Peter L. Salgo, MD: Is it fair to say that, whatever the minute details of this cycle are—whether or not deer are the ‘no-tell motel’ for the ticks—to get people infected, you need people? You need Borrelia, you need ticks, and the ticks need to have blood meals, which eventually gets them infected, and they eventually bite people.
Leonard Sigal, MD: And proximity. So, if you walk to the edge of my backyard, to the next property, there are a gazillion ticks. And every time I go out, when Triver comes back, I have to pull lots and lots of ticks off her. There they are.
Patricia V. Smith: If I may just add to that—you normally need ticks, but if you have a pregnant woman who has Lyme disease and that woman has not been treated, there’s a chance that it can cross the placenta and cause death of the fetus.
Peter L. Salgo, MD: Fair enough. But that’s why everybody is talking about deer, mammals, ticks, Borrelia, and spirochetes; it’s all part of the very complex, interrelated issue.
Samuel Shor, MD, FACP: Right, with one other qualifier—the co-infection component. Co-infections can create a more clinically robust presentation, and, according to work in New York, the Borrelia, Babesia, and probably other co-infections actually contribute to the dissemination of those more widespread, infectious etiologies.
Peter L. Salgo, MD: Just when you thought you understood this, there’s another wrinkle to it all. But, before we leave this topic, let’s set the table again. How many folks, each year, get diagnosed with Lyme disease?
Robert C. Bransfield, MD, DLFAPA: Well, there are confusing statistics. The surveillance criteria report that there are basically about 30,000 people-per-year affected. However, when you look at the testing, there are over 3 million Lyme tests done per year. So, those 3 million Lyme tests yield 1 in 100 patients who meet the surveillance criteria. By other criteria, by research looking at insurance records through the [Centers for Disease Control and Prevention] CDC, there are over 300,000 people per year, and that was a study done a while back. So, it’s at least 300,000—probably quite a bit more—that we miss. The problem is the question about testing, which I’m sure we’ll get to later.
Peter L. Salgo, MD: Is one age group more at risk than any other age group?
Patricia V. Smith: Yes, most decidedly. Ages 5 to 9 and 10 to 14 are at the highest risk for acquiring the disease, because, obviously, they are children. They tend to go in the woods and roam, and they don’t necessarily pay attention to their parents.
Peter L. Salgo, MD: Their parents tell them to stay out of the brush, and they laugh and do it anyway. Finally, you mentioned misdiagnosis, or you alluded to it. How big of an issue is misdiagnosis, or an incorrect diagnosis, for this disease?
Robert C. Bransfield, MD, DLFAPA: Well, it’s a major issue if it’s overlooked early. Then, you can have greater disease progression and more serious neuropsychiatric problems, and I think that’s the greater area. That’s often what I see as a psychiatrist, and it’s very similar to what we think of in syphilis—where it starts as a rash and then, later, has other symptoms; and then, in the tertiary stage, it’s more of a neuropsychiatric illness.
Peter L. Salgo, MD: Not necessarily. Coincidently, syphilis is another spirochetal disease, so there’s some interest there as well.