Re: Lyme Disease in the South

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From

Infections in Medicine®

Letters to the Editor:

Lyme Disease in the South

[infect Med 18(5):260, 2001. © 2001 Cliggott Publishing Co., Division of

SCP/Cliggott Communications, Inc.]

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Dr Jerome Goddard's column on Lyme disease in the South is very timely.[1}

All too often, physicians are led to believe that Lyme disease does not

occur in the South. I am located in Clearwater, Fla, and have treated many

patients for Lyme disease, a number of whom have acquired it in Florida.

In fact, the very second case of Lyme disease I ever saw, some 17 years ago,

was acquired in Clearwater. A 23-year-old waitress who had not traveled

outside the Tampa Bay area developed a flu-like illness with multiple

lesions characteristic of erythema migrans. Her symptoms were classic for

early Lyme disease even though at that time there had been no reports of

Lyme disease acquired in Florida. Nevertheless, I treated her with

doxycycline, and her symptoms disappeared and her rash cleared promptly.

Meanwhile, I had sent a sample of blood to Dr Steere's laboratory for

testing. The test came back with a positive IgM assay for Lyme disease. On

further questioning, the patient remembered having a " mole " on her shoulder

that she was thinking of going to the dermatologist about when it

disappeared. This was probably a tick that had attached to her while she was

gardening and had become engorged.

Subsequently, I have treated numerous individuals who have acquired their

Lyme disease in Florida -- some on the East Coast; some in northern Florida

(usually while hunting), Pinellas County, and Hillsborough County. Some of

these have had positive blood tests, others have had only positive urine

tests, and some have had negative blood and urine tests but have responded

completely to antibiotics.

Since the blood test is aimed only at Borrelia burgdorferi, it is possible

that some of the patients with negative tests had disease caused by Borrelia

garinii or Borrelia afzelii. However, I did have one patient, ill for 5

years with symptoms typical of Lyme disease, who had a negative Western blot

test result. One year after he was cured (off antibiotics and symptom-free),

I repeated the Western blot test, out of curiosity, and it was positive,

supporting the concept that sometimes the antibody is " imprisoned " by immune

complexes.

The Florida Department of Health has issued reports of patients meeting very

strict CDC criteria for Lyme disease who have acquired it in Florida as far

south as the Keys and Lee County. Although not numerous, such reports are

sufficient to counter the statement I have heard from many doctors that Lyme

disease is not acquired in Florida.

Reference

Goddard J. What's going on with Lyme disease in the South? Infect Med.

2001;18:132-133.

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N. Reifsnyder, MD, Clearwater, Fla

[ ] Fw: Re: Fw: Lyme Found in Florida contradicts claims by

docs

> ON a Dog-tick list we are having this 'debate' about Lyme in the S.E.

This

> is a letter written in and as you can tell, she doesnt believe Lyme is a

> prob. Needless to say, she is getting hammered LOL What do y'all have

to

> say in response? TYIA, Pissy-Pepi

>

>

>

> > There is a huge controversy about whether Lyme exists in the SE US.

> > Doctors and scientists often take opposite sides of the argument

> > with the doctors believing that Lyme does occur fairly often. I

> > have been working on my dissertation on human TBDs and have heard

> > many good arguments about why Lyme may not be present in the SE from

> > very respected scientists. One of the issues that is brought up is

> > that Lyme tests are notoriously misused. For instance there was a

> > doctor in the SE that was testing many patients for Lyme and found

> > quite a few with reactive antibodies (the tests were positive). A

> > public health officer that I was working with discovered that the

> > tests where not being performed properly. I do not have details nor

> > am I an expert in Lyme disease but it seems that the test that was

> > used was cross-reactive with several other organisms and a second

> > test was required to confirm the diagnosis but was not done.

> > Anyway, there were many cases of Lyme reported which when discovered

> > by the public caused undue concern. Second, there have definitely

> > been cases of EM in the SE. There has been a name given to this

> > condition, Southern Tick Associated Rash Illness (STARI). It is

> > possible that this condition is caused by Borrelia lonestari. The

> > CDC is presently trying to collect specimens from humans that

> > experience EM in the SE. There is very little published about

> > STARI. There is an article that discusses this. I have not had a

> > chance to get a copy myself but here is the source and abstract:

> >

>

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