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.