From: EWALKER@utmmg.med.uth.tmc.edu (Eldon Walker)
Newsgroups: rec.backcountry
Subject: Re: Lyme Disease E-mail Network...
Date: 21 Dec 1992 17:04:40 GMT
Organization: UT MEDICAL SCHOOL AT HOUSTON
X-News-Reader: VMS NEWS 1.23

In <1992Dec20.214709.71383@ns1.cc.lehigh.edu> mcg2@ns1.cc.lehigh.edu writes:

> >EWALKER@utmmg.med.uth.tmc.edu (Eldon Walker) writes:
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ 
> >
> >If you go to the doctor when you have got the first symptoms (erythema
> >migrans, nausea etc) LD can be cured with short courses of simple anti-
> >biotics. If you have had LD for years and you get the late symptoms
> >LD is treated by a few weeks intra venous cure of kephalosporins
> >(3rd generation) and after that you have to eat oral antibiotics for
> >months. (At least this is the way LD is treated here in Finland.)
> 
> Unfortunately, that is a bit simplistic.
> * 40% of LD patients don't get the erythema migrans (rash).  How are these
>   patients dignosed?  Nausea alone?
> * The antibody tests are universally acknowledged to be not very accurate.
>   So how do you diagnose?  Is arthritic pain and documented exposure in an
>   endemic area enough?  What about Bell's palsy?  Carditis?
> * In the past 12 months, about half a dozen papers and abstracts have been
>   published documenting the spirochete's ability to evade antibiotic
>   treatment.  I actually know IV treated patients who are _culture positive_.
> 
>   The conclusion is that we are far from closing the book on LD.  We currently
> don't know enough to be able to manage the epidemic in endemic areas.  I
> formed the Lyme Disease E-mail Network to disseminate the latest info on this
> still mysterious illness.
> 
> -Marc.

  Please be careful with your attributions. I did not write the article
to which you replied in the post quoted above. In fact, I am in agreement
with the points you make here. My previous contribution to this thread was
to state that I am not aware of anyone in spirochete research who believes
Lyme borreliosis is in all cases responsive to short-term antibiodic therapy;
the fact that this disease can be refractory to treatment is well illustrated
by the example you give above and is a concern we share.
  One observation on the above is that simply asserting the lack of accuracy
of antibody tests for Lyme borreliosis understates the problem somewhat. A
serodiagnostic tool that would unequivocally distinguish Lyme borreliosis from
the diseases caused by spirochetes in the genus Treponema is greatly to be
desired. As it stands, a Lyme serum will light up any of the treponemal tests
for syphilis (such as FTA-ABS or MHA-TP), a fact that further complicates the
use of the cardiolipin-based non-treponemal screening tests for syphilis (VDRL,
RPR). And this does not address the problem of distinguishing among the
treponemal diseases (syphilis, endemic syphilis, yaws, and pinta). Thus
diagnostic problems can be severe when confronted with the disseminated forms
of Lyme borreliosis and syphilis (and its cousins) in the absence of some
definitive history, as these diseases can manifest very similar symptom
complexes. And here I am not addressing the protean symptomology of early
Lyme borreliosis and the problems caused by the frequent absence of classic
manifestations such as erythema chronicum migrans. Syphilis has been called
"the great imitator" because it can mimic many diseases; Lyme borreliosis
is called "the new great imitator." Rather than beat this to death and still
not do it justice (both of which I think I already have accomplished), I
would be happy to email a lengthy list of references to anyone interested.
 Finally, treatment failure, a problem especially acute in the case of Lyme
borreliosis, is more than a pharmacological abstraction; it is a tragedy (a
very important point Marc makes).
***
  To return to newsgroup relevancy, as a Californian transplanted to Houston,
I miss mountains. I recently made the 700 mile pilgrimage to the nearest
mountains (in Big Bend N.P.), and had a very interesting desert/mountain
backpack (Chihuahuan Desert/Chisos Mountains). This is rugged, beautiful
country.

--Eldon Walker; ewalker@casper.med.uth.tmc.edu-------------------------- 
Persons attempting to find a motive in this narrative will be prosecuted;
persons attempting to find a moral in it will be banished;
persons attempting to find a plot in it will be shot. -S. Clemens