Here is an example of a poorly written article in a major medical journal that misinforms health care practitioners about Lyme disease. My response?
Most patients DO NOT get an EM rash. More than half do
not look like a bulls-eye. Ticks can transmit multiple infections if
they have had partial feeding and can transmit infections in as little
as 5-15 minutes (Relapsing fever, rickettsia, Powassan v.). Disseminated
LD requires more than 21 days of antibiotics, especially if there is
peripheral nervous system or central nervous system involvement.
This type of article, which regurgitates the same misinformation we have
been listening to for decades, is part of the reason so many get ill.
Here are the scientific assertions and references backing up my
assertions (excerpted from an article I am working on):
Tick
bites can result in a wide variety of illnesses with diverse clinical
manifestations. These can range from asymptomatic early presentations of
an erythema migrans rash (EM), to symptoms resembling viral prodromes
with fevers, sore throats, swollen glands, and headaches followed by the
acute onset of a fatiguing, musculoskeletal illness with
neuropsychiatric manifestations (15) . Malarial-type presentations with
drenching sweats, chills, flushing, and cough with respiratory distress
with or without hemolytic anemia can be associated with babesiosis (16),
while gastrointestinal manifestations with transaminitis, nausea,
vomiting, abdominal pain and diarrhea can be seen with tick-borne
diseases including LD, RF, BMD, HGA, HME, RMSF, Q-fever, tularemia and
POWv (17 18 19 20). Acute onset of neurological symptoms can be seen
with most tick-borne diseases (LD, RF, BMD, HGA, HGE, RMSF, Q-fever,
tularemia, babesiosis, POWv, TBEV) (21 22 23 24), while neuroinvasive
POWv can result in particularly severe central nervous system
manifestations with a meningitis and encephalitis occurring after an
initial febrile illness with a sore throat, drowsiness, headache and
disorientation (16).
The truth is much more complex and nuanced than
discussed in the BMJ article and co-infections are a major player in
many with symptoms of chronic LD.
15. Bratton RL, Whiteside JW,
Hovan MJ, Engle RL, Edwards FD. Diagnosis and treatment of Lyme disease.
Mayo Clin Proc. 2008;83(5):566-571.
16. Policy (OIDP) O of ID and H. Babesiosis and Tick-Borne Pathogens Subcom Report to the TBDWG. HHS.gov. Published January 23, 2020. Accessed March 1, 2020.
17. Horowitz HW, Dworkin B, Forseter G, et al. Liver function in early Lyme disease. Hepatol Baltim Md. 1996;23(6):1412-1417.
18. Zaidi SA, Singer C. Gastrointestinal and hepatic manifestations of
tickborne diseases in the United States. Clin Infect Dis Off Publ
Infect Dis Soc Am. 2002;34(9):1206-1212.
19. Telford SR, Goethert
HK, Molloy P, et al. Borrelia miyamotoi disease (BMD): Neither Lyme
disease nor relapsing fever. Clin Lab Med. 2015;35(4):867-882.
20. Fatmi SS, Zehra R, Carpenter DO. Powassan Virus—A New Reemerging Tick-Borne Disease. Front Public Health. 2017;5.
21. Bransfield RC, Aidlen DM, Cook MJ, Javia S. A Clinical Diagnostic
System for Late-Stage Neuropsychiatric Lyme Borreliosis Based upon an
Analysis of 100 Patients. Healthcare. 2020;8(1):13.
22. Office of HIV/AIDS and Infectious Disease Policy AS for H (ASH). Report of Other TBDS and Co-Infections Subcommittee. HHS.gov. Published May 9, 2018. Accessed May 21, 2018.
23. Kofteridis DP, Mazokopakis EE, Tselentis Y, Gikas A. Neurological
complications of acute Q fever infection. Eur J Epidemiol.
2004;19(11):1051-1054.
24. Usmani-Brown S, Halperin JJ, Krause PJ.
Neurological manifestations of human babesiosis. Handb Clin Neurol.
2013;114:199-203.
