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Editorials

Lyme disease: time for a new approach?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6520 (Published 03 December 2015) Cite this as: BMJ 2015;351:h6520

Re: Lyme disease: time to shift the paradigm

Many physicians who care for patients with Lyme disease and who follow the decades-long medical debate on appropriate diagnosis and treatment agree that a new approach is needed. Numerous scientific papers have demonstrated that the two-tiered testing strategy for diagnosing Borrelia burgdorferi will miss a large percentage of cases, and this approach is unable to diagnose new species of borrelia including Borrelia miyamotoi and Borrelia burgdorferi sensu lato, infections also known to cause chronic illness. Persistence of borrelia has also been recently reported by Johns Hopkins researchers, and mechanisms of persistence have included immune evasion and formation of biofilms. The CDC recently has reported a 320% increase in the number of Lyme cases within the last two decades, so without a fundamental shift in the medical paradigm that we use to diagnose and treat Lyme disease, we are looking at significant increases in the number of individuals chronically disabled from this illness.

Ang, C.W., et al. Large differences between test strategies for the detection of anti-Borrelia antibodies are revealed by comparing eight ELISAs and five immunoblots. Eur. J. Clin. Microbiol. Infect. Dis. 30, 1027-1032 (2011).

Branda JA, Rosenberg, E.S. Borrelia miyamotoi: A lesson in disease discovery. Ann Intern Med 159: 61-2 (2013).

Kugeler, K.J. et al Geographic distribution and expansion of human Lyme disease, United States, E.I.D., 21, (8), August 2015.
http://wwwnc.cdc.gov/eid/article/21/8/14-1878_article

Rudenko, N. et al. Isolation of live Borrelia burgdorferi sensu lato spirochetes from patients with undefined disorders and symptoms not typical for Lyme borreliosis. Clin Microbiol Infect, Published online Dec 07, 2015.

Competing interests: No competing interests

13 December 2015
Richard I. Horowitz
Internist
4232 Albany Post Road, Hyde Park, N.Y. 12538