July 11, 2019
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Lyme disease often misdiagnosed, resulting in unnecessary antibiotics

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Paul Auwaerter
Paul G. Auwaerter

Findings from a 14-year study at an infectious disease clinic outside Baltimore suggest many patients may be incorrectly diagnosed with Lyme disease and prescribed unnecessary antibiotics, researchers said.

During the study period, most patients referred to the clinic for Lyme disease were not infected, yet more than 80% of the uninfected patients had received antibiotics.

Paul G. Auwaerter, MD, professor of medicine and clinical director of the division of infectious diseases at Johns Hopkins University School of Medicine, and colleagues conducted the single-center, retrospective observational cohort study at the Johns Hopkins infectious disease clinic in Lutherville, Maryland, to help characterize diagnostic accuracy for Lyme disease. They included 1,261 patients who were referred to the center with “a presumed diagnosis or concern” for Lyme disease from 2000 through 2013.

According to the study, 72.2% of the referred patients did not have Lyme disease, 14.6% had active or recent Lyme disease, 11.9% had a remote history of Lyme disease and 1.3% had possible Lyme disease. Of the patients without Lyme disease, 83.9% received antimicrobials to treat either Lyme disease or their coinfections, Auwaerter and colleagues reported.

“While Lyme disease is overdiagnosed in this population, a novel finding, not previously reported in a large series, is the frequency of diagnoses of coinfections in addition to Lyme disease (both Ixodes and non-Ixodes tickborne [diseases], plus non-tickborne infections), which were believed to be contributing to the symptoms for11% of study patients,” the researchers wrote. “Babesia, Epstein-Barr virus, Bartonella and Ehrlichia species infections were the most frequent infections co-diagnosed prior to referral.”

Patients who did not have current Lyme disease were more likely to be female (OR = 1.56; 95% CI, 1.08-2.45), have symptoms for more than 3 months (OR = 8.78; 95% CI, 5.87-13.1), have higher symptom counts (OR per additional symptom = 1.08; 95% CI, 1.02-1.13), have 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), the researchers reported.

They noted that the percent of patients with Lyme disease was lower than in previous studies that looked at referred patient populations.

“Many patients seen for infectious disease evaluation of Lyme disease usually have multiple, longer standing complaints such as fatigue and musculoskeletal pain yet have been treated with antibiotics when there is not good evidence they have an active infection,” Auwaerter told Infectious Disease News. “Though the study doesn’t directly address reasons, I believe this points to a disconnect between appropriate clinical, evidence-based diagnosis and approaches by some clinicians who follow alternative medical practices, treat on suspicion or [are] confused by test results.” – by Marley Ghizzone

Disclosures: Auwaerter reports serving on a scientific advisory board for DiaSorin. All other authors report no relevant financial disclosures.