source: The Medical Detectives
author: Berton Rouech`e
last chapter -" The Foulest and Nastiest
Creatures That Be"

The last chapter of this book titled, " The Foulest and Nastiest Creatures that Be" deals with Lyme disease. There is case history of a patient in East Hampton in the summer of 1982.
The patient descibes her nightmare encounter with this horrible disease. Her husband describes her condition and says at one point he thought she was
dying. "..I suppose
this sounds a bit silly,...But there was a time,
when Priscilla was at her
worst, when I had an awful thought: We had
never talked about death as
something that might happen to one of us.
I realized that I didn't know
if she wanted a burial or cremation....It gives
you an idea of how sick I thought she was."

The author, Bertron Rouech'e reports , "Dr. Grunwaldt told me that he had only seen
one case of RMSF in his thirteen years
of practice on Long Island, and
only twenty cases of babesiosis. But
he had seen and treated at least
four hundred cases of Lyme disease." (1982)
Earlier in the chapter Dr.
Grunwaldt tells the author about an EM
rash he saw on Shelter Island in
1975 and again in the summer of 1976.
He talks about taking the trouble
to search the literature- " most of the
reports I found were Scandanavian,
some of them going back to the nineteen
twenties.
I found a 1962 paper by
three researchers at the university of Helsinki
which discussed a possible
relationship between Ixodes ticks and the erythema
chronicum migrans that
was then associated with meningitis. But you can't
count on a rash as an
infallible clue. For one thing, as we know now,
it isn't always present.
For another it only appears several days
after the bite and the intial
symptoms . In any event, I started
treating my cases with antibiotics,
and that seemed to do some good.
I followed Steere's work as it was
published, and that's when I realized that
what I was seeing was his Lyme
Disease. I remember a telephone conversation
I had with Steere in 1978.
He had decided that in certain cases Lyme
disease was self-limiting---that
it cured itself and after a while just
vanished. That's true, of course ,
in a way. It seems to go away, but it
really just goes underground, and
then emerges in a much more serious way.
The late complications usually
take one of three forms......arthritis....
neurological....The third form
affects the heart. When Steere assured me
that the disease was self
-limiting, I stopped using antibiotics. But
then he dug deeper and
changed his mind. We now know that prompt
treatment with a penicillin
can GENERALLY prevent the later manifestations."
"...The laboratory work--the most significant
work---was done at the
Rocky Mountain Laboratories, in Hamilton,
Montana, by a team headed by
Willy Burgdorferi.....As you know the cause
of syphillis is also a
spirochete. Not the same one...And untreated
syphillis, like lyme
disease, can later reappear, with very
serious consequences.
"The laboratory findings were published
in Science and in the Journal
of Clinical Investigation in 1982 and 1983.
And that's
about where we
stand right now. We have the disease
as an
entity, we have the causative
organism, and we have the vector---the tick.
And we have an effective
treatment. There are still some loose ends....."

The chapter ends with an author's note
" A report published in the
June 14, 1990, issue of The New England
Journal England of Medicine
suggests that the avoidance of ticks or tick
country may not be enough to
avoid exposure to Lyme disease.
Dr. Steven W. Luger.. offers both
laboratory and anecdotal clinical evidence
that biting flies--deerflies
and horseflies ---- may carry the Borrelia
burgdorferi spirochete and
transmit it to human beings. He does,
however offer a word of
consolation:"In contrast to the painless bit of
I. dammini, (Ixodes scapularis ) the bite of
flies is painful and not likely to be overlooked." ________________________________
If late manifestations can show up
years down the road and no one can
find the organism--you can't say
treatment prevented late manifestations
of the disease.

source : The American Journal of Medicine
Volume 98 (suppl 4A) April 24, 1995
pg. 4A-38S

John J. Halperin: ".......To draw an analogy
to syphilis, we know from the
infamous Tuskegee study that two thirds
of those who develop early meningitis
will never go on to develop late neurologic
disease...." there are other forms of tertiary syphilis and they are not refered to . The organ most affected by syphilis is the heart. "There are a lot of
reassuring data, although
WE DON"T THE ANSWER.
A.R. Pachner: ".....I know some people will
fail doxycycline therapy no matter
what some of the data show..."....The
organism does enter the CNS fairly
soon....the organism likes the basilar areas,
and sometimes it takes a while
for the inflammation and the organism to
reach there...."
Question: "I was involved in a the study
...........for treatment of late
Lyme disease. Most of the
patients that I saw in Westchester County
(New York) had well-documented Lyme
arthritis, with typical presentation and
confirmatory serology. One of the
observations I made is that almost none
of these patients had any CNS
complaints. In light of your animal data,
can you comment on that?"

Pachner: "I don't know why more patients
with Lyme arthritis don't have
neurologic symptoms. The organism goes
into the CNS early. Many of the
troubling symptomatic signs can be
attributed to early inflammation in the
nervous system. The headache, the stiff neck,
and the malaise are often due to
this intial inflammation. As my study in the
monkey shows, frequently this
inflammation can subside, but the organism
does not go away. There are
patients who have Lyme arthritis who will
end up having organism in their
brain. And we still don't know whether that
is live organism or dead organism
because PCR does not allow you to
differentiate. But, I suspect that if I
examined the brains of those patients,
a large percentage of them would have
Borrelia burgdorferi. Why do I think that?
Out of three spinal taps from
people who had no CNS symptoms whatever,
one was clearly PCR positive. It is
not a huge number, but my access to
brain biopsies is limited."

Question: "So the conclusion is, then,
that frequently the neurologic disease
is silent?"

Pachner: "Yes, silent."

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