Lyme disease is a bacterial infection caused by the bite of certain black-legged ticks. The symptoms of Lyme disease include fever, headache, fatigue, and in some cases, loss of function in arms and legs. The Reeve Foundation Paralysis Resource Guide lists Lyme among the various conditions related to paralysis.
Lyme hasn't been known that long -- the primary bacteria that causes it wasn't identified until 1981 -- but all indications are that the disease is more widespread than ever, and not just in the woods of the East Coast. The Centers for Disease Control reported 38,000 cases in 2009. Two years later there were three times as many cases.
The natural history of the disease, the ticks, and the host animals that they favor for propagation -- deer and white-footed mice, in particular -- makes for fascinating reading. What's more relevant, perhaps, it the story of how Lyme is treated, how the disease is defined, and why almost everything about the disease is surrounded by controversy. For example, is there such a thing as chronic Lyme disease? The medical establishment conflicts with the folks who claim to have such an ailment.
This week in the New Yorker magazine, reporter Michael Specter looks at the "Lyme Wars."
From the article:
The disease is caused by the bacterium Borrelia burgdorferi. In the Northeast and the Midwest, B. burgdorferi is transmitted by the bite of a black-legged tick, Ixodes scapularis. (In the Western United States, a related tick, Ixodes pacificus, prevails, and in Europe the main vector is Ixodes ricinus.) Lyme was all but unknown until 1977, when Allen Steere, a rheumatologist at Yale, produced the first definitive account of the infection. The condition was initially thought to have been an outbreak of juvenile rheumatoid arthritis in and around Lyme, Connecticut. In 1982, Willy Burgdorfer, a medical entomologist at the National Institutes of Health's Rocky Mountain Laboratories, determined that the infection was caused by the previously unknown spirochete borrelia. As is common in scientific practice, the bacterium was named for him: Borrelia burgdorferi.
Those facts are undisputed. Nearly everything else about Lyme disease -- the symptoms, the diagnosis, the prevalence, the behavior of the borrelia spirochete after it infects the body, and the correct approach to treatment -- is contested bitterly and publicly. Even the definition of Lyme disease, and the terminology used to describe it, has fuelled years of acrimonious debate. The conventional medical assessment is straightforward: in most cases, the tick bite causes a skin rash, called erythema migrans, which is easily identified by its bull's-eye. If left untreated, the bacteria can spread to muscles, joints, the heart and even the brain. Public-health officials say that a few weeks of antibiotic treatment will almost always wipe out the infection, and that relapses are rare. In this view, put forth in guidelines issued by the Infectious Diseases Society of America, Lyme is normally easy to treat and easy to cure.
For many people, though, the clinical situation is far more complicated. Some who have been infected with borrelia don't notice the rash. Others -- up to a quarter of those with Lyme -- never even get one. Most troubling, some patients who are treated continue to suffer from a variety of symptoms long after their therapy has ended. Nobody really knows why they fail to get better. Infectious-disease experts refer to the phenomenon, which can affect up to 20 per cent of patients, as Post-Treatment Lyme Disease Syndrome. Researchers have attempted to resolve the mystery in experiments with monkeys, mice, and dogs; human studies are also under way. As the number of infections grows, so does the number of people struggling to figure out what is wrong with them.
Specter notes that the Lyme world has its conspiracy theorists: I was told by several Lyme activists that the government created the infection on Plum Island, that reporters at the Times have been "muzzled" and prevented from reporting honestly about Lyme, and that the N.I.H. has made a pact with pharmaceutical companies to ignore chronic Lyme. There is now a bill before the legislature in New York that would require insurance companies to reimburse long-term treatment with antibiotics -- even though no study has proved their effectiveness, and treatment with I.V. antibiotics can cause serious, and sometimes fatal, complications.
Headed for the woods?
You'll want to double check to make sure you don't bring home any ticks. And if you do see the tell-tale bulls-eye rash around a bite area? See a doctor; you should be prescribed antibiotics; conventional medicine says that should knock down the Lyme bugs.
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