Authors:
Address: From the Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
Journal:

Publication:

abstract

BACKGROUND:

Concerns about over-diagnosis and inappropriate management of Lyme disease (LD) are well documented in North America and supported by clinical data. There are few parallel data on the situation in the UK.

AIM:

To describe the patterns of referral, investigation, diagnosis and treatment of patients with suspected LD referred to an infectious disease unit in Liverpool, UK. Previous management by National Health Service (NHS) and non-NHS practitioners was reviewed.

DESIGN:

Descriptive study conducted by retrospective casenotes review.

METHODS:

Retrospective casenotes review of adults referred with possible LD to an infectious disease unit in Liverpool, UK, over 5 years (2006-2010).

RESULTS:

Of 115 patients, 27 (23%) were diagnosed with LD, 38 (33%) with chronic fatigue syndrome (CFS) and 13 (11%) with other medical conditions. No specific diagnosis could be made in 38 (33%). At least 53 unnecessary antibiotic courses had been given by non-NHS practitioners; 21 unnecessary courses had been prescribed by NHS practitioners. Among 38 patients, 17 (45%) with CFS had been misdiagnosed as having LD by non-NHS practitioners.

CONCLUSION:

A minority of referred patients had LD, while a third had CFS. LD is over-diagnosed by non-specialists, reflecting the complexities of clinical and/or laboratory diagnosis. Patients with CFS were susceptible to misdiagnosis in non-NHS settings, reinforcing concerns about missed opportunities for appropriate treatment for this group and about the use of inappropriate diagnostic modalities and anti-microbials in non-NHS settings.

Related Articles
The Newcastle NHS Chronic Fatigue Syndrome Service: not all fatigue is the same.
J R Coll Physicians Edinb. 2010
The Newcastle NHS Chronic Fatigue Syndrome Service: not all fatigue is the same.
Newton JL, Mabillard H, Scott A, Hoad A, Spickett G. J R Coll Physicians Edinb. 2010 Dec; 40(4):304-7.
Tick bites and Lyme disease in an endemic setting: problematic use of serologic testing and prophylactic antibiotic therapy.
JAMA. 1998
Tick bites and Lyme disease in an endemic setting: problematic use of serologic testing and prophylactic antibiotic therapy.
Fix AD, Strickland GT, Grant J. JAMA. 1998 Jan 21; 279(3):206-10.
Summary of the first 100 patients seen at a Lyme disease referral center.
Am J Med. 1990
Summary of the first 100 patients seen at a Lyme disease referral center.
Sigal LH. Am J Med. 1990 Jun; 88(6):577-81.
Review Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis.
Health Technol Assess. 2010
Review Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis.
Black C, Sharma P, Scotland G, McCullough K, McGurn D, Robertson L, Fluck N, MacLeod A, McNamee P, Prescott G, et al. Health Technol Assess. 2010 Apr; 14(21):1-184.
Review Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups.
Health Technol Assess. 2004
Review Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups.
Beswick AD, Rees K, Griebsch I, Taylor FC, Burke M, West RR, Victory J, Brown J, Taylor RS, Ebrahim S. Health Technol Assess. 2004 Oct; 8(41):iii-iv, ix-x, 1-152.

To top • Home

---

Show map | Diseases | Vaccination | Chronic disease | Medicine | Pregnancy | Heat & Sunburn | Cold | Security | Useful tips | Faq | News

TraveldoctorOnline 2001 • Disclaimer • webmaster