Misdiagnosis of Early Lyme Disease

by lmatthews on July 9, 2012

misdiagnosing lyme disease doctor surprised

Would a Lyme disease diagnosis be a surprise for your doctor?

Lyme disease season is well and truly here with peak Lyme-time May to September in the US. Unfortunately, however, Lyme disease is still believed to be a rare problem by many physicians which can lead to them misdiagnosing Lyme disease as the summer flu, or even as polymyalgia rheumatica, particularly in older patients.

Early symptoms of Lyme disease can, indeed, resemble the flu as well as being mistaken for summer allergies or fatigue from outdoor activities. Sneaky ticks often bite in hard to see places and the Lyme disease rash that is a clear sign of infection is not always present, prompting self-diagnosis and delays to treatment. Lyme disease can masquerade as a non-specific viral-like illness and, as its peak season coincides with cases of West Nile virus and early cases of influenza, it is easy to see why physicians unfamiliar with Lyme disease can be confused (Aucott and Seifter, 2011).

Missing Lyme Disease Diagnosis

Patients who present with a viral-like illness in the summer are not usually checked thoroughly for skin rashes or asked about any skin lesions or rashes that could help pinpoint Lyme disease as the culprit. Instead, many patients are given basic advice to manage suspected summer flu and sent home only to return later with persistent symptoms and possible tissue damage due to the spread of borreliosis or another pathogen.

Too Busy to Diagnose Lyme Disease

The pressure many physicians are under to see huge numbers of patients every day means that they often don’t feel they have time, or simply forget, to ask about a patient’s exposure to tick-infested areas. Patients may note that their symptoms arose after a camping trip, a day-hike, or a forest walk with their dog but an inexperienced physician could simply take this as evidence of the symptoms being related to over-exertion rather than a potential tick-bite. Patients may mention that their dog is also out-of-sorts, which could, for an experienced physician, help narrow down the diagnosis and prompt tests for both their patient and the animal suffering canine Lyme disease symptoms.

Lyme Disease – Be Your Own Advocate

Although less than ideal, it is wise for patients to become their own advocates for Lyme disease recognition. As with most professionals, no doctor wants their patients to insist on a specific diagnosis when the evidence is contradictory. However, many doctors are still learning about Lyme disease and its numerous ways of manifesting, so mentioning the possibility could help lead you to a diagnosis, or at least help you and your physician rule this out during the course of your consultation. If you don’t feel your concerns are being taken seriously then consider getting a second opinion, this is no time to suffer for the sake of embarrassment.


Elderly Lyme DIsease Patients at Risk

Elderly patients are, perhaps, less likely to have symptoms of Lyme disease misdiagnosed as fatigue or joint pain from an active hiking or camping trip. However, aches and pains from osteoarthritis, depression and cognitive deficits related to lack of social contact and ageing, and even heart problems are more likely to be diagnosed than symptoms of Lyme arthritis, neuroborreliosis, or Lyme carditis. Patients with the types of non-specific signs and symptoms seen in polymyalgia rheumatica should also have their symptoms considered as potential signs of Lyme disease, according to Paparone (1995). Both conditions can result in marked elevations in erythrocyte sedimentation rate (ESR), commonly over 100mm/hr in polymyalgia rheumatica and over 85mm/hr in Lyme disease infection. Patients can, of course, have both conditions simultaneously, adding extra confusion.

Dangerous Lyme Disease Treatment

In order to confirm the diagnosis of polymyalgia rheumatica it is necessary to closely monitor response to treatment, especially as inappropriate use of corticosteroids can have a deleterious effect on patients with a Lyme disease infection. Testing for Lyme disease in tick-infested areas is wise during the summer months, especially if these elderly patients are fond of gardening or spend lots of time outside, with grandchildren perhaps. Elderly patients may be more at risk of summer flu but this should not cause a physician to disregard the possibility of Lyme disease infection.

Monitoring Symptoms of Early Lyme Disease

Applying no treatment or inappropriate and dangerous treatment for early Lyme disease mistaken for the summer flu or polymyalgia rheumatica can have serious effects on a patient’s recovery. Watch out for ticks, watch for rashes, and note down any symptoms, large or small, so as to help prevent your physician from misdiagnosing Lyme disease.

References

Aucott JN, Seifter A., Misdiagnosis of early Lyme disease as the summer flu. Orthop Rev (Pavia). 2011;3(2):e14. Epub 2011 Jun 29.

Paparone PW., Polymyalgia rheumatica or Lyme disease? How to avoid misdiagnosis in older patients. Postgrad Med. 1995 Jan;97(1):161-4, 167-70.

Leave a Comment

Previous post:

Next post: