July 30, 2011 in Features

Dr. Gott: Lyme disease testing varies

Peter H. Gott, United Feature Syndicate
 

DEAR DR. GOTT: I am a 39-year-old female recently diagnosed with Lyme disease. For the past 3- 1/2 months, I have been experiencing many nervous system symptoms and actually had a test done to detect Lyme disease about 1- 1/2 months ago. It came up negative.

I happened to get information through a friend that there are actually two types of Lyme tests and that one is much more accurate than the other. I then went to a specialist who ordered the more sensitive test and discovered that I do, indeed, have Lyme.

I am shocked because I haven’t been hiking much in recent years, although I did a fair amount when I was younger – and I don’t live in a particularly high-risk area. I have been freaking out for the past few months thinking I had MS or God knows what else.

I am very concerned about others out there who could have Lyme disease and come up with a negative test because it was not the right test. I am confused about why the less accurate test hasn’t been discontinued, as it is so misleading. (This is the test currently being ordered by most MDs). Please tell your readers about the two types of test as well as Lyme symptoms. It could literally save someone’s life! Sign me … GLAD TO BE DIAGNOSED FROM THE CENTRAL COAST OF CALIFORNIA

DEAR READER: Lyme disease is the most common tick-borne illness in North America. It is caused by a bacterium known as Borrelia burgdorferi. The bacterium is spread by deer ticks that feed on the blood of humans, mice, deer, birds, cats and dogs. They are brown and approximately the size of the head of a pin, making them very difficult to spot. In order for a person to develop Lyme disease, he or she must be bitten by an infected deer tick. Before any bacteria can be transmitted, however, the tick typically has to be attached for at least 48 hours.

Symptoms vary from person to person, with various areas of the body affected. Common signs may include a rash or bull’s-eye ring in one location or over the body, joint pain, headache, body aches, fever and chills. Less common symptoms are neurological in nature – such as Bell’s palsy, weakness of the limbs, irregular heartbeat, impaired memory, hepatitis and overwhelming fatigue. These are typically associated with advanced disease.

Some symptoms of Lyme disease (without the telltale bull’s-eye ring or rash) are also found in disorders such as fibromyalgia, depression, joint pain and chronic fatigue. Therefore, if your physician has any question at all, he or she might choose to order lab testing such as an ELISA (enzyme-linked immunosorbent assay) test, a Western blot to detect antibodies to several proteins of B. burgdorferi, or a PCR (polymerase chain reaction) that detects bacterial DNA through fluid drawn from an infected joint or spinal fluid.

The ELISA test is the current standard of care and is ordered first. It can take several weeks following the initial bite for the body to develop sufficient antibodies for the test to be positive. Testing too early may produce a negative result when in fact, infection is present. If the ELISA is positive, it is followed up with a Western blot; in patients with “chronic” Lyme or Lyme arthritis, the PCR may also be ordered.

It is important for both physician and patient to realize that testing may not indicate Lyme disease. And, once an individual has been diagnosed, a portion of the report known as the IgG may remain positive for months or years after the initial infection. This doesn’t require treatment, but remains an indication that the patient had Lyme at one stage.

Treatment is commonly initiated with oral antibiotics such as doxycycline for adults and children over the age of 8, or amoxicillin or cefuroxime for those younger, pregnant women or women who breast-feed. A two- to four-week course is the norm. However, some research studies now indicate that between 10 and 14 days might be sufficient.

With progression of Lyme disease that fails to respond to traditional methods, treatment with intravenous antibiotics may be appropriate and can last anywhere from two to four weeks. This method is extremely effective in eradicating infection; however, it may cause a low white blood cell count, diarrhea, or infection with other antibiotic-resistant organisms unrelated to Lyme.

The Food and Drug Administration has warned consumers and health care providers to avoid Bismacine. This injectable compound contains high levels of a metal known as bismuth. It has been prescribed by some alternative medicine practitioners. While safe in some oral medications, in its injectable form it can cause poisoning that can lead to heart and kidney failure and is not approved.

Dr. Peter H. Gott is a retired physician. His website is www.askdrgottmd.com.


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