Lyme & ME - Mists & Myths

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Reference: *Lyme Disease & ME -Dr. Darrel Ho-Yen*; Help ME

Circle, 6 October 2006:

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From: " Annie Drummond

via: Co-Cure Moderator "

Letter to the ME community

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

re Dr Ho-Yen's statements on Lyme and ME/CFS

Letter to the ME/CFS/FM community in response to comments

under the heading " Lyme disease - let's dispel the myths " , by Dr

D. Ho-Yen, October 2006 ME Essential, published by the ME

Association, UK.

Mists and Myths swirl around Inverness

By Annie Drummond

Scotland is a land of mists, mountains, and malicious ticks.

Sorry Scotland, I love your beautiful country and your hospitable,

friendly people, but it is where I was bitten by a tick which gave

me Lyme disease (also known as borreliosis.)

Several researchers have found that many patients diagnosed

with myalgic encephalomyelitis (ME), Chronic Fatigue

Syndrome (CFS), Fibromyalgia (FM) (1,2,3) and Multiple

Sclerosis (4,5,6,7) have borreliosis, as do a certain proportion

of psychiatric patients (8,9,10).

Scotland has its very own Lyme diagnostic laboratory at

Raigmore Hospital in Inverness, while the rest of the British Isles

relies on one reference laboratory at Southampton in England.

At Raigmore, Dr D. Ho-Yen is the chief microbiologist and has

been interested in ME for many years. In fact, he published the

first " How to treat ME " book in 1985. He maintains that only a

small minority of ME/CFS patients could have Lyme disease as

the cause of their illness (11). But is he right?

Lyme disease was brought to worldwide attention in 1975, but

its history goes back further (12). However, Ho-Yen in 2006 still

feels that he must call Lyme an " emerging disease " . Perhaps

the pandemic levels (13) that have now been reached have

allowed the illness to " emerge " from the cloak of silence that has

covered the spread of the disease in the UK. Yet as far back as

1989, i.e. over 17 years ago, the World Health Organisation was

aware that the whole of the British Isles, plus Scandinavia,

Germany, Austria, half of France, California, areas South of the

Great Lakes, and other areas, were endemic for Lyme disease

(14).

Ho-Yen has recently admitted that his laboratory missed 33% of

Lyme cases (15). He retested old serum samples for the year

2003 to 2004, using different methods of interpretation, and

found that previous negative tests were becoming equivocal or

strongly positive. One is left to speculate how many suspected

victims over the last 30 years have been retested, if any, using

these new criteria, and how many patients have been recalled

for further investigation. It is admirable that Ho-Yen has

published these results, but they sit uncomfortably with his latest

pronouncements on the ME/Lyme question.

The ME charities, Action for ME, the ME Association and the

TYMES Trust, have relied on Ho-Yen to inform the ME

community on the relationship between Lyme and ME in the

October and November 2006 issues of their recent magazines.

Many scientists and commentators, while not disputing his

personal findings and his integrity, would wish to respond to

some of the statements he has made in these articles.

There are 6 so-called " myths " that Ho-Yen identifies as current in

the Lyme world; each one will be discussed in the light of

knowledge available. A very different picture from the one he

paints will emerge.

Myth 1: The Internet has the best information on Lyme disease.

Verdict: True. This is not a myth. The Internet is the source of

millions of archived peer-reviewed scientific reports. We all use

the Internet; most of us would be lost without it. The data is more

accessible and available to be used more readily; researchers

no longer have to physically retrieve dusty documents from

medical or university libraries.

To be fair there is a lot of rubbish on the World Wide Web, but it

is the easiest place to look for the very latest research. Ho-Yen

suggests that it is almost impossible to discern the rubbish from

the good material, and at first it can be difficult. However, a

recent peer-reviewed paper from 2005, authored by several of

the most experienced doctors and scientists working in the

Lyme field (16), gives a very useful overview of the data

available on the Internet and how this relates to their clinical

experience.

Myth 2: Doctors are ignorant of Lyme disease.

Verdict: True. This is not a myth and is definitely true in Britain.

Please ask your GPs, whether rural or urban [(Richmond Park,

as well as other London parks, has been found to harbour

Lyme-carrying ticks (17)] if they have heard of Lyme, or of

borreliosis, or of the latest infection rates being reported in

Europe?

Most doctors, and members of the public too, think of it as an

American disease, (that is, if they have heard of it at all!). But the

increasing number of cases across Europe is a cause of

concern. For example, in Holland (18), the incidence of the

" bull's eye " rash, Erythema Migrans, (EM), which is pathognomic

for Lyme disease, was estimated at 39 per hundred thousand in

1994, which doubled to 74 per 100,000 in 2001, and tripled to

103 per 100,000 in 2005. In southern Sweden (19), the mean

annual incidence rate in 2005 was 464 cases of EM per

100,000 inhabitants. The incidence was significantly higher in

women than in men, 505 and 423 cases per 100,000

respectively.

These are epidemic rates of infection. Britain's approximate

incidence figures, quoted from the Health Protection Agency

(20) are no greater than 1.1 per 100,000. It is difficult to

rationalise figures that are 2 orders of magnitude lower than

those in Holland for example. The island status of the UK will not

have protected it from migratory birds, which are

well-documented carriers of Lyme-infected ticks (21,22,23,24).

It is also not necessarily true that rural doctors are aware of

Lyme disease. There have been several cases in my own rural

area of the so-called " well recognised " EM rash being labelled

as ringworm and others have been told that they were suffering

from shingles or allergies. How many GPs will recognise the

condition Acrodermatitis Chronica Atrophicans (25), which is a

skin disease associated with Lyme?

Ho-Yen has stated himself that the number of cases in Scotland

is underestimated by as much as a factor of 1 in 10. The point is

- if Lyme is continually labelled as one of " those obscure foreign

diseases " doctors will not even bother to test for it. The head of

the UK's Lyme reference lab continues to inform the medical

world that the disease is rare in Britain (26) and that positive

tests are to be ignored in non-endemic areas.

With the exception of Scotland, Lyme is yet to be made a

notifiable disease in Britain. Currently the Health Protection

Agency (HPA) website (20) gives the estimated incidence as

1000 to 2000 additional cases per year. This is to be added to

the figure for the lab reports for the year, which was 585 cases in

England and Wales. The true incidence is unknown.

If the laboratories testing for Lyme are not aware of the many

reasons for negative antibody tests in the presence of the

disease, and do not inform consultants that the patient could still

have Lyme, despite the serology being negative, then the

situation is perpetuated.

Myth 3: Most ME is Lyme disease.

Verdict: Open. But it is likely to be true for a high proportion of

ME/CFS/FM cases, and not a myth at all, according to many

Lyme specialists (27,28,29). Most open-minded people agree

that not all cases of ME/CFS/FM would be due to Lyme but there

are now thousands of people with these conditions who are

finding out that they have Lyme borreliosis or other tick-borne

infections.

Recent research in the UK points to the fact that biochemical

and immunological markers are very similar in Lyme and ME. In

a presentation to the Edinburgh ME group in September 2005,

Professor Gow of Glasgow University stated that gene

expression regulation in those with ME is identical to that seen in

Lyme patients.

In contrast to Ho-Yen's assertion that the EM rash of Lyme is an

easily recognised indicator, half of those bitten do not show the

rash and those that do may have atypical presentations (30,31).

Seventy percent of Lyme patients who responded to a poll by the

Internet group EuroLyme stated that they were previously

diagnosed with ME/CFS. The UK government has stated that

Lyme can cause Chronic Fatigue Syndrome, but has not

broadcast this statement as an important issue. While there is a

heated dispute between specialists who believe that Lyme

infection is easily cured by a short course of antibiotics and

those who say it persists, nevertheless, both sides agree that the

" post Lyme syndrome " often presents as fibromyalgia and

chronic fatigue syndrome. However, many studies have shown

that there is persisting infection, and that this is treatable

(32,33,34,35).

Late Lyme is also hard to distinguish from many other diseases,

and is more often under-diagnosed than over -diagnosed

(36,37,38,39). Most importantly, although Ho-Yen has listed

cardiac, joint and skin manifestations of Lyme, he has omitted to

mention the devastating neurological symptoms manifest both in

ME/CFS/FM and Lyme (40), unless he is implying that the term

" fatigue state " encompasses all of the central and peripheral

nervous system deficits that may occur in neuroborreliosis, (e.g.

encephalopathy, facial paralysis, vertigo, light and sound

sensitivity, tinnitus, meningitis). Ho-Yen fails to state the source

of his belief that only 10% of late Lyme patients show this

" fatigue state " . Most people with late Lyme are crippled by a

" fatigue state " , as are most people with ME/CFS/FM.

Ho-Yen contends that only 5% of ish ME patients studied

by him had Lyme. However, he does not state which criteria

were used for diagnosing Lyme (as mentioned earlier, blood

tests cannot be relied upon to rule out Lyme.) Neither does he

mention the length of time of follow up of these patients, despite

the fact that Lyme, like ME, is known to be a relapsing-remitting

disease (41).

Myth 4: Antibiotics can cure Lyme disease.

Verdict: True. This is not a myth. Antibiotics and other drugs in

combination or in series can cure many cases of Lyme disease.

The treatment needs to be under the supervision of an

experienced Lyme specialist and sometimes must be carried

out for months or even years.

According to Ho-Yen " the very need for such prolonged

treatment with antibiotics suggests that the success rate is not

good " . Applying his criteria we would refuse to treat TB patients

and leave them to their misery. The longer that Lyme disease

remains untreated or under-treated, the worse the potential for

permanent damage. In some cases, antibiotics may merely

lessen the progress of the disease. However Lyme patients

across the world who can access appropriate medical care may

recover their health or at least have partial remission. (42).

Ho-Yen states " Indeed, it is difficult to separate the natural

improvement that occurs with chronic disease from the effects of

antibiotic treatment " . His solution is to treat ME/CFS as if it were

a viral illness, but this is not appropriate knowing the bacterial

causation of Lyme. Viruses and bacteria are quite different

biologically, needing completely different treatment approaches.

Myth 5: All laboratories produce dependable results.

Verdict: False. This is perhaps the only myth on which we have a

point of agreement: if all laboratory tests were reliable, Ho-Yen

would not have published his 2005 paper, saying that his lab had

had to reinterpret a third of its own tests.

Two comprehensive reviews of the accuracy of standard tests

for Lyme, in Europe (43) and the US (44), showed that the same

sample of blood could test positive or negative depending on

which lab it was sent to, or even if tested again in the same lab.

Worse still for those with suspected Borrelia infections, the

Polish National Institute of Health has reported that patients with

low or negative antibody levels have tested positive using other

more sensitive techniques. Specific DNA capture and culturing

showed that there were live bacteria in their body fluids (45)

indicating that those with negative blood tests could be even

more ill than those who have circulating antibodies. The problem

of co-infections with other organisms is another complicating

factor.

In 2003 Dr Lowes, head of microbiology at Southampton, where

the Lyme reference laboratory is housed, promised that an

internal audit would be conducted into the lab's operations. He

made that promise following complaints that inaccurate testing

and interpretation procedures were being carried out at the

Lyme lab. The results of that audit have never been made public

to this day.

We agree with Ho-Yen that commercial motives could

compromise the quality of lab diagnostics. However, nowhere is

this more reflected than in the vested interests of the Lyme

committee of the Infectious Disease Society of America (IDSA),

which as mentioned below, is currently the subject of an anti trust

investigation by the Attorney General in Connecticut, where there

is one of the highest rates of Lyme infection in the world.

Dr O'Connell, the head of the UK'S Lyme Reference

Laboratory, was a consultant to that committee, and both she

and the Department of Health promote its viewpoint as a model

for diagnostic and treatment policy in this country. Ho-Yen's

recent article demonstrated that he too has adopted much of that

view.

Myth 6: There is misleading expert comment

Verdict: True. This is definitely not a myth. As alluded to earlier,

in November 2006, Connecticut Attorney General

Blumenthal ordered a Civil Investigative Demand under the

anti-trust laws concerning the recently published guidelines

produced by the Lyme committee of the IDSA. This group of 14

scientists have been the most vociferous in stating that Lyme

disease is never chronic and that treatment, beyond a few

weeks of antibiotics, is not indicated. (46).

In a press interview (47) Blumenthal voiced his fear that the

guidelines were being used by the powerful US insurance

industry to deny health coverage to Lyme patients. In addition to

the close ties with the insurance industry held by some members

of the committee, a number of them have significant conflicts of

interest due to their involvement with companies producing

Lyme vaccines or test-kits.

Two of the members, Wormser, lead author of the

guidelines, and Steere, admit to receiving money from the

multi-national Baxter corporation, which is currently developing a

vaccine for the European market. A restrictive approach to Lyme

diagnosis serves the interests of vaccine manufacturers as it

can cover vaccine failure. It is also difficult to conduct clinical

testing of vaccines without using antibody tests to rule out the

disease. However, all the evidence indicates that the tests are

not sensitive enough to be used in this way. The end losers are

the patients.

Clinicians associated with the International Lyme and

Associated Diseases Society (ILADS) oppose the IDSA, and

treat thousands of patients in the US and across the world with

long-term antibiotics if necessary (48).

How many Infectious Disease experts in the UK know about the

many reasons (49) why both chronic and early Lyme disease

can show no antibodies in blood tests (seronegative)? Why

does the Health Protection Agency's Lyme Reference

Laboratory inform doctors that a negative ELISA test rules out

Lyme in all but the earliest stages, when there is documented

evidence (50) that this is not the case?

Conclusion

A combination of the facts above, and the lack of openness

surrounding the topic of Lyme borreliosis, has left many

thousands of Lyme patients undiagnosed and untreated.

There are many people who suffer for long periods of time,

decades in some cases, who have never been tested for Lyme

or who have had negative tests. Years later, they find that the

antibodies can be seen in their blood or that other more precise

tests reveal the DNA of borrelia in their bodies.

A Lyme diagnosis means virtually nothing here in Britain since

there are very few doctors who know how to proceed. The

persistence of borrelia infections (51,52) means that antibiotic

therapy must be extended in order to reduce the bacteria to a

low enough level for the immune system to take over.

There is also the problem of co infections, with growing

evidence that many Lyme patients may be infected with

anaplasma, babesia, bartonella and mycoplasma species

(53,54,55,56).

If the patient has been ill for years, thousands of generations of

bacteria will have multiplied and spread throughout the body.

They may then lie dormant until the immune system is challenged

by other events - perhaps by toxicological insult from

organophosphates and other poisonous chemicals in the

environment, or by catastrophic life events such as automobile

accidents etc.

In other patients, the bacteria may rampage continuously and

may cause ME/CFS/FM, heart disease, arthritis, MS, ALS,

thyroid disease, and visual defects. They may endure pain and

vertigo and brain fog, arthralgia and arthritis, endocrine

problems, endometriosis, irritable bowel and bladder disease,

skin rashes, rapid heart beats, heart failure, hearing loss,

seizures, temporary or permanent paralysis, muscle spasms,

tendonitis, memory loss and panic attacks. There is even some

evidence to suggest that borrelia infection may lead to bipolar

disorder, schizophrenia and Alzheimer's disease (6, 57,58).

On and on the list goes, making many doctors certain that it is an

impossible mixture of symptoms to have and therefore must be

all in the patient's mind. Victims of Lyme disease, like those with

ME/CFS/FM, have consequently been called over-emotional

yuppies with personality problems, stressed-out under-

achievers, or over-anxious and depressed individuals.

Now Ho-Yen has exacerbated this situation by accusing British

Lyme patients of hysteria. Lyme victims are hysterical, and

demand antibiotics. They are hysterical, and say they know more

than doctors. Worse still, people with ME/CFS/FM are catching

the hysteria, and phoning him up in hundreds to ask if they have

Lyme.

Patients with ME/CFS/FM are advised to beware of this

hysterical label and to remember how the two hundred or so

nurses, doctors and patients in the Royal Free Hospital came

down with a nasty epidemic of so-called " hysteria " in 1955.

Many of them never recovered from the disease, and never

recovered from the stigma attached to that label.

Over the last 30 years Lyme patients have received the same

sort of treatment as people with ME/CFS/FM, - ridicule,

contempt, disbelief, denial of investigations and treatment, and

the ignominy of a psychosomatic label.

Unfortunately, over the last 20 years, there has been a concerted

effort by a small but very influential group of psychiatrists to

inundate both the scientific literature and the ordinary press with

tales of " psychosocial " causes of ME/CFS/FM (59).

We are all being confused by myths, according to Ho-Yen, but is

it possible that he has himself been myth-taken? His

suggestions that " fatigue " is only shown by the minority of Lyme

patients; that antibody tests can rule out the disease; and that

chronic Lyme responds to palliative rather than antimicrobial

therapy, are all unproven. They are especially unhelpful in the

present situation.

Now the common sense of decent people and the integrity and

honesty of certain doctors and scientists, such as

Liegner (60), will unearth the truth about the causes of

ME/CFS/FM. These may be multiple. However, in every case,

patients are entitled to full information about their diagnosis and

prognosis.

Ho-Yen concludes with " In the end, it is a matter of what makes

you better " and urges patients to take responsibility for their own

illness. We contend that ME/CFS/FM patients struggle heroically

to cope with their condition and are forced to take responsibility

for their illness every day. Patients will never get better until there

is clarity (61) over the issues surrounding Lyme, ME/CFS/FM

and other chronic infections.

References

(1.) Treib, J., Grauer, M.T., Haas, A., Langenbach, J., Holzer, G.,

Woessner, R. Chronic Fatigue Syndrome in patients with Lyme

borreliosis Eur Neurol. 2000; 43(2): 107 - 9

(2) Nicolson GL, and Nicolson NL. Chronic infections as a

common etiology for many patients with chronic fatigue

syndrome, fibromyalgia, and Gulf War Illness. Intern J Med.

1998; 1:42-6.

(3.) , S. Lyme disease (borreliosis). A plague of ignorance

regarding the ignorance of a plague.

http://www.autoimmunityresearch.org/lyme-disease/

(4.) Fritzsche, M. Geographic and seasonal correlation of

multiple sclerosis to sporadic schizophrenia. Int J Health Geogr.

2002; 1(1): 5

(5.) Fritzsche, M. Seasonal correlation of sporadic

schizophrenia to Ixodes ticks and Lyme borreliosis. Int J Health

Geogr. 2002; 1(1): 2

(6.) Chmielewska-Badora, J., Cisak, E., Dutkiewicz, J. Lyme

borreliosis and multiple sclerosis: any connection? Ann Agric

Environ Med. 2000; 7: 141 - 3

(7.) Brorson, O., Brorson, S.H., Henriksen, T.H., Skogen, P.R.,

Schoyen, R. Association between multiple sclerosis and cystic

structures in cerebrospinal fluid. Infection 2001; 29(6): 315 - 9

(8.) Fallon, B.A., Nields, J.A. Lyme disease: a neuropsychiatric

illness. Am J Psychiatr. 1994; 151(11): 1571 - 83

(9.) Sherr, V.T. Panic attacks may reveal previously unsuspected

chronic disseminated Lyme disease J Psychiatr Pract. 2000;

6(6): 352-6

(10.) Hajek, T., Paskova, B. Janovska, D., Bahbou, R., Hajek, P.,

et al. Higher prevalence of antibodies to Borrelia burgdorferi in

psychiatric patients than in healthy subjects. Am J Psychiatr.

2002; 159(2): 297 - 301

(11.) Ho-Yen, D. Lyme Disease - let's dispel the myths. October

2006 ME Essential. Published by the ME Association.

(12.) Schaltenbrand, G. Durch Arthropoden übertragene

Erkrankungen der Haut und des Nervensystems Verhandl Dtsch

Ges Inn Med.1967; 72:975-1006

(13.) Harvey, W.T., Salvato, P. Lyme disease: ancient engine of

an unrecognised borreliosis pandemic? Med Hypotheses 2003;

60(5): 742 - 759

(14.) World Health Organisation Epidemiology of Erythema

Lyme borreliosis http://www.ciesin.org/docs/001-613/map25.gif

(15.) , R., Mavin, S., Ho-Yen, D.O. Audit of the laboratory

diagnosis of Lyme disease in Scotland. J Med Microbiol. 2005

Dec; 54(Pt 12): 1139 - 41

(16.) Stricker, R. B., , L.J.D., , N., Burrascano, J.J.

Inaccurate information about Lyme disease on the Internet

Pediatr Infect Dis J., 2005 Jun; 24(6): 577 - 8

(17.) Rees, D.H., Axford, J.S. Evidence for Lyme disease in

urban park workers: A potential new health hazard for city

inhabitants. Br J Rheumatol. 1994 Feb; 33(2): 123 - 8

(18.) Hofhuis, A., van der Giessen, J.W.B., Borgsteede, F.H.M.,

et al. Lyme borreliosis in the Netherlands: strong increase in GP

consultations and hospital admissions in past 10 years. Euro

Surveill. 2006; 11(6): E060622.2

(19.) Bennet, L., Halling, A., Berglund, J. Increased incidence of

Lyme borreliosis in southern Sweden following mild winters and

during warm, humid summers. Eur J Clin Microbiol Infect Dis.

2006-11-21

(20.) Health Protection Agency website.

http://www.hpa.org.uk/infections/topics_az/zoonoses/lyme_borreliosis/

enhanced.htm

(21.) Poupon, M-A., Lommano, E., Humair, P-F, Douet, V., Rais,

O.,et al. Prevalence of Borrelia burgdorferi sensu lato in ticks

collected from migratory birds in Switzerland. Appl Environ

Microbiol. 2006; 72(1): 976 - 79

(22) Olsen, B., Jaenson, T.G., Bergstrom, S. Prevalence of

Borrelia burgdorferi sensu lato-infected ticks on migrating birds.

Appl Environ Microbiol. 1995; 61(8): 3082 - 7

(23.) Hoogstraal, H. Birds as tick hosts and as reservoirs and

disseminators of tick borne infectious agents. Wiad Parazytol.

1972; 18(4): 703 - 6

(24.) , R.P., Muzaffer, S.B., Lavers, J., Lacombe, E.H., et

al. Borrelia garinii in seabird ticks (Ixodes uriae), Atlantic coast,

North America. Emerg Infect Dis. 2006; 12(12): 1909 - 12

(25.) http://www.emedicine.com/derm/topic4.htm

(26.) Aliyu, S.H., Ludlam, H., O'Connell, S. Lyme borreliosis - a

preventable disease? CPD Infect. 2002; 3(2): 54 - 8

(27.) Donta, S. Lyme disease as a model of Chronic Fatigue

Syndrome. CFS Res Rev. 2002; 3(2): 1 - 4

(28.) Goldenberg, D.L. Fibromyalgia, chronic fatigue syndrome,

and myofascial pain syndrome. Curr Opin Rheumatol. 1995;

7(2): 127 - 35

(29.) Nicolson GL, and Nicolson NL. Chronic infections as a

common etiology for many patients with chronic fatigue

syndrome, fibromyalgia, and Gulf War Illness. Intern J Med

1:42-6, 1998.

(30.) Gustaw, K. Chronic fatigue syndrome following tick-borne

diseases. Neurol Neurochir Pol. 2003; 37(6): 1211 - 21

(31.) Lesniak, O.M., Belikov, E.S. The classification of Lyme

borreliosis (Lyme disease). Ter Arkh. 1995; 67(11): 49 - 51

(32.) ILADS position papers on diagnosis and treatment of

Lyme disease.

http://www.guidelines.gov/summary/summary.aspx?ss=15 & doc_id=4836 & nbr=3481

(33.) Priem, S., Munkelt K., Franz, J.K., Schneider, U., Werner,

T. et al. Epidemiology and therapy of Lyme arthritis and other

manifestations of Lyme borreliosis in Germany: results of a

nation-wide survey Z Rheumatol. 2003; 62(5): 450 -8

(34.) Stricker, R.B., McNeil, E. Duration of antibiotic therapy for

Lyme disease. Ann Intern Med.2004; 140(4): W6

(35.) Bransfield, R., Brand, S., Sherr, V.T. Treatment of patients

with persistent symptoms and a history of Lyme disease. N Engl

J Med. 2001; 345: 1424 - 5

(36.) Frey, M., Jaulhac, B., Piemont, Y. et al. Detection of

Borrelia burgdorferi DNA in the muscle of patients with chronic

myalgia related to Lyme disease. Am J Med. 1998; 104: 591 - 4

(37.) Stricker, R.B., Lautin, A., Burrascano, J.J. Lyme disease:

point/counterpoint. Exp Rev Anti Infect Ther. 2005; 3(2): 155 - 65

(38.) Fallon, B.A., Kochevar, J.M., Gaito, A., Nields, J.A. The

underdiagnosis of neuropsychiatric Lyme disease in children

and adults. Psychiatr Clin North Am 1998; 21(3): 693 - 703,viii

(39.) Bachman, D.T., Srivastava, G. Emergency department

presentations of Lyme disease in children. Pediatr Emerg Care

1998; 14(5): 356 - 61

(40.) Shadick, N.A., , C.B., Logigian, E. L., Steere, A.C.

et al. The long-term clinical outcomes of Lyme disease. A

population-based retrospective cohort study. Ann Intern Med.

1994; 121: 560 - 7

(41.) Omasits, M., Seiser, A., Brainin, M. Recurrent and

relapsing course of borreliosis of the nervous system. Wien Klin

Wochenschr. 1990; 102(1): 4 - 12

(42.) The ILADS Working Group: Cameron, D. et al.

Evidence-based guidelines for the management of Lyme

disease. Expert Rev Anti Infect Ther. 2004; 2(1): S1 - S13

(43.) Hunfeld, K.P., Stanek, G., Straube, E., Hagedorne, H-J., et

al. Quality of Lyme serology. Wien Klin Wochenschr. 2002;

114(13-14): 591 - 600

(44.) Bakken, L.L., Callister, S.M., Wand, P.J., Schell, R.F.

Interlaboratory comparison of test results for detection of Lyme

disease by 516 participants in the Wisconsin State Laboratory

of Hygiene/ College of American Pathologists

proficiency-testing program. J Clin Microbiol. 1997; 35:537 - 43

(45.) Tylewska-Wierzbanowska, S., Chmielewski, T. Limitation

of serological testing for Lyme borreliosis: Evaluation of ELISA

and Western blot in comparison with PCR and culture methods.

Wien Klin Wochenschr. 2002; 114(13-14): 601 - 5

(46.) Wormser, G. et al. IDSA Guidelines Clin Infect Dis. 2006;

43: 1089 - 1134

(47.)

http://pqasb.pqarchiver.com/courant/access/1164183821.html?dids=1164183821:11641\

83821 & FMT=ABS & FMTS=ABS:FT & type=current & date=Nov+17%2C+2006 & author=ELIZABETH+HAMI\

LTON & pub=Hartford+Courant & edition= & startpage=B.1 & desc=LYME+DISEASE+GUIDELINES+FO\

CUS+OF+ANTITRUST+PROBE

Article by Hamilton. Lyme disease guidelines focus of

antitrust probe. Connecticut News November 17th 2006 edition.

(48.) ILADS op cit.

(49.) . N. An understanding of laboratory testing for Lyme

disease Journal of Spirochetal and Tick-borne Diseases. 1998;

Volume 5, Spring/Summer http://www.igenex.com/labtest.htm

(50.) http://www.lymeinfo.net/medical/LDSeronegativity.pdf

(51.) Lawrence, C., Lipton, R.B., Lowy, F.D., Coyle, P.K.

Seronegative chronic relapsing neuroborreliosis. Eur Neurol.

1995; 35: 113 - 7

(52.) Bradley, J.F., , R.C., Goodman, J.L. The

persistence of spirochetal nucleic acids in active Lyme arthritis.

Ann Intern Med. 1994; 120: 487 - 9

(53.) Krause, P.J., McKay, K., , C.A. et al.

Disease-specific diagnosis of co-infecting tickborne zoonoses:

babesiosis, human granulocytic Ehrlichiosis and Lyme disease.

Clin Infect Dis. 2002; 34: 1184 - 1191

(54.) Benach, J., , J.L., Habicht, G.S., Grunwaldt, E.,

Giron, J.A. Serological evidence for simultaneous occurrences

of Lyme disease and babesiosis. J Infect Dis. 1985; 152(3): 473

- 7

(55.) Eskow, E., Rao, R.V., Mordechai, E. Concurrent infection

of the central nervous system by Borrelia burgdorferi and

Bartonella henselae: evidence for a novel tick-borne disease

complex. Arch Neurol. 2001; 58(9): 1357 - 63

(56.) Nasralla, M., Haier, J. Nicolson, G.L. Multiple mycoplasma

infections detected in blood of patients with CFS and/or

Fibromyalgia. Eur J Clin Microbiol Infect Dis. 1999; 18: 859 - 65

(57.) Mac, A.B., Miranda, J.M. Concurrent neocortical

borreliosis and Alzheimer's disease. Hum Pathol. 1987; 18(7):

759 - 61

(58.) Miklossy, J., Khalili, K., Gern, L., son, R.L., Darekar, P.,

Borrelia burgdorferi persists in chronic Lyme neuroborreliosis

and may be associated with Alzheimer disease. J Alzheimers

Dis. 2004; 6(6): 639 - 49

(59.) Document prepared for the Countess of Mar by Malcolm

Hooper, Emeritus Professor of Medicinal Chemistry, University

of Sunderland UK, in collaboration with members of the ME

community. The mental health movement: persecution of

patients? A consideration of the role of Professor Simon

Wessely and other members of the " Wessely school " in the

perception of myalgic encephalomyelitis (ME) in the UK.

Background briefing for the House of Commons Select

Committee. December 2003.

(60.) B. Liegner, M.D., P.C. Remarks before the NYS

Assembly Committee, chaired by Gottfried. Albany,

2001, November 27th.

(61.) Stricker, R.B., Lautin, A. The Lyme Wars: time to listen.

Expert Opin Investig Drugs 2003; 12(10).