For most patients who develop Lyme disease, oral antibiotics will successfully treat the symptoms. Some patients receiving the infection caused by the bacterium Borrelia burgdorferi report persistent symptoms such as fatigue, pain, and joint and muscle pain long after the end of antibiotics. Sometimes referred to as “chronic” Lyme disease (CLD), which Centers for Disease Control and prevention (CDC) refers to the condition as post-treatment Lyme disease symptoms (PTLDS) or post-Lyme disease syndrome (PLDS).
The cause of PTLDS is not only unknown, but the term “chronic” Lyme disease is embroiled in controversy. The National Institute of Allergies and Infectious Diseases reported that CLD “was used to describe people with various diseases. While the term is sometimes used to describe disease in patients with Lyme disease, it has also been used to describe symptoms in people who have no clinical or diagnostic evidence of a current or past infection with B. burgdorferi.”
A 2015 report, which was Infectious Disease Clinics of North America points out that “chronic” Lyme disease “has no clinical definition and is not characterized by objective clinical findings.” In 7 studies conducted in areas where Lyme disease is common, 50% to 88% of 1902 patients referred for suspected infection had no evidence ever infected with the disease.
“Most of these patients had either alternative medical diagnoses or medically unexplained symptoms such as chronic fatigue syndrome or fibromyalgia,” he said. to study States. “In many cases, Lyme disease has simply been diagnosed for the lack of an alternative diagnosis – 1 paper as “diagnosis of Lyme disease by exclusion.””
If it is possible that more than half of the patients suspected of having PTLDS were never exposed, then the question arises as to how doctors evaluate patients who report symptoms of the disease? The medical director of Quest Diagnostics for Infectious Diseases, Robert S. Jones, DO, MS, FACP FIDSA helps answer this question. He offered the following recommendations to physicians treating PTLDS patients.
Start from scratch
“PTLDS can be a frustrating disease,” Dr Jones said. “The first thing I do is keep an open mind when patients come to me.”
He mentioned the many factors that need to be taken into account when assessing patients. These include the patient’s medical history, length of symptoms, type of symptoms where they suspect they contract Lyme disease, and the possibility of other tick-borne diseases.
Symptoms of Lyme disease may vary depending on the length of time the patient has been infected. While one of the most commonly known symptoms is a rash, Dr. Jones recommends that doctors consider the patient’s medical history.
A 2010 Clinics in laboratory medicine Article went into detail on the possibility that symptoms may be related to other conditions and reiterated the need to consider all possibilities. “Diagnosis of Lyme disease, especially in the absence of the characteristic rash, can be difficult as the other clinical manifestations of Lyme disease are not specific. Diagnosis of erythema migrans can also be difficult at times, as the rash can initially be confused with nummulary eczema, granuloma annulare, an insect bite, ringworm or cellulitis.”
Symptoms associated with PTLDS can be even more difficult to attribute. In the Lantos Articles Earlier, more than half of patients who lacked evidence of Lyme disease “had alternative medical diagnoses or medically unexplained symptoms, such as chronic fatigue or fibromyalgia.”
Duration of symptoms
Another critical factor in diagnosing PTLDS is the study of the duration of a patient’s symptoms. The medical community is aware that some patients experience longer symptoms while being treated for Lyme disease. These symptoms can lead to a “partial set of significant functional impairments,” including joint and muscle pain, headache, fatigue, neck and back pain, irritability and difficulty with memory and concentration.
The International Lyme and Associated Diseases Society recommends the following timeline in its proposed definition of post-Lyme disease syndromes:
Beginning of one of the following subjective symptoms within 6 months of diagnosis of Lyme disease and persistence of continuous or relapsing symptoms for at least a period of 6 months after completion of antibiotic therapy:
- Widespread musculoskeletal pain
- Complaints about cognitive difficulties
They add that the symptoms must be so severe that they have a significant impact on a patient’s work, education, social and personal activities.
Place of suspected exposure
Where a person lives and travels is another consideration in diagnosing PTLDS. While Lyme disease is a recognised public health problem, most to fell in the Northeast, Mid-Atlantic, and Northern United States.
“It’s important to remember that there are different tick species in the United States,” Dr Jones said. Deer ticks, or black-legged ticks, are found in the eastern United States and are the ones that can transmit the bacteria that cause Lyme disease.
Other tick-borne diseases
As Dr Jones pointed out, the location of the suspected infection plays a role. This information can help physicians eliminate or take into account other tick-borne diseases.
“Different ticks carry different diseases,” Jones said. “Sometimes a single tick can carry more than one disease.”
The Cdc reported that Lyme disease is the most commonly reported tick-borne disease. Others include babesiosis, ehrlichiosis, Rocky Mountain spotted fever, anaplasmosis, southern tick-associated rash disease, tick-borne thrust fever, and tularemia.
Take the next step
PTLDS or “chronic” Lyme disease diagnosis involves a lengthy process of elimination. In addition to understanding a patient’s history, one of the first steps to make a diagnosis and start treatment is to perform the right tests. For more information on getting started, see click here.