AJM onlineReviewCommon Misconceptions About Lyme Disease
Section snippets
Diagnosis: Are Serologic Tests for Lyme Disease Reliable?
Underlying the assertion of the purported unreliability of serologic testing are observations that some patients with Lyme disease do indeed have negative serologic tests. However, in large part these observations merely reflect the normal evolution of the antibody response. In all infections in which there is a humoral antibody response, there is a lag between the onset of infection and the time at which detectable levels of serum antibodies are first demonstrable. Consequently, many patients
Does Antibiotic Therapy Affect Seropositivity for Lyme Disease During Treatment?
An often-voiced concern is that positive serologic tests for B. burgdorferi may become transiently negative during—and because of—antibiotic therapy. There is no precedent in the scientific literature—with respect to Lyme disease or any other identified infection—of noncurative antibiotic treatment transiently suppressing an already-existing antibody response, nor is there a plausible biologic explanation of why this might occur. In patients receiving early, effective treatment for
Is Persistent Seropositivity Following Treatment Significant?
Strongly IgG or immunoglobulin M (IgM) seropositive patients may remain seropositive—and even cerebrospinal fluid-positive—for decades12, 13 despite resolution of the clinical manifestation of Lyme disease for which they were treated. When serially collected serum samples are tested in parallel, a gradual decline in antibody levels is usually observed in treated seropositive patients.7 Conversely, patients with ongoing infection can develop increasing antibody levels with increasing numbers of
Is Isolated IgM Seropositivity Significant in Longstanding Infection?
Currently recommended 2-tier serologic testing for Lyme disease includes testing all first-tier (usually ELISA) reactive patients by separate IgM and IgG immunoblots.16 The IgM immunoblot should be used only for the diagnosis of early infection. In infections, the host immune system initially produces IgM antibodies; IgG antibodies are usually demonstrable by about 4 weeks after onset of B. burgdorferi infection. False-positive IgM immunoblots are common in clinical practice17 and appear to
Should Lyme Disease be Primarily a “Clinical Diagnosis”?
Before the development of reliable laboratory testing, diagnosis of what is now known to be B. burgdorferi infection was based on clinical phenomenology. The development of reliable laboratory testing now provides a far more accurate means of diagnosis in all but a small number of well-defined circumstances—accuracy that can be described quantitatively in terms of those tests' positive predictive value18 (defined as the probability that a patient who has a positive test result truly has Lyme
Is Persistent Fatigue and Perceived Memory and Cognitive Difficulty Evidence of Brain Infection Due to B. Burgdorferi?
An estimated 10%-15% of patients with B. burgdorferi infection develop central nervous system involvement.26 This most often consists of meningitis; rarely, there are clinically evident focal findings. As with all central nervous system infections, there is almost always supporting laboratory evidence (ie, imaging or cerebrospinal fluid abnormalities) of both the infection and nervous system involvement.27
Some patients with Lyme disease—who have other signs and symptoms of active
Lyme Disease—Can it be Lethal?
A few case reports suggest that Lyme carditis might have contributed to a patient's death.31, 32, 33 This question was formally examined as part of a review of 1999-2003 US death certificate data.34 Lyme disease was a listed diagnosis on 119 of the reviewed death certificates. Among these, only one patient had symptoms consistent with Lyme disease. If this one patient actually died because of Lyme disease, a comparison to the reported Lyme disease incidence data during the same period would
Is There a Rationale for Longer Treatment Courses?
Numerous studies have now shown that Lyme disease can be effectively treated with fairly short courses of recommended antibiotics.5 Controlled treatment trials have repeatedly demonstrated that more prolonged antibiotic treatment results in no lasting benefit,5, 35, 36, 37 but significantly increases risk. The treatment durations recommended for Lyme disease are consistent with those for syphilis and most other bacterial infections.38
The argument for extended antibiotic therapy arises from 3
Does Symptomatic Improvement While on Antibiotic Therapy Confirm the Diagnosis of Lyme Disease?
When patients rapidly feel better while taking antibiotics, they often assume that this proves that they did indeed have B. burgdorferi infection, regardless of whether or not the initial evidence of Lyme disease was compelling. However, at least 3 other factors may contribute to such symptomatic improvement. First, other infections, if present, can respond to the same antimicrobials. Second, in blinded, placebo-controlled trials of patients with persisting symptoms, improvement occurred in up
Conclusion
Lyme disease has been the source of considerable controversy, with the debate spilling over into political and other arenas. It is regrettable that this has detracted from a reasoned approach to the scientific evidence. The latter has advanced sufficiently over the past 2 decades that diagnosis and treatment of this infection are now generally quite straightforward. Legitimate biologic questions remain to be studied, with answers that may well be relevant in the study of other disorders.
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Cited by (55)
Nervous System Lyme Disease–Facts and Fallacies
2022, Infectious Disease Clinics of North AmericaCitation Excerpt :“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity…” These famous opening words of Dickens’ A Tale of Two Cities aptly describe much of what is said today about Lyme disease and its effects on the nervous system. Numerous factors contribute to this1,2; probably the single most important is that patients, the public in general and even many physicians struggle with the concept of what does–and does not–constitute nervous system disease. While nervous system function is essential for all behavior, many things affect behavior in the absence of damage to the nervous system–the defining requirement of neurologic disorders.
Borrelia burgdorferi sensu lato infection in patients with peripheral facial palsy
2019, Ticks and Tick-borne DiseasesCitation Excerpt :Considerable debate has focused on the need for CSF examination in patients with suspected Lyme neuroborreliosis, particularly in those with PFP (Halperin, 2008). In Europe, positive CSF results are required for a diagnosis of Lyme neuroborreliosis (Mygland et al., 2010; Stanek et al., 2011), but in the USA diagnostic lumbar puncture is not always required (Halperin et al., 2013; Kowalski et al., 2011). As expected from the findings of earlier studies (Bremell and Hagberg, 2011; Lotrič-Furlan et al., 1999), CSF pleocytosis in the present study was significantly more frequent in patients with confirmed LB (62%) than in patients with PFP of unknown etiology (9.5%) or possible LB (5.8%); CSF protein levels and CSF/serum albumin quotients were also higher in confirmed LB.
Should Patients Infected with Borrelia burgdorferi No Longer Be Referred to as Having Lyme Disease?
2019, American Journal of MedicineBorreliosis in Sport Horse Practice
2018, Veterinary Clinics of North America - Equine PracticeStraight Talk About Chronic Lyme Disease
2018, American Journal of MedicinePediatric stroke related to Lyme neuroborreliosis: Data from the Swiss NeuroPaediatric Stroke Registry and literature review
2018, European Journal of Paediatric Neurology
Funding: Dr Halperin receives funding from the Centers for Disease Control and Prevention (CDC); Dr Wormer has received research grants from CDC, the National Institutes of Health, Immunetics, Inc., BioRad, DiaSorin, Inc., and BioMerieux.
Conflict of Interest: Dr Halperin served as expert witness in medical malpractice cases defending physicians accused of failure to diagnose Lyme disease; he has no other conflicts. Dr Wormser: Equity in Abbott; expert witness in malpractice cases involving Lyme disease; unpaid board member American Lyme Disease Foundation; expert witness on Lyme disease in a disciplinary action for the Missouri Board of Registration for the Healing Arts; consultant to Baxter for Lyme vaccine development.
Authorship: All authors participated in the conceptualization and writing of this manuscript.