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Open Forum Infect Dis. 2019 Jul 1;6(7). pii: ofz299. doi: 10.1093/ofid/ofz299.

Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic.

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Infectious Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
University of Maryland School of Medicine, Baltimore, Maryland.
Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Medicine and Pediatrics, Duke University School of Medicine, Durham, North Carolina.
Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.



Although Lyme disease is the most common vector-borne infection in the United States, diagnostic accuracy within community settings is not well characterized.


A retrospective observational cohort study of patients referred to an academic center with a presumed diagnosis or concern for Lyme disease between 2000 and 2013 was performed to analyze diagnoses and treatments. Characteristics of those with Lyme disease and those misdiagnosed as having Lyme disease were compared.


Of 1261 patients, 911 (72.2%) did not have Lyme disease, 184 (14.6%) had active or recent Lyme disease, 150 (11.9%) had a remote history of Lyme disease, and 16 (1.3%) were identified as having possible Lyme disease. Patients without current Lyme disease were more likely to be female (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.08-2.45), to have had symptoms for >3 months (OR, 8.78; 95% CI, 5.87-13.1), to have higher symptom counts (OR per additional symptom, 1.08; 95% CI, 1.02-1.13), to have had more Lyme-related laboratory testing (OR per additional laboratory test, 1.17; 95% CI, 1.03-1.32), and to have been diagnosed with what were regarded as coinfections (OR, 3.13; 95% CI, 1.14-8.57). Of the 911 patients without Lyme disease, 764 (83.9%) had received antimicrobials to treat Lyme disease or their coinfections. The percentage of patients established to have Lyme disease was lower than in earlier studies of referred populations.


Among patients referred to an academic Infectious Diseases practice for Lyme disease, incorrect diagnoses and unnecessary antibiotic treatment were common, both for Lyme disease and for coinfections.


Borrelia burgdorferi ; Lyme disease; chronic Lyme disease; tick-borne coinfections

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