Confusion over Lyme disease diagnosis can result in inappropriate treatment
It appears that many still receive treatment for Lyme disease when comprehensive laboratory tests reveal no objective evidence of infection, or with post-Lyme-disease syndrome when symptoms persist despite objective confirmation that a documented infection has been eradicated. An excellent paper published in the European Journal of Clinical Microbiology & Infectious Diseases offers data showing that the causes of persistent symptoms, often autoimmune, are then missed while patients may be subject to ineffectual and harmful long-term antibiotic treatment. The authors state:
"The symptoms of Lyme borreliosis are similar to those of a variety of autoimmune musculoskeletal diseases. Persistence of complaints is frequently interpreted as unsuccessful antibiotic treatment of Borrelia-associated infections. However, such refractory cases are rare, and re-evaluation of differential diagnoses helps to avoid the substantial risk of long-term antibiotic therapy...Post-Lyme-disease syndrome (PLDS) is characterized by symptoms such as fatigue, myalgia, arthralgia, or dysesthesia/paresthesia. This condition of subjective complaints is defined by a Borrelia associated infection adequately treated with antibiotics while objective findings of other diseases are absent."
They further note that:
"Persistence of borreliae after antibiotic treatment is frequently suspected in PLDS . Long-term antibiotic regimens are targeted to eliminate spirochetes that might survive in areas less accessible to the immune system. However, evidence of a beneficial effect of such long-term treatment is limited to only a few open studies. On the other hand, several double-blinded controlled trials of patients with Lyme disease or PLDS have shown no benefit after repetitive antibiotic treatment. Moreover, case reports indicate severe complications arising from continuous antibiotic therapy. Autoimmune phenomena have been suspected to occur after successful antibiotic treatment."
They undertook thorough laboratory and clinical evaluations of 86 patients over a 3.5 year period who were diagnosed with Lyme borreliosis or PLDS, taking great care to discriminate suspected Lyme borreliosis or PLDS from other diseases. such as reactive arthritis,psoriasis arthritis (PsA), or rheumatoid arthritis (RA, Bannwarth’s syndrome other polyneuropathies or radicular compression syndromes, and fibromyalgia. Their data demonstrated Lyme disease in only 9%, and no cases of PLDS (persistent infection after antibiotic therapy) were observed. The authors concluded:
"In summary, the findings of Borrelia assays were frequently inconsistent, and several patients who were treated with antibiotics prior to referral to our institute lacked Borrelia-specific antibodies. Patients with Lyme borreliosis were rare in this study, and no cases of PLDS were observed. Degeneration of the vertebral spine was the most frequent differential diagnosis. Although a definite diagnosis could not always be made, the presence of autoimmune antibodies suggested a pathogenesis separate from borreliosis. The results of this study may help to avoid unnecessary long-term antibiotic therapy and the potentially severe complications resulting from such treatment."
It is very important for clinicians and patients to be attentive to the increasingly widespread phenomenon of acute infections acting as a trigger for autoimmune symptoms that persist long after the original infection is gone.