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Guidelines for the Clinical Diagnosis of Lyme Disease
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
The position paper on laboratory diagnosis of Lyme disease [1] is based on a widely accepted paradigm that is inconsistent with a growing body of medical literature. According to this paradigm, cases of Lyme disease are overwhelmingly seropositive and are unlikely to be associated with persistent symptoms after presumed adequate therapy. In addition, any patients remaining persistently symptomatic are presumed to no longer have Lyme disease at all but rather to have such conditions as fibromyalgia, depression, or the chronic fatigue syndrome and, as a result, to be unlikely to respond to additional antibiotic therapy [2]. Such presumptions are inconsistent with an increasing number of reports.
A 1994 article [3] reports the increased frequency of multiple symptoms in previously treated patients with Lyme disease compared with controls. Antibodies on ELISA were found in less than half of the patients with Lyme disease. Re-treatment was associated with improvement in half of re-treated patients. Had the guidelines been followed in a clinical evaluation of these or similar patients, Lyme disease would have been diagnosed in few of them.
In a 1996 report [4], Borrelia burgdorferi plasmid DNA was detectable by polymerase chain reaction assay only in a subset of patients with Lyme disease who were seronegative. Many case reports have described patients with Lyme disease who remain antigen positive and symptomatic despite intensive antibiotic treatment [5].
I suggest the acceptance of a new paradigm that incorporates the above information. Physicians involved in the treatment of Lyme disease should consider that 1) Patients with Lyme disease, especially those in late stages of the disease, are frequently seronegative; 2) the persistence of symptoms, which may be vague, is common and may respond to additional antibiotic therapy; and 3) there is much to be learned about the optimal treatment of Lyme disease at any stage.
Mark E. McCaulley, MD
Steamboat Medical Group; Steamboat Springs, CO 80487
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
