Misdiagnosis of Lyme Disease

Summary
Lyme disease shares common symptoms with fibromyalgia and chronic fatigue syndrome. Lyme disease is more prevalent in males while fibromyalgia and chronic fatigue syndrome is more common in females. However, the current study found that more females compared to males, receive therapy for chronic Lyme disease. This could be related to errors in diagnosis based on the symptoms alone. Often, a prolonged therapy with antibiotics is prescribed for patients classified as suffering from chronic Lyme disease. The antibiotic therapy could be unnecessary as well as risky.

Introduction
Lyme disease is caused by bacteria. Most of the patients with Lyme disease are cured after a course of antibiotics. Few patients have persistent symptoms like fatigue, musculoskeletal pain, and difficulties with concentration or short-term memory. All these symptoms are common to many diseases. Some doctors classify patients with these symptoms as suffering from chronic Lyme disease. They prescribe these patients a prolonged course of antibiotics and unconventional therapies. In reality, these patients might not have Lyme disease or even its long-term manifestations. This study compared the gender of patients being treated for chronic Lyme disease with those actually diagnosed to be suffering from acute symptoms or post-Lyme disease syndrome.

Methodology
* Electronic data in PubMed till December 2007 was searched to find articles related to the key word, chronic Lyme disease.
* The gender of adult Lyme disease patients in the United States was determined, based on cases reported to the Center of Disease Control (CDC).
* Studies of antibiotic treatment of chronic Lyme disease and the controlled antibiotic treatment trials of patients with post-Lyme disease syndrome in the United States were used to document genders of the patients.
* Statistical analysis was carried out to determine the difference between the groups.

Results
* Results showed that of the 43,282 cases of Lyme disease in adults reported to the CDC, 48 percent cases were diagnosed in females.
* In three clinical trials of antibiotic treatment of post-Lyme disease syndrome, 48.9 percent were females.
* In three studies on treatment of chronic Lyme disease, the female to male ratio was 1.8, 2.3, and 2.8, respectively. In these three studies, which actually treated post-Lyme disease with antibiotics after carrying out blood test to determine seropositivity, the female to male ratio was 0.7, 1.2, and 1.1, respectively.
* This indicated that females were more likely to be included in patients categorized as those suffering from chronic Lyme disease.

Next steps/Shortcomings
The data about patients with chronic Lyme disease came from the practice of a single clinician and, thus, may not be truly representative. Similarly, data on the actual number of patients diagnosed annually with chronic Lyme disease in the United States do not exist. Chronic Lyme disease may be a misnomer and a wrong classifier, as very few patients of acute Lyme disease ever suffer from long-term symptoms, after the infection is controlled.

Conclusion
Chronic Lyme disease is a term used by physicians. Lyme disease is an infection caused by the bacteria Borreliaburgdorferi. Patients with residual symptoms, after possible acute Lyme disease, are classified under chronic Lyme disease. Post-Lyme disease syndrome is a term used for patients who have actually suffered the infection, confirmed by laboratory tests. The study showed that patients categorized under chronic Lyme disease include more females, but, in reality, males are affected more by an infection caused by B. burgdorferi. This also indicates that a large number of patients may receive prolonged courses of antibiotic therapy for an infection they might not have at all. Because symptoms of fibromyalgia and chronic fatigue syndrome are common with post-Lyme syndrome, physicians might be wrongly classifying the female patients and prescribing them with unnecessary and risky antibiotic therapy. This study shows the necessity to better educate physicians to help them differentiate between these diseases. A more specific laboratory test for diagnosing Lyme disease might also be useful.

For More Information:
Implications of Gender in Chronic Lyme Disease
Journal of Women’s Health, 2009
By Gary Wormser, MD; Eugene Shapiro, MD
Form the New York Medical College, Valhalla, New York; Yale University School of Medicine and Graduate School of Arts and Sciences, New Haven, Connecticut

*FYI Living Lab Reports Are Summaries of the Original Research.

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