U.S. Scientists Hunt Better Tests for Tick-Borne Illness (Int'l Herald Tribune)

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_http://www.iht.com/articles/ap/2007/08/13/america/NA-MED-US-Lyme-Disease.php_

(http://www.iht.com/articles/ap/2007/08/13/america/NA-MED-US-Lyme-Disease.php)

U.S. scientists hunt better tests for tick-borne illness

The Associated Press

August 13, 2007

WASHINGTON: President W. Bush's recently disclosed treatment for Lyme

disease makes him part of an unfortunate trend: The tick-borne infection is

on the rise in the United States, with cases more than doubling in the past

15 years.

The good news is that most patients, like Bush, take antibiotics for a few

weeks and are cured, especially if they were diagnosed early.

But people who are not treated promptly can develop painful arthritis,

meningitis and other serious illnesses. If they do not experience, or notice,

Lyme's hallmark round, red rash, they can struggle to be diagnosed, as other

early symptoms are flu-like and vague.

And a small fraction of patients report pain and fatigue that linger for

months or years after treatment. Do they still have Lyme, or something else? No

one knows, although desperate patients often try repeated antibiotics despite

little evidence that the drugs do more good than harm.

The central problem: No test can tell when someone has active Lyme disease —

when Lyme-causing bacteria are alive in the body. Today's tests instead spot

infection-fighting antibodies, which can take weeks to form but then linger

long after Lyme is gone.A push is on for better Lyme tests, with parallel

hunts getting started by the National Institutes of Health and, separately, by

patient advocacy groups angry that modern medicine hasn't found an answer.

" The time is right to take a closer look, " says Dr. Dennis M. Dixon, chief

of bacteria research at the NIH's National Institute for Allergy and

Infectious Diseases, which plans to gather leading scientists later this year

to

determine the best approaches. " We would not rule out any avenue. "

" We have a lot of new tools " to explore, adds Dr. Fallon, who directs

Columbia University's new Lyme and Tick-borne Diseases Research Center,

funded by the advocacy groups Time for Lyme and the Lyme Disease Association.

" Science is going to bridge the gap. "

Among the research:

_A newer antibody test seems to indicate when antibiotics are working in

early Lyme stages, offering the possibility of tracking treatment response.

_Hunting markers of active infection, including bits of Lyme-related protein

in the blood or spinal fluid.

_Fallon is using brain imaging to try to distinguish when Lyme penetrates

the nervous system.

About 20,000 new cases of Lyme disease are reported to the government every

year, says a June analysis from the Centers for Disease Control and

Prevention.

The CDC acknowledges that's a fraction of the true toll, as many cases go

unreported. Experts say it may be five times higher.

Still, the figure is more than double the count in 1991, when official

tracking began, and CDC says it's not due just to better awareness of Lyme. The

rise is expected to continue as suburbia expands into the woodland home of

black-legged tick species, commonly called deer ticks, that carry Lyme-causing

" Borrelia burgdorferi " bacteria in the Northeast, mid-Atlantic, north-central

states and Pacific Coast.

The only human vaccine was pulled off the market in 2002 for lack of

consumer interest. It was partly protective; better, next-generation vaccines

are

years away.

Don't live in a high-Lyme area? Different tick species carry different

threats, such as Rocky Mountain spotted fever. Most recently discovered is

STARI,

or Southern tick-associated rash illness — a rash very similar to Lyme's but

not yet linked to other symptoms. It's caused by a still unknown organism

carried by the lone star tick.

But Lyme is the most common tick-borne infection, and overshadowing the

treatment success for most patients is debate over what patient groups call

" chronic Lyme " and mainstream medicine, striving for neutrality, calls

" post-Lyme

syndrome. "

The two camps became even more polarized as two major medical associations

released guidelines in the past year that found no good evidence that

long-term antibiotics help lingering symptoms — but warned they can cause

serious

side effects and spur formation of drug-resistant super-germs.

" If there were evidence that prolonged therapy was beneficial ... I'd be the

first person to jump on the bandwagon, " says Dr. Eugene Shapiro, a Yale

University pediatrics professor and co-author of the guidelines from the

Infectious Diseases Society of America and American Academy of Neurology.

That is not to say some people are not sick, the guidelines stress, just

that it is not clear why. Among other possibilities, Lyme may over-activate

some

people's immune systems so that antibodies attack their own joints.

Coughlan, President

MA Lyme Disease Awareness Assoc.

Cape Cod, MA

(508) 564-7445

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