Chronic Lyme disease: Sigal and Hassett's response. (Correspondence).Nowhere in our article (Sigal and Hassett 2002) do we minimize or devalue the pain or suffering of patients with chronic Lyme disease chronic Lyme disease A predominantly neurologic condition ranging from mild–eg, fatigue, paresthesia, arthralgia, memory loss, mood swings, and dysomnia, to severe–eg, spastic paraparesis, tetraparesis, ataxia, chorea, cognitive impairment, bladder nor do we state that such patients are "crazy" or "delusional de·lu·sion n. 1. a. The act or process of deluding. b. The state of being deluded. 2. A false belief or opinion: labored under the delusion that success was at hand. ." Further, we do not dismiss the possibility that some such patients actually have infection that persists despite adequate prior antibiotic treatment. Nonetheless, we take this opportunity to again issue a caution against making the diagnosis of chronic Lyme disease in the absence of objective clinical and microbiologic evidence of infection. Without demonstrable physical findings and laboratory proof of the persistence of Borrelia burgdorferi Borrelia burg·dor·fe·ri n. A spirochete causing Lyme disease in humans. Borrelia burgdorferi The spirochete agent of Lyme disease, which contains several outer membrane proteins and a highly immunogenic flagellar , the diagnosis should remain in significant doubt. Certainly, a few, often poorly documented case reports claiming persistence (many in Europe, where the organism, the vector, and the ambient human immunogenetic types are different) cannot be a basis for the widespread diagnosis of chronic infection in certain regions of the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. and in certain practices. We hope our article (Sigal and Hassett 2002) will help educate physicians and assist them in being more sensitive to their patients and to more correctly identify the true underlying cause of their patients' symptoms in a compassionate manner. However, many patients are misdiagnosed with chronic Lyme disease, a diagnosis often made to provide an explanation for a bewildering be·wil·der tr.v. be·wil·dered, be·wil·der·ing, be·wil·ders 1. To confuse or befuddle, especially with numerous conflicting situations, objects, or statements. See Synonyms at puzzle. 2. array of complaints within an acceptable framework for both patient and physician. Instead, these patients deserve the truth. Improvement and cure require provision of a correct scientific and medical explanation and properly directed therapies. For many of the patients we see, chronic antibiotics, continuous reassurance, and yet another antibiotic regimen when the current one fails have led to frustration, anger, depression, and chronic suffering. Further, the inappropriate use of broad spectrum antibiotics, often for long periods, is not without personal (e.g., Clostridium clostridium Any of the rod-shaped, usually gram-positive bacteria (see gram stain) that make up the genus Clostridium. They are found in soil, water, and the intestinal tracts of humans and other animals. Some species grow only in the complete absence of oxygen. dificile infection, allergies, and other adverse reactions adverse reactions, n.pl unfavorable reactions resulting from administration of a local anesthetic; responsible factors include the drug used, concentration, and route of administration. ) and societal (e.g., contribution to the development of resistant strains such as methicillin- and vancomycin-resistant Staphylococcus staphylococcus (stăf'ələkŏk`əs), any of the pathogenic bacteria, parasitic to humans, that belong to the genus Staphylococcus. The spherical bacterial cells (cocci) typically occur in irregular clusters [Gr. ) risks. Leonard H. Sigal Afton L. Hassett UMDNJ-Robert Wood Johnson Medical School New Brunswick, New Jersey E-mail: sigallh@umdnj.edu REFERENCE Sigal LH, Hassett AL. 2002. Contributions of societal and geographical environments to "chronic Lyme disease": the psychopathogenesis and aporology of a new "medically unexplained symptoms" syndrome. Environ Health Perspect 110(suppl 4):607-611. |
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