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

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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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References

  1. Wormser GP, Nadelman RB, Dattwyler RJ, Dennis DT, Shapiro ED, Steere AC et al (2000) Practice guidelines for the treatment of Lyme disease. Clin Infect Dis 31(Suppl 1):1–14

    Article  PubMed  Google Scholar 

  2. Oksi J, Nikoskelainen J, Viljanen MK (1998) Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis. Eur J Clin Microbiol Infect Dis 17:715–719

    Article  PubMed  CAS  Google Scholar 

  3. Klempner MS, Hu LT, Evans J, Schmid CH, Johnson GM, Trevino RP et al (2001) Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 345:85–92

    Article  PubMed  CAS  Google Scholar 

  4. Hunfeld KP, Ruzic-Sabljic E, Norris DE, Kraiczy P, Strle F (2005) In vitro susceptibility testing of Borrelia burgdorferi sensu lato isolates cultured from patients with erythema migrans before and after antimicrobial chemotherapy. Antimicrob Agents Chemother 49:1294–1301

    Article  PubMed  CAS  Google Scholar 

  5. Priem S, Burmester GR, Kamradt T, Wolbart K, Rittig MG, Krause A (1998) Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane, but not in synovial fluid from patients with persisting Lyme arthritis after antibiotic therapy. Ann Rheum Dis 57:118–121

    Article  PubMed  CAS  Google Scholar 

  6. Hassler D, Zoller L, Haude M, Hufnagel HD, Heinrich F, Sonntag HG (1990) Cefotaxime versus penicillin in the late stage of Lyme disease—prospective, randomized therapeutic study. Infection 18:16–20

    Article  PubMed  CAS  Google Scholar 

  7. Hassler D, Schnauffer M, Ehrfeld H, Muller E (2004) Disappearance of specific immune response after successful therapy of chronic Lyme borreliosis. Int J Med Microbiol 293(Suppl 37):161–164

    PubMed  Google Scholar 

  8. Krupp LB, Hyman LG, Grimson R, Coyle PK, Melville P, Ahnn S et al (2003) Study and treatment of post Lyme disease (STOP-LD): a randomized double-masked clinical trial. Neurology 60:1923–1930

    PubMed  CAS  Google Scholar 

  9. Wormser GP, Ramanathan R, Nowakowski J, McKenna D, Holmgren D, Visintainer P et al (2003) Duration of antibiotic therapy for early Lyme disease. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 138:697–704

    PubMed  CAS  Google Scholar 

  10. Patel R, Grogg KL, Edwards WD, Wright AJ, Schwenk NM (2000) Death from inappropriate therapy for Lyme disease. Clin Infect Dis 31:1107–1109

    Article  PubMed  CAS  Google Scholar 

  11. Bolz DD, Weis JJ (2004) Molecular mimicry to Borrelia burgdorferi: pathway to autoimmunity?. Autoimmunity 37:387–392

    Article  PubMed  CAS  Google Scholar 

  12. Gross DM, Forsthuber T, Tary-Lehmann M, Etling C, Ito K, Nagy ZA et al (1998) Identification of LFA-1 as a candidate autoantigen in treatment-resistant Lyme arthritis. Science 281:703–706

    Article  PubMed  CAS  Google Scholar 

  13. Kalish RS, Wood JA, Golde W, Bernard R, Davis LE, Grimson RC et al (2003) Human T lymphocyte response to Borrelia burgdorferi infection: no correlation between human leukocyte function antigen type 1 peptide response and clinical status. J Infect Dis 187:102–108

    Article  PubMed  CAS  Google Scholar 

  14. Wilske B, Zöller L, Brad V, Eiffert H, Göbel UB, Stanek G, in cooperation with Pfister H-W (2000) Lyme borreliose MIQ 12. http://pollux.mpk.med.uni-muenchen.de/alpha1/nrz-borrelia/miq-lyme/frame-miq-interpretation.html

  15. Wormser GP, Aguero-Rosenfeld ME, Nadelman RB (1999) Lyme disease serology problems and opportunities. JAMA 282:79–80

    Article  PubMed  CAS  Google Scholar 

  16. Kalish RA, McHugh G, Granquist J, Shea B, Ruthazer R, Steere AC (2001) Persistence of immunoglobulin M or immunoglobulin G antibody responses to Borrelia burgdorferi 10 to 20 years after active Lyme disease. Clin Infect Dis 33:780–785

    Article  PubMed  CAS  Google Scholar 

  17. Werner M, Nordin P, Arnholm B, Elgefors B, Krantz I (2001) Borrelia burgdorferi antibodies in outdoor and indoor workers in south-west Sweden. Scand J Infect Dis 33:128–131

    Article  PubMed  CAS  Google Scholar 

  18. Qureshi MZ, New D, Zulqarni NJ, Nachman S (2002) Overdiagnosis and overtreatment of Lyme disease in children. Pediatr Infect Dis J 21:12–14

    Article  PubMed  Google Scholar 

  19. Svenungsson B, Lindh G (1997) Lyme borreliosis—an overdiagnosed disease? Infection 25:140–143

    Article  PubMed  CAS  Google Scholar 

  20. Rose CD, Fawcett PT, Gibney KM, Doughty RA (1994) The overdiagnosis of Lyme disease in children residing in an endemic area. Clin Pediatr (Phila) 33:663–668

    Article  CAS  Google Scholar 

  21. Hsu VM, Patella SJ, Sigal LH (1993) “Chronic Lyme disease” as the incorrect diagnosis in patients with fibromyalgia. Arthritis Rheum 36:1493–1500

    Article  PubMed  CAS  Google Scholar 

  22. Sigal LH, Patella SJ (1992) Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia. Pediatrics 90:523–528

    PubMed  CAS  Google Scholar 

  23. Steere AC, Taylor E, McHugh GL, Logigian EL (1993) The overdiagnosis of Lyme disease. JAMA 269:1812–1816

    Article  PubMed  CAS  Google Scholar 

  24. Renaud I, Cachin C, Gerster JC (2004) Good outcomes of Lyme arthritis in 24 patients in an endemic area of Switzerland. Jt Bone Spine 71:39–43

    Article  Google Scholar 

  25. Hauser U, Lehnert G, Lobentanzer R, Wilske B (1997) Interpretation criteria for standardized Western blots for three European species of Borrelia burgdorferi sensu lato. J Clin Microbiol 35:1433–1444

    PubMed  CAS  Google Scholar 

  26. Hauser U, Lehnert G, Wilske B (1999) Validity of interpretation criteria for standardized Western blots (immunoblots) for the serodiagnosis of Lyme borreliosis based on sera collected throughout Europe. J Clin Microbiol 37:2241–2247

    PubMed  CAS  Google Scholar 

  27. Fournie B, Crognier L, Arnaud C, Zabraniecki L, Lascaux-Lefebvre V, Marc V et al (1999) Proposed classification criteria of psoriatic arthritis. A preliminary study in 260 patients. Rev Rhum Engl 66:446–456

    CAS  Google Scholar 

  28. Goie The HS, Steven MM, van der Linden SM, Cats A (1985) Evaluation of diagnostic criteria for ankylosing spondylitis: a comparison of the Rome, New York and modified New York criteria in patients with a positive clinical history screening test for ankylosing spondylitis. Br J Rheumatol 24(3):242–249

    Article  PubMed  CAS  Google Scholar 

  29. Nahimana I, Gern L, Peter O, Praz G, Moosmann Y, Francioli P (2000) Epidemiology of Lyme borreliosis in French-speaking Switzerland. Schweiz Med Wochenschr 130:1456–1461

    PubMed  CAS  Google Scholar 

  30. Marguet C, Rouillier-Saas M, Mallet E, Meunier M, Jeannot E, Boulloche J et al (2000) Lyme disease in Upper Normandy: report of a hospital. Arch Pediatr 7(Suppl 3):517–522

    Article  Google Scholar 

  31. Woodrum JE, Oliver JH Jr (1999) Investigation of venereal, transplacental, and contact transmission of the Lyme disease spirochete, Borrelia burgdorferi, in Syrian hamsters. J Parasitol 85:426–430

    Article  PubMed  CAS  Google Scholar 

  32. Weiss NL, Sadock VA, Sigal LH, Phillips M, Merryman PF, Abramson SB (1995) False-positive seroreactivity to Borrelia burgdorferi in systemic lupus erythematosus: the value of immunoblot analysis. Lupus 4:131–137

    PubMed  CAS  Google Scholar 

  33. Rawlins ML, Gerstner C, Hill HR, Litwin CM (2005) Evaluation of a Western blot method for the detection of Yersinia antibodies: evidence of serological cross-reactivity between Yersinia outer membrane proteins and Borrelia burgdorferi. Clin Diagn Lab Immunol 12:1269–1274

    Article  PubMed  CAS  Google Scholar 

  34. Hunfeld KP, Brade V (1999) Prevalence of antibodies against the human granulocytic ehrlichiosis agent in Lyme borreliosis patients from Germany. Eur J Clin Microbiol Infect Dis 18:221–224

    Article  PubMed  CAS  Google Scholar 

  35. Hunfeld KP, Allwinn R, Peters S, Kraiczy P, Brade V (1998) Serologic evidence for tick-borne pathogens other than Borrelia burgdorferi (TOBB) in Lyme borreliosis patients from midwestern Germany. Wien Klin Wochenschr 110:901–908

    PubMed  CAS  Google Scholar 

  36. Brown SL, Hansen SL, Langone JJ (1999) Role of serology in the diagnosis of Lyme disease. JAMA 282:62–66

    Article  PubMed  CAS  Google Scholar 

  37. Zhioua E, Rodhain F, Binet P, Perez-Eid C (1997) Prevalence of antibodies to Borrelia burgdorferi in forestry workers of Ile de France, France. Eur J Epidemiol 13:959–962

    Article  PubMed  CAS  Google Scholar 

  38. Karch H, Huppertz HI, Böhme M, Schmidt H, Wiebecke D (1994) Demonstration of Borrelia burgdorferi DNA in urine samples from healthy humans whose sera contain B. burgdorferi-specific antibodies. J Clin Microbiol 32:2312–2314

    PubMed  CAS  Google Scholar 

  39. Wormser GP (2005) Prevention of Lyme borreliosis. Wien Klin Wochenschr 117:385–391

    Article  PubMed  Google Scholar 

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Acknowledgment

M.F. Seidel and A. Belda Domene contributed equally to this study.

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  1. Medical University Policlinic, Rheumatology Unit Wilhelmstr, 35-37, 53111, Bonn, Germany

    M. F. Seidel, A. Belda Domene & H. Vetter

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  1. M. F. Seidel
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  2. A. Belda Domene
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Correspondence to M. F. Seidel.

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Seidel, M.F., Domene, A.B. & Vetter, H. Differential diagnoses of suspected Lyme borreliosis or post-Lyme-disease syndrome. Eur J Clin Microbiol Infect Dis 26, 611–617 (2007). https://doi.org/10.1007/s10096-007-0342-0

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