title: Ticking the right boxes: classification of patients suspected of Lyme borreliosis at an academic referral center in the Netherlands.
abstract: To provide better care for patients suspected of having Lyme borreliosis (LB) we founded the Amsterdam Multidisciplinary Lyme borreliosis Center (AMLC). The AMLC reflects a collaborative effort of the departments of internal medicine/infectious diseases, rheumatology, neurology, dermatology, medical microbiology and psychiatry. In a retrospective case series, characteristics of 200 adult patients referred to the AMLC were recorded, and patients were classified as having LB, post-treatment LB syndrome (PTLBS), persistent Borrelia burgdorferi sensu lato (s.l.) infection despite antibiotic treatment or no LB. In addition, LB, PTLBS and persistent B. burgdorferi s.l. infection cases were classified as 'definite,' 'probable' or 'questionable.' Of the 200 patients, 120 (60%) did not have LB and 31 (16%) had a form of localized or disseminated LB, of which 12 were classified as definite, six as probable and 13 as questionable. In addition, 34 patients (17%) were diagnosed with PTLBS, of which 22 (11%) were probable and 12 (6%) questionable. A total of 15 patients (8%) were diagnosed with persistent B. burgdorferi s.l. infection, of which none was classified as definite, three as probable and 12 as questionable. In conclusion, in line with previous studies, the number of definite and probable (persisting) LB cases was low. The overall high number of questionable cases illustrates the fact that it can sometimes be challenging to either rule out or demonstrate an association with a B. burgdorferi s.l. infection, even in an academic setting. Finally, we were able to establish alternative diagnoses in a large proportion of patients.
authors: Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands.
authors: J
authors: J
authors: Coumou
authors: Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands.
authors: E A
authors: EA
authors: Herkes
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Neurology, Amsterdam, The Netherlands.
authors: M C
authors: MC
authors: Brouwer
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Neurology, Amsterdam, The Netherlands.
authors: D
authors: D
authors: van de Beek
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Rheumatology, Amsterdam, The Netherlands.
authors: S W
authors: SW
authors: Tas
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam, The Netherlands.
authors: G
authors: G
authors: Casteelen
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Infectious Diseases, Amsterdam, The Netherlands.
authors: M
authors: M
authors: van Vugt
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Dermatology, Amsterdam, The Netherlands.
authors: M V
authors: MV
authors: Starink
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Dermatology, Amsterdam, The Netherlands; Center for Infection and Immunity Amsterdam, Amsterdam, The Netherlands.
authors: H J C
authors: HJ
authors: de Vries
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: B
authors: B
authors: de Wever
authors: Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: L
authors: L
authors: Spanjaard
authors: Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands; Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam, The Netherlands. Electronic address: lyme@amc.uva.nl.
authors: J W R
authors: JW
authors: Hovius
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015748:Borrelia burgdorferi Group / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D055815:Young Adult
keywords: Chronic disease; Lyme disease; multidisciplinary communications; retrospective studies; tertiary care centers