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Microbiologically Confirmed Early Lyme Disease
- Robert P. Smith, MD; and
- Allen C. Steere, MD
- Maine Medical Center Research Institute; Portland, ME 04102 New England Medical Center; Boston, MA 02111
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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.
Robert P. Smith, MD
Maine Medical Center Research Institute
Portland, ME 04102
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
