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REPLY
Microbiologically Confirmed Early Lyme Disease
Robert P. Smith, MD, and
Allen C. Steere, MD
15 October 2002 | Volume 137 Issue 8 | Page 698
IN RESPONSE:
Dr. Masters objects to our inclusion of the reference by Campbell and associates (1) in our brief allusion to an erythema migrans–like rash that has been associated with the bites of lone star ticks (Amblyomma americanum). Although the clinical characteristics of this illness, which has been reported predominantly in the southeastern and south-central United States, have been described by Masters and colleagues (2), others, including Campbell and associates, have also contributed to the investigation of its epidemiology and possible etiology (1, 3–5). Attempts to demonstrate infection in these patients by Borrelia burgdorferi sensu stricto, the recognized cause of Lyme disease in the United States, have been unsuccessful. Nevertheless, as pointed out by Masters and colleagues, the characteristics of the rash and its apparent response to antibiotics suggest that this illness may be provoked by an infectious agent. The identification of "Borrelia-like organisms" in lone star ticks provides tantalizing circumstantial evidence that these organisms may turn out to be the cause (4, 5). Campbell and associates refer to this possibility as "intriguing and deserving of further study." Their article, although unable to provide direct evidence for a specific infectious cause for this illness, does provide a well-designed epidemiologic analysis of its occurrence in Missouri. It also describes an intense effort to search for an infectious cause. Given the wide distribution of lone star ticks in the United States, continued investigation into the clinical characteristics, epidemiology, and pathogenesis of this illness is certainly warranted.
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Author and Article Information
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Maine Medical Center Research Institute; Portland, ME 04102
New England Medical Center; Boston, MA 02111
1. Campbell GL, Paul WS, Schriefer ME, Craven RB, Robbins KE, Dennis DT. Epidemiologic and diagnostic studies of patients with suspected Lyme disease in Missouri, 1990-1993 J Infect Dis. 1995;172:470-80. [PMID: 7622891].[Medline]
2. Masters E, Granter S, Duray P, Cordes P. Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites Arch Dermatol. 1998;134:955-60. [PMID: 9722725].[Abstract/Free Full Text]
3. Kirkland KB, Klimko TB, Meriwether RA, Schriefer M, Levin M, Levine J, et al. Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease? Arch Intern Med. 1997;157:2635-41. [PMID: 9531233].[Abstract]
4. Barbour AG, Maupin GO, Teltow GJ, Carter CJ, Piesman J. Identification of an uncultivable Borrelia species in the hard tick Amblyomma americanum: possible agent of a Lyme disease-like illness J Infect Dis. 1996;173:403-9. [PMID: 8568302].[Medline]
5. Burkot TR, Mullen GR, Anderson R, Schneider BS, Happ CM, Zeidner NS. Borrelia lonestari DNA in adult Amblyomma americanum ticks, Alabama Emerg Infect Dis. 2001;7:471-3. [PMID: 11384533].[Medline]
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