TO THE EDITOR:
The provocative report by Bradley and colleagues [1] supports the emerging view that persistence of spirochetes is important in the pathogenesis of chronic, relapsing Lyme disease [2, 3]. It is disturbing that the patients described have not responded to courses of antibiotic therapy exceeding those previously thought to be curative in studies with only short-term follow-up [4]. The long periods of clinical latency (sample, 25 patients) spanning 5 years also raise doubt about the presumption that routinely prescribed, short-duration antibiotic treatment is curative and that persistent or relapsing symptoms are necessarily caused by the development of fibromyalgia [5]. The authors are correct in calling for further study of the microbiologic state of Borrelia burgdorferi in cases of chronic or relapsing disease and the mechanisms that allow for such latency. Given the many potentially affected patients, these studies are urgently needed to clarify the appropriate mode of therapy. When clinicians in intensely endemic areas such as Ocean County, New Jersey, are confronted with persistent relapsing symptoms after "adequate" treatment, do we treat patients for fibromyalgia or chronic infection?
1. Bradley JF, Russell LJ, Goodman JL. The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann Intern Med. 1994; 120:487-9.
2. Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Bauman, A, et al. Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection. 1989; 17:355-9.
3. Leigner KB, Rosenklide CE, Campbell GL, Quan TJ, Dennis DT. Culture-confirmed treatment failure of cefotaxime and minocycline in a case of Lyme meningoencephalitis in the United States. In: Program and Abstracts of the Fifth International Conference on Lyme Borreliosis, Arlington, Virginia, May 30-June 2, 1992. Bethesda, Maryland: Federation of American Societies for Experimental Biology; 1992.
4. Steere AC, Taylor E, McHugh GL, Logigan EL. The overdiagnosis of Lyme disease. JAMA. 1993; 269:1812-6.
5. Hsu VM, Patella SJ, Sigal LH. "Chronic Lyme disease" as the incorrect diagnosis in patients with fibromyalgia. Arthritis Rheum. 1993; 36:1493-500.
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