Preventive Medicine Column
Dr. David L. Katz
An analysis by the CDC indicates that there is ten times as much Lyme disease in the U.S. as formal reporting channels suggest. Rather than the 30,000 official cases each year, there are roughly 300,000 cases.
The report, which was issued at medical conference in Boston, combines findings from three separate, ongoing studies overseen by the CDC. One is looking at medical claims, another at lab reports, and the third is a survey of the population.
The data in question are comparing actual rates, to reported rates, not comparing trends over time. The new report does not indicate anything about a sharp rise in Lyme- just a prevailing tendency to underreport. It still matters that there may be ten times as much the disease among us as we officially recognize, but it’s not nearly as worrisome as a sudden explosion in the number of cases.
Then again, Lyme disease is cause for concern at almost any level. The condition is caused by the bacterium, Borrelia burgdorferi, transmitted as I suspect everyone knows, by tick bite, and specifically in most cases, the blacklegged tick. The bacterium is classified as a spirochete; the germ responsible for syphilis, Treponema pallidum, is in in this same category.
Syphilis, a scourge since long before effective treatment was available, is notorious for progressing through complex stages and involving multiple organ systems over a span of decades if left untreated. The Lyme organism can do much the same. Just like Treponema pallidum, Borrelia burgdorferi can, given the opportunity, invade and damage multiple organ-systems, the nervous system prominent among them.
When a full course of appropriate antibiotic is administered and the organisms lack resistance, the evidence is strong that this reliably does the job most of the time. When treatment is prompt and the disease in its early stage, it is almost invariably cured.
And yet, many people report “chronic Lyme” in the aftermath of what should be decisive therapy. Some go on to get very extended courses of antibiotics, which in some cases still fail to resolve the clinical syndrome- or do so only temporarily. The persistence of chronic symptoms after an infection, and the pushback by experts that this is not “chronic Lyme” have led to what some now call ‘the Lyme wars.’
The wars are an unfortunate distraction. Is the persistence of symptoms from an infection possible long after the infecting organism is gone? Of course. Just talk to anyone using braces after a polio infection decades ago.
The adamancy of some experts that chronic Lyme following effective treatment doesn’t occur, and the insistence by patients that it does may miss the essential point: something is still wrong with these patients. Maybe only the experts are qualified to say if it is Lyme infection, but only the patients can say how they feel. We don’t need to find viable Borrelia burgdorferi to have lingering consequences of their temporary stay.
In my clinic, and many others, we work hard to treat the aftermath of Lyme accordingly, with varying degrees of success. The infection should be treated decisively, certainly. Once it has been, any lingering symptoms should be given the full measure of respect they deserve and treated diligently as well- whether or not they have anything to do with ongoing infection. Patients should perhaps be less adamant about why they don’t feel well, since it can be hard to know. But clinicians are well advised to remember that only a patient can say how she or he feels-and ultimately, that’s really what matters most.
This new analysis may stimulate new efforts directed at Lyme prevention by various means, from tick control to immunization. While waiting, we all have means to defend ourselves. Clothing can be used as a reliable defense against both excessive sun and ticks. Pets can be treated appropriately so they are less likely to share viable ticks with us. Showering promptly after outdoor activities that represent opportunities for ticks is likely to send them into the plumbing before they can dig into our skin. Ticks need to be embedded for 24 hours or more to transmit Lyme, so just having a tick crawl around a bit and try to get settled is not a danger.
I suspect we are all familiar with the adage about doing the best we can with a bad situation: when life gives us lemons, we are supposed to make lemonade. Lyme is common, but no more so now than before this report- this is simply recognition of what has been, not a portent of some new threat to come. More awareness means more reliable prevention, detection, and treatment. We may not have a recipe for lemonade here, but we have no reason for panic, either.