South Middlesex Times

Every year in the United States, an estimated 476,000 people are diagnosed and treated for Lyme disease, according to the U.S. Centers for Disease Control and Prevention (CDC).

Lyme disease can be treated with antibiotics, with the best health outcomes occurring when diagnosis is made within the first weeks of infection. If left untreated, Lyme disease can cause long-term effects such as neurological problems and arthritis. However, diagnosing Lyme disease can be challenging, leading to some cases going undetected long after initial transmission.

To aid clinicians in improving Lyme disease outcomes, physician-scientists at Rutgers New Jersey Medical School and Stony Brook University have published a guidance article in NEJM Evidence on the informed evaluation and treatment of early-stage Lyme disease.

Lead author Steven E. Schutzer, a professor of medicine at Rutgers Health, discussed approaches for clinicians dealing with potential early Lyme disease infections.

"The most common sign of Lyme disease is erythema migrans," said Schutzer. "But that rash doesn’t occur in all patients, nor is it always recognized or noticed by patients when it does occur."

Currently, only antibody tests approved by the Food and Drug Administration (FDA) are available; these tests may take weeks or longer before detecting a sufficient immune response.

"Another complicating issue is that once somebody has had Lyme disease, they could be positive on the antibody tests for years to life," added Schutzer.

In early stages, symptoms may include fever, headache, muscle aches, joint aches, and fatigue without respiratory symptoms. Neurological symptoms such as headaches can also develop but may result from other illnesses like meningitis.

The CDC recommends a two-tier blood antibody testing approach against Borrelia burgdorferi. The first-tier test is sensitive but must be followed by a second-tier test measuring more specific antibodies if results are borderline or positive.

Schutzer emphasized that doctors should not focus solely on Lyme: "Once antibiotics are administered, they may blunt the patient’s antibody response." He advised considering factors like endemic areas and conducting neurological exams to rule out other diseases.

During the first few weeks of infection, conventional two-tier tests usually yield negative results before detectable immune responses develop. Schutzer suggested drawing a second blood sample for comparison over time to identify emerging positivity.

Looking ahead, researchers aim to develop more accurate early detection tests including DNA detection of the Lyme agent and point-of-care tests pending rigorous confirmation of their accuracy.

"Fortunately," Schutzer concluded, "the outlook is good for most patients with early Lyme disease when an alert clinician recognizes it and begins treatment."