Chronic Lyme disease diagnosis and treatment remain highly debated. More importantly, the potential overuse of antibiotics—especially in high doses and over long periods—is a major concern.
Long-Term Antibiotic Use
- As a result, antibiotic resistance may develop, enabling bacteria to evolve and withstand future treatments.
- While probiotics have recognized benefits for gut and immune health, research highlights the need to evaluate potential risks. A study on the Escherichia coli Nissle 1917 strain suggests that certain probiotic strains may carry genotoxic risks, emphasizing the complexity of restoring gut health after long-term antibiotic use (Benefits and concerns of probiotics: an overview of the potential genotoxicity of the colibactin-producing Escherichia coli Nissle 1917 strain)
- Probiotics, although helpful, cannot replace a diverse, healthy microbiome.
- An increased risk of infections exists even with the assistance of probiotics.
For instance, opportunistic pathogens may continue to thrive, leading to infections with Clostridium difficile (C. difficile) and Candida.
• The gut microbiome plays a crucial role in immune function.
• Increased gut permeability (leaky gut) and malabsorption
Consequences of Misdiagnosis and Unnecessary Treatment
• In many cases, antibiotic treatment lasts for months or even years.
• However, the treatment often fails to address the actual cause of symptoms.
Impact on Quality of Life
Notably, gut and immune system issues are not the only factors affecting quality of life. Additionally, long-term antibiotic therapy may cause side effects such as fatigue, dizziness, allergic reactions, and neurological issues.
- Importance of Informed Consent
Given these risks, it is crucial to approach chronic Lyme disease treatment with caution. Therefore, healthcare providers should encourage fully informed consent.
- Moreover, financial concerns play a role. Patients may invest in costly, long-term treatments with little evidence of effectiveness. As a result, the risk of overdiagnosis and unnecessary treatment increases.
Chronic Lyme Disease as a “Catch-All” Diagnosis
Chronic Lyme disease sometimes serves as a ‘catch-all’ diagnosis for patients whose conditions do not fit established medical categories. Because Lyme disease symptoms vary and are nonspecific, misdiagnosed patients may receive unnecessary treatments that fail to address the root cause of their symptoms.
Use of “Lyme-Like” Labels
Some refer to symptoms commonly associated with Lyme disease as ‘Lyme-like illness’ or ‘chronic Lyme syndrome,’ even without a confirmed diagnosis. This can lead to confusion and over-diagnosis.
Factors Contributing to Misdiagnosis of Chronic Lyme Disease
Lack of Reliable Testing
Inappropriate test usage or misinterpretation can play a role.
Standard Lyme disease testing approach follows a two-tier system:
• ELISA screening test (initial screening)
• Western blot (confirmatory test for positive ELISA results)
This method aims to reduce false positives and improve diagnostic accuracy.
- Challenges with Western Blot Testing
Variable Accuracy and Interpretation Difficulties:
• Western blot detects IgM and IgG antibodies against Borrelia burgdorferi antigens, relying on specific antibody bands for interpretation. Cross-reactivity with other infections may lead to false positives. (Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment ).
• Using the Western blot alone can lead to misdiagnosis.
Any positive result from a test that relies solely on Western blotting is most likely a false positive (Lyme Disease: How Reliable Are Serologic Results?).
Diagnoses that prioritize self-reported symptoms over objective testing are more prone to misdiagnosis.
Misdiagnosis and Unnecessary Treatment
A study reviewing 1,261 patients referred for Lyme disease evaluation found:
- Only 26.5% received an accurate diagnosis.
- Many misdiagnosed patients were female.
- Co-infections were wrongly diagnosed, increasing the risk of unnecessary antimicrobial treatment. (Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment).
There are other conditions with similar symptoms as chronic Lyme disease that need to be excluded. This is to avoid misdiagnoses:
Thyroid disorders (hypothyroidism or hyperthyroidism)
Multiple sclerosis (MS)
Chronic infections like Epstein-Barr virus, herpes simplex virus, and cytomegalovirus
Neurodegenerative and autoimmune conditions
Serious Conditions Missed
A study published in JAMA Internal Medicine illustrates how neoplasms were misdiagnosed as “Chronic Lyme Disease” This resulted in delayed treatments for the patients.
Such delays underscore the critical need for accurate diagnosis (Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease).
Tests that assist with the correct diagnosis of disseminated manifestations of Lyme disease include cerebrospinal fluid tests, brain imaging, EMG/nerve conduction studies, skin biopsy, and neuropsychological testing (Columbia Lyme and Tick-Borne Diseases Research Center).
Impact of Unconventional Treatments
Some treatments lack scientific backing and may carry health risks.
A multidisciplinary approach—drawing from neurology, immunology, and rheumatology—helps ensure accurate diagnosis and effective care.
Scientific accuracy should accompany raising awareness about the condition. Less risky treatment solutions should be encouraged.
An evidence-based approach remains essential for proper diagnosis and treatment.
Medical Disclaimer
The information provided in this article is for informational purposes only and is not intended as medical advice. It should not be used as a substitute for professional medical guidance, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider regarding any medical concerns. Please always seek medical advice timeously.
Related: Bacterial Antibiotic Resistance Bacterial Antibiotic Resistance – EMFSA