• Ticks - The Medical Detectives - Lyme disease on Long Island in1982 - p

    From georgia@21:1/5 to All on Sun Jun 12 11:02:46 2016
    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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