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

Abstract

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, Martinsried, 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.

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  • Authors+Show Affiliations

    ,

    Medical University Policlinic, Rheumatology Unit Wilhelmstr, Bonn, Germany. Matthias.Seidel@ukb.uni-bonn.de

    ,

    Source

    MeSH

    Adult
    Age Factors
    Aged
    Animals
    Anti-Bacterial Agents
    Antibodies, Bacterial
    Arthritis, Rheumatoid
    Blotting, Western
    Borrelia
    Diagnosis, Differential
    Enzyme-Linked Immunosorbent Assay
    Female
    HLA-B27 Antigen
    Humans
    Lyme Disease
    Male
    Middle Aged
    Radiography
    Retrospective Studies
    Spinal Diseases
    Spine

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    17605053

    Citation

    TY - JOUR T1 - Differential diagnoses of suspected Lyme borreliosis or post-Lyme-disease syndrome. AU - Seidel,M F, AU - Domene,A Belda, AU - Vetter,H, PY - 2007/7/3/pubmed PY - 2007/10/12/medline PY - 2007/7/3/entrez SP - 611 EP - 7 JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur. J. Clin. Microbiol. Infect. Dis. VL - 26 IS - 9 N2 - 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, Martinsried, 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. SN - 0934-9723 UR - https://www.unboundmedicine.com/medline/citation/17605053/abstract/Differential_diagnoses_of_suspected_Lyme_borreliosis_ L2 - https://dx.doi.org/10.1007/s10096-007-0342-0 ER -