Why do patient symptoms vary so much? Everyone seems to have different symptoms so how can we be sure we all have Lyme disease?
There is virtually no illness in which a specific disease manifests the exact same way in everyone who has that disease. For example, if a woman goes through menopause, she may experience primarily hot flashes or night sweats, or she may have difficulty sleeping, or low energy, or mood swings, or depression, or vaginal dryness, or decreased libido, or difficulties with focus, memory, and concentration, or some combination of all of these.
Lyme disease is much more complicated than menopause, and it is not surprising that it can present in many different forms. It is so varied, in fact, that we often call it the “great masquerader.” And, of course, we are often not only dealing with the Lyme spirochete, Borrelia burgdorferi, but also with the the accompanying co-infections which include Bartonella, Babesia, Ehrlichia, and Mycoplasma. If that were not complicated enough, the weakened immune system produced by the Lyme infection(s) allows for other opportunistic infections which had been latent in the patient to show up as well, including Epstein-Barr virus, Cytomegalovirus, HHV6 (Human Herpes Virus 6), and Chlamydia pneumoniae, among others.
I hope this explains why symptoms vary so extensively. The second aspect to this question is even more difficult: how can we be sure that any individual truly has Lyme disease and all that entails? The most accurate answer is that certainty is very difficult to come by. Our tests are not as accurate as we would like, and we base a great deal of our treatment plan around how our patient responds to our presumed diagnosis and treatment. Improvement in our patients may take weeks or months to occur. This leaves us frequently uncertain about our decisions and choices, but hopeful that the choices were the right ones for that individual. It would be wonderful if we could bring a great deal more scientific analysis to the table, but at this moment we have to make do with what we have.
If an individual requires certainty to make these difficult choices, they may be faced with waiting a long time to decide on a treatment plan, and if that individual does have Lyme disease and associated co-infections, waiting is likely to lead to a significant progression of their illness.