An article published on August 2, 2018 in JAMA entitled Lyme Disease in 2018 provides important information regarding Lyme disease in the United States, including: “There has been considerable publicity about substantial increases in the incidence of Lyme disease; however, even though the incidence of Lyme disease has increased from 2007 to 2016, there has not been a statistically significant increase in the number of reported cases of Lyme disease in the United States during the most recent 4 years (2013-2016) for which data are available.”
“In 2016, a total of 26,203 confirmed cases of Lyme disease were reported in the United States (incidence = 8.1 cases/100 000 population), although an estimate suggests that approximately 300,000 cases occur annually. The geographic distribution of Lyme disease (although still limited primarily to New England, the Middle Atlantic states, and Wisconsin and neighboring states) has increased, with evidence of spread to new areas, generally in locations that are adjacent to recognized endemic areas.”
Lyme Disease Infections
The article states: “Lyme disease is caused by infection with Lyme Borrelia, which include Borrelia burgdorferi, Borrelia garinii, and others, and are transmitted to humans through the bite of infected Ixodes ticks; in the United States, primarily by Ixodes scapularis—the deer tick. The vast majority of patients with Lyme disease (≥90%) develop the characteristic skin lesion, erythema migrans. Extracutaneous manifestations may include facial nerve palsy, lymphocytic meningitis, radiculopathy, heart block from myopericarditis, and pauciarticular large joint arthritis.”
The Difference Between Lyme Disease And Borrelia Miyamotoi Infection
The authors state: “Borrelia miyamotoi, a member of the relapsing fever group of Borrelia first reported to cause human disease in the United States in 2013, is transmitted by the same tick species that transmit Lyme disease. Patients infected with B miyamotoi may be misdiagnosed as having Lyme disease because this infection may cause positive results with enzyme-linked immunosorbent assays (ELISAs) used to diagnose Lyme disease. B miyamotoi is geographically widespread, and in a survey of nymphal Ixodes scapularis ticks in 11 Lyme disease–endemic US states, 2% and 20% were infected with B miyamotoi or with B burgdorferi, respectively. No diagnostic tests for B miyamotoi infection have been approved by the US Food and Drug Administration.”
“Unlike with Lyme disease, patients infected with B miyamotoi in the United States typically do not have a rash, but instead present with fever in conjunction with headache (96%), myalgia (84%), arthralgia (76%), and malaise/fatigue (82%) … Fever may be relapsing in untreated patients. Severely immunocompromised patients may develop chronic meningitis … Both doxycycline and amoxicillin appear to be effective for treatment of immunocompetent patients with this infection.”
Diagnosing Lyme Disease
The article states with regard to Lyme disease diagnosis: “because the skin lesion usually is clinically identifiable based on its appearance, serology is neither recommended nor needed to make the diagnosis of erythema migrans in Lyme disease–endemic areas. It is important to emphasize the need for a complete examination of the skin in any patient with possible early Lyme disease; erythema migrans lesions often are not noticed by patients when lesions occur on areas not easily seen, such as the popliteal fossa or the back. For extracutaneous manifestations of Lyme disease, the sensitivity of antibody tests is excellent (87%-100%), although some patients with early neurologic manifestations will need a repeat test in 1 to 2 weeks for a result to become positive. Virtually all patients with Lyme arthritis (a late manifestation of Lyme disease) will have a positive immunoglobulin G (IgG) antibody test result at the time of presentation.”
The article warns: “The use of serologic tests for Lyme disease for screening patients with a low probability of having Lyme disease results in a large number of false-positive results. Among a nationally representative sample of approximately 77,000 noninstitutionalized adults interviewed in the United States in 2010, 10% of men and 15% of women were either exhausted or very tired either every day or most days in the previous 3 months. Likewise, 17% of the men and 21% of the women often had pain in the previous 3 months. Clearly, Lyme disease is responsible for, at most, a tiny fraction of the many millions of individuals with chronic fatigue, chronic pain, or both.”
With regard to Lyme disease treatment, the article states: “amoxicillin and cefuroxime axetil are as effective as doxycycline to treat erythema migrans, and data do not support that use of doxycycline should be preferred over other antibiotics to reduce the likelihood that patients with erythema migrans will develop a neurologic manifestation of Lyme disease, which occurs infrequently in treated patients, whichever antibiotic is used.”
If you or a loved one suffered harm as a result of the misdiagnosis of Lyme disease in the United States, you should promptly find a Lyme disease lawyer who may investigate your Lyme disease claim for you and represent you in a Lyme disease malpractice case, if appropriate.
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