August 25, 2008

In My Opinion A Different View On Signs And Treatment Of Lyme Disease

By Rita M Rhoads

By Rita M. Rhoads / Special to the Sunday News

In an article on Lyme disease (Aug. 3), there were several inaccurate statements. I will delineate these errors, but will admit one huge truth: Lyme is on an upswing. In our small nurse-midwifery practice we had five pregnant women with Lyme disease in 2007.

As a nurse practitioner, I am also seeing many more patients with Lyme disease than in previous years.

First inaccurate statement: "80 percent of patients with Lyme disease will manifest a bull's-eye rash." Neither of my two young adult children who were diagnosed with Lyme disease years after their initial symptoms had a bull's-eye rash, nor have many of my patients whom I have since proved positive for Lyme through Western blot tests. Of the five pregnant women with Lyme in 2007, two had a history of a bull's-eye rash.

Fact: A study published in the Annals of Internal Medicine in 2002 showed only 9 percent had a bull's-eye rash. Without my citing other studies, this shows a wide variation in the rate of bull's- eye rash in Lyme disease.

Second inaccurate statement: "If a tick is not attached for 48 hours, you won't get Lyme disease." Rutgers University on its National Ag Safety Database Web site states "research indicates that a tick must feed at least 24 hours," half of what was quoted in the Sunday News article, and the timeline most commonly cited in the literature. A baby tick, or nymph, may also transmit illness. The nymph is the size of a pinpoint and is clear, often unnoticed by the victim. In fact, Dr. Virginia Sherr in Practical Gastroenterology, April 2006, states that "about half of fully diagnosed [Lyme] patients have no evidence whatsoever of having had a tick bite."

Lyme is also (rarely) transmitted by other insects. In 1990, the New England Journal of Medicine reported a case of Lyme disease from bites of a fly. There are reports out of Moravia of mosquitoes infected with strains of Borrelia (Lyme). They are researching whether it can be spread by this means. Other modes of transmission may exist. The spirochete that causes Lyme disease has been found alive in semen, urine and breast milk. Tears and saliva also are mentioned on several Web sites. Entire families have been found with active Lyme disease and research is needed to determine the mode of transmission. The blood bank in Sacramento, Calif., has stated it can be transmitted in blood transfusions.

Third inaccurate statement: "It is a myth that Lyme is not cured." This ignores the long-term sequelae suffered by many victims of Lyme disease. The question is three-fold: 1) Is the Lyme still present after treatment? 2) Is the Lyme bacteria eradicated, but damage persists? 3) Are there co-infections that have been left undiagnosed? How many patients with a true Lyme diagnosis, verified by laboratory values, have been treated, but remain with symptoms, often progressively worsening? Why? How many of those have been tested for Bartonella, Ehrlichia, Babesia or Mycoplasma, all infections transmitted by tick bites? The Bartonella rash is different from that of Lyme. Does this account for some rashes that are not the typical bull's-eye, yet respond to antibiotic treatment? There are more than 300 strains of Lyme, for which only one is tested, and 33 strains of Bartonella, for which only two are tested.

One recent study on treatment of Lyme disease, from the University of California, states, "The UC Davis researchers infected three groups of mice with Borrelia burgdorferi, the bacteria that causes Lyme disease. Mice showed comparable symptoms of Lyme disease as humans and responded similarly to antibiotic treatment. One group of mice received antibiotics during the first three weeks of infection, while another got antibiotics four months later. The third group received only a placebo. When the treatments were completed, the placebo group showed continued infection in a standard lab test, while the two antibiotics groups showed no trace of the bacteria using the same test. Nonetheless, researchers still found small numbers of Borrelia persisting in collagen-rich tissue in the antibiotic-treated mice that the lab tests missed."

Of interest is the suit in Connecticut where the attorney general has sued the Infectious Disease Society of America over their treatment guidelines for Lyme disease. The AG contends that IDSA only looked at scientific evidence supporting short-term treatment of Lyme/eradication and did not include long-term treatment/chronic infection scientific evidence. As we all know, Lyme, Conn., is the modern-day seat of an old infection. It will be interesting to see how the suit plays out.

I do not have the answers to all these questions, and prevention is the best cure, but I felt the Sunday News article both portrayed some aspects inaccurately, and oversimplified Lyme disease.

Rita M. Rhoads, of Quarryville, is a certified family nurse practitioner and a certified nurse-midwife.

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