198. More of Everything: Characteristics of Those Seeking Opinions Regarding Lyme Disease
Session: Poster Abstract Session: Diagnostics: Bacteriology, Sequencing, and Resistance
Thursday, October 27, 2016
Room: Poster Hall
  • Kobayashi et al. ID week 2016.pdf (329.5 kB)
  • Background: Some with chronic fatigue or pain express concern regarding Lyme disease. Use of non-FDA approved laboratory-developed tests (LDT) for Lyme disease as well as misapplication of standard serological testing may lead to misdiagnosis and unnecessary antibiotic therapy. We compared patient characteristics of those with LDTs compared to those without LDT.

    Methods: Retrospective review of 1261 patients referred (2000-2013) for concern of Lyme disease. Patients were assessed for symptoms, clinical history, testing, and antibiotic therapy before referral as well as diagnostic conclusions.

    Results: LDTs were identified in 257/1261 (20.4%). These patients compared to those without LDTs had median findings of longer symptom duration (986d vs 482d, P<0.0001), longer prior antibiotic duration (63d vs 42d, P<0.0001), more frequent infection-related testing (4 times vs 2 times, P<0.0001), higher prior co-infection diagnoses (25% vs 8%, P<0.0001) and less likely to result in a final Lyme disease diagnosis at our facility (14% vs 31%, P<0.0001). Among all patients with FDA-approved testing who received prior antibiotics, mean treatment durations were longer with negative serologies (131.8d) than those with positive Lyme IgG Western blot (WB) serologies (74.9d).

    Conclusion: Prior LDTs correlated with substantially longer antibiotic use and greater testing burden and inversely with true Lyme disease diagnoses. This suggests some community practice patterns for this population are considerably distant from accurate diagnosis or recommended treatment for Lyme disease. Enhanced educational efforts for clinicians and patients alike are needed to avoid LDTs, missteps in diagnosis and unnecessary and prolonged antibiotic therapy for patients with and without Lyme disease.

    Takaaki Kobayashi, M.D.1,2, Yvonne Higgins, PA, MAS, MS/ITS2, Roger Samuels, M.D., MPH3, Aurasch Moaven, B.S.4, Paul Lantos, MD, FIDSA5, Michael T. Melia, MD3 and Paul Auwaerter, MD, MBA, FIDSA6, (1)Internal Medicine, Mount Sinai Beth Israel, New York, NY, (2)Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, (3)Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, (4)Medicine, University of Maryland School of Medicine, Baltimore, MD, (5)Medicine and Pediatrics, Duke University School of Medicine, Durham, NC, (6)Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD


    T. Kobayashi, None

    Y. Higgins, None

    R. Samuels, None

    A. Moaven, None

    P. Lantos, None

    M. T. Melia, None

    P. Auwaerter, Biomerieux: Consultant , Consulting fee
    Johnson & JOhnson: Shareholder , equity holding

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.