The Great Imitator of Diseases

Borreliosis is an infection with a spirochete bacteria, commonly called "Lyme Disease".  Borreliosis is one of many tick-borne infections that can be transmitted to humans.  These pathogens include Borrelia burgdorferi, Babesia, Bartonella, Erlichia, Chliamydia, Rickettsia, Mycoplasma, Epstein-Barr virus, Cytomegalovirus and Herpes simplex virus. The tick-borne infections most commonly result in fatigue, arthritic conditions and cardiovascular impairment. Known as “the great imitator”, each patient’s symptoms will ultimately depend upon the combination of pathogens present.

Defining the etiology of tick-borne disease is dependent upon one’s wisdom in utilizing a variety of diagnostic tests and pertinent clinical observations. There are many tests that the doctor needs to be familiar with to diagnose the presence of tick-borne infections and their involvement of immune pathology; however, testing alone may not be sufficient. Many of the diagnostic tests are deeply flawed in determining with any degree of certainty the exact nature of the pathogen. For example, it is estimated that the rate of false-negative Borreliosis test results may be as high as 50%. This very high rate of erroneous results can occur in both local labs and specialty labs. Borrelia bacteria are adept at causing immune suppression and changing form in order to “hide” from the host immune system. In light of these characteristics, the difficulty in testing for Borrelia becomes apparent.

Upon treatment, several "bands", indicating immune activation against the Borrelia infection, may appear on the Western Blot test. It may be only after several months of empiric treatment, based on clinical presentation, that the immune system can react to the pathogen and a positive test will result. Unfortunately, for many suffering patients, doctors following the CDC surveillance criteria will not investigate beyond the initial negative test result. This phenomenon of treating a patient based on clinical suspicion is a rather inductive process, but it is not without precedent. Despite scientific advances, a doctor's clinical experience is his greatest asset. Hence, it appears that the heralded "Lyme literate doctor" must choose to be knowingly "illiterate" in order to properly care for certain patients.

The goal of any physician is not "literacy", but rather an evolving awareness of the complexities involved in disease diagnosis and treatment. Commitment is needed not only from the physician, but from the patient as well, who faces a dizzying set of choices not faced in other disease states. Together, doctor and patient can make treatment choices with the greatest compassion, concern and clarity possible. With the right course of action, the tick-borne infections can be overcome and health can be restored.

Read this for an in depth article on Lyme Disease - Burrascano 10/2008
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