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Misconceptions about Lyme Disease: Confusions Hiding behind Ill-Chosen Terminology
- Lyme disease
- Terminology
- Chronic disease
- Pathological conditions, signs and symptoms
- Serologic tests
- Diagnosis
“The beginning of wisdom is to call things by their right names.”
—Ancient Chinese proverb
Nomenclature influences perceptions of reality and frames ensuing discussions. Imprecision contributes to misinterpretation of observations and studies, altering clinicians' approaches. The impact of imprecision and novel reinterpretation of terminology can be seen in the Lyme disease debate. A quarter century after its initial description, a review of the terminology contributing to confusion about Lyme disease is needed.
Lyme disease is treatable and curable with antibiotics (1-4), especially if treated promptly, usually with an excellent long-term prognosis. The term “promptly” taken out of context suggests one must treat without any delay. In fact, even untreated patients have a good prognosis. A 10- to 20-year follow-up of patients at Yale's Lyme Disease Clinic from 1976 to 1983, many of whom were not treated for early Lyme disease, shows that the patients with erythema migrans did not differ from normal controls in current symptoms, physical findings, results of neuropsychological testing, or responses to the Short-Form 36 Health Assessment Questionnaire (5). However, significant long-term sequelae occurred in patients with untreated facial palsy who probably had disseminated Lyme disease at initial evaluation and probably required intravenous therapy (5).
“Chronic Lyme Disease”—A Term in Search of Definition
Despite this generally optimistic picture, claims of persisting infection and antibiotic unresponsiveness have contributed to anxiety. “Chronic Lyme disease” (6, 7) is a common clinical diagnosis in some geographic areas (8, 9) and is based on thinking that is at odds with scientifically validated findings. No objective physical findings or unique historical features define “chronic Lyme disease,” a term used by support groups and their few physician allies, not the academic medical community. Although the subject of much debate, “chronic Lyme disease” is not well defined. The term is usually applied to patients with symptoms, such as fatigue, achiness, malaise, and difficulty …
