Few docs recognize chronic Lyme disease

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Few docs recognize " chronic " Lyme disease

By Frederik ving

NEW YORK | Fri Oct 22, 2010 10:33pm BST

http://uk.reuters.com/article/idUKTRE69L58A20101022

NEW YORK (Reuters Health) - Despite lots of media attention, " chronic " Lyme

disease is only recognized by a small group of doctors in Connecticut, where the

tick-borne infection was first discovered.

That's according to a new statewide survey, reported in the Journal of

Pediatrics, that found just two percent of doctors in Connecticut said they had

diagnosed and treated the controversial chronic version of the disease.

If you are online a lot, " you think every doctor in Connecticut believes in

chronic Lyme, " said Dr. Henry Feder, of the University of Connecticut Health

Center in Farmington, who worked on the study.

" What the poll shows is that's not true, " he added.

Most medical groups agree that Lyme disease should be treated with antibiotics

only for a few weeks, but some doctors and patient groups argue that longer

treatments, lasting months or even years, may be necessary if symptoms linger.

Compounding the scientific controversy over whether chronic Lyme disease

actually occurs, Connecticut's attorney general sued the Infectious Diseases

Society of America (IDSA) two years ago for barring physicians who advocate

longer treatment courses from a guidelines panel.

While the guidelines were upheld by an independent review panel last April, that

didn't end the debate.

" There is a very small number of doctors who are very active on the Internet as

well as politically and have a different point of view than the evidence

dictates, " said Feder, who is a member of the IDSA but was not involved in

establishing the guidelines.

According to the National Institute of Allergy and Infectious Diseases, rigorous

clinical studies have shown that prolonged treatment is of little benefit to

patients who have no signs of infection, but still suffer from fatigue and

headaches.

Apart from making patients prone to diarrhea and fungal infections, long-term

antibiotic treatment can also lead to serious infections if it's delivered by an

intravenous line.

According to the Centers for Disease Control and Prevention, about 38,000

confirmed or probable cases of Lyme disease occurred in the U.S. in 2008, mainly

in Wisconsin, Minnesota and the Northeast where the ticks that carry it are

widespread. In Connecticut, the rate translated to about 78 cases per 100,000

residents.

When diagnosing Lyme disease, doctors look for a red skin rash that is often

found at the site of the tick bite and may also do a blood test for antibodies

to the bacteria that causes the illness, called Borrelia burgdorferi.

If they find nothing, but still diagnose Lyme disease, they may actually be

missing another severe disease, said Feder.

" If someone is going to get IV therapy for Lyme disease, there are dangers

involved and they should get a second opinion, " he said, adding that Lyme

disease is usually treated with only one antibiotic, such as doxycycline, taken

by mouth.

He found half of the 285 doctors who answered his poll didn't believe in the

existence of chronic Lyme disease. Slightly fewer said they were undecided, but

did not diagnose or treat the chronic version.

While the results could be swayed by the fact that many doctors chose not to

respond to his mailed survey, Feder said he believed the findings were reliable.

Dr. Cameron, an outspoken opponent of the IDSA guidelines and

past-president of the International Lyme and Associated Diseases Society, which

was formed by advocates for chronic Lyme disease, could not be reached for

comment.

Lyme expert Dr. Dattwyler, of New York Medical College, said he wasn't

surprised by the poll results.

" Chronic Lyme disease is just not accepted by the vast majority of physicians, "

he told Reuters Health. " The majority of people who get the diagnosis of chronic

Lyme disease have either depression, fibromyalgia or another chronic illness. "

" If you look at the symptoms that they report to be associated with chronic

Lyme, " he added, " population studies have shown those are very common complaints

among the general population. "

" The tragedy is that sometimes really serious, treatable diseases are ignored. "

SOURCE: link.reuters.com/zyb89p Journal of Pediatrics, online September 1, 2010.