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Guidelines for the Clinical Diagnosis of Lyme Disease
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 Unpublished letters cannot be returned.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.
TO THE EDITOR:
The American College of Physicians' position paper on Lyme disease [1] ignores the serious problem of false-negative test results, thereby promoting continuation of circular reasoning in the diagnosis of this illness. Delay in diagnosis and application of treatment because of overreliance on the diagnostic criteria and therapeutic approach promoted by the position paper has resulted in advanced neurologic injury, debility, and death [2].
A review of simultaneous enzyme-linked immunosorbent assay (ELISA) and Western blotting in our practice, which specializes in Lyme disease, showed that 16% of patients had concurrent positive test results but that 21% had fully diagnostic IgG or IgM Western blots when ELISA results were entirely negative [3]. Two-tiered testing, suitable for diagnosis of HIV infection, is inappropriate in Lyme disease because ELISA-negative patients may have either diagnostic or suspicious Western blots. The presence of only one or two highly specific bands on Western blot such as the 23-, 31-, 34-, 39-, or 93-kD bands may be vital early clues to diagnosis and frequently are harbingers of further expansion of bands over time. However, fully diagnostic immunoblots may take months or years to develop.
The position paper admonishes against empirical treatment based on cold calculation of statistical probabilities and cost–benefit ratios. Withholding empirical treatment in individual patients with suspected Lyme disease who fall within the seronegative subset or who have positive results on Lyme ELISA but indeterminate Western blots may result in needless, incalculable, avoidable suffering and irreversible neurologic injury.
The position paper does not address the problem of chronic, persistent infection despite treatment, the evidence for which is now abundant in the worldwide peer-reviewed literature and which can no longer be dismissed as “anecdotal” [4, 5]. The unwillingness of the medical profession and many in the biomedical research community to deal with this problem is resulting in denials of treatment of seriously ill patients.
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
