Lyme Topics 
Lyme Disease Story of Lyme Disease
Lyme Disease Story of Lyme Disease
Story of Lyme Disease
Indeed, children were integral to the identification of Lyme as a new, tick-borne bacterial threat during the summer of 1975 in the coastal town of Lyme, Connecticut. A concerned mother noticed an unusual cluster of juvenile rheumatoid arthritis cases in her section of Connecticut and finally asked Yale University for an investigation. The doctors who responded eventually concluded that an infection was responsible for both the arthritis and the neurological symptoms, such as Bell’s palsy (paralysis of half the facial muscles) and heart rhythm abnormalities, which were emerging among the patients. Many of the affected people reported finding a circular red rash with a central clearing that resembled a target or “bull’s-eye” prior to the onset of their other symptoms. This clue helped investigators realize that the bacteria were probably spreading through the bite of an infected tick, spider, or insect; and, eventually, the small deer tick (Ixodes scapularis species) was identified as the culprit.
Researchers soon discovered the cause of Lyme symptoms to be a spiral-shaped bacteria called a spirochete, the same class of bacteria that causes syphilis and periodontal disease among other ailments (Burgdorfer and others 1982). The species responsible for Lyme symptoms was named Borrelia burgdorferi after its discoverer, Dr. Willy Burgdorfer of the National Institutes of Health (NIH).
The experts also came to attribute a plethora of signs and symptoms to Lyme disease. Its manifestations were found to be so broad that it earned the nickname “The Great Imitator” of dozens of other medical conditions (Pachner 1988, Blanc and GEBLY 2007). As researchers at a Philadelphia hospital noted in 2000, “Lyme neuroborreliosis is diagnostically challenging because of its diverse manifestations” (Zhang and others 2000). Frequent symptoms include incapacitating fatigue (Steere and others1984), musculoskeletal “joint” pain (Steere and others 1983, Schmid 1989, Steere and others 1988), pain and odd nerve sensations in the extremities (Halperin and others 1987, Shadick and others 1994, Weissenbacher and others 2005, Fallon and others 1998), and cognitive and mood disorders such as memory loss (Logigian and others 1997, Krupp and others 1991, Kaplan and others 1992), concentration difficulties (Reik and others 1995, Sigal 1990, Vrethem and others 2002) and depression (Logigian and others 1997, Duray and Steere 1988).
In living up to its title as “The Great Imitator,” Lyme can mimic and be misdiagnosed as serious autoimmune conditions such as multiple sclerosis (Pachner 1988, Oksi and others 1996, Reik and others1985, Trock and others 1989, Duray 1989), lupus (Duray and Steere 1988), and Lou Gehrig’s disease (Halperin and others 1990, Frederickson and Link 1988, Hansel and others 1995), as well as devastating conditions ranging from Alzheimer’s disease (Miklossy 1993, Miklossy and others 2004, Miklossy and others 2006, MacDonald 1986, MacDonald and Miranda 1987, Waniek and others 1995) to schizophrenia (Hess and others 1999, Roelcke and others 1992). This characteristic of the infection seriously complicates proper diagnosis.
Patients are fortunate if they observe the tell-tale “bull’s-eye” rash at the time of their tick bite, which allows them to seek prompt antibiotic treatment. Studies have shown, however, that 50 percent or less of all patients with confirmed or suspected late-stage Lyme disease see this rash (Donta 2002). Harvard Medical School Professor Jonathan A. Edlow, M.D., reported in 2002 that the traditional “bull’s-eye” rash is no longer the most common rash associated with a Lyme-infected tick bite (Edlow 2002). Once flu-like symptoms begin to afflict the whole body, the infection is considered to be disseminated or Stage 2, and the march towards the serious Stage 3 neurological symptoms listed above begins.
Studies have shown that the financial and emotional cost of disseminated Lyme disease can be severe. Shadick and others (1994) found that "Persons with a history of Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal memory impairment when compared with those without a history of Lyme disease. Our findings suggest that disseminated Lyme disease may be associated with long-term morbidity." Seven years later, researchers announced that patients with chronic symptoms following a bout with Lyme disease suffer a quality of life equal to someone with osteoarthritis or congestive heart failure and worse than someone with Type 2 diabetes or a recent heart attack (Klempner and others 2001). The Centers for Disease Control noted that “The longterm sequelae of LD [Lyme disease] are debilitating to patients and costly to society” (Zhang and others 2006). Finally, March 2008 witnessed the publication of a Columbia University study which re-inforced these earlier findings and added that patients complaining of chronic Lyme disease also suffer fatigue comparable to that caused by multiple sclerosis (Fallon and others 2008).
As the twenty-first century opens, serious dilemmas in the diagnosis and treatment of Lyme disease remain unresolved. Johns Hopkins University announced that a clinical diagnosis of Lyme disease – one based on the patient’s history and symptoms rather than blood or urine tests – is "still the most appropriate approach," because "the degree of sensitivity needed for a high level of assurance at the time of early Lyme disease is still not obtainable, even through combinations of various laboratory tests” (Coulter and others 2005). Current Lyme serological testing is known to lack both sensitivity (to the presence of the infection) and specificity (the ability to distinguish between Lyme and similar spirochetal infections, such as syphilis and periodontal disease). Unreliable testing can result in both false positives and more often false negative results on blood tests, which underlies the recommendation from Johns Hopkins that doctors rely on patient history and complaints rather than currently-available blood tests to diagnose Lyme.
Perhaps the most contentious area of debate revolves around patients who have received a month or more of antibiotics for Lyme disease yet continue to suffer from persistent symptoms. The Infectious Disease Society of America (IDSA) acknowledges in its 2006 treatment guidelines for Lyme and two other tick-borne infections that “unexplained chronic subjective symptoms” persist in “a minority” of patients who have already received “treatment with conventional courses of antibiotics for Lyme disease” (Wormser and others 2006). Although not offering a firm or thorough explanation for this phenomenon, the IDSA suggests that these symptoms may result from an undiagnosed and untreated tick-borne co-infection—which would produce symptoms similar to Lyme—or even an emotional reaction to the past infection with Lyme. The IDSA authors also note, “In many patients, posttreatment symptoms appear to be more related to the aches and pains of daily living rather than to either Lyme disease or a tickborne coinfection. Put simply, there is a relatively high frequency of the same kinds of symptoms in ‘healthy’ people” (Wormser and others 2006). Thus, Wormser and his co-authors dismiss some patients’ complaints of fatigue, pain, and memory dysfunction due to “the high frequency of identical complaints in the general population” (2006). Accordingly, the IDSA recommends that doctors seek alternative diagnoses for these complaints and provide therapies for symptom relief.
Research has suggested that “post-Lyme syndrome” (as the IDSA prefers to call it) results from an autoimmune reaction to the Lyme bacteria, in which the immune system does not shut down after the Lyme bacteria are eliminated, resulting in damage to healthy, normal body tissues. Studies have shown that some people possess certain genetic traits called HLA-DR4 and HLA-DR2 which result in a severe, persistent, and autoimmune-like arthritic reaction when they are exposed to the Lyme spirochete, whether in a vaccine or in nature (Steere and others 1990). This theory might explain the depth of suffering that some people experience once infected with Lyme and the ability of Lyme to mimic autoimmune conditions. A significant effort to identify a common genetic marker besides HLA-DR4 and HLA-DR2 among all those claiming to suffer “post-Lyme” symptoms failed (Klempner and others 2005), leading some to abandon this theory as insufficient to explain “post-Lyme” suffering.
A third explanation for continuing Lyme symptoms, one embraced by many physicians and patients, is that the Lyme bacterium is capable of surviving the short-term doses of antibiotics currently administered to become a persistent and bedeviling infection. A significant number of studies have documented the cultivation of live Lyme spirochetes or their DNA from the bodies of patients who have already received one or more rounds of antibiotics (e.g., Oksi and others1999, Breier and others 2001, Hudson and others 1998). Some studies, written by prominent members of the IDSA, have posited persistent Lyme infections as the cause of persisting symptoms (Halperin and Heyes 1992, Liegner and others 1993, Dattwyler and others 1988, Breier and others 2001, Steere and others 1988, Logigian and others 1990). Still other studies have explored the exact mechanisms by which the spirochetes are believed to evade eradication by either antibiotics or the immune system (Klempner and others 1993, Georgilis and others 1992, Liang and others 2002, Diterich and others 2003, Seiler and Weis 1996, Murgia and others 2002, Duray and others 2005, Brorson and Brorson 1998, Alban and others 2000, Barbour and others 1982, Radolf and others 1994, Benach 1999, Barbour and Hayes 1986, Sadziene and others 1994, Kurtti and others 1987, Aberer and others 1996, Mursic and others 1996, Embers and others 2004, Garon and others 1989, Livengood and Gilmore 2006, Ma and others 1991, Dorward and others 1997, Jackson and others 2007).
Clinicians who believe that Lyme can be a persistent and relapsing infection often treat their patients with combinations of antibiotics over a long period until symptoms resolve, not according to the short-term treatment schedules set forth by the IDSA. This approach to treatment has put these physicians, frequently called “Lyme-literate” doctors, at odds with the IDSA, which denies that the Lyme bacteria can persist in the human body after a month or two of antibiotic therapy.
Many medical professionals who espouse long-term treatment of a resilient Lyme infection have organized themselves into a medical society called the International Lyme and Associated Diseases Society (ILADS). They hope to begin a dialogue with the IDSA and other sectors of the medical community about the growing threat of Lyme and tick-borne infections which do not seem to resolve in some patients. Unfortunately, the rancorous debate over the possibility of persistent Lyme infection and the best way to provide relief to suffering patients continues. ILADS doctors who disagree with the short treatment recommendations of the IDSA sometimes find themselves investigated and tried by their state medical licensing board for breaking with the IDSA.
Meanwhile the IDSA’s own 2006 Lyme treatment guidelines, quoted above, underwent an antitrust, monopolization, and exclusionary conduct investigation by the attorney-general of Connecticut, Richard Blumenthal. AG Blumenthal sought to know whether the IDSA ignored crucial and relevant data about the seriousness and persistence of Lyme infections when it formulated its treatment guidelines in 2006, quoting about two percent of the published literature about Lyme available at the time and ignoring treatment guidelines published two years earlier by the ILADS (Cameron and others 2004).
On May 1, 2008, AG Blumenthal announced a settlement between the State of Connecticut and the IDSA, in which the IDSA agreed, among other things, to re-assess its Lyme treatment guidelines by an entirely new panel of experts in a process overseen by an expert in medical ethics, Dr. Howard A. Brody, author of the book Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry.
The reason for this forced reassessment of the IDSA's guidelines for Lyme is the fact that AG Blumenthal’s antitrust investigation of the IDSA found "undisclosed financial interests held by several of the most powerful IDSA panelists. The IDSA's guideline panel improperly ignored or minimized consideration of alternative medical opinion and evidence regarding chronic Lyme disease, potentially raising serious questions about whether the recommendations reflected all relevant science" (quoted from AG Blumenthal’s May 1 press release, available at http://www.ct.gov/ag/cwp/view.asp?a=2795&q=414284. AG Blumenthal's investigation found that the IDSA broke its own internal ethical policies in the selection of its Lyme expert panel, in its exclusion of scientists and medical studies with divergent opinions on chronic Lyme infections, and in its collaboration with another medical society (the American Academy of Neurology) to create a false sense of "consensus" within the medical community about the cause of persisting Lyme symptoms.
Unfortunately, the IDSA’s reevaluation of its 2006 guidelines produced no meaningful change. Rather, the IDSA review panel stood by the 2006 guidelines as being accurate to current science. Therefore, patient advocacy groups were heartened by the decision of the Institutes of Medicine (IOM) in late 2010 to conduct hearings into the “state of the science” regarding tick-borne infections. The patient community eagerly awaits an accurate and objective assessment of the weaknesses in current Lyme diagnostic and treatment paradigms so that relief will come to the many thousands who are suffering.
As the attorney-general of Connecticut found in his antitrust investigation, policy-makers are divided over the significance of some scientific data about Lyme disease, resulting in confusion and lack of awareness among doctors and the public alike. As the cantankerous national debate about Lyme and related diseases continues, the National Capital Lyme and Tick-Borne Disease Association remains committed to informing both the Lyme community and the public about the scientific and political developments surrounding tick-borne diseases so that affected patients may better advocate for their own healthcare.
Other sources of information
Published Treatment Guidelines from the Infectious Disease Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS):
IDSA http://www.journals.uchicago.edu/doi/full/10.1086/508667
ILADS http://www.ilads.org/files/ILADS_Guidelines.pdf
Other web sites which may contain useful overviews of the crucial issues related to Lyme: (Please note: The National Capital Lyme and Tick-Borne Disease Association does not endorse or necessarily agree with the content found at these sites.)
The Turn the Corner Foundation http://turnthecorner.org/content/facts-about-lyme
The Centers for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/lyme/
The Lyme Disease Research Studies Center at Columbia University in New York City http://www.columbia-lyme.org/patients/controversies.html
The International Lyme and Associated Diseases Society Basic Information page http://www.ilads.org/lyme_disease/about_lyme.html
The National Institutes of Health: Two Web resources available at these sites: http://www3.niaid.nih.gov/topics/lymeDisease/understanding/intro.htm and http://www3.niaid.nih.gov/topics/lymeDisease/PDF/LymeDisease.pdf
The Rhode Island Department of Health http://www.health.ri.gov/diseases/lyme/
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