People who have recurring symptoms of Lyme disease after taking a full course of antibiotics most likely have a new infection, according to research that undercuts the theory that the illness can relapse.
The Lyme disease bacterium is spread by the tick bite that appears in the form of a “bull’s-eye rash,” according to the U.S. Centers for Disease Control and Prevention. If untreated, patients may develop fatigue, fever and muscle aches, palsy and eventually arthritis, nerve and heart disease.
A small number of patients have reported symptoms years after their initial treatment, raising concern that an incurable form of the disease exists, said Robert Nadelman, a researcher at New York Medical College in Valhalla. He analyzed bacteria from 17 people with consecutive episodes of the rash starting in 1991, and found the infections were caused by genetically distinct bacteria. There’s less than a 1 in 5 million chance that happened by chance, he said.
“Our data provide compelling evidence that courses of antibiotics that are recommended by Infectious Disease Society of America regularly cure early Lyme disease,” said Nadelman, a professor of medicine in the division of infectious diseases at New York Medical College in Valhalla, in a telephone interview. “When people have early Lyme disease again, it’s likely due to a new infection due to a new tick bite.”
The National Institutes of Health and the William and Sylvia Silberstein Foundation funded the study, which appears in Thursday’s New England Journal of Medicine.
There were 24,364 confirmed cases of Lyme disease reported in the United States last year, according to the CDC, including 3,118 in New York, 3,398 in New Jersey and 4,739 in Pennsylvania, states with the largest number of cases.
The controversy aboutrelapses versus the risk of repeat infection has broad implications for treatment and prevention, the researchers said. Chronic Lyme disease is showing up as a common diagnosis in people with unexplained pain, mental defects or fatigue, even if there is no evidence of infection with the bacteria that causes the disease, wrote Allen Steere, from Massachusetts General Hospital and Harvard Medical School.
“These patients are said to have persistent infection, which can be suppressed only with months or years of antibiotic therapy, and the therapy must be restarted when symptoms recur,” he wrote in an editorial that accompanied the study. “The weight of evidence is strongly against persistent infection as the explanation for persistent symptoms in antibiotic-treated patients with Lyme disease.”
The findings are “absolutely reassuring,” showing that people who have been bitten by tick that may harbor Lyme disease have an excellent chance of a cure, Nadelman said. Because it takes several days for a tick to transmit the infection, people who live in areas where the ticks are endemic should check themselves from head to toe each night, he said.
This is one of several articles I have seen which conflates this study on new rashes and new infection with the issue of chronic Lyme disease or persisting post-treatment symptoms – when the two issues are distinctly separate ones.
Even if one does not believe that Lyme disease can be a chronic infection (which in the scientific world it continues to be a matter of debate if a study like Dr. Embers’ Persistence of Borrelia Burgdorferi after antibiotic treatment in Rhesus Macaques has been published recently and the NIH-NIAID is funding a xenodiagnosis study to see if human hosts with chronic Lyme disease can pass their infection onto lab-raised ticks – hardly a sign the debate has been resolved), the IDSA itself recognizes that a percentage of patients who were treated for Lyme disease go on to have persisting symptoms for months to even years after initial infection. They think it is autoimmune and call it Post-Lyme disease syndrome; there are now proteomics studies that have been done which provide markers for this condition.
Whichever model of persisting symptoms you support, it is incorrect to associate this one study with disproving the existence of either a chronic infection or post-infection autoimmune condition in patients with ongoing disease and disability since contracting Lyme disease.
I think that one has to be careful about the utility of the EM or bulls’ eye rash in proper diagnosis of Lyme disease in general: According to Dr. Jorge Benach of Stonybrook University, if more satellite rashes erupt after the initial rash (usually within weeks to months) the infection has disseminated. Also, not all cases of Lyme disease present with an EM rash, and research by Dr. Benjamin Luft has shown that some strains of Borrelia which disseminate with a rash do not cause disease and some without rashes do cause disease.
One study like this is not enough to set the course for Lyme disease, which is an emerging infectious disease which requires more research.