Diagnosing Lyme Disease

Richard Krieger, MD, chairman of the Infection Control Committee at Chilton Medical Center, and infectious disease physician at ID care, discusses how clinicians go about diagnosing Lyme disease.

Interview Transcript (slightly modified for readability)

“The problem with misdiagnosing people who have chronic symptoms for Lyme disease is that some of them are so nonspecific and so there are many people who are having a lot of these nonspecific symptoms (fatigue, achiness, weakness, difficulty concentrating, that sort of thing) and they come in and it’s almost like they’re a disease looking for a diagnosis.

When Lyme disease came around, people really hopped on that bandwagon because this [was] something treatable that can cause those things. The way to think of it is that if that’s all somebody presents with, it’s not highly likely they have Lyme disease. It should be investigated, but if they have those symptoms and they’ve had them for a while, we’re talking about chronic symptoms, [they] have a positive test for Lyme disease.

If they come in with all those symptoms and we do a blood test and it’s negative for Lyme disease, it’s probably not Lyme disease. A lot of people have made a lot of mileage in the past saying, ‘Well, it could be a false negative test,’ and in rare situations that’s perhaps the case, but in most cases if somebody has those symptoms and no positive test, they probably don’t have Lyme disease.

Again, I would hark back to if they had other pre-existing [symptoms], such as Bell’s palsy, weakness of the facial muscles, or if they had the typical rash, in the past, that would, of course, make one think more about Lyme disease. If they are in a particularly tick-infested area or if they’re engaged in activities that would make them prone to getting a tick bite, if they spend a lot of time gardening, hiking, outdoors, then they’re more likely to pick up a tick and get infected. Whereas somebody who’s more or less a homebody couch potato goes outside just to walk from the front door to the car, they’re far less likely to get bitten by a tick.”