoms may be related to a new disease process.
YALE/SHAPIRO- These reactions typically last 1 to 2 days, are not an indication to discontinue antimicrobial therapy, and respond to non steroidal antiinflammatory agents. Appropriate therapy for erythema migrans almost always prevents development of the later stages of Lyme disease.
YALE/SHAPIRO- The optimal duration of therapy for the various stages of Lyme disease is not well established, but there is no evidence that children with any manifestation of Lyme disease benefit from either prolonged (greater than 4 weeks) or repeated courses of oral or parenteral antibiotics.
YALE/SHAPIRO- Nonspecific symptoms such as fatigue, arthralgia, or myalgia may persist for several weeks, even in patients with early Lyme disease that was successfully treated. The presence of these symptoms should not be regarded as an indication for additional treatment with antimicrobials, but non steroidal anti-inflammatory agents usually help.
YALE/SHAPIRO- These findings support earlier recommendations that such patients are best treated symptomaticallyrather than with prolonged courses of antibiotics, which can be associated withserious side effects.
YALE/SHAPIRO- CONGENITAL LYME DISEASE Much of the initial information about the potential fortransplacental infection with Lyme disease was alarming. However, this information came from a small number of case reports, most of which involved women with unrecognized and untreated Lymedisease during their pregnancies.
YALE/SHAPIRO- CONGENITAL LYME DISEASE There has been a considerable amount of skepticism about these cases because there was no evidence of inflammation and no consistent pattern of disease. In addition, although spirochetes compatible with B. burgdorferi were seen in pathologic specimens, B. burgdorferi was neverisolated in culture from any of these cases.
YALE/SHAPIRO- Because most individuals (approximately 75%) who recognize that they were bitten by a tick remove the tick within 48 hours, the risk of Lyme disease from recognized deer tick bites is low, approximately 1% to 3% in areas with a high incidence of Lyme disease.
YALE/SHAPIRO- Routine use of antimicrobial agents to prevent Lyme disease in individuals who are bitten by a deer tick, even in highly endemic areas, is not generally recommended because the overall risk of disease is low (1% to 3%).
YALE/SHAPIRO- In prelicensure studies, there was no evidence that the vaccine exacerbated prior Lyme arthritis, caused neurologic disease, or caused arthritis in subjects, including those with a history of Lyme disease.
LYME HYSTERIA- A panel of experts who developed clinical guidelines for treating patients with Lyme disease for the Infectious Diseases Society of America concluded that there is no such diagnostic entity as "chronic Lyme disease."
YALE/SHAPIRO- This contention [chronic Lyme] is supported by clinical trials that found that long-term treatment with antimicrobials was not effective for patients who believed that they had chronic Lyme disease.
YALE/SHAPIRO- Some have erroneously inferred that nonspecific symptoms can often be the sole manifestation of Lyme disease. The nonspecific symptoms sometimes attributed to Lyme disease are highly prevalent in the general population and can be caused by common ailments such as viral infection, anxiety, or depression.
YALE/SHAPIRO- The idea that Lyme disease might be the cause of nonspecific symptoms alone, without any objective signs of the illness, has been publicized by patient-advocate groups and augmented by misinformation in the lay press and on the Internet. In some instances, anxious (often misinformed) parents are driven by the fear that their child's nonspecific complaints may be a manifestation of Lyme disease, which, if not detected and treated, could lead to serious, chronic disability.
YALE/SHAPIRO- Although long-term problems have been documented, they are extremely rare and have occurred almost exclusively among adults with objective evidence of Lyme disease, most of whom either were not treated with antimicrobials or received treatment only many years after the onset of Lyme disease.
YALE/SHAPIRO- Nevertheless, physicians in referral centers who specialize in Lyme disease continue to be inundated with patients who are thought to have, or who believe they have, chronic Lyme disease. Reports from such centers indicate that in most instances the patients either do not have Lyme disease or the symptomsthat led to the referral are not due to Lyme disease.
YALE/SHAPIRO- Sometimes, a parent's anxiety about a child's behavior can be allayed by reassurance. In other instances, aparent may insist that the child is ill, although objective signs of organic illness are not present.
YALE/SHAPIRO- Helping such patients [anxious] obtain the type of assistance they need without alienating them may be difficult. Sometimes this can best be accomplished by explaining that you simultaneously want to assess the possibilities of both organic and behavioral causes of the problem.
Infectious Diseases Stony Brook- Overdiagnosis and overtreatment of Lyme disease is a major concern in areas endemic for Lyme disease, even after 1995 when standard criteria for diagnosis were published.
German Committee for Infectious Diseases and Vaccinations- In case of Lyme arthritis, the enzyme immunoassay is highly positive for IgG antibodies against B. burgdorferi; the results of which are confirmed byimmunoblot with a multitude of bands.
German Committee for Infectious Diseases and Vaccinations- Borreliosis is sometimes suspected in patients with functional problems or mental state disturbances. However,symptoms usually do not fit with known manifestations ofLyme borreliosis.
German Committee for Infectious Diseases and Vaccinations- In case of chronic headache or diminishing academicachievements, often patients are not able to indicate whencomplaints started, which is not typical of neuroborreliosis.
German Committee for Infectious Diseases and Vaccinations- In case of muscular and skeletal complaints, sometimesLyme arthritis is suspected, although arthritis is missing, asign which is necessary for the diagnosis of Lyme arthritis.
German Committee for Infectious Diseases and Vaccinations- If serology has been performed in spite of the absence ofarthritis, the lack of antibodies of immunoglobulin G againstB. burgdorferi excludes Lyme arthritis. If this determinationof specific IgG antibodies is positive, anti-B. burgdorferiantibody production has been detected; however, the causeof musculoskeletal pain remains unclear in the absence ofarthritis.
German Committee for Infectious Diseases and Vaccinations- The assessment of ticks for borrelial genomic sequences overestimates the importance of a single tick bite, since most tick bites are not recognized by the host.
German Committee for Infectious Diseases and Vaccinations- In addition, a positive result doesnot allow a reasonable conclusion: prophylactic antibiotictreatment after a tick bite is not recommended in Europe themore so as this treatment may not prevent infection followedby clinical manifestations.
CDC- The first step is testing with a highly sensitive enzyme immunoassay or immunofluorescence assay. If the first test is either equivocal or positive, a Western immunoblot test should be performed. If the first test is negative, no further testing is necessary.
CDC- In nonendemic areas, public health programs can benefit by focusing on educational messages regarding the limited risk for acquiring Lyme disease; this effort could relieve public anxiety and reduce the occurrence of inappropriate testing and treatment of Lyme disease.
1999 or before
Department of Infectious Diseases, Solvenia/Strle - The characteristic sign that permits the diagnosis of Lymeborreliosis is a typical erythema migrans skin lesion. Highly suggestive manifestations are ear lobe lymphocytoma, acrodermatitis chronica atrophicans and Bannwarth's syndrome. The majority of other signs and symptoms are only suggestive and, when expressed individually, may have a very limited or even symbolic value for the purpose of diagnosis.
Department of Infectious Diseases, Solvenia/Strle- Immunoblotting may solve some of the many dilemmas but could (especially in Europe) raise additional questions in a field in which numerous uncertainties already exist.
YALE/CT DOH- Such patients occasionally receive either repeated or prolonged parenteral courses of antimicrobial therapy despite statements by the American College of Rheumatology, the Infectious Diseases Society of America, and others that such treatment is not warranted.
YALE/CT DOH- Patients who had only nonspecific symptoms (eg, arthralgia, fatigue), with or without serologic evidence of infection with B burgdorferi, and patients who had objective signs consistent with Lyme disease other than erythema migrans (eg, arthritis) but with no serologic evidence of infection with B burgdorferi, were classified as not meeting the surveillance case definition for Lyme disease.
YALE/CT DOH- Patients who met the surveillance case definition for Lyme disease were more likely to have received antimicrobial therapy for Lyme disease than were subjects who did not meet the surveillance case definition.
YALE/CT DOH- Some patient advocacy groups and physicians believe that Lyme disease is a very serious and difficult-to-treat illness. Others believe that the majority of patients with Lyme disease remain relatively healthy, regardless of the stage of the illness at the time they present, and suggest that in many of the patients who have either persistent or recurrent subjective complaints, Lyme disease either was a misdiagnosis or was not the cause of the symptoms.
YALE/CT DOH- Among the patients reported to have had Lyme disease who did not meet the surveillance case definition, three quarters had only nonspecific symptoms (such as fatigue, arthralgia, or headache). In these patients, the diagnosis was based primarily on positive serologic test results. Because of the poor specificity of serologic tests and the low probability that a patient with only nonspecific symptoms has Lyme disease, it is likely that the diagnosis of Lyme disease was inaccurate in many of these patients.
University of Würzburg, Germany- The diagnosis of Lyme borreliosis required the presence of (i) erythema migrans (diameter > or =5 cm); (ii) lymphocytoma; or (iii) another specific manifestation including Lyme arthritis, neuroborreliosis, carditis or acrodermatitis chronica atrophicans in conjunction with serological confirmation.
Delaware duPont Hospital for Children- The results of long-term follow-up of the pediatric population continue to strongly support the finding that children treated appropriately for LD have an excellent prognosis for normal cognitive functioning.
A. I. duPont Hospital for Children- Antibodies produced in response to OspA vaccination did not significantly affect the performance of the dot blot test; thus, it could provide a reliable means to test for infection with B. burgdorferi in OspA vaccine recipients.
Hunterdon Medical Center/Sigal, L.- Rarely, Lyme disease manifests as localized arthritis, heart block or disease of the nervous system.
Hunterdon Medical Center/Sigal, L.- Overdiagnosis and overtreatment of Lyme disease have become common.
PN Malleson- Vancouver, Canada/Rheumatology- Paediatricians should be wary of treating children witharthritis without a history of tick bites orerythema migrans for Lyme disease, unlessthere is western blot confirmation of a positiveserology, as the risk of antibiotic toxicity isprobably higher than the risk of complicationsfrom the untreated disease.
PN Malleson- Vancouver, Canada/Rheumatology- It is worth noting that in areas where the disease is endemic,many children diagnosed as having chronicLyme disease actually have fibromyalgia.
Department of Infectious Diseases/Sweden- It is concluded that there probably is an overdiagnosis of Lyme borreliosis and that better microbiological methods are needed to confirm active disease.
Fawcett/Alfred A. duPont- These results indicate that serologic tests designed to have high specificity can reliably rule out Lyme borreliosis in patients with chronic symptoms, thus preventing unnecessary treatment with antibiotics.
Stanek/J.G. Mendel Children's Hospital/Infectious Disease Department- A 3 months follow-up was completed with 151 children. No child showed clinical evidence of illness, nor were there abnormalities in laboratory parameters.
Adams, Rose/Department of Pediatrics, Alfred I. duPont Institute, Jefferson Medical College, DE- No differences between LD and control groups were found for any of the numerous neuropsychologic measures.
Adams, Rose/Department of Pediatrics, Alfred I. duPont Institute, Jefferson Medical College, DE- No predisease versus post-disease difference in academic performance was found.
Adams, Rose/Department of Pediatrics, Alfred I. duPont Institute, Jefferson Medical College, DE- No perceived long-term deterioration in cognitive, social, or personality areas was reported by parents.
Adams, Rose/Department of Pediatrics, Alfred I. duPont Institute, Jefferson Medical College, DE-Children appropriately treated for LD have an excellent prognosis for unimpaired cognitive functioning.
New York Medical College, Valhalla- Western Blots- The presence of at least 2 bands of moderate to high intensity (> 40 optical units) or at least 5 bands of lower intensity (> 20 optical units) was over 90% sensitive and 100% specific for the diagnosis of Lyme arthritis.
CDC- In 1993, two U.S. manufacturers received FDA approval to conduct field trials of LD vaccines in humans. One was conducting Phase III trials of 10,000 people in the northeast, north central and mid-Atlantic regions. The 2nd manufacturer was conducting trials on 400 humans in New England. Both reported prior to 1993 the vaccines were safe and immunogenic. (LD wasn't reportable until 1990. In 1993 only 8,185 cases were reported to CDC, with an incidence rate of 3.3 per 100,000.)
Strickland, University of Maryland/MD Dept. of Health & Mental Hygiene- Study information came from the practicing physicians Confidential Morbidity Report and labs reporting positive results. Often information was obtained via the telephone.
Strickland, University of Maryland/MD Dept. of Health & Mental Hygiene- Of 373 patients reported, 90 did not meet the CDC's case definition and were excluded from the study.
Strickland, University of Maryland/MD Dept. of Health & Mental Hygiene- Flu-like symptoms and positive serology patients, those with no joint swelling, and arthralgia with positive serology patients were excluded from the study.
Strickland, University of Maryland/MD Dept. of Health & Mental Hygiene- In about 10% of cases physicians changed the antibiotics within the first week of treatment due to the patient's intolerance to the drug.
Strickland, University of Maryland/MD Dept. of Health & Mental Hygiene- Of 283 patients meeting the CDC criteria, 104 were without cardiac, arthritic or neurologic symptoms.
Strickland, University of Maryland/MD Dept. of Health & Mental Hygiene- It is generally accepted that 2-3 weeks of antibiotic therapy is sufficient for treating early onset Lyme disease. This almost always clears the rash and other symptoms and prevents more chronic manifestations.
Strickland, University of Maryland/MD Dept. of Health & Mental Hygiene- The overdiagnosis and treatment of patients with chronic manifestations suggestive of Lyme disease is of major concern, since many of these patients are being treated with expensive and potentially toxic regimens.
Feder/University of Connecticut- Treatment errors were made for 19 (25%) of these 75 patients.
Feder/University of Connecticut- Of the 146 patients, 56 (38%) were overdiagnosed, 12 (8%) were underdiagnosed, and 75 (51%) were correctly diagnosed with Lyme disease.
Feder/University of Connecticut- In addition, three patients (2%) with tick bites were misdiagnosed or mistreated.
Feder/University of Connecticut- Frequent pitfalls included misidentifying rashes as erythema migrans, ascribing nonspecific symptoms to Lyme disease, failing to ascribe fleeting objective symptoms to Lyme disease, and inappropriate antibiotic therapy for patients with Lyme disease.
Orthopedic Surgery Service/Ohio- Although the patient's right knee symptoms and positive Lyme serology were consistent with a diagnosis of Lyme arthritis, the presence of sensorineural hearing loss and interstitial keratitis with inflammatory arthritis suggested a diagnosis of Cogan's syndrome. Subsequent Western blot analysis was negative for Borrelia burgdorferi antigens. The patient had dramatic clinical improvement of musculoskeletal and ophthalmologic complaints shortly after receiving high-dose corticosteroids.
Shapiro/Yale- Extensive publicity in the lay press about the effects of Lyme disease has led to widespread anxiety about this illness that is out of proportion to the actual frequency of severe consequences, especially among children.
Shapiro/Yale- Although there has been great concern about congenital Lyme disease, no data suggest that it is a significant problem, nor has transmission of Lyme disease through breast milk been documented.
Shapiro/Yale- The IgM rOspC ELISA is a convenient, readily automated, easily standardized serologic test that is significantly more sensitive for the diagnosis of early Lyme disease than either WC ELISA or immunoblot assay.
CDC/Ft. Collins, Colorado- Treatment of unsubstantiated Lyme disease has led to serious complications in some cases.
CDC/Ft. Collins, Colorado- Two case-control studies, based on information in clinical records of patients discharged with a diagnosis of Lyme disease during 1990-1992, were conducted at a central New Jersey hospital.
CDC/Ft. Collins, Colorado- Only 3% of 71 evaluatable subjects met the study criteria for disseminated Lyme disease.
CDC/Ft. Collins, Colorado- Treatment of unsubstantiated diagnoses of Lyme disease is associated with biliary complications.
Academic Rheumatology Group, St George's Hospital Medical School, University of London- Seven had a history of tick bite or tick exposure in an endemic area; however, only four had specific antibodies to B. burgdorferi confirmed on immunoblot.
Service de Dermatologie, Groupe Hospitalier Bichat-Claude Bernard, Paris- Antibiotic prophylaxis is not necessary.
Stanek/Hygieneinstitut, Universität Wien- Clinical diagnosis of suspected cases of Lyme borreliosis requires confirmation by the demonstration of the aetiologic agent and the recognition of its causative role in the respective disorder.
Stanek/Hygieneinstitut, Universität Wien- Interpretation of serological test results may lead to the clinical diagnosis of Lyme borreliosis and in consequence to antibiotic treatment.
Rose, Fawcett/Division of Rheumatology, Alfred I. duPont Institute, Delaware- Medical records of 227 children ages 1 to 19 years referred to the Lyme disease pediatric clinic over a 32-month period since May 1990 were reviewed.
Rose, Fawcett/Division of Rheumatology, Alfred I. duPont Institute, Wilmington, Delaware- Clinico-serologic criteria for a positive diagnosis were applied. One hundred thirty-eight of 227 referred children did not fulfill those criteria.
Rose, Fawcett/Division of Rheumatology, Alfred I. duPont Institute, Delaware- Four subsets of patients emerged: (1) 54 patients with predominantly subjective symptoms; (2) 52 patients with objective evidence for an alternative diagnosis; (3) eight patients who had documented infection in the past and continued with symptoms after antibiotic treatment; and (4) 24 patients with a history of tick attachment or prenatal/family history of Lyme disease.
Rose, Fawcett/Division of Rheumatology, Alfred I. duPont Institute, Delaware- Fifty-seven percent of these patients had received treatment prior to our evaluation. Children residing in an endemic area who present with vague symptoms are being diagnosed with and treated for Lyme disease without clinical or serologic documentation.
Rose, Fawcett/Division of Rheumatology, Alfred I. duPont Institute, Wilmington, Delaware- In addition, fear in the lay community may be inducing doctors to diagnose Lyme disease in patients with symptoms that may be suggestive of an alternative diagnosis.
Strickland/University of Maryland/Maryland DHMH- The recommended treatment of Lyme disease is evolving and important questions remain unanswered, such as (a) Are inexpensive oral regimens effective in curing acute illness and preventing arthritic, neurologic, and cardiac manifestations or are much more costly, and potentially toxic, intravenous antibiotics required?
Strickland/University of Maryland/Maryland DHMH- Questions remain unanswered, such as (b) Are relatively short 2- to 3-week courses of antibiotics sufficient or are prolonged regimens of a month, or more, better?
Strickland/University of Maryland/Maryland DHMH- This study reviews antibiotic therapy prescribed by Maryland physicians for the 283 cases reported in 1991 that meet the Centers for Disease Control and Prevention's case definition for Lyme disease.
Strickland/University of Maryland/Maryland DHMH- The most frequently prescribed antibiotics for either the 60 percent of patients presenting with erythema migrans or the 40 percent with arthritic, neurologic, or cardiac manifestations were oral doxycycline (47 percent), tetracycline (11 percent), and amoxicillin (13 percent).
Strickland/University of Maryland/Maryland DHMH- The average course [of antibiotic therapy] was 2 days longer in treating those with arthritic, neurologic, or cardiac manifestations than in treating those with erythema migrans alone.
Strickland/University of Maryland/Maryland DHMH- Efforts to educate physicians should be directed more towards the diagnosis rather than the treatment of Lyme disease.
Columbia-Presbyterian Medical Center, New York- Based on the low frequency of illness, the absence of stage II disease, and the inability to establish the efficacy of early antibiotic treatment, we suggest that physicians not routinely use prophylactic antibiotics for deer tick bites.
New York Medical College, Valhalla- Maternal Lyme disease or an increased risk of exposure to Lyme disease was not associated with fetal death, decreased birth weight, or length of gestation at delivery.
New York Medical College, Valhalla- Tick bites or Lyme disease around the time of conception was not associated with congenital malformations.
Aland Central Hospital, Finland- General screening for Lyme disease is not recommended in the area due to uncertainty about how to deal with seropositive healthy persons in this heavily exposed population.
Aland Central Hospital, Finland- Treatment of all those suffering tick-bites with an antibiotic would be an option in view of the incidence of infected ticks, but cannot be considered because tick-bites are extremely common among the inhabitants.
Steere, New England Medical Center, Boston- One hundred fifty-six patients (20%) had previous Lyme disease and another current illness, most commonly chronic fatigue syndrome or fibromyalgia; and in 49 patients, these symptoms began soon after objective manifestations of Lyme disease.
Steere, New England Medical Center, Boston- The remaining 452 patients (57%) did not have Lyme disease. The majority of these patients also had the chronic fatigue syndrome or fibromyalgia; the others usually had rheumatic or neurological diseases.
Steere, New England Medical Center, Boston- Of the patients who did not have Lyme disease, 45% had had positive serological test results for Lyme disease in other laboratories, but all were seronegative in our laboratory.
Steere, New England Medical Center, Boston- In 322 (79%) of these patients, the reason for lack of response to treatment was incorrect diagnosis.
Steere, New England Medical Center, Boston- Only a minority of the patients referred to the clinic met diagnostic criteria for Lyme disease. The most common reason for lack of response to antibiotic therapy was misdiagnosis.
University of British Columbia, Vancouver, Canada- Borrelia burgdorferi is not known to be endemic in this region, but considerable anxiety about Lyme disease has developed among the general public.
University of British Columbia, Vancouver, Canada- Strict diagnostic criteria consistent with published standards were applied. Only two of the 65 patients were judged to have probable Lyme disease.
University of British Columbia, Vancouver, Canada- Definite major alternate diagnoses were made for 50 [Lyme] patients (77%); firm medical diagnoses (11 dermatologic, 9 rheumatologic, 9 infectious disease, 6 gastrointestinal, 4 neurological, and 2 miscellaneous) were made for 41 patients (63%); and major psychiatric diagnoses were made for 9 patients (14%). Probable diagnoses of chronic fatigue syndrome and fibromyalgia were made for 11 patients (17%). The conditions of four patients (6%) were undiagnosed.
Sood, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY- As false positive reactions are frequent in ELISA for Lyme borreliosis, they cannot be used reliably to make the distinction.
Sood, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY-
Ninety-nine children diagnosed as having JRA at a children's hospital in an endemic area were evaluated by ELISA and immunoblot for antibodies to Borrelia burgdorferi. Sera from 9% were positive by ELISA, 5 of which showed bands on immunoblot. None met criteria for positive immunoblot.
Sood, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY- The antigenic basis of false positive ELISA was most frequently a reactivity to both 21 and 41 kDa.
Sood, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY- Analysis by immunoblot can help to definitively exclude Lyme borreliosis in children presenting with JRA in an endemic area.
University Hospital, Göttingen, Germany- Lyme neuroborreliosis was the focus of the study, with the chief concern being to minimize false-positive results. To this end, we chose to narrow the diagnostic criteria, using the presence of specific antibodies in the cerebrospinal fluid as the determining factor.
Feder, Krause, Shapiro, et. al. University of Connecticut Health Center- The existence of a form of early Lyme disease characterized by a flu-like illness without erythema migrans is controversial.
Feder, Krause, Shapiro, et. al. University of Connecticut Health Center- The diagnosis of Lyme disease was based on the appearance of IgM or IgG antibodies to Borrelia burgdorferi as demonstrated by both enzyme-linked immunosorbent assay and immunoblot assay.
Feder, Krause, Shapiro, et. al. University of Connecticut Health Center- Twenty-four untreated patients were studied.
Feder, Krause, Shapiro, et. al. University of Connecticut Health Center- The flu-like illness in these five patients was characterized by fever and fatigue and resolved spontaneously in 5 to 21 days. Symptoms recurred in three of these five patients.
CDC- In June 1992, CDC and the New Jersey Department of Health (NJDOH) conducted a telephone survey in both counties of 65 schoolchildren who required home instruction because of suspected LD to determine the public health impact of the disease.
CDC- 79% had been hospitalized for treatment of suspected LD or management of treatment complications, most notably drug-induced symptoms of gallbladder disease occurring in patients receiving ceftriaxone (Rocephin), and bloodstream infections associated with intravenous catheters.
Steere, et. al. Tufts-New England Medical Center, Boston, Massachusetts- We have done a retrospective study that compared the clinical course of Lyme arthritis in 83 patients.
Marshfield Medical Center Laboratory, Wisconsin- Cultivation of B. burgdorferi from skin lesions suggestive of erythema migrans is a practical and clinically relevant procedure.
Müller M, Stanek, et. al. Hygiene-Institut, Universität Wien- In case of a suspected Borrelia burgdorferi infection confirmatory tests are needed.
Müller M, Stanek, et. al. Hygiene-Institut, Universität Wien- The retrospective evaluation of patients' records showed that anamnestic and clinical findings alone do not suffice to establish the specific diagnosis of Lyme borreliosis and, hence, do not provide the indication of appropriate therapy.
Sigal- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, NJ- In areas endemic for Lyme disease there is increasing concern and anxiety about possible chronic and untreatable manifestations of the disease.
Sigal- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, NJ- The authors have diagnosed fibromyalgia in many patients with chronic musculoskeletal complaints in whom chronic Lyme arthritis had previously been diagnosed as the cause of their joint pains.
Sigal- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, NJ- Fibromyalgia is a common disorder, causing arthralgia (not true arthritis), fatigue, and debility.
Sigal- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, NJ- The repeated and/or long-term antibiotic therapy prescribed for "chronic Lyme disease" is not successful in curing the symptoms of fibromyalgia.
Sigal- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, NJ- Especially in areas where anxiety about Lyme disease is great, it is important to be careful in diagnosing chronic Lyme disease.
Sigal- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, NJ- Fibromyalgia is a potentially treatable and curable cause of chronic complaints and should be considered in the differential diagnosis of "refractory Lyme arthritis."
Nadelman, Wormser, et. al. New York Medical College, New York- A satisfactory clinical outcome (success or improvement) was achieved in 51 of 55 (93%) evaluable patients treated with cefuroxime axetil and in 45 of 51 (88%) patients treated with doxycycline (difference, 5%, 95% Cl, -5% to 14%).
Nadelman, Wormser, et. al. New York Medical College, New York- Of the patients with satisfactory outcomes at 1 month post-treatment who were evaluable at 1 year post-treatment, a satisfactory outcome was achieved in 43 of 48 (90%) and in 35 of 38 (92%) patients treated with cefuroxime axetil and doxycycline, respectively.
Canadian Infectious Diseases and Immunization Committee- Doxycycline in a dosage of 100 mg twice daily may be a convenient alternative.
Fawcett, Rose, et. al. Alfred I. duPont Institute, Wilmington, Delaware- Often, for families and physicians, the clinical dilemma is whether fatigue, arthritis/arthralgias, a positive enzyme-linked immunosorbent assay (ELISA), and tick exposure, but no evidence of erythema chronicum migrans, are sufficient to diagnose and treat Lyme disease.
Fawcett, Rose, et. al. Alfred I. duPont Institute, Wilmington, Delaware- Ninety-one percent of group 2 (positive ELISA, negative WB) had a rheumatic or inflammatory condition other than Lyme disease.
Ostrov, University of Pennsylvania- Most disease manifestations are not specific to this illness. In addition, in endemic areas, almost 100% of the tick vector, the Ixodes species, are infected and the incidence rate of LB is as high as 1%. Because of these factors, the illness is overdiagnosed and overtreated.
University of Tsukuba, Japan- Like syphilis, the disease can be self-healing without treatment.
Sigal, Robert Wood Johnson Medical School, NJ- In areas where anxiety about the disease is high, patients and physicians often ascribe clinical concerns to Lyme disease. Incorrect diagnosis often leads to unnecessary antibiotic treatment (often prolonged or repeated intravenous therapy).
Sigal, Robert Wood Johnson Medical School, NJ- In only 37 [of 100] of the patients referred was Lyme disease, either current or preceding, the explanation for the complaints.
Sigal, Robert Wood Johnson Medical School, NJ- Many of the patients had another definable arthropathy. Twenty-five of the patients had fibromyalgia, which has not previously been reported in Lyme disease.
Sigal, Robert Wood Johnson Medical School, NJ- Three of these patients had active Lyme disease at the time of evaluation, and 17 had a history suggesting preceding Lyme disease.
Sigal, Robert Wood Johnson Medical School, NJ- Approximately half of the 91 courses of antibiotic therapy given to these 100 patients before referral were probably unwarranted.
Sigal, Robert Wood Johnson Medical School, NJ- Anxiety about late manifestations of Lyme disease made Lyme disease a "diagnosis of exclusion" in many endemic areas.
Sigal, Robert Wood Johnson Medical School, NJ- Persistence of mild to moderate symptoms after adequate therapy and misdiagnosis of fibromyalgia and fatigue may incorrectly suggest persistence of infection, leading to further antibiotic therapy.
Sigal, Robert Wood Johnson Medical School, NJ- Attention to patient anxiety and increased awareness of musculoskeletal problems after therapy should decrease unnecessary therapy of previously treated Lyme disease.
CDC/Yale- Persons with erythema migrans who had reported neurologic, cardiac, or arthritic symptoms and a negative serologic test result were considered to have erythema migrans as their only Lyme disease manifestation. This distinction was primarily made to minimize misclassifying arthralgia as arthritis.
CDC/Yale- Persons with a positive serologic test but without erythema migrans, and without cardiac, neurologic, or arthritic manifestations were not counted as cases.