Misdiagnosis of Lyme Disease

Detection of Lyme disease can be difficult, especially in later stages.

The bacteria that causes Lyme disease is hard to detect with current lab tests, making misdiagnosis of the disease is common. Lab tests for Lyme disease can produce both false positive and false negative tests. False positive tests occur when the test incorrectly suggests a person has the disease. A false negative test misses the presence of the disease.

If a person’s Lyme disease is not detected and treated early, the result can be lingering symptoms, even after a person has been treated with appropriate antibiotic treatment. This is called Post-treatment Lyme Disease Syndrome, or PTLDS (see Treatment for more information).

People often test positive for Lyme disease when they actually have a different bacterial illness. It is possible that a person could test positive because they were infected with Lyme bacteria at some point, but the infection is not currently active and is not causing illness.

In some cases, a person may test negative for Lyme disease when they have been infected.

Diagnosis of Lyme disease is especially tricky because symptoms may closely resemble those of other illnesses. For instance, some early symptoms of Lyme disease (headache, stiff neck, and fatigue) may be mistaken for viral meningitis. There are several key differences, however. Children with viral meningitis are more likely to have a higher fever. A person with Lyme disease often has other symptoms, such as the characteristic bull's-eye rash.

(Source: 123RF)

Other conditions that may have similar symptoms to Lyme disease include:

  • Viral infections such as influenza or infectious mononucleosis (both cause fever, muscles aches and fatigue)
  • Multiple sclerosis (both cause nervous system symptoms)
  • Arthritis (both cause joint pain)
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Other tick-borne illnesses

Some non-Lyme infections can be transmitted by ticks—in some cases, by the same ticks that transmit Lyme disease. These infections can cause fever, headache, muscle aches, fatigue and other Lyme-like symptoms. These include:

  • Tick-borne relapsing fever (TBRF), a flu-like illness that occurs in mountainous areas of the West during the summer.
  • Rocky Mountain spotted fever, reported under the new category called Spotted Fever Rickettosis. This disease is also transmitted by ticks, is most common in the south central and southeastern parts of the United States, but occurs throughout North and South America. The most typical symptom is a spotty rash that appears 5 - 10 days after infection. Rocky Mountain spotted fever causes death in up to 10% of all cases.
  • A tick-borne infection called by human monocyte ehrlichiosis (HME), carried by the Lone Star tick, strongly resembles Lyme disease. It causes a similar rash. It has been identified in southern states.

A person bitten by a tick may have an allergic reaction and develop a rash. If the rash appears hours, instead of days, after a tick bite, it is likely to be an allergic reaction to the tick, instead of a symptom of Lyme disease—even if the rash is ring-shaped. Other insect or spider bites can also cause a rash.

Pain management and treatment options for PTLDS can include acupuncture, ultrasound, or treatments involving radio waves, infrared light or lasers. All of these treatments may help muscles, tendons, and joints stay flexible and mobile.

Range of motion and stretching exercises help keep joints mobile and prevent muscle constriction. Water therapy is very comforting. Corticosteroid injections or topical applications (such as a cream or gel) may be essential for treatment, especially if joint swelling is present and patients have limited mobility.

Updated on: 05/23/19
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Lyme Disease Overview