Supportive of both underdiagnosed and over diagnosed Lyme disease

€ TITLE:
Role of serology in the diagnosis of Lyme disease [see comments]
AUTHORS:
Brown SL; Hansen SL; Langone JJ
AUTHOR AFFILIATION:
Division of Postmarket Surveillance, Food and Drug Administration, Center for Devices and Radiological Health, Rockville, MD, USA. syb@cdrh.fda.gov
SOURCE:
JAMA 1999 Jul 7;282(1):62-6
COMMENT:
Comment in: JAMA 1999 Jul 7;282(1):79-80
"Numerous concerns regarding the potential for misdiagnosis of Lyme disease using commercial assays have been voiced by the US Food and Drug Administration (FDA). We attempted to clarify the clinical value of serologic testing for Lyme disease using the results of commonly marketed assays for detecting antibody to Borrelia burgdorferi, the organism that causes Lyme disease. ...To reduce this risk of misdiagnosis, it is important that clinicians understand the performance characteristics and limitations of these tests. These tests, in common use in clinical or commercial laboratories, should be used only to support a clinical diagnosis of Lyme disease, not as the primary basis for making diagnostic or treatment decisions."

€ TITLE:
[Presentation of the Environmental-Health Prize 1997: Lyme borreliosis]
AUTHORS:
Molina C
SOURCE:
Bull Acad Natl Med 1998;182(2):263-5
"The prevention and the treatment of this disease are well standardized, the main risk being its misdiagnosis."

€ TITLE:
[Thoraco-abdominal manifestation of stage II Lyme neuroborreliosis]
AUTHORS:
Pfadenhauer K; Schonsteiner T; Stohr M
AUTHOR AFFILIATION:
Neurologische Klinik mit klinischer Neurophysiologie, Zentralklinikum Augsburg.
SOURCE:
Nervenarzt 1998 Apr;69(4):296-9
"In the past little attention was paid to the thoracoabdominal manifestation of Lyme radiculoneuritis, because paralysis of the abdominal wall muscles was considered to be a very uncommon clinical manifestation of Lyme neuroborreliosis. ...n patients from an area with a high incidence of Lyme disease it is recommended to exclude neuroborreliosis even in patients with known diabetes mellitus in order to avoid the misdiagnosis of diabetic thoracoabdominal radiculopathy. This has occured in 2 of our patients."

€ TITLE:
Borrelia burgdorferi infection: clinical diagnostic techniques.
AUTHORS:
Coyle PK
AUTHOR AFFILIATION:
Department of Neurology, School of Medicine, State University of New York at Stony Brook 11794, USA.
SOURCE:
Immunol Invest 1997 Jan-Feb;26(1-2):117-28
"Cases of Lyme disease are both underdiagnosed and overdiagnosed."

€ TITLE:
Recommendation to include OspA and OspB in the new immunoblotting criteria for serodiagnosis of Lyme disease [published erratum appears in J Clin Microbiol 1997 Oct;35(10):2713]
AUTHORS:
Hilton E; Devoti J; Sood S
AUTHOR AFFILIATION:
Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA.
SOURCE:
J Clin Microbiol 1996 Jun;34(6):1353-4
"Although overdiagnosis of Lyme disease appears to be the more frequent problem, our concern is that the exclusion of the 31- and 34- kDa protein bands from the diagnostic criteria may result in the underdiagnosis of Lyme disease by those who would rely too heavily on serological confirmation."

€ TITLE:
Misdiagnosis of erythema migrans.
AUTHORS:
Feder HM Jr; Whitaker DL
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut Health Center, Farmington 06030, USA.
SOURCE:
Am J Med 1995 Oct;99(4):412-9
"CONCLUSIONS: There are pitfalls associated with the diagnosis of erythema migrans that may result in overdiagnosis or underdiagnosis."

€ TITLE:
Pitfalls in the diagnosis and treatment of Lyme disease in children [see comments]
AUTHORS:
Feder HM Jr; Hunt MS
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut Health Center, Farmington 06030-3960, USA.
SOURCE:
JAMA 1995 Jul 5;274(1):66-8
COMMENT:
Comment in: JAMA 1995 Nov 8;274(18):1427-8
"MAIN OUTCOME MEASURES--Of the 146 patients, 56 (38%) were overdiagnosed, 12 (8%) were underdiagnosed, and 75 (51%) were correctly diagnosed with Lyme disease. ...CONCLUSIONS--Errors in the diagnosis and treatment of Lyme disease in children are common."

€ TITLE:
Persisting complaints attributed to chronic Lyme disease: possible mechanisms and implications for management [see comments]
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
Department of Medicine, University of Medicine and Dentistry, Robert Wood Johnson Medical School, New Brunswick, NJ.
SOURCE:
Am J Med 1994 Apr;96(4):365-74
COMMENT:
Comment in: Am J Med 1995 Oct;99(4):440
ABSTRACT:
"A better understanding of the natural history of Lyme disease and of possible causes for persisting symptoms other than active infection is needed to optimize management of patients with persistent symptoms. Review of patients seen at a Lyme disease referral center and of the immunologic and clinical literature on Lyme disease suggests most symptoms that persist after therapy can be explained by one or more of seven proposed pathogenetic mechanisms, only one of which includes active ongoing infection. Individualization of care and reanalysis of patients problems are crucial if misdiagnosis and overtreatment of Lyme disease are to be avoided."

Supportive of overdiagnosed Lyme disease

€ TITLE:
Overdiagnosis and overtreatment of Lyme disease leads to inappropriate health service use.
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
Division of Rheumatology, UMDNJ-R.W. Johnson Medical School, New Brunswick, USA.
SOURCE:
Clin Exp Rheumatol 1999 Jan-Feb;17(1):41
"[No abstract available.]"

€ TITLE:
Overdiagnosis of Lyme disease [letter; comment]
AUTHORS:
Ferguson H
SOURCE:
Ann Intern Med 1998 Nov 1;129(9):752; discussion 752-3 [complete text]
COMMENT:
Comment on: Ann Intern Med 1998 Mar 1;128(5):354-62 [complete text]
"To the Editor: I carefully read Reid and colleagues' article, (1) copies of which had been sent to me by two physicians who had previously tried to convince me that I did not have Lyme disease. ...After 2 years, I received neither diagnosis nor treatment. ...So I began researching the subject myself. ...Today, after 6 weeks of treatment [antibiotics], I feel robust and pain-free."

€ TITLE:
Lyme disease update. Current approach to early, disseminated, and late disease.
AUTHORS:
Rahn DW; Felz MW
AUTHOR AFFILIATION:
Section of General Internal Medicine, Medical College of Georgia School of Medicine, Augusta 30912-3104, USA. deptmed.drahn@mail.mcg.edu
SOURCE:
Postgrad Med 1998 May;103(5):51-4, 57-9, 63-4 passim
"Late Lyme disease must be distinguished by clinical characteristics from fibromyalgia (the commonest source of misdiagnosis in several studies)."

€ TITLE:
Overdiagnosis of Lyme disease [letter; comment]
AUTHORS:
Cherney CL
SOURCE:
Ann Intern Med 1998 Nov 1;129(9):752; discussion 752-3 [complete text]
COMMENT:
Comment on: Ann Intern Med 1998 Mar 1;128(5):354-62 [complete text]
"To the Editor: After reading Reid and colleagues' report (1), I came away with a feeling of "Enough already!""

€ TITLE:
The consequences of overdiagnosis and overtreatment of Lyme disease: an observational study [see comments]
AUTHORS:
Reid MC; Schoen RT; Evans J; Rosenberg JC; Horwitz RI
AUTHOR AFFILIATION:
Veterans Affairs Connecticut Healthcare System, West Haven 06516, USA.
SOURCE:
Ann Intern Med 1998 Mar 1;128(5):354-62 [complete text]
COMMENT:
Comment in: Ann Intern Med 1998 Nov 1;129(9):752; discussion 752-3 [complete text]
"CONCLUSIONS: Overdiagnosis and overtreatment of Lyme disease are associated with inappropriate use of health services, avoidable treatment-related illness, and substantial disability and distress."

€ TITLE:
Recognition and management of Lyme disease.
AUTHORS:
Verdon ME; Sigal LH
AUTHOR AFFILIATION:
Hunterdon Medical Center Family Practice Residency Hunterdon Medical Center, Flemington, New Jersey, USA.
SOURCE:
Am Fam Physician 1997 Aug;56(2):427-36, 439-40
"Overdiagnosis and overtreatment of Lyme disease have become common."

€ TITLE:
Lyme borreliosis--an overdiagnosed disease?
AUTHORS:
Svenungsson B; Lindh G
AUTHOR AFFILIATION:
Dept. of Infectious Diseases, Karolinska Institute, Huddinge University Hospital, Sweden.
SOURCE:
Infection 1997 May-Jun;25(3):140-3
"It is concluded that there probably is an overdiagnosis of Lyme borreliosis and that better microbiological methods are needed to confirm active disease."

€ TITLE:
Myths and facts about Lyme disease.
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
Department of Medicine, Robert Wood Johnson Medical School, USA.
SOURCE:
Cleve Clin J Med 1997 Apr;64(4):203-9
ABSTRACT:
"Lyme disease has taken hold in the imagination of the general public and physicians alike. Although the disease is real, the diagnosis is often false. Patients demanding an explanation for feeling out of sorts, and physicians too willing to oblige them with improper use of serologic tests and useless therapies both foster a mythology that conscientious physicians should try to combat. This article debunks the myths and presents the facts."

€ TITLE:
[Musculoskeletal symptoms often incorrectly attributed to Lyme disease]
AUTHORS:
Blaauw AA; Bijlsma JW
AUTHOR AFFILIATION:
Academisch Ziekenhuis, afd. Reumatologie en Klinische Immunologie, Utrecht.
SOURCE:
Ned Tijdschr Geneeskd 1997 Mar 8;141(10):474-7
"OBJECTIVE: To establish, in patients referred with persisting noninflammatory musculoskeletal complaints. diagnosed elsewhere with Lyme disease, whether Lyme disease was present. ...CONCLUSION: In this patient group with persisting musculo-skeletal complaints, 'Lyme disease' had been diagnosed correctly as often as incorrectly."

€ TITLE:
Lyme disease in children.
AUTHORS:
Shapiro ED; Seltzer EG
AUTHOR AFFILIATION:
Department of Pediatrics, Children's Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
SOURCE:
Semin Neurol 1997 Mar;17(1):39-44
"Children with only non- specific symptoms such as headache, arthralgia or fatigue commonly are misdiagnosed as having Lyme disease. Although such non-specific symptoms often accompany more specific signs and symptoms (e.g., erythema migrans, arthritis) in children with Lyme disease, very rarely are non-specific symptoms the sole manifestation of Lyme disease."

€ TITLE:
The Lyme disease controversy. Social and financial costs of misdiagnosis and mismanagement [see comments]
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA.
SOURCE:
Arch Intern Med 1996 Jul 22;156(14):1493-500
COMMENT:
Comment in: Arch Intern Med 1997 Mar 24;157(6):697, 700
Comment in: Arch Intern Med 1997 Apr 14;157(7):817-8
"The financial cost of the overdiagnosis and overtreatment of Lyme disease includes expenses related to testing and therapy and those of side effects and toxic effects of these treatments."

€ TITLE:
Lyme disease overdiagnosis: causes and cure [editorial] [see comments]
AUTHORS:
Sigal LH
SOURCE:
Hosp Pract (Off Ed) 1996 May 15;31(5):13-5, 20, 26 passim
COMMENT:
Comment in: Hosp Pract (Off Ed) 1996 Aug 15;31(8):35, 40
"[No abstract available.]"

€ TITLE:
Anxiety and persistence of Lyme disease.
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
Division of Rheumatology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, USA.
SOURCE:
Am J Med 1995 Apr 24;98(4A):74S-78S
"Most symptoms persisting after adequate therapy can be explained by a small number of pathogenic mechanisms, only one of which is ongoing infection. Individualization of care and prudent analysis are crucial if overdiagnosis and overtreatment of Lyme disease are to be avoided."

€ TITLE:
Lyme disease in children.
AUTHORS:
Shapiro ED
AUTHOR AFFILIATION:
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
SOURCE:
Am J Med 1995 Apr 24;98(4A):69S-73S
"Misdiagnosis is the most common reason for treatment failure."

€ TITLE:
Management of Lyme disease refractory to antibiotic therapy.
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, USA.
SOURCE:
Rheum Dis Clin North Am 1995 Feb;21(1):217-30
"Lyme disease has become a major public health problem. One result of this anxiety is over-diagnosis and over-treatment in many endemic and near-to-endemic areas. The diagnosis of Lyme disease is often made solely on the basis of often misinterpreted serologic tests. Therefore, a major reason for inadequate response to antibiotic therapy is initial misdiagnosis."

€ TITLE:
The overdiagnosis of Lyme disease in children residing in an endemic area.
AUTHORS:
Rose CD; Fawcett PT; Gibney KM; Doughty RA
AUTHOR AFFILIATION:
Division of Rheumatology, Alfred I. duPont Institute, Wilmington, Delaware 19899.
SOURCE:
Clin Pediatr (Phila) 1994 Nov;33(11):663-8
"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. 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."

€ TITLE:
Tendency for overdiagnosis of neuroborreliosis [letter; comment]
AUTHORS:
D'Alessandro R; Rinaldi R; Azzimondi G; Schiavina M; Pazzaglia P
SOURCE:
Ital J Neurol Sci 1994 Oct;15(7):374
COMMENT: Comment on: Ital J Neurol Sci 1992 Apr;13(3):271-4
"[No abstract available.]"

€ TITLE:
Lyme disease in northwestern coastal California.
AUTHORS:
Ley C; Davila IH; Mayer NM; Murray RA; Rutherford GW; Reingold AL
AUTHOR AFFILIATION:
Epidemiology Program, School of Public Health, University of California, Berkeley 94720.
SOURCE:
West J Med 1994 Jun;160(6):534-9
"Many suspected cases of Lyme disease in this endemic area do not meet surveillance criteria, which are intentionally restrictive. Although some of the illnesses not meeting surveillance criteria may be due to infection with Borrelia burgdorferi, it appears that Lyme disease is being overdiagnosed in this area."

€ TITLE:
Lyme disease: a growing threat to urban populations.
AUTHORS:
Steere AC
AUTHOR AFFILIATION:
Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111.
SOURCE:
Proc Natl Acad Sci U S A 1994 Mar 29;91(7):2378-83
"A recent phenomenon is that a number of poorly understood conditions, such as chronic fatigue syndrome or fibromyalgia, are misdiagnosed as "chronic Lyme disease.""

€ TITLE:
The overdiagnosis of Lyme disease [letter; comment]
AUTHORS:
Burrascano JJ Jr
SOURCE:
JAMA 1993 Dec 8;270(22):2682; discussion 2683
COMMENT: Comment on: JAMA 1993 Apr 14;269(14):1812-6
"[No abstract available.]"

€ TITLE:
The overdiagnosis of Lyme disease [letter; comment]
AUTHORS:
Kramer M
SOURCE:
JAMA 1993 Dec 8;270(22):2683
COMMENT:
Comment on: JAMA 1993 Apr 14;269(14):1812-6
"[No abstract available.]"

€ TITLE:
The overdiagnosis of Lyme disease [letter; comment]
AUTHORS:
Cleveland CP
SOURCE:
JAMA 1993 Dec 8;270(22):2682-3
COMMENT:
Comment on: JAMA 1993 Apr 14;269(14):1812-6
"[No abstract available.]"

€ TITLE:
The overdiagnosis of Lyme disease [letter; comment]
AUTHORS:
Burke J
SOURCE:
JAMA 1993 Dec 8;270(22):2682; discussion 2683
COMMENT:
Comment on: JAMA 1993 Apr 14;269(14):1812-6
"[No abstract available.]"

€ TITLE:
The overdiagnosis of Lyme disease [see comments]
AUTHORS:
Steere AC; Taylor E; McHugh GL; Logigian EL
AUTHOR AFFILIATION:
Division of Rheumatology/Immunology, New England Medical Center, Boston, MA 02111.
SOURCE:
JAMA 1993 Apr 14;269(14):1812-6
COMMENT:
Comment in: JAMA 1993 Dec 8;270(22):2682; discussion 2683
Comment in: JAMA 1993 Dec 8;270(22):2682-3
Comment in: JAMA 1993 Dec 8;270(22):2683
"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. Prior to referral, 409 of the 788 patients had been treated with antibiotic therapy. In 322 (79%) of these patients, the reason for lack of response was incorrect diagnosis. CONCLUSIONS--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."

€ TITLE:
Current understanding of Lyme disease.
AUTHORS:
Steere AC
AUTHOR AFFILIATION:
Tufts University School of Medicine, Boston.
SOURCE:
Hosp Pract (Off Ed) 1993 Apr 15;28(4):37-44
"It is now the most common vector-borne disease in the United States. But because of misdiagnosis, the spread of this disease may also be more apparent than real."

€ TITLE:
Neurological manifestations of Lyme borreliosis [published erratum appears in Infection 1991 Sep-Oct;19(5):350]
AUTHORS:
Kristoferitsch W
AUTHOR AFFILIATION:
Neurologische Abteilung, Wilhelminenspital der Stadt Wien, Austria.
SOURCE:
Infection 1991 Jul-Aug;19(4):268-72
"While prior to the availability of serodiagnostic tests neurological manifestations of Lyme borreliosis frequently remained undiagnosed, we now face a tendency for overdiagnosis. The great variety of neurological manifestations in Lyme borreliosis--most of them can also be attributed to other conditions-- and the high rate of seropositivity for B. burgdorferi amongst the population living in endemic areas require strict criteria for the correct diagnosis of new and typical neurological manifestations."

€ TITLE:
Lyme disease. Difficulties in diagnosis and management [published erratum appears in Pediatr Clin North Am 1991 Oct;38(5):viii]
AUTHORS:
Ostrov BE; Athreya BH
AUTHOR AFFILIATION:
Department of Pediatrics, University of Pennsylvania, Philadelphia.
SOURCE:
Pediatr Clin North Am 1991 Jun;38(3):535-53
"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."

€ TITLE:
Neurological manifestations of Lyme borreliosis: clinical definition and differential diagnosis.
AUTHORS:
Kristoferitsch W
AUTHOR AFFILIATION:
Department of Neurology, Wilhelminen-Spital der Stadt Wien, Vienna, Austria.
SOURCE:
Scand J Infect Dis Suppl 1991;77:64-73
"Soon after B. burgdorferi was identified and serologic tests became available, many reports were published which attributed to a large variety of different neurological disorders to Lyme borreliosis. In many cases the diagnosis was primarily based on serodiagnostic results. Yet some scepticism is indicated since 10-30% of the population in endemic areas have been found to be seropositive. While prior to 1983 and before the availability of serodiagnostic tests neurological manifestations of Lyme borreliosis were recognized by a minority of neurologists, they now seem to be overdiagnosed."

Unspecified support of underdiagnosed/overdiagnosed Lyme disease

€ TITLE:
Misdiagnosis of Lyme disease: when not to order serologic tests.
AUTHORS:
Seltzer EG; Shapiro ED
AUTHOR AFFILIATION:
Department of Medicine, Yale University School of Medicine, New Haven, CT 06520-8064, USA.
SOURCE:
Pediatr Infect Dis J 1996 Sep;15(9):762-3
"[No abstract available.]"

€ TITLE:
[Lyme borreliosis: underdiagnosed?--overtreated?]
AUTHORS:
Peuckert W
AUTHOR AFFILIATION:
Universitats-Kinderklinik Freiburg.
SOURCE:
Monatsschr Kinderheilkd 1990 Apr;138(4):190-5
"[No pertinent statements found in abstract.]"

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For more information about Lyme disease, see: Lots Of Links On Lyme Disease

Comments or questions concerning this page should be directed to Art Doherty.

Last updated on 21 September 1999 by
Art Doherty
Lompoc, California
doherty@utech.net

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