This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Allen C. Steere, MD; Elise Taylor; Gail L. McHugh, MS; Eric L. Logigian, MD

JAMA. 1993;269(14):1812-1816.

Abstract
Objective.
—To analyze the diagnoses, serological test results, and treatment results of the patients evaluated in a Lyme disease clinic, both prior to referral and from current evaluation.

Design.
—Retrospective case survey of prescreened patients.

Setting.
—Research and diagnostic Lyme disease clinic in a university hospital.

Patients.
—All 788 patients referred to the clinic during a 4.5-year period who were thought by the referring physician or the patient to have a diagnosis of Lyme disease.

Main Outcome Measurements.
—Symptoms and signs of disease, immunodiagnostic tests of Lyme disease, and tests of neurological function.

Results.
—Of the 788 patients, 180 (23%) had active Lyme disease, usually arthritis, encephalopathy, or polyneuropathy. One hundred fifty-six patients (20%) had previous Lyme disease and another current illness, most commonly chronic fatigue syndrome or fibromyalgia; and in 49 patients, these symptoms began soon after objective manifestations of Lyme disease. The remaining 452 patients (57%) did not have Lyme disease. The majority of these patients also had the chronic fatigue syndrome or fibromyalgia; the others usually had rheumatic or neurological diseases. Of the patients who did not have Lyme disease, 45% had had positive serological test results for Lyme disease in other laboratories, but all were seronegative in our laboratory. Prior to referral, 409 of the 788 patients had been treated with antibiotic therapy. In 322 (79%) of these patients, the reason for lack of response was incorrect diagnosis.

Conclusions.
—Only a minority of the patients referred to the clinic met diagnostic criteria for Lyme disease. The most common reason for lack of response to antibiotic therapy was misdiagnosis.

(JAMA. 1993;269:1812-1816)

Author Affiliations
From the Division of Rheumatology/Immunology, New England Medical Center, Tufts University School of Medicine (Dr Steere and Mss Taylor and McHugh), and the Department of Neurology, Brigham and Womens' Hospital, Harvard University School of Medicine (Dr Logigian), Boston, Mass.

Footnotes
Reprint requests to New England Medical Center, Box 406, 750 Washington St, Boston, MA 02111 (Dr Steere).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Evaluation of the Recombinant VlsE-Based Liaison Chemiluminescence Immunoassay for Detection of Borrelia burgdorferi and Diagnosis of Lyme Disease
Ledue et al.
CVI 2008;15:1796-1804.
ABSTRACT | FULL TEXT  

Evaluation of Two Commercial Systems for Automated Processing, Reading, and Interpretation of Lyme Borreliosis Western Blots
Binnicker et al.
J. Clin. Microbiol. 2008;46:2216-2221.
ABSTRACT | FULL TEXT  

A Critical Appraisal of "Chronic Lyme Disease"
Feder et al.
NEJM 2007;357:1422-1430.
FULL TEXT  

Lyme Disease--United States, 2003-2005
JAMA 2007;298:278-279.
FULL TEXT  

Coinfections Acquired from Ixodes Ticks
Swanson et al.
Clin. Microbiol. Rev. 2006;19:708-727.
ABSTRACT | FULL TEXT  

Author's response to comments by Sigal and Hassett, Phillips et al., and Shapiro et al.
Cairns
Int J Epidemiol 2005;34:1440-1443.
FULL TEXT  

Response to meta-analysis of Lyme borreliosis symptoms
Shapiro et al.
Int J Epidemiol 2005;34:1437-1439.
FULL TEXT  

Lyme Arthritis in 20 Children Residing in a Non-Endemic Area
Saulsbury
CLIN PEDIATR 2005;44:419-421.
ABSTRACT  

Appropriateness of Lyme Disease Serologic Testing
Ramsey et al.
Ann Fam Med 2004;2:341-344.
ABSTRACT | FULL TEXT  

Morphoea and Borrelia burgdorferi: results from the Scottish Highlands in the context of the world literature
Goodlad et al.
Mol. Pathol. 2002;55:374-378.
ABSTRACT | FULL TEXT  

A 58-Year-Old Man With a Diagnosis of Chronic Lyme Disease
Steere
JAMA 2002;288:1002-1010.
FULL TEXT  

Misconceptions about Lyme Disease: Confusions Hiding behind Ill-Chosen Terminology
Sigal
ANN INTERN MED 2002;136:413-419.
FULL TEXT  

Ross River Virus Transmission, Infection, and Disease: a Cross-Disciplinary Review
Harley et al.
Clin. Microbiol. Rev. 2001;14:909-932.
ABSTRACT | FULL TEXT  

Use of Serum Immune Complexes in a New Test That Accurately Confirms Early Lyme Disease and Active Infection with Borrelia burgdorferi
Brunner and Sigal
J. Clin. Microbiol. 2001;39:3213-3221.
ABSTRACT | FULL TEXT  

Studying Symptoms: Sampling and Measurement Issues
Kroenke
ANN INTERN MED 2001;134:844-853.
ABSTRACT | FULL TEXT  

The Cost-effectiveness of Vaccination Against Lyme Disease
Shadick et al.
Arch Intern Med 2001;161:554-561.
ABSTRACT | FULL TEXT  

Clinical Manifestations of Tick-Borne Infections in Children
Bryant and Marshall
CVI 2000;7:523-527.
FULL TEXT  

Differences Are Voiced by Two Lyme Camps at a Connecticut Public Hearing on Insurance Coverage of Lyme Disease
Feder and MD
Pediatrics 2000;105:855-857.
FULL TEXT  

Long-term Outcomes of Persons With Lyme Disease
Seltzer et al.
JAMA 2000;283:609-616.
ABSTRACT | FULL TEXT  

Multiple sclerosis vs Lyme disease: A case presentation to a discussant and a review of the literature
Karussis et al.
Mult Scler 1999;5:395-402.
 

Sensitive and Specific Serodiagnosis of Lyme Disease by Enzyme-Linked Immunosorbent Assay with a Peptide Based on an Immunodominant Conserved Region of Borrelia burgdorferi VlsE
Liang et al.
J. Clin. Microbiol. 1999;37:3990-3996.
ABSTRACT | FULL TEXT  

Solitary Erythema Migrans in Georgia and South Carolina
Felz et al.
Arch Dermatol 1999;135:1317-1326.
ABSTRACT | FULL TEXT  

Clinical evaluation of guidelines and two-test approach for Lyme disease
Blaauw et al.
Rheumatology (Oxford) 1999;38:1121-1126.
ABSTRACT | FULL TEXT  

Role of Serology in the Diagnosis of Lyme Disease
Brown et al.
JAMA 1999;282:62-66.
ABSTRACT | FULL TEXT  

Fibromyalgia Syndrome a Decade Later: What Have We Learned?
Goldenberg
Arch Intern Med 1999;159:777-785.
ABSTRACT | FULL TEXT  

Geographic Risk for Lyme Disease and Human Granulocytic Ehrlichiosis in Southern New York State
Daniels et al.
Appl. Environ. Microbiol. 1998;64:4663-4669.
ABSTRACT | FULL TEXT  

Underreporting of Lyme Disease
Young
NEJM 1998;338:1629-1629.
FULL TEXT  

Lyme Disease
Shapiro
Pediatr. Rev. 1998;19:147-154.
FULL TEXT  

Erythema Migrans--like Rash Illness at a Camp in North Carolina: A New Tick-Borne Disease?
Kirkland et al.
Arch Intern Med 1997;157:2635-2641.
ABSTRACT  

Fibromyalgia in Hepatitis C Virus Infection: Another Infectious Disease Relationship
Buskila et al.
Arch Intern Med 1997;157:2497-2500.
ABSTRACT  

The Costs of Lyme Disease
McCaulley
Arch Intern Med 1997;157:817-817.
ABSTRACT  

The Costs of Lyme Disease-Reply
Sigal
Arch Intern Med 1997;157:817-818.
ABSTRACT  

Lyme Disease in Children
Leib-Feldman et al.
NEJM 1997;336:1107-1108.
FULL TEXT  

Lyme Disease: Shift the Paradigm!
Ellenbogen
Arch Fam Med 1997;6:191-195.
ABSTRACT  

Review : The concurrence of lupus and fibromyalgia: implications for diagnosis and management
Bennett
Lupus 1997;6:494-499.
 

The Lyme Disease Controversy: Social and Financial Costs of Misdiagnosis and Mismanagement
Sigal
Arch Intern Med 1996;156:1493-1500.
ABSTRACT  

Pitfalls in the Diagnosis and Treatment of Lyme Disease in Children
Feder and Hunt
JAMA 1995;274:66-68.
ABSTRACT  

Topical Review: The Diagnosis of Congenital Infections: Contemporary Strategies
Souza and Bale
J Child Neurol 1995;10:271-282.
ABSTRACT  

Fortnightly review: Lyme disease in the United Kingdom
O'Connell
BMJ 1995;310:303-308.
ABSTRACT | FULL TEXT  

The Overdiagnosis of Lyme Disease in Children Residing in an Endemic Area
Rose et al.
CLIN PEDIATR 1994;33:663-668.
ABSTRACT  

Detection of Borreliacidal Antibodies by Flow Cytometry: An Accurate, Highly Specific Serodiagnostic Test for Lyme Disease
Callister et al.
Arch Intern Med 1994;154:1625-1632.
ABSTRACT  

Physician Beliefs, Attitudes, and Approaches Toward Lyme Disease in an Endemic Area
Eppes et al.
CLIN PEDIATR 1994;33:130-134.
ABSTRACT  

The Use of Serologic Tests for Lyme Disease in a Prepaid Health Plan in California
Ley et al.
JAMA 1994;271:460-463.
ABSTRACT  

Lyme Disease -- Where's the Bug?
Rahn
NEJM 1994;330:282-283.
FULL TEXT  

The Overdiagnosis of Lyme Disease
Burrascano
JAMA 1993;270:2682-2682.
ABSTRACT  

The Overdiagnosis of Lyme Disease
Kramer
JAMA 1993;270:2683-2683.
ABSTRACT  

The Overdiagnosis of Lyme Disease
Burke
JAMA 1993;270:2682-2682.
ABSTRACT  

The Overdiagnosis of Lyme Disease
Cleveland
JAMA 1993;270:2682-2683.
ABSTRACT  

Lyme Disease Overdiagnosis
Journal Watch Dermatology 1993;1993:2-2.
FULL TEXT  

LYME DISEASE MAY BE OVERDIAGNOSED
JWatch General 1993;1993:3-3.
FULL TEXT