however the diagnostic criteria would make a key difference as to who was
possibly misdiagnosed and who was not - even by these researchers. As the
authors note, there are similar complexities involved in the diagnosis of
Lyme disease.
QJM. <http://www.ncbi.nlm.nih.gov/pubmed/22301822?dopt=Abstract#> 2012 Feb
1. [Epub ahead of print]
Lyme disease in a British referral clinic.
Cottle LE<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Cottle%20LE%22%5BAuthor%5D>
, Mekonnen E<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mekonnen%20E%22%5BAuthor%5D>
, Beadsworth MB<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Beadsworth%20MB%22%5BAuthor%5D>
, Miller AR<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Miller%20AR%22%5BAuthor%5D>
, Beeching NJ<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Beeching%20NJ%22%5BAuthor%5D>
.
Source
From the Tropical and Infectious Disease Unit, Royal Liverpool University
Hospital, Prescot Street, Liverpool L7 8XP, UK.
AbstractBACKGROUND:
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.
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