Title : Wide variety of symptoms and lack of proper tests add to the difficulties in diagnosing this tick-borne infection
Abstract:
Lyme disease does not come with a list of specific symptoms. Depending on the part of the body affected by the Lyme-causing bacteria and the extent of its impact, patients may exhibit a wide variety of symptoms including, but not limited to, joint pain, chronic fatigue, sensitivity to light, difficulties in reading, writing, and remembering, and other cognitive problems. With a vast array of symptoms potentially pointing to Lyme disease and the lack of proper tests to diagnose this disease, Lyme disease largely remains underdiagnosed in the United States.
Why Tests May Remain Inconclusive
Most of the common tests for Lyme disease, like Elisa and Western Blot, are dependent on the patient’s immune system response. These antibody-based tests are designed to indicate results by detecting the presence of antibodies produced by the immune system in response to the bacteria, B. burgdorferi. However, studies indicate that B. burgdorferi utilizes several immune evasion tactics ranging from the regulation of surface proteins, tick saliva, antimicrobial peptide resistance, and the disabling of the germinal center. If the immune system is unable to produce antibodies in response to these bacteria either due to its immune evasion tactics or its suppression of the immune system, the antibody-based Lyme tests will show false negative results. The risk of such false-negative results is high in the initial stages because the immune system may not start producing antibodies immediately after exposure to the bacteria. However, in the later stages of the disease the bacteria may have weakened the immune system to such an extent that it is no longer able to produce antibodies, thus leaving only a narrow window of opportunity for the antibody-based tests to reveal accurate results. Even the DNA-based Lyme tests have certain limitations, which further highlights the need for an experienced clinical eye in diagnosing Lyme disease.
Clinical Eye for Symptom Analysis and Interpretation of Results
Due to inaccurate Lyme results, patients are often misdiagnosed as they are told by doctors that they do not have Lyme disease. Without proper diagnosis, such patients go from one specialist to another, who treat them symptomatically, as the core cause of their problem remains undiagnosed. In our clinical experience, we have seen multiple such patients being misdiagnosed for years and decades till they circle back to Lyme disease again. To overcome these challenges, it is imperative that Lyme disease patients consult physicians who have extensive experience in treating this chronic condition. It is their clinical experience that comes in handy to map the symptoms and determine which tests should be utilized at what stage of the disease to get a clearer picture of the infectious load.
Dismissing the Geographical Limitations
Contrary to widespread belief, people may be affected with Lyme disease in regions other than the North-east or the Mid-west, which are typically considered the hotbeds of Lyme disease in the United States. People belonging to the non-hotbed regions may sometimes have a tough time even getting tested for Lyme as conventional doctors, without experience in treating Lyme, may not even suspect Lyme disease in these patients. Lyme disease, with its various symptomatic complications, diagnostic challenges, and misperceived geographical limits, presents a true challenge for healthcare providers, who are not experienced in treating such patients. These hurdles in diagnosing Lyme disease further reiterate the need for Lyme literate doctors, who can precisely target Lyme disease through customized treatment protocols for lasting results.
