The Controversy Surrounding Lyme Disease
There are two polarized views of Lyme disease, both in terms of diagnostic criteria and treatment:
The IDSA Lyme disease guidelines suggest that Lyme disease is hard to catch, easy to cure, and that short-term antibiotic use of a few weeks can cure most cases of Lyme disease. Those who hold this view don’t believe in the existence of a chronic form of Lyme disease. They maintain that a small number of patients may have lingering symptoms after short-term antibiotic use, and they refer to these symptoms as “Post-Lyme Syndrome.” It is their opinion that unresolved symptoms are not persistent infection by Borrelia burgdorferi, but rather autoimmune in nature. The IDSA recommends against long-term courses of antibiotics.
The ILADS guidelines contest that chronic Lyme disease and persistent infection with Borrelia burgdorferi, even after treatment with antibiotics, are realities and are more frequently the norm rather than the exception. ILADS advises that treatment with long-term antibiotic therapy is often needed to manage chronic Lyme symptoms. ILADS supports their point of view by stating that peer-reviewed, scientific research, published in reputable medical and scientific journals, demonstrates that Lyme bacteria can survive after treatment with long-term antibiotics. Physicians from this point of view use varied combinations and repeated courses of antibiotics to treat Lyme disease. ILADS-trained physicians frequently report that patients with persistent infections of Lyme benefit from and have been helped to regain self-sufficiency by way of long-term antibiotic treatment.
Some may argue against the usage of long-term antibiotics stating that this use can develop resistance to bacteria. ILADS refutes this claim and contends that antibiotic resistance generally develops as a result of improper usage of the antibiotics (i.e. not taking long enough), and thus recommend to patients to take antibiotics as prescribed, most often until symptoms are resolved. The ILADS position defends the long-term use of antibiotics by arguing that the consequences of untreated chronic Lyme disease far outweigh the consequences of long-term antibiotic use. They maintain that there has never been a published study demonstrating that 30 days of antibiotics will cure chronic Lyme disease.
The key diagnostic criterion for Morgellons disease is the presence of unusual filaments beneath unbroken skin or projecting from skin. At present, there are no diagnostic laboratory tests specifically targeting Morgellons disease. Recent research suggests that Morgellons disease is a manifestation of Lyme disease and if Morgellons disease is suspected in a patient, he/she should therefore be tested for Lyme disease. Unfortunately, however, there is no test currently available that is 100% accurate for diagnosing Lyme disease. Both false positive and false negative results can occur, with the latter being far more common. Ultimately, a Lyme diagnosis is a clinical diagnosis to be made by a qualified physician or other healthcare provider, based on symptoms and patient history, with test results used as tools to aid in the diagnosis. Lyme serologic testing at many laboratories fails to detect antibodies at levels high enough to be interpreted as positive by the CDC surveillance criteria. Consequently, Lyme disease testing at laboratories specializing in tick-borne diseases is recommended. A physician or other qualified healthcare provider must sign a requisition for Lyme disease testing, and a physician or other qualified healthcare provider knowledgeable about Lyme disease should be consulted for interpretation of test results and for the diagnosis and treatment of Lyme disease.
Borrelia burgdorferi sensu stricto, a spirochetal bacterium and causative agent of Lyme disease, has been detected in dermatological tissue from Morgellons patients, as has Borrelia garinii, a closely-related Lyme disease-causing bacterium falling into the Borrelia burgdorferi sensu lato group. Lyme-like illness can also be caused by spirochetes other than Borrelia burgdorferi (Bb). At present other spirochetes from other genera have not been detected in Morgellons dermatological tissue, but neither have they been ruled out. Not a lot is known about the genetic diversity of spirochetes associated with Morgellons disease. Some laboratories offer testing based on several strains of Bb, including European strains and other related strains. In addition to spirochetal infection, ticks may carry other organisms that co-infect the patient at the time of a tick bite. Patients who have been diagnosed with Lyme disease should be tested for tickborne co-infections.
The most common laboratory tests for Lyme disease are serologic tests for antibodies against Bb. Other tests include Bb antigen detection, PCR detection of Bb DNA, lymphocyte transformation tests (LTT), and culture of spirochetes. Elevated complement C4a levels and decreased CD57 natural killer cell levels may be associated with chronic Lyme disease. These tests may aid physicians in determining a Lyme disease diagnosis.
The following laboratories are reputable laboratories offering testing for Lyme disease: