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What Doctors Treat Lyme Disease?
Lyme disease is caused by a spirochete (Borrelia burgdorferi) that is transmitted to humans via the bite of a deer tick 1. According to the Mayo Clinic, the disease causes symptoms such as a rash, fever, chills, body aches, joint swelling, weakness and temporary paralysis 1. Physicians who treat this disease in their practice include internists and family practice physicians. In addition, infectious disease or rheumatology physicians may also be involved in the treatment.
Internists/Family Practice Physicians
Internists and family practice physicians are the gate keepers, or caregivers who see cases of Lyme disease first 1. Diagnosis is based on clinical suspicion and is confirmed by two-tiered serologic testing (enzyme-linked immunosorbent assay as a screening test, followed by Western blot as confirmation).
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Sometimes patients are initially misdiagnosed as having a rash due to a spider bite, for example. If Lyme disease is allowed to progress without antibiotic treatment, patients may progress to Lyme arthritis; sometimes the pain is so severe or unrelenting that patients seek support groups 1.
Usually, infectious diseases physicians get involved when the diagnosis of Lyme disease has not been made or confirmed by serologic testing 1. For example, Dr. Raymond Dattwyler, affiliated with the Mount Sinai School of Medicine, is a disease identification expert who often diagnoses Lyme patients after they have initially been misdiagnosed 1.
Rheumatologists
Dr. Steere, a rheumatologist--a physician who deals with diseases and disorders of the bones, joints and muscles--was the first doctor who identified the cause of Lyme disease 1. Dr. Steere is a professor at Harvard Medical School and has written hundreds of articles on Lyme Disease 1. He is also an invited speaker at national and international meetings. Dr. Steere is conducting research on diagnostic assays for Lyme disease, as well as antibiotic refractory cases of Lyme arthritis 1.
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References
- Mayo Clinic: Lyme Disease
- Skar GL, Simonsen KA. Lyme Disease. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431066/
- van der Heijden A, Mulder BC, Poortvliet PM, van Vliet AJH. Social-cognitive determinants of the tick check: a cross-sectional study on self-protective behavior in combatting Lyme disease. BMC Public Health. 2017;17(1):900. Published 2017 Nov 25. doi:10.1186/s12889-017-4908-1
- Nadelman RB. Erythema migrans. Infect Dis Clin North Am. 2015;29(2):211-39.
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Tick bites: Lyme disease. 2012 Apr 3 [Updated 2019 Apr 25].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279242/
- Cook MJ. Lyme borreliosis: a review of data on transmission time after tick attachment. Int J Gen Med. 2014;8:1–8. Published 2014 Dec 19. doi:10.2147/IJGM.S73791
- Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD. Diagnosis and treatment of Lyme disease. Mayo Clin Proc. 2008;83(5):566-71.
- Biesiada G, Czepiel J, Leśniak MR, Garlicki A, Mach T. Lyme disease: review. Arch Med Sci. 2012;8(6):978–982. doi:10.5114/aoms.2012.30948
- Djukic M, Schmidt-Samoa C, Lange P, et al. Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis. J Neurol. 2012;259(4):630–636. doi:10.1007/s00415-011-6221-8
- Marques AR. Laboratory diagnosis of Lyme disease: advances and challenges. Infect Dis Clin North Am. 2015;29(2):295–307. doi:10.1016/j.idc.2015.02.005
- Wormser GP, Molins CR, Levin A, et al. Evaluation of a sequential enzyme immunoassay testing algorithm for Lyme disease demonstrates lack of test independence but high diagnostic specificity. Diagn Microbiol Infect Dis. 2018;91(3):217–219. doi:10.1016/j.diagmicrobio.2018.02.006
- Waddell LA, Greig J, Mascarenhas M, Harding S, Lindsay R, Ogden N. The Accuracy of Diagnostic Tests for Lyme Disease in Humans, A Systematic Review and Meta-Analysis of North American Research. PLoS One. 2016;11(12):e0168613. Published 2016 Dec 21. doi:10.1371/journal.pone.0168613
- Hofhuis A, van de Kassteele J, Sprong H, et al. Predicting the risk of Lyme borreliosis after a tick bite, using a structural equation model. PLoS One. 2017;12(7):e0181807. Published 2017 Jul 24. doi:10.1371/journal.pone.0181807
- Thomm AM, Schotthoefer AM, Dupuis AP, et al. Development and Validation of a Serologic Test Panel for Detection of Powassan Virus Infection in U.S. Patients Residing in Regions Where Lyme Disease Is Endemic. mSphere. 2018;3(1)
- Wills MKB, Kirby AM, Lloyd VK. Detecting the Lyme Disease Spirochete, Borrelia Burgdorferi, in Ticks Using Nested PCR. J Vis Exp. 2018;(132):56471. Published 2018 Feb 4. doi:10.3791/56471
- Jabbari N, Glusman G, Joesch-Cohen LM, et al. Whole genome sequence and comparative analysis of Borrelia burgdorferi MM1. PLoS One. 2018;13(6):e0198135. Published 2018 Jun 11. doi:10.1371/journal.pone.0198135
- Lymedisease.org About Lyme Disease. 2018
- Koester TM, Meece JK, Fritsche TR, Frost HM. Infectious Mononucleosis and Lyme Disease as Confounding Diagnoses: A Report of 2 Cases. Clin Med Res. 2018;16(3-4):66–68. doi:10.3121/cmr.2018.1419
- Arvikar SL, Crowley JT, Sulka KB, Steere AC. Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease. Arthritis Rheumatol. 2017;69(1):194–202. doi:10.1002/art.39866
- Patrick DM, Miller RR, Gardy JL, et al. Lyme Disease Diagnosed by Alternative Methods: A Phenotype Similar to That of Chronic Fatigue Syndrome. Clin Infect Dis. 2015;61(7):1084-91.
- Batinac T, Petranovic D, Zamolo G, Petranovic D, Ruzic A. Lyme borreliosis and multiple sclerosis are associated with primary effusion lymphoma. Med Hypotheses. 2007;69(1):117-9.
- Donta ST. Issues in the diagnosis and treatment of lyme disease. Open Neurol J. 2012;6:140–145. doi:10.2174/1874205X01206010140
- Centers for Disease Control and Prevention. Signs and Symptoms of Untreated Lyme Disease. cdc.gov August 15, 2019
- Touradji P, Aucott JN, Yang T, Rebman AW, Bechtold KT. Cognitive Decline in Post-treatment Lyme Disease Syndrome. Arch Clin Neuropsychol. 2019;34(4):455-465.
- Ścieszka J, Dąbek J, Cieślik P. Post-Lyme disease syndrome. Reumatologia. 2015;53(1):46–48. doi:10.5114/reum.2015.50557
- Blaser M. Antibiotic Overuse: Stop the Killing of Beneficial Bacteria. Nature. August 25, 2011;476:393-394. doi:10.1038/476393a.
- Centers for Disease Control and Prevention (CDC). Two-Step Laboratory Testing Process. Updated March 26, 2015.
- National Institute of Allergy and Infectious Diseases. Chronic Lyme Disease. National Institutes of Health. Updated September 3, 2015.
Writer Bio
Based in New Jersey, John Riefler has been writing since 1987. His articles have appeared in "MD Magazine," "Emergency Medicine" and "Hospital Practice." Riefler holds a Bachelor of Science in biology from Bucknell University, a Master of Science in microbiology from the Medical University of South Carolina and a medical doctorate from St. George's University School of Medicine.