THE OVERDIAGNOSIS OF LYME-DISEASE IN CHILDREN RESIDING IN AN ENDEMIC AREA

The medical records of 227 children ages 1 to 19 years referred to the Lyme disease pediatric clinic over a 32-month period since May 1990 w ere reviewed. Clinico-serologic criteria for a positive diagnosis were applied. One hundred thirty-eight of 227 referred children did not fu lfill those criteria and became the study population. Four subsets of patients emerged: (1) 54 patients with predominantly subjective sympto ms; (2) 52 patients with objective evidence for an alternative diagnos is; (3) eight patients who had documented infection in the past and co ntinued with symptoms after antibiotic treatment; and (4) 24 patients with a history of tick attachment or prenatal/family history of Lyme d isease. Serologic testing data from commercial laboratories were avail able for the 54 children from the ''predominantly subjective'' group; 50% were negative, and 50% were borderline or positive. Ninety-two per cent of these patients were negative at retesting by our enzyme-linked immunosorbent assay (ELISA) and 100% were negative by Western blot. F ifty-seven percent of these patients had received treatment prior to o ur evaluation. Children residing in an endemic area who present with v ague symptoms are being diagnosed with and treated for Lyme disease wi thout clinical or serologic documentation. In addition, fear in the la y community may be inducing doctors to diagnose Lyme disease in patien ts with symptoms that may be suggestive of an alternative diagnosis.