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October 2014

Lyme Disease: Authentic Imitator or Wishful Imitation?

Author Affiliations
  • 1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina
  • 3Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
JAMA Neurol. 2014;71(10):1209-1210. doi:10.1001/jamaneurol.2014.1193

The spirochete Borrelia burgdorferi may afflict skin, heart, joints, and the central or peripheral nervous system. This agent of Lyme disease, perhaps because of its varied presentations, is often raised as the cause of headache, fatigue, and subjective neurocognitive dysfunction. For clinicians who trained in the 20th century when the spirochete Treponema pallidum was invoked as the “Great Imitator,” testing for Lyme disease now seems as or more common than it had been for syphilis. With a narrower disease spectrum than syphilis, is such frequent testing for Lyme disease justified, and how should results be interpreted?