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Lyme disease can cause serious health problems if left untreated

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class="comment odd alt depth-2" id="comment-24109">

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MSR says

Response from Dr. Crutchfield:

After consulting an infectious disease expert and colleague, this is what I have learned:

There is an entire industry built around the idea that “the tests regular doctors do for lyme disease are not correct”. It advises that people need to send their blood to unaccredited labs to do non-verified tests. It also advises that you need to see “special providers” because “most doctors don’t know.” There are even some who think “doctors” or “the government” or others are “covering things up.” This industry typically is preying upon people who are tired, aching, depressed, have non-concerning “rashes” (skin findings within the normal range). They talk about the terrible long-term sequella of “missed” Lyme disease. Often the associated providers will prescribe months of IV antibiotics and put in central lines. This type of behavior and misinformation is horrible.

There are 2 ways to diagnosis Lyme Disease
1) When a patient presents with the typical errythema migrans rash that expands over days or weeks to > 5 cm in diameter, this is a clinical diagnosis. If they know there has been a tick bite in the center, you could make the diagnosis before the 5 cm mark. In addition, if they see a tic bite, they can watch the site, and if no lesion develops, they know they did not get Lyme infection from that bite. Of course, they could have gotten bitten by a tic in a different site that they didn’t notice and watch, and get Lyme infection that way. “where there’s one tic, there’s likely more!” Often errythema migrans early Lyme infection rash is accompanied by fever, malaise, headache, mild neck stiffness (not true meningismus), myalgia and/or arthralgia (not arthritis).

At this stage of early Lyme infection, the Lyme antibody tests may not yet be positive, so testing is not necessary, and could give a “false negative” result. During the first 4 weeks after infection (tick bite) it is recommended to make the diagnosis based upon the typical rash +/- associated findings.

Diagnosis of Lyme infection with early disseminated disease (Mulitple erythema migrans, usually many smaller lesions at once) is also a clinical diagnosis.

Patients treated at these early stages may never develop detectable Lyme antibody. That is okay, they are cured and not at risk for late disease.

On the other hand, most patients with early disseminated EM, and all patients with late disease (arthritis, meningitis, carditis) do develop antibodies.

Positive antibodies can disappear over time, or persist for many years. The antibody persistence has nothing to do with whether the infection is cured or not.

2. Appropriate tests for Lyme infection include a 2-step approach:
* First the quantitative antibody test using EIA or IFA
* Then if the screening test is positive or equivocal, the Western Blot for both IgG and IgM antibodies needs to be done. The immunoblot test should not be done before or instead of the screening test because the specificity decreases when done on patients without positive screening results. There are rules for interpretation of the western blot results depending upon the clinical findings and timing stage of disease.
This is the method of testing done in all routine, certified testing labs including Mayo, ARUP, University of MN, etc.

False positive tests on the screening antibody test are relatively common, so treatment is based upon the western blot results in these situations.

Antibody testing is also used for testing for CNS Lyme infection. Lyme PCR testing is just for evaluation of arthritis (joint fluid).

For additional legitimate information please see the website of the Infectious Disease Society of America (http://www.idsociety.org/Index.aspx)

Charles E. Crutchfield III, MD

Clinical Professor of Dermatology

University of Minnesota Medical School

and

Medical Director

CrutchfieldDermatology.com

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