Updated Guidelines on Diagnosis, Treatment of Lyme Disease
ALEXANDRIA, VA -- October 2, 2006 -- In response to growing concern and confusion about Lyme disease, the Infectious Diseases Society of America (IDSA) has updated its Clinical Practice Guidelines on the disease, in order to provide guidance to physicians and patients based on the latest scientific evidence. The guidelines were originally published in 2000.
The most significant changes in the updated version include:
-- The addition of information on human granulocytic anaplasmosis (HGA) and babesiosis, two diseases transmitted by the same tick that transmits Lyme disease; -- Recommendations of a single dose of an antibiotic for certain high-risk patients who have been bitten by a tick but do not have symptoms of Lyme disease; -- Expanded discussion and definition of so-called "chronic" or post-Lyme syndromes.
The Guidelines, developed by an expert panel according to widely accepted criteria for evidence-based medicine, contain updated information on the epidemiology, clinical features and diagnosis of Lyme disease, according to Gary P. Wormser, MD, Chief, Division of Infectious Diseases and Vice Chairman of the Department of Medicine, New York Medical College.
Dr.Wormser is lead author of IDSA's 2006 Lyme disease guidelines and chair of the expert panel that developed the guidelines.
"We worked to make the guidelines as comprehensive as possible based on a thorough review of all credible scientific literature," said Dr. Wormser.
The guidelines are now available on the IDSA Web site and will be published in the Nov. 1 edition of the journal, Clinical Infectious Diseases.
Lyme disease is caused by an infection with the bacteria Borrelia burgdorferi. This infection is principally transmitted by the black-legged deer tick (Ixodes scapularis) that typically feeds on small mammals, birds and deer but may also feed on cats, dogs and humans.
Although the disease has been reported in nearly all states, the majority of cases are concentrated in the Mid-Atlantic and northeast states. Other regions in the United States with significant numbers of cases include Wisconsin, Minnesota and northern California.
"Most people who are infected with Lyme disease have a circular, red rash surrounding the site of a tick bite, that may be accompanied by muscle and joint aches and less commonly, facial paralysis," said Lyme disease expert Paul Auwaerter, MD, MBA, who was a reviewer of the IDSA guidelines.
Dr.Auwaerter is the Clinical Director of the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, and managing editor of the Johns Hopkins Antibiotic Guide.
"The symptoms are sometimes alarming, but with proper diagnosis and antibiotic treatment almost all will go away within a few weeks."
HGA and Babesiosis
Although Lyme disease is the most common tick-borne infection in North America and Europe, the updated guidelines now contain information on two other tick-related diseases, HGA and babesiosis. HGA is a tick-associated disease caused by a species of bacteria called Anaplasma phagocytophilum.
The most common symptoms are headache, fever, chills, muscle pain and fatigue. Babesiosis is a parasitic infection which affects the red blood cells, resembling malaria; it is also transmitted through the bite of a deer tick. In the United States, the disease usually does not cause symptoms in healthy individuals and is most likely to affect those who are elderly or have compromised immune systems.
Treatment for Lyme Disease
Although routine preventive antibiotic administration is not recommended for individuals with tick bites and no symptoms of disease, one substantive change in IDSA's treatment recommendations is that some selected, high-risk tick bites may be treated with a single dose of the antibiotic doxycycline for people who are eligible for the drug, according to Dr. Wormser.
Eligibility criteria for preventive Lyme disease treatment with doxycycline include:
-- the attached tick can be reliably identified as an Ixodes scapularis tick that is estimated to have been attached for 36 hours or longer; -- preventive treatment can be started within 72 hours of the time the tick was removed; -- ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi bacteria is 20% or greater.
Whether use of antibiotic prevention after a tick bite will reduce the incidence of HGA or babesiosis is not known, Dr. Wormser said.
In general, doxycycline is not recommended in pregnant women and in children under the age of eight, he said.
Most patients who develop Lyme disease are cured with a single course of 10-28 days of antibiotics, depending on the stage of their illness. Occasionally a second course of treatment is necessary.
More prolonged antibiotic therapy is not recommended and may be dangerous, according to Dr. Wormser.
"Nearly all people -- more than 95% -- who do get sick with Lyme disease and are treated with the recommended course of antibiotics get better and go on with their lives," he said.
"Chronic" or Post -Lyme Disease Syndromes
A small number of patients report a variety of non-specific symptoms such as generalized pain, joint pain or fatigue following an episode of Lyme disease that has been appropriately treated with antibiotics.
The updated IDSA guidelines contain greater detail in the discussion of post-Lyme disease syndromes, and conclude that objective evidence of prior B. burgdorferi infection must be part of any acceptable definition of these syndromes.
As in the past, the guidelines do not recommend ongoing antibiotic therapy for those with chronic symptoms who have completed the recommended initial course of treatment for Lyme disease.
"After a thorough review of the literature, the panel concluded there is no convincing biologic evidence for symptomatic, chronic Borrelia burgdorferi infection after completion of the recommended treatment for Lyme disease," the guidelines state.
Furthermore, long-term antibiotic therapy may be dangerous and it also can lead to complications for the patient such as blood stream catheter infection (for those on intravenous antibiotics) and Clostridium difficile colitis (a potentially severe infection of the bowel).
Long-term antibiotic therapy may also foster the development of drug-resistant superbugs that are difficult to treat, Dr. Auwaerter added.
"IDSA and its expert panel do not doubt that patients with symptoms that persist for weeks, months or longer are suffering, but many report non-specific symptoms that also are associated with a number of other medical conditions," Dr. Wormser said.
"People who continue to have symptoms that persist after appropriate antibiotic treatment for Lyme disease should talk to their physicians about whether the diagnosis was accurate or if they may have a different or new illness to be certain they get the proper medical care."
The IDSA updated practice guidelines and more information about Lyme disease -- including a fact sheet for the public and practice guidelines for physicians -- can be found on the IDSA Web site at www.idsociety.org.
lymie tony z
Frequent Contributor (1K+ posts)
Member # 5130
posted
Thanks Ann,
But what a bunch of Steere Crap!
OK, now how do we sue the pants off these morons!??
We need that California Lawyer that helps "Lost causes" that I saw on TV awhile back...
Holy Jumpin Jehosephat! Can you BELIEVE these guys Ann?
zman
-------------------- I am not a doctor...opinions expressed are from personal experiences only and should never be viewed as coming from a healthcare provider. zman Posts: 2527 | From safety harbor florida(origin Cleve., Ohio | Registered: Jan 2004
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posted
At the same time I saw this post on my screen, a skunk let off a great big stink outside my window. Did that skunk time his blast to coincide with the IDSA guidelines announcement here? I believe it did. Even the four legged wild creatures know this thing is a stinker.
How I feel about the authors of these guidelines can only be expressed in language that can't be used here.
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
Here are the authors of the new guidelines. Some changes from the previous edition, but they kept their entomologist, Durland Fish, who is surely qualified to decide how human patients should be treated for infectious diseases. Dr. Jones can't diagnose over the phone (but this hasn't been proved) even with 10,000 patients having been treated, but an entomologist without a medical degree can specify treatment?
Gary P. Wormser,1 Raymond J. Dattwyler,2 Eugene D. Shapiro,5,6 John J. Halperin,3,4 Allen C. Steere,9 Mark S. Klempner,10 Peter J. Krause,8 Johan S. Bakken,11 Franc Strle,13 Gerold Stanek,14 Linda Bockenstedt,7 Durland Fish,6 J. Stephen Dumler,12 and Robert B. Nadelman1
Divisions of 1Infectious Diseases and 2Allergy, Immunology, and Rheumatology, Department of Medicine, New York Medical College, Valhalla, and 3New York University School of Medicine, New York, New York; 4Atlantic Neuroscience Institute, Summit, New Jersey; Departments of 5Pediatrics and 6Epidemiology and Public Health and 7Section of Rheumatology, Department of Medicine, Yale University School of Medicine, New Haven, and 8Department of Pediatrics, University of Connecticut School of Medicine and Connecticut Children's Medical Center, Hartford; 9Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, and 10Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; 11Section of Infectious Diseases, St. Luke's Hospital, Duluth, Minnesota; 12Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland; 13Department of Infectious Diseases, University Medical Center, Ljubljana, Slovenia; and 14Medical University of Vienna, Vienna, Austria
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
Tomorrow I will post the numbers on how many of these authors are board certified in infectious diseases. On the last guideline, less than half of them were.
Posts: 8430 | From Not available | Registered: Oct 2000
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Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020
posted
It is exactly what we dreaded and more...
Here is their purpose included in Bold Type . I have split it up for easier reading. Ann- OH
Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America.
These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14).
The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them.
For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment.
Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided.
A definition of post-Lyme disease syndrome is proposed.
posted
So, here is the breakdown on board certification in infectious diseases for the authors of this IDSA guideline:
5 of these are board cert in ID
7 of these are not board cert in ID
2 of these are Europeans, status of ID training unknown
In the previous edition, 5 of 12 were board certified in ID
In this edition, 5 of 14 are board certified in ID. So the proportion is worse, unless the Europeans have specialized training equivalent.
Furthermore, the authors include no psychiatrists even though lyme has significant psychiatric symptoms.
And the authors include an entomologist with no medical degree at all.
And none of these authors has any experience in treating chronic lyme disease because they do not recognize it to be an infectious disease.
(This information was checked on the website of the organization that certifies medical specialists.)
Posts: 8430 | From Not available | Registered: Oct 2000
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Greatcod
Unregistered
posted
This is a disaster, and on another level, a joke. Symptoms are not "subjective", only physical entities that science cannot measure yet.
The complexity of these guidelines for the treatment of Lyme is certain to confuse many, many doctors, and assure us a a long stream of chronically ill people who were not treated or undertreated for Lyme.
Its too bad this board does not allow serious swearing-I have a mouthful for the IDSA. I suppose I can dump them on SciMedLyme.
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lymie tony z
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posted
UP
-------------------- I am not a doctor...opinions expressed are from personal experiences only and should never be viewed as coming from a healthcare provider. zman Posts: 2527 | From safety harbor florida(origin Cleve., Ohio | Registered: Jan 2004
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posted
Here, from the end of the guidelines, is a list of other people who read and advised on the contents. Note that at least one of them works for the CDC in the Ft. Collins office (Barbara Johnson).
Acknowledgments
We thank Lisa Giarratano and Richard Minott for assistance in the preparation of this manuscript. The following individuals served as consultants to the Infectious Diseases Society of America panel in the development of these guidelines: Maria Aguero-Rosenfeld, Stephen W. Barthold, Susan O'Connell, Volker Fingerle, Jerry Green, Barbara J. Johnson, Richard Kaplan, Jooyun Lee, Muhammad Morshed, Jose Munoz, Benjamin H. Natelson, John Nowakowski, Mario Philipp, Joseph F. Piesman, Arthur Weinstein, and Bettina Wilske. The Expert Panel also wishes to express its gratitude to Paul G. Auwaerter, Michael A. Gerber, and Leonard H. Sigal for their thoughtful review of an earlier draft of these guidelines.
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Even the four legged wild creatures know this thing is a stinker.
HA!
Made ME laugh!
Thanks Ann and lou.. good info!
I like this too.. They said..
"Expert Panel also wishes to express its gratitude to Paul G. Auwaerter, Michael A. Gerber, and Leonard H. Sigal for their thoughtful review of an earlier draft of these guidelines."
Another Hopkins skunk there. And there we see old Seagull too. GEEZE!
A single dose treatment for anyone bitten by a tick is reckless beyond belief. Not only will it not protect the patient from tick-borne disease, it could create a superbug.
I truly hope that the guidelines are yet to be corrected.
Certainly hope Health Canada is not listening to your guidelines as you clearly know only enough about TBID to get into trouble.
Mary J BC Canada
and email sent to Health Canada Oct 13,06:
October 13, 2006
Email to: Dr David Butler-Jones Chief Public Health Officer Canada
Re: TBID New IDSA Guidelines
The Infectious Disease Society of America has recently published new treatment guidelines for the treatment of Tick-borne Infectious Diseases. It is public knowledge that the same people who have adopted and approved these guidelines have conflicts of interest with the pharmaceutical/insurance industry.
Members of the Canadian Lyme Disease Foundation and other support groups across Canada are outraged at the IDSA / USCDC denial of treatment for TBID.
I suggest Health Canada and all health departments across the county do not follow these guidelines without thorough investigation and research into the IDSA conclusions.
For example: denial of treatment unless the tick is known to be attached for 36 hours. This is not only ridiculous, but impossible unless it is arranged.
Further, it appears the IDSA has used flawed, selective research in compiling these new guidelines.
Yours truly, Mary J
Posts: 267 | From Abbotsford BC | Registered: Jul 2003
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5dana8
Frequent Contributor (1K+ posts)
Member # 7935
posted
this really stinks-and I don't mean the skunk
I just don't know how the IDSA can live with themselves
-------------------- 5dana8 Posts: 4432 | From some where over the rainbow | Registered: Sep 2005
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bettyg
Unregistered
posted
quote:Originally posted by lou:
Here, from the end of the guidelines, is a list of other people who read and advised on the contents.
Note that at least one of them works for the CDC in the Ft. Collins office (Barbara Johnson ).
Acknowledgments
We thank Lisa Giarratano and Richard Minott for assistance in the preparation of this manuscript.
The following individuals served as consultants to the Infectious Diseases Society of America panel in the development of these guidelines:
Maria Aguero-Rosenfeld, Stephen W. Barthold, Susan O'Connell, Volker Fingerle, Jerry Green, Barbara J. Johnson, Richard Kaplan, Jooyun Lee, Muhammad Morshed, Jose Munoz, Benjamin H. Natelson, John Nowakowski, Mario Philipp, Joseph F. Piesman, Arthur Weinstein, and Bettina Wilske.
The Expert Panel also wishes to express its gratitude to
Paul G. Auwaerter, Michael A. Gerber, and Leonard H. Sigal
for their thoughtful review of an earlier draft of these guidelines.
I wanted to be able to read the last names of ALL these guilty parties contributing to the BIGGEST SHAM DETRIMENTAL TO ALL CHRONIC LYME PATIENTS HEALTH!
Shame on you all! If I were a tick right now, I'd bite you all leaving you with lyme and co-infections! Bettyg
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I am hororfied that the majority of that panel are not even certified in infectious diseases and because they do not believe in the possibility that it exists they have no experience in treating late stage or chronic lyme disease. Since the tests the use will miss around 40% of even the earliest cases this means that they could be misdiagnosing and not treating the majority of patients with lyme disease who come to see them.
I can only describe the IDSA thingie, in the words of the poet Catullus as "cacaca charta", I cannot remember the whole Latin sentence, now in my senility but the English is "**** toilet paper from the lavatory fresh" It is not only toilet paper, my dear, it is USED toilet paper. Catullus comment was about some loveletter or other. Some love letter, ain't it. Cheers. Thomas Parkman
-------------------- Thomas Parkman Posts: 341 | From Columbia SC 29206 | Registered: Feb 2003
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It seems like the IDSA has a "Let them eat cake" attitude. Cake is not so good for those of us with Lyme. Doctors are supposed to care and "do no harm".
Posts: 158 | From Ecuador | Registered: Apr 2006
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dontlikeliver
Frequent Contributor (1K+ posts)
Member # 4749
posted
Dr. Susan O'Connell who is on that list is a Microbiologist. (She does not work as a doctor treating patients yet tells doctors how to do so, even though she is not really in a position to give treating instructions afaik). She worked as a GP something like 20 years ago. She is the UK's equivalent pretty much of Shapiro.
Health Protection Agency Level B South Lab Block Southampton General Hospital Southampton SO16 6YD UK Ph 023 8079 6408
Posts: 2824 | From The Back of Beyond | Registered: Oct 2003
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these guidelines are a complete joke and are solely designed to prevent panic among the populace and preserve the economic and political status quo in the US. it's all about dollars.
there is no scientific evidence for many of the claims made by wormser et. al.
this document is full of lies, and seeks at every corner to deny the existence of a vast body of literature {including some authored by the very authors of these guidelines} which contradicts many if not most of the claims made herein.
Posts: 523 | From Stillwater,OK,USA | Registered: Sep 2004
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And you are so right on the pack of lies in this guideline. Several of the referenced papers directly contradict what is said in the body of the text. Two that immediately come to mind are the papers by Hunfeld, Strle, et al on persistence of borrelia, and the one on testing done by Johns Hopkins people, including Dumler. It amazes me that these people can be such baldfaced liars and get away with it. Makes me wonder if medicine is across the board crooked. If not, why haven't they been challenged on this by mainstream medicine? Only a few persecuted docs can tell the truth? What does that say about mainstream medicine?
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Ann-OH
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posted
Bringing this back up for people who have not read about the Infectious Diseases Society of America [IDSA] guidelines.
It is published in this journal: Clinical Infectious Diseases 2006;43:1089-1134 � 2006 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2006/4309-0001$15.00
Here is one of the things they say on treatment: (I split it up for easier reading) [quote]
Therapeutic modalities not recommended.
Because of a lack of biologic plausibility, lack of efficacy, absence of supporting data, or the potential for harm to the patient, the following are not recommended for treatment of patients with any manifestation of Lyme disease: first-generation cephalosporins, fluoroquinolones, carbapenems, vancomycin, metronidazole, tinidazole, amantadine, ketolides, isoniazid, trimethoprim-sulfamethoxazole, fluconazole, benzathine penicillin G, combinations of antimicrobials, pulsed-dosing (i.e., dosing on some days but not others), long-term antibiotic therapy, anti-Bartonella therapies, hyperbaric oxygen, ozone, fever therapy, intravenous immunoglobulin, cholestyramine, intravenous hydrogen peroxide, specific nutritional supplements, and others (see table 4) (E-III). [end quote]
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