Lyme Disease: Tick-Bourne Trouble

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Dr. David J. Holcombe
Dr. David J. Holcombe

Lyme disease, first described by Dr. Willy Burgdorfer in 1892, has evoked a tremendous amount of interest in the scientific and mainstream press.  The disease, caused by a spirochete, Borrelia burgdorferi, occurs in certain host animals, such as the white-tailed deer, and can be transmitted to humans through the bite of the infected deer tick (or black legged tick), Ixodes scapularis.  As anyone who enjoys the outdoors knows, ticks are extremely common, and the deer tick is found throughout the East, South and Western Great Lakes regions in the United States.

 

If bitten by an infected tick, there is a 3 day to one month incubation period, followed by the appearance of a typical bull’s eye-like rash, up to 20 inches in diameter, known as “erythema migrans”.  This is often accompanied by fever, headache, fatigue and muscular and joint pains.  If the disease is identified, the patient can receive a two to four week course of antibiotics—either doxycycline or amoxicillin—with complete resolution of the disease.

 

There are laboratory tests for Lyme disease whose interpretations are very problematic for patients outside of the limited endemic areas mentioned above.  For those with a clear history of tick exposure and clear symptomatology from the appropriate geographical regions, a screening test (ELISA or enzyme-linked immunosorbant assay) and confirmatory test (Western Blot) are both required.   There are other screening tests, including the ILA (Immunofluorescent assay), C6 and PreVue B. burgdorferi Antibiody Detetection Assay.  Unfortunately, the multiplicity of tests, especially when performed in those with a low probability of disease, leads to numerous false-positive diagnoses, meaning the patient does not actually have Lyme disease.  About 5% of the general population will have a false positive IgM Western Blot, sometimes caused by common viruses (Cytomegalovirus, Epstein-Barr virus, Varicella-Zoster or Herpes Simplex) or rheumatoid arthritis, lupus or syphilis.  In addition, some laboratory tests are not recognized

by the CDC or the Infectious Diseases Society of America (IDSA) as being valid for making a definitive diagnosis of Lyme disease. Thus, over-diagnosis is a rampant problem.

 

One curiosity about the proliferation of purported Lyme disease is that it does not follow the disease’s true geographic distribution.  While the deer tick is found all over the Eastern and Southern United States, true cases of Lyme disease are densely concentrated in the Northeast and the Western Great Lakes region.  Rare cases have been reported elsewhere, often related to travel to endemic areas.  The exact explanation for this limited geographical disease distribution is unclear, although it suggests the tick might feed on non-deer hosts that do not transmit the disease outside of the limited Northern concentrations.  Under any circumstances, it is best to avoid ticks, since they carry a number of other diseases, notably Rocky Mountain spotted fever, which is found in the Mid-Atlantic and Southern states as well.

 

Aggravating the difficulties of making a correct diagnosis, there has been a proliferation of providers specializing in the treatment of a so-called “Chronic Lyme Disease,” an entity which has no basis in medical fact.  A whole group of self-described “Lyme Literate Medical Doctors” (LLMDs) has emerged and has promulgated their own “Official Guidelines” (not recognized by the CDC or IDSA) for treatment of Chronic Lyme Disease.  Such physicians may recommend treatments are  that are unproven and unsafe, including  Malaria therapy, intracellular hyperthermia therapy with DNP (2,4-dinitrophenol), hyperbaric oxygen therapy, colloidal silver, electromagnetic “rife machines”,  and injections with hydrogen peroxide or bismacine.

 

Some LLMDs use prolonged, recurrent courses of IV antibiotics, including ceftriaxone, which can provoke gallstones and sometimes result in line-associated sepsis.  Some sufferers become “antibiotic addicts”, who insist on repeated courses of IV and oral antibiotics, even as the risks of such treatments exceed the purported benefits.  Recurrent antibiotic use can cause a constellation of uncomfortable symptoms, including fever, chills, tachycardia and muscle aches.  These “Jarish-Herxheimer Reactions”—popularly called “herxing”—are actually accepted and requested by certain patients who feel that suffering is necessary to achieve a cure. All such unsubstantiated treatments have caused harm to some patients, including death, and have resulted in the subsequent sanctioning of practitioners, up to and including loss of licensure, fines and jail time.

 

Fortunately, true Lyme disease and most other tick-borne diseases are readily treated with oral antibiotics.  Lyme disease does not remain indefinitely in the body, and the myth of “Chronic Lyme disease” should be put to rest.  Unexplained symptoms frustrate patients, especially if they cannot get what they consider to be a reasonable explanation.  Suffers may seek an unreasonable explanation, which they sometimes defend with great passion.  A complicit practitioner, therefore, becomes part of the problem, not part of the solution.