Lyme disease is tick borne, bacterial infection that is relatively common in the United States.
Not very unusual, not very exotic, so what is it and why there is so much controversy surrounding it.
First discovered in 1975 in a town in Connecticut where it derives its name, lyme disease is caused by the spirochete, Borrelia burgdorferi (Bb).
The disease is characterized by a distinctive skin lesion known as erythema migrans (EM) and possibly systemic symptoms including neurological, rheumatologic and cardiac involvement over time (months to years).
Some reports say that the optic nerve may also be affected.
The EM which is the first manifestation in the majority of cases is a red papule that expands slowly frequently showing a clear center (bull's eye).
They may be seen singly or in multiples.
With or without EM, other early symptoms may include malaise, fatigue, fever, headache and stiff neck.
Body aches and migratory joint pain may also be seen.
In the USA, lyme disease is endemic along the Atlantic coast, in Wisconsin and Minnesota and parts of California and Oregon.
Where then lies any controversy? First is the mode of transmission.
It is well documented that lyme is a tick borne disease.
Ixodes scapularis and I.
pacificus are the common species of ticks known to harbor Bb.
The larval and nymphal ticks feed on small animals while adults feed on deers.
Household pets like dogs can also get lyme disease.
However there are those that believe that there other vectors that carry the disease such as fleas, mites and mosquitoes.
The Centers for Disease Control and Prevention (CDC) has stated on their web site that there is no credible evidence that Lyme disease can be transmitted through air, food, water, or from the bites of mosquitoes, flies, fleas, or lice.
The second issue frequently expressed by lyme sufferers is the testing and misdiagnosis.
Many patients complain that it is a problem getting properly diagnosed.
Some say it may take years to get diagnosed for lyme disease.
Some people talk of being misdiagnosed with fibromyalgia, chronic fatigue or lupus.
The diagnosis of lyme disease is based on a two step laboratory testing process.
The first step is using an antibody test known as ELISA or IFA.
These are very sensitive tests and if you have lyme disease you should be positive.
There are times when someone who doesn't have lyme disease may also come up positive in these screening tests.
Cross reacting antibodies may cause false positives in patients with syphilis, leptospirosis, HIV, infectious mononucleosis and rheumatoid arthritis among others.
The ELISA and IFA tests are insensitive during the first weeks of infection and can remain negative if treated early with antibiotics.
The second step is the Western Blot test.
This test is designed to be "specific," meaning that it will usually be positive only if a person has been truly infected.
Unless the ELISA or IFA is positive, the Western Blot should not be tested.
Critics say this two step testing process doesn't work.
They say purpose of standardization was to establish parameters for laboratory confirmation of Lyme disease surveillance cases, not clinical diagnosis.
They also say that the tests in step one is insufficiently sensitive to be used as screening tests.
Also it is argued that the interpretation of the Western Blot was chosen on statistical rather than clinical grounds.
A third issue of contention is the appropriate treatment for lyme disease.
According to studies funded by the National Institute of Health (NIH) most patients can be cured with a few weeks of antibiotics taken by mouth.
Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil.
Patients with certain neurological or cardiac forms of illness may require intravenous treatment with drugs such as ceftriaxone or penicillin.
Patients treated with antibiotics in the early stages of the infection usually recover rapidly and completely.
A few patients, particularly those diagnosed with later stages of disease, may have persistent or recurrent symptoms.
Critics say that these treatments work only occasionally or rarely.
Sometimes they help for a while and sometimes they do nothing at all.
Most infectious diseases have a very clear cut diagnostic test and a specific treatment, however Lyme disease has and probably will in the future be a problem for physicians and patients for the above reasons and others not mentioned here.