The great imitator produces numerous symptoms and illnesses.

Recognising Lyme borreliosis is difficult because it can produce a wide variety of diseases and symptoms – the first major imitator was syphilis. The two pathogens can be considered related, as both belong to the spirochaete family, Dr. Erik Kolbenheyer, internist, gastroenterologist, family physician, occupational health specialist and doctor of traditional Chinese medicine, told Weborvos. He added that the borrelia bacterium that causes Lyme disease is a smarter version of this, but it is also important to note that we cannot talk about a single strain, as there are many subspecies. He added that the Borrelia bacterium that causes Lyme disease is a smarter version of this, but it is also important to note that we cannot talk about a single strain, as there are many subspecies.

In Central Europe, we know of four to six human pathogenic subspecies that can cause disease in humans – it is precisely this diversity that causes diagnostic difficulties. The subspecies trigger different laboratory reactions, but sometimes they do not trigger any reaction at all or cannot be detected. Each of the different sub-strains has its own characteristics, depending on which one is dominant. Some prefer joints, others the nervous system, explains Dr. Erik Kolbenheyer.

Patients visit his practice with all kinds of symptoms. From the point of view of Lyme disease, it is particularly suspicious if a patient has been struggling with various health symptoms for years in the healthcare system.

There is a questionnaire that helps both doctors and patients, developed by Dr Richard Horowitz, an American doctor specialising in Lyme borreliosis. The questionnaire is called the Horowitz questionnaire. It lists the most common symptoms of Lyme disease and can therefore be used as an initial screening tool to assess the risk of this tick-borne disorder. It uses a scoring system to help guide the assessment: if someone scores 45 points or more, they are likely to be infected.

When people start searching and researching because something hurts or is not working as it should, they cannot even articulate what is wrong with them because they are struggling with such complex problems and the symptoms fluctuate and vary so much that one week they have gastroenterological problems, the next week cardiological problems, and the third week rheumatological problems. This group of patients seeks help from at least four or five different specialists.

“Since we always want to establish a specific diagnosis for each organ system, we are in a difficult situation because the patient presents with symptoms suggestive of a different disease the following week. This makes it very difficult to get a clear picture of what is wrong with the patient,” says Dr Kolbenheyer, outlining the diagnostic challenges.

He also finds that, thanks to the increasing amount of information available, patients are reading more and more about the disease. In his opinion, Lyme borreliosis has become somewhat of a “fad”: it is becoming increasingly well known in English and German literature, and recently in Hungarian literature as well.

“Some patients come in saying they think they have Lyme disease, and some even bring their final reports from the last five or six years. This leads the doctor to believe that the patient has Lyme disease and to try to confirm this in some way. But here comes the difficult part! Sometimes laboratory confirmation is not available because of some technical obstacle, and the more chronic the disease, the weaker the immune response,” he explains. “In such cases, we may not be able to confirm the infection with laboratory tests, and we can only rely on the symptoms. I have encountered a wide variety of patients, as these patients present with a wide range of problems, from abdominal pain to neurological symptoms and joint complaints.”

What makes a doctor most suspicious that they are dealing with Lyme disease? Migratory joint pain is always suspicious, but strange neurological symptoms and bizarre neuropsychiatric conditions can also arouse a doctor’s suspicion. With the central nervous system affected, Lyme borreliosis can cause virtually any neurological and psychiatric symptoms.