Sunday, July 31, 2011

Lyme Disease: Two Sides to a Story

ARTICLE:   “Lyme disease on rise in state:   Wisconsin human cases up 35% in 2010.”  Milwaukee Journal Sentinel  [Milwaukee]  10 July 2011, B1+.

TAKE HOME MESSAGE:  There are two sides of a story.  The truth dwells in the space between.  Ask lots of questions of many types of sources and a balanced view will evenually emerge.


1)      What makes Borrelia burgdorferi such an infective, often insidious bacteria?

2)      Can you clarify how the presence of the bacteria is detected?  My impression is that an ELISA is performed and then confirmed by western blot?  What protein is actually detected by western analysis?

3)      Does the analysis occur using serum or whole blood?

4)      I’m under the impression that there are co-infections that are prevalent when one contracts Lyme disease.  Is this accurate?  Besides Borrelia burgdorferi, what are the other bacteria likely to co-infect a patient?  (I’ve been told that Babesia parasite is of particular concern?)

5)      Are there bacterial co-infections that are particularly worrisome in terms of how the disease progresses?

6)      Do you know whether or not co-infections can be detected in the clinic?  In your opinion, are co-infections clinically relevant when diagnosing or treating Lyme disease?

7)      Must co-infections be treated with different antibiotics?

1)      Are you seeing more Lyme disease in the clinic this past spring and summer?

2)   What is the most challenging aspect of diagnosing and treating Lyme disease?

3)   Why do some people become so sick from Lyme disease?

4)   Can you tell me about the chronic form of Lyme disease and what the standard treatment of chronic Lyme disease is?

5)   There are patients I’ve spoken to who are convinced they have been cured with long term IV antibiotics…and they have sought treatment through an underground network of doctors who have quietly agree to treat the chronic form of the illness.  These patients claim that doctors typically aren’t willing to prescribe long term antibiotic treatments because they are often flagged by insurance companies for doing so.  Can you comment on this?

6)   There is a perception among patients in the Milwaukee area that primary care doctors aren’t adequately addressing the disease in terms treating it when it’s suspected.  Rather, they tend to wait on blood test results, which sometimes results in a missed diagnosis.  Do you think there is an awareness among doctors that deer ticks are a problem in Wisconsin and that patients exposed to deer ticks have a high risk of contracting Lyme disease?

1)      Infected ticks are abundant in Wisconsin and in the Mid-Atlantic and Lyme disease is endemic in both  regions.  What about Wisconsin makes the state particularly hospitable to infected ticks?

2)   There was a 35% increase in human cases in Wisconsin last year, which doesn’t appear to be declining. Why the persistent increase?  Better surveillance, diagnosis, or awareness?

3)   Are deer still considered the carriers of Lyme disease-carrying ticks?  Do deer transmit the bacteria to the ticks?  If that’s the case, can you tell me a little about deer management programs in Wisconsin?  Is there an effort to manage the disease by managing the deer herd?  Are there other animals that are believed to transmit the bacteria to ticks?
4)   Are ticks always the vector of the disease in the human population?  Are there other insects or animals that can pass borrelia to humans?

5)   The black legged tick or the deer tick (Ixodes scapularis or Ixodes pacificus) carry borrelia burgdorferi.  Can you tell me a little about the natural history of borrelia infection in the black legged tick?  Why does this particular tick spread this particular bacteria?
6)   You have expertise in Integrated Pest Management.  Any recommendations for avoiding Lyme disease beyond covering up exposed skin?
7)   How is the state addressing the rising incidence of Lyme disease?

I let the patients talk and listened carefully.