The Lancet Infectious Diseases,
Volume 12, Issue 5, Pages 361 - 362, May 2012
Lyme disease antiscience
Paul Auwaerter and colleagues1 compare some Lyme disease activists who use
non-evidence-based arguments with anti-HIV or antivaccination extremists.
Their Personal View shows that unscientific thinking and malpractice occur in many specialties.
Such a focus has unfortunately resulted in suppression of legitimate and necessary scientific debate about the management of syndromes of unclear aetiology, which sometimes occur after a previously proven episode of Lyme disease or tick bites.
Public health recommendations should rely on strong evidence-based data and not on expert opinion, as Lee and Vielmeyer's review2 of the Infectious Disease Society of America guidelines shows is the case with Lyme disease.
Recommended serological tests for Lyme disease vary greatly in sensitivity.
Since no reliable reference standard exists—such as a specific clinical score, culture, or PCR—the cut-off levels of such tests are decided with healthy donors and calculated arbitrarily.
Several studies have shown that seronegative Lyme disease cases can be proved with culture or PCR. Seronegative patients have been included as Lyme disease cases in a major clinical trial.3
Another difficulty is that, although many variants and new species of Borrelia are regularly discovered, most commercial tests rely on the original Massachusetts B31 isolate of Borrelia burgdorferi, used since 1982.
However, Scottish experts were able to improve the sensitivity of their tests with local strains of Borrelia spp.4
In Brazil, a Lyme-like syndrome has also been described that is due to a non-cultivable spirochete—not a Borrelia species—and is therefore undetected by current serological tests.5
Additionally, peer-reviewed studies show that other bacterial, viral, or parasitic infections might contribute to syndromes associated with Lyme disease or its mimics.
Microbial involvement is being actively investigated in other well known but poorly understood conditions.
For example, the possible role of spirochetes, including B burgdorferi, has become the subject of research into the pathophysiology of Alzheimer's disease.6
Syndromes without a clear cause or objective evidence should no longer be called chronic Lyme disease.
These syndromes are probably caused by several factors; therefore, both infectious and non-infectious aetiologies should be considered.
To limit the debate to Lyme disease alone is highly unproductive, because this disease is unlikely to be the universal explanation of our patients' persisting ailments.
These syndromes with possible microbial involvement should be investigated with the best available tests and with a fresh and open-minded scientific approach.
I declare that I have no conflicts of interest.
1 Auwaerter PG, Bakken JS, Dattwyler RJ, et al. Antiscience and ethical concerns associated with advocacy of Lyme disease. Lancet Infect Dis 2011; 11: 713-719. Summary | Full Text | PDF(89KB) | CrossRef | PubMed
3 Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 345: 85-92. CrossRef | PubMed
4 Mavin S, Milner RM, Evans R, Chatterton JMW, Joss AWL, Ho-Yen DO. The use of local isolates in Western blots improves serological diagnosis of Lyme disease in Scotland. J Med Microbiol 2007; 56: 47-51. CrossRef | PubMed
5 Mantovani E, Costa IP, Gauditano G, Bonoldi VLN, Higuchi ML, Yoshinari NH. Description of Lyme disease-like syndrome in Brazil: is it a new tick borne disease or Lyme disease variation?. Braz J Med Biol Res 2007; 40: 443-456. CrossRef | PubMed
a Infectious Diseases Department, Groupe hospitalier Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris, University of Versailles-St Quentin, 92380 Garches, France