RCP 2018 – ‘Parallel Universe’ has developed around Lyme disease

  • UK Medical News
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By Rachel Pugh


Lyme disease has become a ‘fashionable’ illness since singer Avril Lavigne and billionaire Phones 4u’s businessman John Caudwell claimed to be suffering from it, according to Dr. Matthew Dryden, Director of Infection at Royal Hampshire Hospital, Winchester, United Kingdom.


Describing the ‘parallel universe’ that had developed around Lyme disease, with highly vocal patient advocacy groups, Dr. Dryden urged clinicians facing the condition to stick to clinical diagnoses based on serology, rather than unvalidated laboratory reports from abroad brought in by patients.


Dr. Dryden said: “Serology is the mainstay for detecting antibodies specific for Borrelia. However, in late-presenting Lyme disease, a positive serology test does not prove current infection.”


In his myth-busting talk, he reviewed the epidemiology of Lyme disease, which is the most common tick-borne infection in the northern hemisphere, caused by the Borrelia spp. Incidence in the United Kingdom is 1.7/100,000 compared with 206/100,000 in Slovenia and 135/100,000 in Austria.


The disease is caused by a spirochete, a sheath pathogen that infects ticks. Prevalence rates of Borrelia in ticks vary widely throughout the United Kingdom, with Exmoor having a rate of 9/100,000. Other areas of high prevalence include Dalby in Yorkshire (8.02), Mabie Forest, Dumfries (8.19) and Hampsfell Woods in Cumbria (7.75).


Lyme disease starts with a local infection following a tick bite. Over the following days or weeks, half of those infected may develop flu-like symptoms and an erythema migrans (classic bull’s eye) rash, although this is not present in up to 50% of cases.


Early disseminated disease can occur weeks or months after the infection, via the blood or lymphatic system, leading to possible multiple secondary erythema migrans lesions, lymphocytoma (especially in children), facial palsies and arthritis. First-line treatment is with doxycycline or amoxicillin for 14-21 days.


Rarely, late disseminated Lyme disease develops, with persistent symptoms including arthritis, carditis and cognitive impairments sometimes lasting years after infection. This form of Lyme disease has become controversial, with vocal patient groups disputing official guidance.


Dr. Dryden urged for more research on Lyme disease, especially on disease criteria. Some patients convinced they have late disseminated Lyme disease have turned out to be suffering from completely different conditions such as motor neuron disease or multiple sclerosis.

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