Magazine article Drug Topics

Lyme Disease Up Close and Personal: 'Or, What I Learned about This Enigmatic Disease'

Magazine article Drug Topics

Lyme Disease Up Close and Personal: 'Or, What I Learned about This Enigmatic Disease'

Article excerpt

'Or, What I learned

about this enigmatic disease'

'How many cases do you need before you say, This is not anecdotal; we have to reassess our entire approach to the treatment of Lyme disease?' Kenneth B. Liegner

I've spent almost a year recovering from Lyme disease--at least, I think I have. To tell you the truth, I'm not positively sure I had Lyme disease in the first place. Some physicians said I had a clear-cut case, and others said that despite four positive Western Blots, along with debilitating fatigue, fever, chills, muscle aches, and stiffness, I did not have Lyme disease.

Assuming that I did have Lyme, I'm not sure I was treated appropriately. Did I really need seven courses of antibiotics, including one month of intravenous therapy? And my No. 1 question-is it gone? I feel better, but I can't help wondering whether Borrelia burgdorferi, the nasty bacterium that causes Lyme disease, is still hiding out somewhere in my body waiting for the right moment to once again prey on my immune system.

During the course of my illness, my biggest obstacle was getting information about the treatment of Lyme disease. I'm a pharmacist-I understand diseases and drugs. I'm a medical journalist--I know how to ask questions and where to look for answers. But, as I learned firsthand, Lyme disease isn't a clear-cut infectious illness. The symptoms can be vague, the accuracy of diagnostic tests is questionable, and the optimal treatment regimens are the subject of much controversy.

Diagnostic dilemma Caused by the transmission of Borrelia burgdorferi from a tick to a human host, Lyme disease is a rapidly emerging infectious disease, accounting for 90% of all vector-borne illnesses in the United States, according to the Centers for Disease Control & Prevention.

Early Lyme disease is characterized by the appearance of a rash called erythema migrans (EM). The rash may or may not be accompanied by flu-like symptoms, including fever, chills, headache, arthralgias, joint pain, stiffness, and fatigue. As time goes on, the spirochete disseminates, targeting various organ systems, causing cardiac abnormalities, neurologic symptoms, arthritis, and other maladies.

Left untreated, late-stage Lyme disease can have severe consequences, resulting in encephalitis, heart block, and chronic arthritis. Sometimes, Lyme disease symptoms persist even after treatment. Some experts, who believe the symptoms are caused by immunologic factors, call this condition "post Lyme syndrome." Other experts believe the chronic symptoms are due to chronic persistent infection and label the condition "chronic Lyme disease."

According to Dennis T. Davis, M.D., M.P.H., coordinator of the CDC's Lyme Disease Program, 15,000 cases of Lyme disease were reported by states to the CDC in 1994, representing a 26-fold increase since 1982 when the national Lyme disease surveillance program was initiated. By the end of 1994, a cumulative total of more than 71,000 cases of Lyme disease had been reported.

Davis said Lyme disease is not an epidemic, but there are three areas of the country where the risk of acquiring Lyme disease is particularly high. These include the Northeast, the upper North Central states, and the Pacific Northwest.

The enigma of Lyme Often called "the great imitator," Lyme disease can be a difficult infection to diagnose. The symptoms are vague and are frequently mistaken for other illnesses, such as multiple sclerosis, fibromyalgia, and chronic fatigue syndrome, among others. Although considered the hallmark of Lyme disease, the characteristic EM occurs in only 60% to 80% of Lyme cases, which can cause the diagnosis of Lyme disease to be missed. On the other hand, what might appear to be EM, may actually be some type of skin condition, such as urticaria or a hypersensitivity reaction to an insect bite.

Once Lyme disease is suspected, laboratory confirmation presents a whole new set of problems. …

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