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Lyme Anxiety
Extensive (often inaccurate) publicity about both the risks and the outcomes of Lyme disease
has produced considerable anxiety about this disease (many states with no endemic disease
have Lyme disease support groups organized by patients). This concern has also led to
inappropriate use of serological tests for Lyme disease as a screening test (often ordered as a
result of requests by patients) in an attempt to identify the cause of widely prevalent,
nonspecific symptoms such as pain and fatigue. This has, in turn, led to a virtual epidemic of
overdiagnosis and overtreatment of patients for Lyme disease, which only serves to perpetuate
the myth that Lyme disease is commonly associated with severe, long-term morbidity. Most
studies indicate that with rare exceptions, the outcomes for persons with Lyme disease are
excellent. It is important for clinicians to consider what evidence (both clinical and
epidemiological) there is to "rule in" Lyme disease before serological tests are ordered to rule
out the diagnosis. Persons with only nonspecific symptoms and no objective signs of Lyme
disease are very unlikely to have Lyme disease, regardless of the results of serological tests.
Inappropriate use of these tests frequently will result in misdiagnosis of Lyme disease and may
prevent or delay the patient from receiving appropriate care for the true problem.
E. D. Shapiro and M. A. Gerber. Lyme Disease. Clinical Infectious Diseases
2000;31:533-542
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