Diagnosing and Treating Lyme Disease
The CDC estimates there are about 30.000 cases of Lyme disease in the U.S. These figures don’t include many who believe they have Lyme disease even though signs of infection don’t show up on lab tests. In addition, among many with evidence of exposure, there’s no proof that the bacteria associated with Lyme disease is actually the cause of their health problems - especially when these problems have been long term. Among doctors debate has been vicious. Some say chronic Lyme is real and is major health issue. Others argue these claims are not supported by the research. Careers have been ruined. Contradictory and misinformation is everywhere, and patients, many with truly debilitating conditions, are left in the lurch. Join us to talk about challenges in diagnosing and treating Lyme disease.
associate professor of medicine, Johns Hopkins University School of Medicine
and clinical director, division of infectious diseases.
Johns Hopkins Hospital
internist, private practice and associate clinical professor at George Washington University.
professor of clinical psychiatry.
director, Lyme and Tick-Borne Diseases Research Center. and
director, Center for the Study of Neuroinflammatory Disorders & Biobehavioral Medicine
professor,department of pathology, microbiology and immunology
Center of Comparative Medicine at the School of Veterinary Medicine, University of California, Davis
Questions as to whether chronic Lyme disease exists, how to test for it, and how to treat it are dividing doctors and confounding patients. Diane's guests discuss why diagnosing and treating the disease remains so challenging and controversial.
Best Treatment Practices
Doses of specific antibiotics are recommended for both early-stage Lyme disease and for patients who may be experiencing some neurological problems or arthritis, like knee swelling, Dr. Auwaerter said. But as for the question about whether or not it's possible to have so-called "chronic" Lyme disease, Auwaerter said that carefully performed studies have shown no evidence that bacteria seems to persist in people with ongoing complaints after being treated for Lyme disease.
A Different View On Chronic Lyme Disease
Dr. Shor believes that there's "no scientific basis" for concluding that 30 days of treatment in all patients with Lyme disease is going to be adequate to cure the disease. Dr. Barthold has found in his veterinary practice and research that the bacteria that causes Lyme disease is very
good at persisting in an animal's body for that animal's entire lifespan. It's possible, Dr. Barthold said, that this could be the same pattern for the disease in humans.
What Happens With "Chronic" Lyme Disease?
"The infection is persistent, the disease is not," Dr. Barthold said. "And what's curious about Lyme disease is in the early phase of the infection you have arthritis and inflammation of the heart and other manifestations in animals as you see in humans. And then the immune response, particularly antibody, comes in and clears a large number of the bacteria from tissues leaving behind persisting organisms that are sequestered away in connective tissue," he said.
Difficulties In Diagnosis And Treatment
Dr. Fallon said that it's certainly possible for some patients to have Lyme disease but to not test positive for it. Dr. Shor agrees that the available testing is "insensitive." "And we have managed care which pushes physicians to see very complex patients in short periods of time and insurance companies that are loathe to pay any more than they have to," Dr. Shor said.
You can read the full transcript here.