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Lyme disease: time for a new approach?

BMJ 2015; 351 doi: (Published 03 December 2015) Cite this as: BMJ 2015;351:h6520

Rapid Response:

Re: Lyme disease: time for a new approach?

The editorial by Borgemans et al is timely and calls for greater open mindedness rather than slavish following of dogma. Dogma leads to extreme views and intransigence in all walks of life and Lyme disease is no exception.

Following up patients with Lyme disease in Hampshire for 20 years has revealed two distinct groups (ref1): those with objective clinical signs and positive serology by the two tiered test system and those with symptoms but no objective signs and negative or equivocal serology. Most of the former recover with short course antibiotics. Managing the latter group is much more challenging because there are many uncertainties: do they have Lyme disease; if they do, is the infection active; if it is not active, what is the pathology - immune system activation, another infection, a toxin, a psychosomatic disorder. It can be anyone of these and possibly all of them together. Giving the patient a diagnosis is impossible because there is no clear case definition in this group to differentiate chronic Lyme from post infectious symptoms, fibromyalgia or chronic fatigue syndrome. To complicate matters recent publicity has encouraged many patients with neurodegenerative disorders to question their diagnosis which often fails to define an aetiology and explore the possibility that they in fact might have Lyme disease.

Much research is needed on this group, as outlined in the editorial, but most urgently there needs to be research on diagnosis to establish whether persisting infection is present in some of the patients with persisting chronic symptoms. This will allow the development of more appropriate treatments for this group. It will also save the anguish and confusion that many patients experience when forced to spend money on tests which have not been clinically validated.

1. Dryden M, Saeed K, Ogborn S, Swales P. Lyme borreliosis in southern United Kingdom and a case for a new syndrome, chronic arthropod-borne neuropathy. Epidemiol. Infect., 2014. 9:1-12 . doi:10.1017/S0950268814001071

Competing interests: No competing interests

22 December 2015
Matthew S Dryden
Consultant in infection and microbiology
Hampshire Hospitals NHS Foundation Trust & RIPL, PHE, Porton
Royal Hampshire County Hospital, Winchester, SP11 6NU