Diagnosis Of Chronic Lyme Disease Research Articles

Somatic symptom disorder should be suspected in children with alleged chronic Lyme disease

We report a case series of seven children admitted to a tertiary level pediatric ward for long-lasting physical symptoms with a previous diagnosis of chronic Lyme disease. In these children, medical history and clinical features were strongly suggestive of a psychopathological disorder, mainly a somatic symptom disorder. What is Known: • There is an increasing number of diagnoses of chronic Lyme disease both in North America and in Europe. Adults receive this diagnosis to explain chronic physical complaints often with negative history and serology. What is New: • Somatic symptom disorder should be suspected in children and adolescents with non-specific symptoms diagnosed with chronic Lyme disease.

Chronic Lyme Disease: A Working Case Definition

Although Lyme disease is the most common tickborne illness in the USA and Eurasia, the pathophysiology and clinical course of chronic Lyme disease (CLD) have not been formally defined. The purpose of this paper is to present a working case definition of CLD based on analysis of more than 700 peer-reviewed publications. According to this definition, CLD is a multisystem illness with diverse musculoskeletal, neuropsychiatric and/or cardiovascular manifestations that result from ongoing infection with pathogenic members of the Borrelia spirochete complex often associated with other tickborne disease (TBD) pathogens. To qualify for the diagnosis of CLD, patients must have Lyme-compatible symptoms and signs that are either consistently or variably present for six or more months. Two subcategories of CLD include untreated chronic Lyme disease (CLD-U) and chronic Lyme disease following a limited course of antibiotic treatment (CLD-T). The symptom patterns and optimal therapy of CLD require further study.

Chronic Coinfections in Patients Diagnosed with Chronic Lyme Disease: A Systematic Review

PurposeOften, the controversial diagnosis of chronic Lyme disease is given to patients with prolonged, medically unexplained physical symptoms. Many such patients also are treated for chronic coinfections with Babesia, Anaplasma, or Bartonella in the absence of typical presentations, objective clinical findings, or laboratory confirmation of active infection. We have undertaken a systematic review of the literature to evaluate several aspects of this practice. MethodsFive systematic literature searches were performed using Boolean operators and the PubMed search engine. ResultsThe literature searches did not demonstrate convincing evidence of: 1) chronic anaplasmosis infection; 2) treatment-responsive symptomatic chronic babesiosis in immunocompetent persons in the absence of fever, laboratory abnormalities, and detectable parasitemia; 3) either geographically widespread or treatment-responsive symptomatic chronic infection with Babesia duncani in the absence of fever, laboratory abnormalities, and detectable parasitemia; 4) tick-borne transmission of Bartonella species; or 5) simultaneous Lyme disease and Bartonella infection. ConclusionsThe medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses.

Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study.

BackgroundChronic Lyme disease is a term that describes a constellation of persistent symptoms in patients with or without evidence of previous Borrelia burgdorferi infection. Patients labeled as having chronic Lyme disease have a substantial clinical burden. Little is known about chronic Lyme disease patient experiences in the healthcare system and their relationships with healthcare providers. The purpose of this study was to gather insights about the experiences of patients who carry a diagnosis of chronic Lyme disease in the United States healthcare system.MethodsQualitative, phenomenological study in 12 adult participants who identified themselves as having chronic Lyme disease. Semi-structured face-to-face in-depth interviews were conducted, 60–90 minutes in length, focusing on perceptions of disease burden and of their healthcare providers, using the dimensions of the Health Belief Model. Transcribed interviews were analyzed for emergent topics and themes in the categories of beliefs/understanding, personal history/narrative, consequences/limitations, management, and influences on care.ResultsEnrollment continued until theoretical saturation was obtained. Four major themes emerged from participants’ descriptions of their experiences and perceptions: 1) changes in health status and the social impact of chronic Lyme disease, 2) doubts about recovery and the future, 3) contrasting doctor-patient relationships, 4) and the use of unconventional therapies to treat chronic Lyme disease.ConclusionsParticipants reported a significant decline in health status associated with chronic Lyme disease and were often unsatisfied with care in conventional settings. Negative experiences were associated with reports of dismissive, patronizing, and condescending attitudes. Positive experiences were associated with providers who were reported to be attentive, optimistic, and supportive. Consultations with CAM practitioners and use of CAM therapies were common. Actively engaged and sympathetic clinical encounters may foster greater satisfaction in healthcare settings.

Lyme Borreliosis

Lyme Borreliosis

Chronic Lyme disease: the controversies and the science

The diagnosis of chronic Lyme disease has been embroiled in controversy for many years. This is exacerbated by the lack of a clinical or microbiologic definition, and the commonality of chronic symptoms in the general population. An accumulating body of evidence suggests that Lyme disease is the appropriate diagnosis for only a minority of patients in whom it is suspected. In prospective studies of Lyme disease, very few patients go on to have a chronic syndrome dominated by subjective complaints. There is no systematic evidence that Borrelia burgdorferi, the etiology of Lyme disease, can be identified in patients with chronic symptoms following treated Lyme disease. Multiple prospective trials have revealed that prolonged courses of antibiotics neither prevent nor alleviate such post-Lyme syndromes. Extended courses of intravenous antibiotics have resulted in severe adverse events, which in light of their lack of efficacy, make them contraindicated.

Proof That Chronic Lyme Disease Exists

The evidence continues to mount that Chronic Lyme Disease (CLD) exists and must be addressed by the medical community if solutions are to be found. Four National Institutes of Health (NIH) trials validated the existence and severity of CLD. Despite the evidence, there are physicians who continue to deny the existence and severity of CLD, which can hinder efforts to find a solution. Recognizing CLD could facilitate efforts to avoid diagnostic delays of two years and durations of illness of 4.7 to 9 years described in the NIH trials. The risk to society of emerging antibiotic-resistant organisms should be weighed against the societal risks associated with failing to treat an emerging population saddled with CLD. The mixed long-term outcome in children could also be examined. Once we accept the evidence that CLD exists, the medical community should be able to find solutions. Medical professionals should be encouraged to examine whether: (1) innovative treatments for early LD might prevent CLD, (2) early diagnosis of CLD might result in better treatment outcomes, and (3) more effective treatment regimens can be developed for CLD patients who have had prolonged illness and an associated poor quality of life.

A Critical Appraisal of “Chronic Lyme Disease”

“Chronic Lyme disease” is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme disease. Once this diagnosis is given, prolonged treatment with multiple antimicrobial agents may follow. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme disease.

A 58-Year-Old Man With a Diagnosis of Chronic Lyme Disease

DR BURNS: Mr C is a 58-year-old man diagnosed as having chronic Lyme disease. He lives in a suburb of Boston and works as a consultant. He has managed care insurance. Mr C had an episode of Bell’s palsy on the left side of his face in August 1992 and reported that he spent a lot of time on Martha’s Vineyard, an endemic area for Lyme disease. Subsequently, he noticed that he became less competent mentally. He could not do simple math and he became depressed. In 1994, he was diagnosed as having Lyme disease. At that time, he complained of neck pain radiating to his left shoulder and hand, with numbness and tingling in his hand; back pain that radiated down his left leg; bilateral joint aches in both elbows and, to a lesser extent, his shoulders; bilateral tinnitus; periodic blurred vision (worse in the right eye than the left); difficulty concentrating and word finding; and periodic sweats. Results of his physical examination were normal with the exception of having difficulty spelling “world” backward and subtracting 7 serially. In October 1994, his Lyme (IgM/IgG) antibody titer was positive at 1:4. He was treated with tetracycline, 500 mg 3 times daily for 1 year. Following the initial course of tetracycline, his symptoms improved. However, in July 1996, Mr C restarted tetracycline 500 mg 3 times daily, for complaints of generalized aches and pains, hot flashes, nausea, sweats, dizziness, and a general uneasy feeling. Since then, persistent symptoms have included fatigue, sweats, slight memory loss, generalized aches and pains, headache, facial flushing, numbness of his left thumb, altered sensation on the left side of his face, and weight gain. Mr C was treated with repeated courses of tetracycline as well as several courses of clarithromycin, 500 mg twice daily, combined with hydroxychloroquine, 200 mg twice daily. His last course of tetracycline was in early 1999, at which time a Lyme Western blot assay showed an IgM reaction to the 83-kd protein and IgG reactions to the 41and 62-kd proteins. In the fall of 1999, due to a change in his insurance, Mr C transferred to a new primary care physician, Dr N. His new physician was not convinced of the benefit of recurrent courses of antibiotics. In the fall of 2001, Mr C returned with multiple concerns including difficulty sleeping, forgetfulness, cognitive difficulties especially with calculations, decreased libido, anxious feelings, facial stiffness, puffy eyes, and cracking in his neck and shoulder. Mr C was concerned that some of his symptoms may be related to Lyme disease. At that time, physical examination findings were normal. Dr N thought that Mr C might have a mild depression and prescribed paroxetine, 10 mg/d, which was later increased to 20 mg/d. With this regimen, Mr C reported that he noticed less anxiety, less joint pain, and improved cognition. He also was sleeping better. His current medications include paroxetine, 20 mg/d, quinapril, 10 mg/d, and atorvastatin, 10 mg/d. Mr C has no known drug allergies. He exercises regularly and rarely drinks. He previously smoked about 1 pack per day but quit smoking about 7 years ago. Mr C has a past medical history of hypertension, hyperlipidemia, seborrheic dermatitis, and chronic Lyme disease. His father died of “natural causes” and his mother of ovarian cancer. He has one brother who recently underwent coronary artery bypass graft surgery.