RESEARCH - Differential diagnoses of suspected Lyme borreliosis or post-Lyme-disease syndrome

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Eur J Clin Microbiol Infect Dis. 2007 Sep;26(9):611-7.

Differential diagnoses of suspected Lyme borreliosis or

post-Lyme-disease syndrome.

Seidel MF, Domene AB, Vetter H.

Medical University Policlinic, Rheumatology Unit Wilhelmstr, Bonn,

Germany. Matthias.

The symptoms of Lyme borreliosis are similar to those of a variety of

autoimmune musculoskeletal diseases. Persistence of complaints is

frequently interpreted as unsuccessful antibiotic treatment of

Borrelia-associated infections. However, such refractory cases are

rare, and re-evaluation of differential diagnoses helps to avoid the

substantial risk of long-term antibiotic therapy. In this study, we

analyzed patients who presented to our rheumatology unit with previous

suspected or diagnosed Lyme borreliosis. Eighty-six patients from a

3.5-year period were evaluated. The mean age of patients was 49.2 +/-

17.2 years; 60% (n = 52) reported a tick bite and 33% (n = 28) an

erythema. Forty-seven percent (n = 39) had positive enzyme-linked

immunoassay results and Western blots (Mikrogen, sried,

Germany). All but 12 patients had already received antibiotic

treatment previously. Nine percent (n = 8) had ongoing or recent Lyme

borreliosis. Twenty-nine percent (n = 25) showed clinical symptoms and

radiographic changes compatible with degenerative disorders of the

cervical and/or lumbar spine. These patients were significantly older

when compared to the other patients (59.3 +/- 13.7 years vs 46.1 +/-

17.2 years, p = 0.001). Seventeen percent (n = 16) had arthropathies

related to psoriasis or rheumatoid arthritis. Twelve percent (n = 10)

were positive for the HLA B27 antigen. Other diseases were less

frequent. Six patients (7%) could not be diagnosed conclusively, and

four of these patients had negative Borrelia immunoassay results. In

conclusion, Borrelia-associated diseases were rare in this study.

Differential diagnoses helped to initiate a successful

disease-specific therapeutic strategy.

PMID: 17605053

http://www.ncbi.nlm.nih.gov/pubmed/17605053

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