Overdiagnosis and overtreatment of Lyme disease in children.

ABSTRACT

AIM: To determine the incidence of overdiagnosis and overtreatment of Lyme disease in children residing in endemic areas using standardized CDC diagnostic criteria. METHODS: Case series, using data collected prospectively from patients referred for Lyme disease to a tertiary care center located in an area endemic for Lyme disease. Data were collected on all referred cases during a 30-month period from August, 1995, to February, 1998. RESULTS: We evaluated 216 patients with ages from birth to 18 years. Results of Lyme enzyme-linked immunosorbent assay and Western blot studies were available for all patients evaluated. Of these, 68 (31%) fulfilled the criteria for active Lyme disease, most commonly having arthritis, facial nerve palsy, aseptic meningitis or erythema migrans; 39 (18%) had a prior history of Lyme disease and were referred with an acute intercurrent illness or lower school grades attributed to the previous Lyme disease; 77% of these were receiving therapy at the time of referral; 109 (50%) of 216 had no past or current evidence of Lyme disease, yet 79% were receiving therapy at the time of referral. CONCLUSIONS: Overdiagnosis and overtreatment of Lyme disease is a major concern in areas endemic for Lyme disease, even after 1995 when standard criteria for diagnosis were published. The most common problem in diagnosis was misinterpretation of Western immunoblot results.