UK lyme info

[Guest guest]

Isn't this just typical , we need to get organised in the UK ...

November 25 2005Stella Huyshe, Partner, Sand, Sidbury, Sidmouth UK. et al have highlighted the gap between our understanding ofthegenetics of B.burgdorferi and our application of research to the treatmentofthe disease that it causes. In the UK there is a similar gap betweengovernment's recognition of the disease and the practical knowledge ofclinicians who bear the brunt of diagnosis and prescribing.Government, in the form of RIDDOR '95, have imposed a legal requirement onemployers to report occurrences of employment acquired Lyme Disease1, and itisa notifiable disease in Scotland. In addition, the NHS on-line guide forGPs2quotes the ILADS guidelines recommending using clinical criteria fordiagnosisand consideration of long term treatment for persistent Lyme for treatment.Onthe ground, however, clinicians with any knowledge of the disease are farandfew between and they all refer for guidance to a single source - the HealthProtection Agency (HPA). This is where the joined up thinking of the UKgovernment departments falls down, because the HPA do not apply the advicethattheir colleagues in the National Library for Health (NLH) have researchedandare providing to GPs. The HPA sit in the camp of 4 weeks antibiotics curesLyme/seronegativity means no Lyme, whereas NLH tells GPs the opposite. GPs arefalling down this particular gap and the NHS should urgently provide abridge.In addition, the gap between the opposing camps in this Lyme debate (wellillustrated in the responses to date) is not so much a gap as a gulf.Floundering in this gulf are patients who don't get treated, clinicians whodon't have the time to research their own decisions, rural employers whoseemployees are on long term sick leave and the NHS which is footing the billbothfor ineffective short term treatment and the long term care of undiagnosedsufferers. This is not just an academic debate.References1. Reporting of Injuries, Diseases and Dangerous Occurrences Regulations1995http://www.riddor.gov.uk/info.html2. National Library for Health http://clinicalanswers.nhs.uk

J Med Microbiol. 2005 Dec;54(Pt 12):1139-41.>>Audit of the laboratory diagnosis of Lyme disease in Scotland.>> R, Mavin S, Ho-Yen DO.>>Microbiology Department, NHS Highland, Raigmore Hospital,>Inverness IV2 3UJ, UK.>>An audit was performed on the laboratory diagnosis of Lyme>disease in Scotland. The problem of a significant number of>patients with clinical symptoms of Lyme disease being reported>as seronegative or equivocal by the confirmatory Western blot>test was identified. Comparisons of current practice were made>with American and European standards, and the Western blot>scoring system revised. When applied retrospectively (April>2003 to March 2004), 39 (33 %) of 116 serum samples previously>negative or equivocal became weak positive or stronger.>Thirty-one (80 %) of these 39 samples were from patients with>clinical details suggestive of early Lyme disease. The changes>were implemented and assessed prospectively for 6 months.>There was a significant increase in the proportion of>equivocal results, with fewer negatives compared to the same>time period 1 year previously. This audit has helped>clinicians in the diagnosis of Lyme disease and the management>of these patients in Scotland.>>PMID: 16278426 [PubMed - in process]