Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic

Takaaki Kobayashi; Yvonne Higgins; Roger Samuels; Aurasch Moaven; Abanti Sanyal; Gayane Yenokyan; Paul M Lantos; Michael T Melia; Paul G Auwaerter

doi:10.1093/ofid/ofz299

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Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic

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Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic

Takaaki Kobayashi, Yvonne Higgins, Roger Samuels, Aurasch Moaven, Abanti Sanyal, Gayane Yenokyan, Paul M Lantos, Michael T Melia and Paul G Auwaerter

Open forum infectious diseases, Vol.6(7), ofz299

07/05/2019

DOI: 10.1093/ofid/ofz299

PMCID: PMC6663506

PMID: 31363774

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Abstract

Background Although Lyme disease is the most common vector-borne infection in the United States, diagnostic accuracy within community settings is not well characterized. Methods A retrospective observational cohort study of patients referred to an academic center with a presumed diagnosis or concern for Lyme disease between 2000 and 2013 was performed to analyze diagnoses and treatments. Characteristics of those with Lyme disease and those misdiagnosed as having Lyme disease were compared. Results Of 1261 patients, 911 (72.2%) did not have Lyme disease, 184 (14.6%) had active or recent Lyme disease, 150 (11.9%) had a remote history of Lyme disease, and 16 (1.3%) were identified as having possible Lyme disease. Patients without current Lyme disease were more likely to be female (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.08–2.45), to have had symptoms for >3 months (OR, 8.78; 95% CI, 5.87–13.1), to have higher symptom counts (OR per additional symptom, 1.08; 95% CI, 1.02–1.13), to have had more Lyme-related laboratory testing (OR per additional laboratory test, 1.17; 95% CI, 1.03–1.32), and to have been diagnosed with what were regarded as coinfections (OR, 3.13; 95% CI, 1.14–8.57). Of the 911 patients without Lyme disease, 764 (83.9%) had received antimicrobials to treat Lyme disease or their coinfections. The percentage of patients established to have Lyme disease was lower than in earlier studies of referred populations. Conclusions Among patients referred to an academic Infectious Diseases practice for Lyme disease, incorrect diagnoses and unnecessary antibiotic treatment were common, both for Lyme disease and for coinfections.

Lyme Disease

Borrelia burgdorferi

chronic Lyme disease

Editor's Choice

Major

tick-borne coinfections

Details

Title: Subtitle: Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic
Creators: Takaaki Kobayashi - University of Iowa
Yvonne Higgins - Johns Hopkins Medicine
Roger Samuels - Johns Hopkins Medicine
Aurasch Moaven - University of Maryland, Baltimore
Abanti Sanyal - Johns Hopkins University
Gayane Yenokyan - Johns Hopkins University
Paul M Lantos - Duke University
Michael T Melia - Johns Hopkins Medicine
Paul G Auwaerter - Johns Hopkins Medicine
Resource Type: Journal article
Publication Details: Open forum infectious diseases, Vol.6(7), ofz299
DOI: 10.1093/ofid/ofz299
PMID: 31363774
PMCID: PMC6663506
NLM abbreviation: Open Forum Infect Dis
ISSN: 2328-8957
eISSN: 2328-8957
Publisher: Oxford University Press
Grant note: ;
Language: English
Date published: 07/05/2019
Academic Unit: Infectious Diseases; Internal Medicine
Record Identifier: 9984359875002771

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