Lyme Disease Continues to Be Top-Of-Mind for Clinicians Based on Past Summer Data

Factors such as climate change, widening distributions of host populations, and better clinician awareness are some of the main reasons for the geographic spread of Lyme disease over the past few months, according to recent data from epocrates.

Acey Albert, MD, director of clinical content at epocrates, is board certified in internal medicine and pediatrics with 15 years of experience in outpatient primary care and medical group leadership. He was able to combine his interest of technology, medicine, and physician leadership as a part of the epocrates team.

Albert explained how there was an increased interest in Lyme disease incidence compared to 2020 among clinicians who use epocrates’ medical application this summer, which measured at a 90% increase YoY.

“This was surprising because, while we know Lyme disease is becoming more common, this was a much steeper increase than we expected,” Albert said in an interview with Contemporary Clinic. “For comparison, CDC data showed a doubling of Lyme disease cases between 1991 and 2018, while cases over the last 3 years of data (most recently, 2019) remained relatively flat.”

The increase in Americans traveling again this year and predictions of a warmer, wetter weather pattern could have also played a major factor in the uptick of Lyme disease this past summer, according to Albert.

As for the main implications that both providers and patients should know about in the spread of Lyme disease, Albert said diagnosis of the disease is highly dependent on the patient’s location and travel history.

“By current CDC and IDSA guidelines, patients with the pathognomonic rash, erythema migrans (EM), and tick exposure in an area where Lyme disease is common can be diagnosed and treated without further testing,” Albert said in an interview with Contemporary Clinic. “Those exposed in areas with Lyme who don’t have EM but have other symptoms require testing.”

These guidelines also focus on when to empirically treat asymptomatic patients with tick bites in areas where Lyme disease is endemic, according to Albert.

“For clinicians, the possible geographic expansion of Lyme means that more of us might need to include it in the differential diagnoses of patients experiencing a fever, headache, myalgia, and joint pain. For patients, it means that more of us should take vital protective measures when venturing outdoors,” Albert said in an interview with Contemporary Clinic.

At epocrates, an issue that was addressed in the summary of Lyme guidelines was how clinicians are often confronted by patients with concerns about chronic Lyme disease at the point-of-care. This term is not usually acknowledged by gold-standard medical organizations, but clinicians are still being asked about it, according to Albert.

Symptoms such as fatigue, pain, and “brain fog” are usually seen in 10% to 15% of patients who are fully treated for the disease, according to the CDC, which is also known as post-treatment Lyme disease syndrome. However, Albert said there have been some controversies around this condition. The society that promotes “Lyme literate” clinicians who believe the condition represents chronic, persistent Borrelia infection, despite a scarcity of evidence supporting this assertion is an example of this issue.

“Unsurprisingly, these tests and treatment aren’t typically covered by insurance, and they’re administered in the offices of those ‘Lyme literate’ providers on a cash-pay basis. (National Institutes of Health)-funded studies show this approach is no better than placebo, and that fatal complications of long-term antibiotic treatment have been observed,” Albert said in an interview with Contemporary Clinic. “Nonetheless, this group is surrounded by large patient advocacy groups with scientific-sounding websites, aggressive social media campaigns, legislative lobbyists, and celebrity spokespeople. As we’ve seen in COVID-19, anti-science disinformation abounds and shapes patient interactions with health care.”

As for suggestions to know about combatting Lyme disease, Albert recommends knowing the evidence-based guidelines for treatment or having a quick, point-of-care reference that summarizes this guidance. Further, keeping an eye out for newer evidence in areas that are more generalized to the rest of the country is also highly recommended.

“Just because there’s Borrelia in ticks around the San Francisco Bay area doesn’t necessarily mean that clinicians in Denver need to think about Lyme disease right now. That said, the study is likely to raise interest in broader investigations of the current geographic range of the disease, and clinicians should be ready to adapt,” Albert said in an interview with Contemporary Clinic.