New test for Lyme unveiled

By PETER URBAN
Staff writer

HARTFORD A Ridgefield doctor has developed a new process to detect Lyme
disease that he hopes will lead to better treatments against the stubborn and
elusive bacteria that causes it.

"My hope is this will force the medical community to develop more effective
treatments against Lyme disease," said Dr. Steven Phillips, a specialist in
internal medicine and Lyme disease.

Phillips was able to grow a culture of Lyme bacteria from the {*filter*} of 43
patients who had persistent symptoms of the disease, even though only four had
tested positive using the standard screening test for the disease, known as
ELISA.

By finding Lyme disease in patients when the standard clinical test had failed
to uncover it, Phillips may have scaled one of the most significant obstacles
in treating the crippling neurological disease.

Early and accurate diagnosis is critical to treating Lyme disease. If treated
in its early stages, the disease can be stopped before permanent damage occurs
to the brain and central nervous system.

Until now, the medical community has had no way to say definitively whether a
person still carries the Lyme bacteria because current {*filter*} tests are not
particularly reliable, Phillips said.

For that reason, scientists have been trying for two decades to grow Lyme
bacteria from the {*filter*} of infected patients with little success. Such
"culturing" of bacteria definitively proves whether a person is infected or
not. Otherwise, scientists must use less reliable tests for antibodies to the
bacteria.

The standard treatment for Lyme disease is four weeks of antibiotics given
orally or intravenously. While many doctors assume the treatment kills the
bacteria, people infected with Lyme bacteria often experience relapses.

The fact that the {*filter*} tests have been unreliable has fueled debate among
doctors over whether the disease is being overdiagnosed and overtreated, or
whether it is being overlooked.

"The ability to culture the Lyme organism from infected patients would solve
this problem," Phillips said.

Karen Forschner, who chairs the Lyme Disease Foundation in Hartford, agreed.

She said Phillips new procedure "might help determine who is chronically
infected with Lyme disease versus those who have lingering side effects due to
damage from the disease," Forschner said.

A reliable test for the disease could also help doctors know when a patient is
clear of the Lyme bacteria.

"When you lack a perfect test, you wind up with the problem of not knowing
which is the right drug for treatment, the length of time the drug should be
used, or whether it should be taken intravenously or orally. This test appears
to be the answer to that problem," Forschner said.

Forschner said that a more reliable test would also help those chronically
infected to obtain disability income or to convince insurance companies that
they need to pay for additional treatment.

A second medical controversy concerns patients who fail antibiotic therapy.
Some researchers claim that patients with recurrent symptoms have developed
another illness called "post-Lyme syndrome."

Phillips said that his study indicates that "post-Lyme syndrome" may simply be
a flare-up of Lyme disease that has otherwise been dormant.

Phillips and colleagues who worked with him detail their "high yield" process
for culturing the Lyme bacteria in the current issue of Infection, Europes
premier journal on infectious disease microbiology.

The key, Phillips said, was developing a "medium" in which to grow the
bacteria. Lyme bacteria mutates after a time in the body losing its cell
wall. Without a cell wall, the bacteria becomes very fragile and will not
survive in most commonly used mediums

"We used a different medium designed to foster the Lyme bacteria to grow back
their cell walls," Phillips said.

Since 1980, more than 112,000 people across the nation including about 17,000
in Connecticut have been diagnosed with the illness.

Kirby Stafford of the Connecticut Agricultural Experiment Station said that he
believes Lyme disease is underreported.

Stafford, chief scientist with the stations department of forestry and
horticulture, said that the number of cases of Lyme disease appears to run in a
two-year cycle, peaking in even years and ebbing in odd years.

Over the long run, the number of cases is steadily rising. More than 3,000
cases were reported in 1998 in Connecticut.

Yale University researchers gave the Lyme bacteria its name in 1977 although
the first medical report of the disease in the United States occurred in 1969
in Wisconsin. The bacteria has also been found in ticks that were alive 100
years ago.

A vaccine that may prevent Lyme disease was recently approved by the cooking.net">food and
Drug Administration.