LYME COMPLEXITIES IN A SMALL FAMILY
PRACTICE SAMPLE (Georgia & Carolinas)
The Finding of "European" Strains and Negative Lab Results
in the Face of Clear Bulls Eye Rashes
Solid studies and the clinical experience of Lyme experts in the USA show that any talk of certain of strains being limited to specific areas is comical. Also, most labs do not have the full critical Lyme proteins in their "test kits." And so miss positive Lyme routinely.
In this study we find that 4% yielded spirochetes considered to be Borrelia garinii--a European strain not known to occur in the United States.
Further, 13% had spirochete-like forms on special tissue stains. (Lyme is a spirochete).
Amazingly, the routine and dubious method of using an ELISA which misses vast numbers of positive patients, followed by the use of a West Blot "kit," appears to have missed 70% of the patients with an EM or bulls-eye rash. Perhaps because junk labs do not show positive Lyme tests in the presence of a bulls-eye rash after a tick bite, some desperate physicians are saying the bulls-eye rash is not associated with Lyme. Of course it is very possible that many different types of Spirochetes can cause this rash. One would be a Lyme related illness called STARI in which Spirochete DNA is found in these bulls-eye rashes and the treatment is similar to Lyme. The treatment is the same as Lyme disease in those who seem to be treating it. Dr. Masters is the world expert on STARI or "Masters disease" dismisses this as a mere "southern form" of spirochete illness, since the aggressive lone star tick that carry's it is now found in most New York counties, New Jersey and even Maine.
In 1998, the CDC, in the form of Dr. Dennis, reported that a bulls-eye rash was specific for Lyme disease. It is probably specific for Lyme and Masterson's Spirochete illness, but the fact is these are both under-diagnosed and under treated illnesses.
Yet my experience with southern physicians in the Carolinas, Georgia, Florida and the other Gulf States is that a bull-eye rash is being treated too casually, and is not seen as a certain sign of a dangerous spirochete illness. Perhaps they blow off the seriousness of this rash because the "Lyme" labs come back negative for Lyme. Perhaps these labs come back negative due to junky lab testing. The Medicare approved lab IgeneX is coming back positive for STARI in both their Lyme antibody tests and DNA searches (PCR testing), perhaps because they use such a full variety of search proteins to catch all the many dozens of Lyme related spirochetes in the USA.
Solitary erythema migrans [a bulls-eye rash]
in Georgia and South Carolina.
Department of Family Medicine, Medical College of Georgia, Augusta 30912-3500, USA.
OBJECTIVE: To evaluate the incidence of Borrelia burgdorferi infection in humans with erythema migrans (EM) in 2 southeastern states. DESIGN: Prospective case series. SETTING: Family medicine practice at academic center. PATIENTS: Twenty-three patients with solitary EM lesions meeting Centers for Disease Control and Prevention (CDC) criteria for Lyme disease. INTERVENTIONS: Patients underwent clinical and serologic evaluation for evidence of B burgdorferi infection. All lesions underwent photography, biopsy, culture and histopathologic and polymerase chain reaction analysis for B burgdorferi infection. Patients were treated with doxycycline hyclate and followed up clinically and serologically. MAIN OUTCOME MEASURES: Disappearance of EM lesions and associated clinical symptoms in response to antibiotic therapy; short-term and follow-up serologic assays for diagnostic antibody; growth of spirochetes from tissue biopsy specimens in Barbour-Stoenner-Kelly II media; special histopathologic stains of tissue for spirochetes; and polymerase chain reaction assays of tissue biopsy specimens for established DNA sequences of B burgdorferi. RESULTS: The EM lesions ranged from 5 to 20 cm (average, 9.6 cm). Five patients (22%) had mild systemic symptoms. All lesions and associated symptoms resolved with antibiotic therapy. Overall, 7 patients (30%) had some evidence of B burgdorferi infection. Cultures from 1 patient (4%) yielded spirochetes, characterized as Borrelia garinii, a European strain not known to occur in the United States; 3 patients (13%) demonstrated spirochetallike forms on special histologic stains; 5 patients (22%) had positive polymerase chain reaction findings with primers for flagellin DNA sequences; and 2 patients (9%) were seropositive for B burgdorferi infection using recommended 2-step CDC methods. No late clinical sequelae were observed after treatment. CONCLUSIONS: The EM lesions we observed are consistent with early Lyme disease occurring elsewhere, but laboratory confirmation of B burgdorferi infection is lacking in at least 16 cases (70%) analyzed using available methods. Genetically variable strains of B burgdorferi, alternative Borrelia species, or novel, uncharacterized infectious agents may account for most of the observed EM lesions.
PMID: 10566829 [PubMed - indexed for MEDLINE]
[All bolding, italics, enlargements and article identification shifting is from Dr. Schaller]
Arch Dermatol. 1999 Nov;135(11):1317-26.
Felz MW, Chandler FW Jr, Oliver JH Jr, Rahn DW, Schriefer ME.