Letter to the Editor,
Journal of the American
Medical Association,
Vol. 283, No. 23,
June 21, 2000

To the Editor: I was disheartened to read that Dr. Seltzer and
colleagues(1) found the consequences of LD to be trivial. In reality,
the disability resulting from disseminated LD is often extreme (2)(3)
It is possible that some patients interviewed by the authors were in
the latent, asymptomatic stage of LD. Perhaps many who were excluded
from the study were too sick to participate or had died from tick-borne
diseases. The nondescribed cases were the ones that the researchers
should have pursued.

The study by Seltzer et al is flawed further by the fact that tertiary
LD may not evidence significantly for decades. The average duration of
time from ECM rash to the time of the authors' interview was a mere 51
months. I see many patients with previously unrecognized asymptomatic
latent disease who now face a number of physical and cognitive
difficulties, as well as emotional problems such as panic, rage,
obsessive-compulsive disorder, and depression as a direct result of
tick infections unrecognized by their physicians. They usually do not
improve until aggressively treated with antibiotics.

The fact that CDC surveillance criteria defined the study's probands
meant that those individuals were excluded who had a negative
enzyme-linked immunosorbent assay (ELISA) result or for whom positive
Western blot bands 31 and 34 kD (both specific to the causative
spirochete) were not counted nor were those who had less than 5 IgG
bands detected. Yet ELISA is notoriously unreliable, and 1 of these
deleted bands is considered essential to the development of the LD
vaccine. (4)

It is remarkable that the study did not focus on patients who had
ongoing symptoms and did not include patients who were untreated for
months to years following an ECM rash.

Finally, vaccine and test kit manufacturers apparently endow a parent
university of some of the authors The widespread offer of vaccine to
the public is dependent on the authors' construct that the CDC's
surveillance criteria are valid for diagnosis of LD. How might this
relate to the authors' surprising claim that LD is an unremarkable
disease with generally good outcomes?

{*filter*}ia T. Sherr, MD
Holland, Pa

1 Seltzer EG, Gerber MA, Cartter ML, Freudigman K, Shapiro ED. [YALE]
Long-term
outcomes of persons with Lyme disease. JAMA. 2000;283:609-616.
2. Liegner KB. Lyme disease: the sensible pursuit of answers. J Clin
Microbial.
1993;31:1961-1963.
3 Fallon BA. Late-stage neuroopsychiatric lyme borreliosis.
Psychosomatics.
1995;36:295-300.
4 Centers for Disease Control and Prevention. Effect of vaccination on
the
serologic diagnosis of LD. September 1999; Erratum: Vol 48: No. RR-7.