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Persistence of Organisms for Lyme Arthritis
- Michael A. Patmas, MS, MD
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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?
Michael A. Patmas, MS, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
