Underdiagnosis of neuropsychiatric Lyme disease in children and adults
Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi. Reported throughout the United States, the greatest incidence of Lyme disease occurs in certain areas, such as the Northeast, the upper Midwest, and the Pacific Coastal states. It has been dubbed “The ‘New Great Imitator” because, like another spirochetal illness neurosyphilis—the original Great Imitator, Lyme disease has a vast array of multisystem manifestations, including neuropsychiatric ones. Failure to recognize Lyme disease early in its course can result in the development of a chronic illness that is only temporarily or partially responsive to antibiotic therapy. The goal of this article is to present the typical and atypical manifestations of Lyme disease in children and adults in order to help the clinician more rapidly unmask the correct diagnosis behind the puzzling presentations of some patients.