The challenge of Lyme disease: tired of the Lyme wars
In their review, Coumou et al. provide a hypothetical case, in which the pre-test probability of Lyme disease is 0.5%. Not surprisingly, their calculations reveal that the predictive value of a positive test is very low. This confirms the textbook knowledge that screening tests for a disease with a likelihood of 0.5% are irrational. However, their example does not apply to patients with specific symptoms after a tick bite or erythema migrans, whose chance of having Lyme disease may be anywhere between 5 and 95%, depending on their ndividual situation.
Excerpted from The Netherlands’ Journal of Medicine
Few diseases have aroused more emotional attention in the press and the public than Lyme Disease. Discussions have not only focused on the increasing incidence or the choice of appropriate treatment, but also on perceived inadequacy of serological testing and whether or not persisting fatigue, cognitive dysfunction and musculoskeletal pain are ‘real disease’ and related to persistent infection. Large numbers of patients with such symptoms attributed to Lyme disease seek medical opinions, but no consensus on approach or treatment exists.
In this issue of the Journal, Coumou et al. provide a review on several aspects of Lyme Disease.
For the full PDF: http://www.zuidencomm.nl/njm/getpdf.php?id=10000692
Lyme Handbook 