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Recurrent Human Granulocytic Ehrlichiosis and Lyme Disease
- Harold W. Horowitz, MD;
- Maria E. Aguero-Rosenfeld, MD; and
- Gary P. Wormser, MD
- Westchester Medical Center; Valhalla, NY 10595 (Horowitz) Westchester Medical Center; Valhalla, NY 10595 (Aguero-Rosenfeld) Westchester Medical Center; Valhalla, NY 10595 (Wormser)
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IN RESPONSE:
Dr. Johnson comments that our patient with recurrent human granulocytic ehrlichiosis and recurrent Lyme disease did not develop antibodies to B. burgdorferi after her initial infection in 1994. Lack of seroreactivity to Lyme borrelial antigens has been reported to occur in about 10% of treated patients with culture-proven erythema migrans when serial antibody testing is done (1), for reasons not yet established. Dr. Johnson also makes the point that after the second episode of erythema migrans in July 1997, the Western blot became negative by 3 months whereas the ELISA result remained positive. He notes that the ELISA result would have been interpreted as falsely positive, citing the American College of Physicians guidelines for laboratory diagnosis of Lyme disease (2).
Dr. Johnson is confusing the use of the two-tier testing for diagnosis of Lyme disease with the issue of the natural history of antibodies to B. burgdorferi in patients who have been successfully treated for Lyme disease. In our experience, an alternative serologic outcome—in which Western blot reactivity outlasts ELISA positivity—may also occur. The duration of reactivity of either test is likely to depend on the sensitivity and specificity of the particular immunoblot and ELISA used.
Dr. Johnson also asks whether the patient remains at risk for yet another episode of infection with B. burgdorferi. There is no reason to think that this patient is now protected from reinfection. We have seen several patients who have had three separate episodes of erythema migrans. Although a recombinant outer- surface lipoprotein A preparation with adjuvant has been licensed for vaccination of humans to prevent Lyme disease, there is still much to be learned about protective immunity against infection with B. burgdorferi(3, 4).
Maria E. Aguero-Rosenfeld, MD
Westchester Medical Center; Valhalla, NY 10595
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
