A Medical Mystery: Diagnosis of Lyme Disease

Authored by: Carissa Nair

Art by: Fiona Reilly

Commonly referred to as “The Great Imitator,” Lyme disease is a condition characterized by a history of medical chaos. Its mode of transmission appears straightforward: a bacterial infection caused by the bite of blacklegged ticks [1]. However, some of the highest rates of medical misattribution, especially with regard to neuropsychiatric symptoms, are associated with Lyme disease [2]. Moreover, a recent study by Shapiro et al. investigated how scientific unreliability with the two-tier test for the disease, overlapping characteristic symptoms, and differential symptom progression in afflicted patients affect diagnostic capabilities [3]. In some cases, patients with Lyme disease are incorrectly diagnosed with alternative disorders–but a growing body of literature attempts to establish a more concerning trend: the potential causal role of Lyme disease in the development of neurodegenerative disorders.

In 2023, Sanchini et al. examined a case of Lyme disease proving to be a precursor to reversible dementia. Their research article presented a case study as evidence, focusing on a 75-year-old patient who presented with a range of neuropsychiatric symptoms: hallucinations, confusion, aggression, memory loss, and aphasia. Following treatment with traditional antipsychotic medications, his blood was found to contain Lyme antibodies. Subsequent treatment with antibiotics was associated with significant symptom reduction and eventual clinical discharge [4]. The precipitating event that led to this patient’s discharge was the fact that no single psychiatric diagnosis, including dementia, fit the range and extent of his symptoms. Similarly, in 2022, a case study by Tulane researchers examined the diagnosis of a 69-year-old woman who initially tested positive for Lyme disease and later for lewy body dementia, suggesting a potential correlation between the two diseases, which remains a subject of scientific debate [5]. The case studies show the surprising correlation, then, between Lyme disease and neurodegenerative disorders.

In an interview with Dr. Sanor, a physician from NEOMED, who is one of the healthcare providers leading the discussion about a potential correlation between neurodegenerative disorders and Lyme disease. In Brain Day events she has organized with the medical school, she has discussed the overwhelming prevalence of Lyme disease, which is three times more prevalent than diseases like syphilis, and its potential connections to schizophrenia, dementia, and related chronic illnesses. As the only spirochete bacteria that can invade the brain and spinal cord, its medical manifestations are particularly debilitating. The primary focus of her discussions is Lyme neuroborreliosis, more commonly referred to as Long lyme disease. This is where there is a long-term inflammation of the CNS through bacteria that infects through the circulatory and peripheral nerves [6]. It is also associated with dementia syndrome in advanced stages of progression.

Lyme disease, a frequently misdiagnosed medical condition, can be especially debilitating due to the ability of the Borrelia burgdorferi bacteria to infect the central nervous system. In advanced stages, this invasion can lead to the development of neuropsychiatric symptoms characteristic  of long-Lyme disease. Although this remains a subject of debate among researchers across the world, scientists have, in recent years, also investigated a causative role between Lyme disease and neurodegenerative disorders like ALS, dementia, and Alzheimer’s.

References

1. Mayo Clinic Staff. (2023, February 10). Lyme disease: Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/lyme-disease/symptoms-causes/syc-20374651 (mayoclinic.org)

2. Kobayashi, T., & Auwaerter, P. G. (2022). Diagnostic Testing for Lyme Disease. Infectious disease clinics of North America, 36(3), 605–620. https://doi.org/10.1016/j.idc.2022.04.001

3. Shapiro, E. D., Baker, P. J., & Wormser, G. P. (2017). False and Misleading Information About Lyme Disease. The American journal of medicine, 130(7), 771–772. https://doi.org/10.1016/j.amjmed.2017.01.030

4. Sanchini, C., Papia, C., Cutaia, C., Poloni, T. E., & Cesari, M. (2023). A Case of Reversible Dementia? Dementia vs Delirium in Lyme Disease. Annals of geriatric medicine and research, 27(1), 80–82. https://doi.org/10.4235/agmr.22.0128

5. Gadila, S. K. G., Rosoklija, G., Dwork, A. J., Fallon, B. A., & Embers, M. E. (2021, May 10). Detecting Borreliaspirochetes: A case study with validation among autopsy specimens. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.628045 (frontiersin.org)

6. Bashchobanov, D. H., Stamatova, E., Andonova, R., Dragusheva, E., Gadzhovska, V., & Popov, G. (2024). Lyme Neuroborreliosis in the Context of Dementia Syndromes. Cureus, 16(8), e67057. https://doi.org/10.7759/cureus.67057