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Ciotti S. "I Get It, I'm Sick Too": An Autoethnographic Study of One Researcher/Practitioner/Patient With Chronic Illness. QUALITATIVE HEALTH RESEARCH 2023; 33:1305-1321. [PMID: 37843470 DOI: 10.1177/10497323231201027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This autoethnographic research utilizes reflexivity as a method to explore my self-experience of Lyme disease while holding co-occurring identities as a researcher, health professional, and mother. Awareness of self is central in psychotherapy so that therapists do not adversely impact their clients. This is similar for researchers who are ethically required to acknowledge and reduce any potential risk(s) of harm to their participants. In this study, I describe and systematically analyze my experiences as a patient with symptom-persistent Lyme disease, contextualized through co-occurring identities as a mother, a regulated (mental) health professional, and a scholar investigating the embodied experience of being a Lyme disease patient in the Canadian context. The central research question guiding this study is: "What are my experiences with symptom-persistent Lyme disease?" The results of this study suggest reflexivity is an important practice in both health research and healthcare. Relationships with health professionals have a significant impact on patients' healthcare experiences, and engaging in reflexive practice may improve the responsivity of healthcare professionals toward patients' needs and embodied experiences and serve as a check on pre-existing power relations in healthcare. Further, this research contributes to the current academic knowledge on symptom-persistent Lyme disease by offering a reflexive representation of my experiences as a researcher who is also a health professional and a patient within the Canadian healthcare system. Representations of patients' experiences are critical in advancing health research and ensuring equitable care for patients. Autoethnography offers important insights into patients' disease experiences.
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Affiliation(s)
- Sarah Ciotti
- Department of Child and Youth Studies, Brock University, St. Catharines, ON, Canada
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Kopsco HL, Krell RK, Mather TN, Connally NP. Identifying Trusted Sources of Lyme Disease Prevention Information Among Internet Users Connected to Academic Public Health Resources: Internet-Based Survey Study. JMIR Form Res 2023; 7:e43516. [PMID: 37494089 PMCID: PMC10413241 DOI: 10.2196/43516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Misinformation about Lyme disease and other tick-transmitted pathogens circulates frequently on the internet and can compete with, or even overshadow, science-based guidance on tick-borne disease (TBD) prevention. OBJECTIVE We surveyed internet users connected to academic tick-related resources to identify trusted sources of Lyme disease prevention information, explore confidence in tick bite prevention information, and examine associations of these responses with answers to commonly disputed issues. METHODS The survey was conducted through social media and website pages for Western Connecticut State University Tickborne Disease Prevention Laboratory and the University of Rhode Island TickEncounter Resource Center. RESULTS Respondents (N=1190) were predominantly female (903/1190, 76.3%), middle-aged (574/1182, 48.6%), and resided in New England states (663/1190, 55.7%). In total 984 of 1186 (83%) respondents identified conventional experts (eg, the Centers for Disease Control [CDC] or other government health agencies, physicians who follow Infectious Diseases Society of America guidelines for Lyme disease treatment guidelines, and academics) as trustworthy TBD prevention resources. However, nearly one-fourth of respondents would first consult personal contacts and web-based communities regarding prevention information before consulting conventional expert sources. The opinions of public health experts and physicians were rated among the top motivators underlying personal prevention decisions; yet, more than 50% of participants revealed distrustful attitudes toward, or were uncertain about, CDC-supported statements related to time to transmission of Lyme disease (708/1190, 59.5%), the safety of diethyltoluamide-based repellents for children (604/1183, 51.1%), and recommended use of antibiotic prophylaxis (773/1181, 65.4%). Multimodal regression models revealed that participants from high-Lyme-disease-incidence states were more likely to first seek TBD prevention information from personal networks and nontraditional sources before approaching conventional sources of TBD prevention information. We found that those reporting high rates of social media usage were more than twice as likely to first seek traditional expert sources of prevention information but were overall more likely to reject CDC-promoted Lyme disease information, in particular the established time to transmission of Lyme disease bacteria. Models also predicted that those participants who disagreed with the conventional scientific view on the antibiotic prophylaxis prevention statement were less likely to be confident in their ability to protect themselves from a tick bite. Overall, uncertainty in one's ability to protect oneself against tick bites was strongly associated with uncertainty about beliefs in CDC-promoted TBD prevention information. Self-reported trust in experts and frequency of social media use suggest that these platforms may provide opportunities to engage directly with the public about TBD prevention practices. CONCLUSIONS Using strategies to improve public trust and provide information where the public engages on social media may improve prevention communication and adoption of best practices.
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Affiliation(s)
- Heather L Kopsco
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Rayda K Krell
- Department of Biological and Environmental Sciences, Western Connecticut State University, Danbury, CT, United States
| | - Thomas N Mather
- Department of Plant Sciences and Entomology, University of Rhode Island, Kingston, RI, United States
| | - Neeta P Connally
- Department of Biological and Environmental Sciences, Western Connecticut State University, Danbury, CT, United States
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3
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The Role of the Infectious Disease Consultation in Lyme Disease. Infect Dis Clin North Am 2022; 36:703-718. [PMID: 36116844 DOI: 10.1016/j.idc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A consultation regarding Lyme disease can be challenging for the infectious disease physician when the referral question centers on the use of prolonged or empirical antibiotic treatment of Lyme disease and associated tick-borne infections. Patients who have been infected with Borrelia burgdorferi, and many who have been misdiagnosed, are confronted with a seemingly endless array of misinformation that is not in keeping with the current understanding of the clinical spectrum of Lyme disease and its response to evidence-based treatment. Preparing for these conversations with a good grasp of the public beliefs regarding Lyme disease and its treatment can be beneficial.
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Abstract
Most patients with Lyme disease will fully recover with recommended antibiotic therapy. However, some patients report persisting nonspecific symptoms after treatment, referred to as posttreatment Lyme disease symptoms (PTLDs) or syndrome (PTLDS), depending on the degree to which the individual's symptoms impact their quality of life. PTLDs occur in a portion of patients diagnosed with chronic Lyme disease (CLD), a controversial term describing different patient populations, diagnosed based on unvalidated tests and criteria. Practitioners should review the evidence for the Lyme disease diagnosis and not overlook unrelated conditions. Current evidence shows that prolonged antibiotic therapy provides little benefit and carries significant risk. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and to understand CLD is needed.
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Affiliation(s)
- Adriana Marques
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, BG 10 RM 12C118 MSC 1888 10 Center, Bethesda, MD 20892-1888, USA.
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Abstract
From vaccination refusal to climate change denial, antiscience views are threatening humanity. When different individuals are provided with the same piece of scientific evidence, why do some accept whereas others dismiss it? Building on various emerging data and models that have explored the psychology of being antiscience, we specify four core bases of key principles driving antiscience attitudes. These principles are grounded in decades of research on attitudes, persuasion, social influence, social identity, and information processing. They apply across diverse domains of antiscience phenomena. Specifically, antiscience attitudes are more likely to emerge when a scientific message comes from sources perceived as lacking credibility; when the recipients embrace the social membership or identity of groups with antiscience attitudes; when the scientific message itself contradicts what recipients consider true, favorable, valuable, or moral; or when there is a mismatch between the delivery of the scientific message and the epistemic style of the recipient. Politics triggers or amplifies many principles across all four bases, making it a particularly potent force in antiscience attitudes. Guided by the key principles, we describe evidence-based counteractive strategies for increasing public acceptance of science.
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Boyce RM. Destroying the Village in Order to Save It: Collateral Damage in the Battle Over Lyme Disease. Open Forum Infect Dis 2022; 9:ofac153. [PMID: 35415197 PMCID: PMC8992362 DOI: 10.1093/ofid/ofac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
A federal court recently dismissed the case against the Infectious Diseases Society of America (IDSA) brought by a group of patients with Lyme disease. While the outcome represented an important victory of the IDSA, I argue that it should also serve as a turning point in our approach to patients with “chronic” Lyme disease, many of whom experience substantial symptoms and suffer an emotional burden due to the uncertainty of their diagnosis. As the incidence of Lyme disease continues to increase and the geographic range of the vector expands, infectious disease specialists—experts in history taking, physical examination, and diagnosis—should play a leading role, not only to combat pervasive misinformation, but more importantly to benefit patients.
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Affiliation(s)
- Ross M Boyce
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Devchand R, Koehler L, Hook S, Marx GE, Hooks H, Schwartz A, Hinckley A. Understanding consumer and clinician perceptions of a potential Lyme disease vaccine. HEALTH EDUCATION RESEARCH 2022; 36:494-504. [PMID: 34529775 PMCID: PMC10911045 DOI: 10.1093/her/cyab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
Each year, over 450 000 Lyme disease diagnoses are estimated to occur in the United States, and current preventive measures have been insufficient to stem the rising incidence. An effective human Lyme disease vaccine could be a powerful intervention for population-level impact. In advance of new Lyme disease vaccines coming to market, this study explored barriers to acceptability and motivations for the uptake of a new Lyme disease vaccine. Researchers conducted 9 online focus groups among consumers who may potentially benefit from the vaccine and 30 in-depth interviews among clinician groups who may provide the vaccine. All participants were recruited from three US regions of high Lyme disease incidence. Researchers found that participants shared common motivators to either recommend (clinicians) or accept (consumers) a Lyme disease vaccine, largely driven by perceived benefits of the vaccine, the lack of current effective preventive measures and a greater peace of mind. The concern about the challenges associated with diagnosing and treating Lyme disease is a primary motivator for clinicians to recommend the vaccine, while the concern about getting Lyme disease is a primary motivator for consumers to desire the vaccine.
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Affiliation(s)
| | - Laura Koehler
- Hager Sharp, 1030 15th Street NW, Washington, DC 20005, USA
| | - Sarah Hook
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Grace E. Marx
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Holley Hooks
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Amy Schwartz
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Alison Hinckley
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
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Dattwyler RJ, Gomes-Solecki M. The year that shaped the outcome of the OspA vaccine for human Lyme disease. NPJ Vaccines 2022; 7:10. [PMID: 35087055 PMCID: PMC8795424 DOI: 10.1038/s41541-022-00429-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/15/2021] [Indexed: 11/09/2022] Open
Abstract
The expansion of Lyme borreliosis endemic areas and the corresponding increase of disease incidence have opened the possibility for greater acceptance of a vaccine. In this perspective article, we discuss the discovery of outer surface protein A (OspA) of B. burgdorferi, and the subsequent pre-clinical testing and clinical trials of a recombinant OspA vaccine for human Lyme disease. We also discuss in detail the open public hearings of the FDA Lyme disease vaccine advisory panel held in 1998 where concerns of molecular mimicry induced autoimmunity to native OspA were raised, the limitations of those studies, and the current modifications of recombinant OspA to develop a multivalent subunit vaccine for Lyme disease.
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Affiliation(s)
- Raymond J. Dattwyler
- grid.260917.b0000 0001 0728 151XDepartment of Microbiology and Immunology, New York Medical College, Valhalla, NY USA
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA.
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Morrison T, Madaras S, Larson C, Harrison R. Personal Agency and Community Resilience: Narratives of Women Navigating Health Care With Chronic Lyme Disease. QUALITATIVE HEALTH RESEARCH 2021; 31:2706-2714. [PMID: 34772306 DOI: 10.1177/10497323211044463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Chronic Lyme disease can manifest as a debilitating illness with symptoms that change over time. With its varied presentation, timeline variation, diagnostic difficulty, and lack of definitive treatment, clinical recognition of chronic Lyme disease remains controversial. At the same time, patients face challenges in finding a provider who is supportive and knowledgeable about diagnosing and treating Lyme. We examined the ways the medical system may have affected the lived experiences of chronic Lyme patients. In this article, we communicate the personal, health care, and community illness experiences of 14 women navigating the medical system with chronic Lyme disease through a qualitative community-based participatory research study using interviews and narrative reflection in a rural community setting. The women were interviewed by a researcher living with chronic Lyme disease and the transcripts were analyzed for themes. All participants described navigating multiple allopathic and nonallopathic care modalities to find satisfactory care. They struggled with physical and emotional burdens of chronic, nonlinear illness, as well as disbelief and discrimination by medical providers. Their lives followed patterns of illness and wellness, trust and mistrust of medical treatment, and community connection and disengagement. They learned to become their own advocates to seek affirmative care. They are aware of the controversial nature of their illness, and many have channeled their frustrations into caring for one another through their Lyme community. Women living with controversial diagnoses like chronic Lyme disease experience increased challenges navigating the medical system to find satisfactory care and thus create communities with each other for mutual aid and support. In understanding these challenges, the medical community can improve care for people living with contested chronic illnesses.
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Affiliation(s)
| | - Sylvia Madaras
- Oregon Health & Science University, Portland, Oregon, USA
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10
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Kopsco HL, Duhaime RJ, Mather TN. An analysis of companion animal tick encounters as revealed by photograph-based crowdsourced data. Vet Med Sci 2021; 7:2198-2208. [PMID: 34414695 PMCID: PMC8604111 DOI: 10.1002/vms3.586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Community science is increasingly utilized to track important vectors of companion animal disease, providing a scalable, cost‐effective strategy for identifying new foci, changing phenology, and disease prevalence across wide geographies. Objectives We examined photographs of ticks found attached to predominately dogs and cats reported to a photograph‐based tick surveillance program to identify potential areas for improvements in tick prevention education and risk intervention. Methods We compared estimated days of tick attachment using a Kruskal–Wallis one‐way analysis of variance, and a Pearson's chi‐square analysis of variance on the number of submissions by host type submitted for each season. Results The blacklegged tick (Ixodes scapularis) was the most common species reported (39.8%). Tick photographs submitted were almost entirely adults (89.5%), and ticks found on companion animals exhibited an estimated median engorgement time of 2.5 days. Ixodes scapularis displayed the highest median engorgement of the top tick species found feeding on companion animals (χ2 = 98.96, p < 0.001). Ticks were spotted year‐round; during spring and summer, ticks collected from pets represented 15.4 and 12.8% of all submissions, but increased to 28.5 and 35.2% during autumn and winter, respectively. Conclusions Crowdsourced data reveal that mostly adult ticks are detected on pets, and they are found at a point in the blood‐feeding process that puts pets at heightened risk for disease transmission. The increase in proportion of ticks found on pets during colder months may reveal a critical knowledge gap amongst pet owners regarding seasonal activity of I. scapularis, a vector of Lyme disease, providing an opportunity for prevention‐education.
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Affiliation(s)
- Heather L Kopsco
- Center for Vector-Borne Disease, University of Rhode Island, Kingston, Rhode Island.,TickEncounter Resource Center, Kingston, Rhode Island.,Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Roland J Duhaime
- TickEncounter Resource Center, Kingston, Rhode Island.,Environmental Data Center, University of Rhode Island, Kingston, Rhode Island
| | - Thomas N Mather
- Center for Vector-Borne Disease, University of Rhode Island, Kingston, Rhode Island.,TickEncounter Resource Center, Kingston, Rhode Island
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11
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Elliott KC. The value-ladenness of transparency in science: Lessons from Lyme disease. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2021; 88:1-9. [PMID: 33945897 DOI: 10.1016/j.shpsa.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/04/2021] [Accepted: 03/18/2021] [Indexed: 05/13/2023]
Abstract
Both philosophers and scientists have recently promoted transparency as an important element of responsible scientific practice. Philosophers have placed particular emphasis on the ways that transparency can assist with efforts to manage value judgments in science responsibly. This paper examines a potential challenge to this approach, namely, that efforts to promote transparency can themselves be value-laden. This is particularly problematic when transparency incorporates second-order value judgments that are underwritten by the same values at stake in the desire for transparency about the first-order value judgments involved in scientific research. The paper uses a case study involving research on Lyme disease to illustrate this worry, but it responds by elucidating a range of scenarios in which transparency can still play an effective role in managing value judgments responsibly.
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Affiliation(s)
- Kevin C Elliott
- Lyman Briggs College, Department of Fisheries & Wildlife, Department of Philosophy, Michigan State University, 35E Holmes Hall, 919 E. Shaw Lane, East Lansing, MI, 48825, USA.
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12
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Bloeser K, McCarron KK, Merker VL, Hyde J, Bolton RE, Anastasides N, Petrakis BA, Helmer DA, Santos S, Litke D, Pigeon WR, McAndrew LM. "Because the country, it seems though, has turned their back on me": Experiences of institutional betrayal among veterans living with Gulf War Illness. Soc Sci Med 2021; 284:114211. [PMID: 34271400 DOI: 10.1016/j.socscimed.2021.114211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
People living with medically unexplained symptoms (MUS) often have poor quality of life and health outcomes. Many struggle to engage with and trust in healthcare systems. This qualitative study examined how experiences with institutions influence perceptions of medical care for MUS by applying the theoretical framework of institutional betrayal to narratives of U.S. military Veterans living with Gulf War Illness (GWI). Institutional betrayal refers to situations in which the institutions people depend upon for safety and well-being cause them harm. Experiences of institutional betrayal both during active military service and when first seeking treatment appeared to shape perceptions of healthcare in this sample. Veterans expressed the belief that the military failed to protect them from environmental exposures. Veterans' concerns regarding subsequent quality of healthcare were intrinsically linked to a belief that, despite official documentation to the contrary, the predominant paradigm of both the U.S. Department of Defense and the U.S. Department of Veterans Affairs (VA) is that GWI does not exist. Veterans reported that providers are not adequately trained on treatment of GWI and do not believe Veterans' descriptions of their illness. Veterans reported taking up self-advocacy, doing their own research on their condition, and resigning themselves to decrease engagement with VA healthcare or seek non-VA care. The study's findings suggest institutional level factors have a profound impact on perceptions of care and the patient-provider relationship. Future research and policy aimed at improving healthcare for people living with MUS should consider the concept of institutional betrayal.
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Affiliation(s)
- Katharine Bloeser
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Silberman School of Social Work at Hunter College, The City University of New York, NY, USA.
| | - Kelly K McCarron
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Vanessa L Merker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Boston University, Department of Medicine, Section General Internal Medicine, Boston, MA, USA
| | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Brandeis University, Heller School for Social Policy and Management, MA, USA
| | - Nicole Anastasides
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Drew A Helmer
- VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA
| | - Susan Santos
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - David Litke
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Wilfred R Pigeon
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa M McAndrew
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Department of Educational and Counseling Psychology, University at Albany, State University of New York, NY, USA
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13
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Frankl S, Hadar PN, Yakhkind A, Lang AE, Sandsmark DK. Devastating Neurological Injury as a Result of Treatment of "Chronic Lyme Disease". Mayo Clin Proc 2021; 96:2005-2007. [PMID: 34218872 DOI: 10.1016/j.mayocp.2021.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah Frankl
- University of Pennsylvania Health System, Philadelphia, PA
| | - Peter N Hadar
- University of Pennsylvania Health System, Philadelphia, PA
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14
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Pascal C, Arquembourg J, Vorilhon P, Lesens O. Emergence of Lyme disease as a social problem: analysis of discourse using the media content. Eur J Public Health 2021; 30:504-510. [PMID: 31688903 DOI: 10.1093/eurpub/ckz198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Chronic Lyme disease (LD) is a matter of debate worldwide and has emerged as a social problem. We aim to analyze the media content and describe the transformation process of a collective pain into a social problem in France. METHODS Using social science methodology, a corpus of articles from 20 newspapers and videos from seven major TV stations from 1987 to 2017 were analyzed for discourse content. The speaking times and the frequency of interventions between doctors supporting the official guidelines and those against them were compared using the Mann-Whitney test and the Chi-square test, respectively. RESULTS In France, the media discourse is carried through testimonials from patient organizations and a professor of infectiology who acted as a whistleblower (WB). We showed that the emergence of the LD alert in the media corresponds to the process described by social sciences as 'naming, blaming, claiming'. Since his first article in 2014, the WB has featured in 24% (22/89) of newspaper articles compared with 20% (18/89) for doctors defending the official guidelines (P = 0.52). Since his first appearance on a TV newscast in 2014, the WB has appeared in 45% (22/49) of news reports on LD with 24% of the speaking time compared with 22% (11/49) for doctors defending the official guidelines (P = 0.018). CONCLUSIONS Media coverage of LD has been unbalanced since 2014 and promotes associations as well as the WB, who seems to be better identified than any of the different doctors defending the official guidelines.
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Affiliation(s)
- Clélia Pascal
- Infectious and Tropical Diseases Department, CRIOA, CHU Clermont-Ferrand, Clermont-Ferrand, France.,UMR CNRS 6023, Laboratoire Microorganismes: Génome Environnement (LMGE), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jocelyne Arquembourg
- Sciences de l'Information et de la Communication, Université Sorbonne Nouvelle - Paris3, Paris, France
| | - Philippe Vorilhon
- Department of General Practice, Institut Pascal, CNRS, SIGMA Clermont, Clermont Auvergne University, Clermont-Ferrand, France
| | - Olivier Lesens
- Infectious and Tropical Diseases Department, CRIOA, CHU Clermont-Ferrand, Clermont-Ferrand, France.,UMR CNRS 6023, Laboratoire Microorganismes: Génome Environnement (LMGE), Université Clermont Auvergne, Clermont-Ferrand, France
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Medically Refractory Neuroborreliosis Case Presented with Coexistance Involvements of Cranial 7 and 8 Nerves. Neurol Int 2021; 13:125-129. [PMID: 33803548 PMCID: PMC8005992 DOI: 10.3390/neurolint13010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
In the US, Lyme disease (LD) has become the most common vector-borne disease. Less than 10% of patients develop cranial nerve palsy or meningitis. There are few reports on cases of Lyme disease with more than one cranial neuropathy. Herein, we will discuss a case of persistent neurological deficits as a result of chronic Lyme disease resistant to standard therapy. Our case is unique due to involvements of cranial seven and eight nerves at the same time. Our case illustrates an extreme example of treatment resistance. However, early diagnosis and prompt establishment of adequate antibiotic treatment are still important to prevent progression to further stages of disease.
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Kopsco HL, Duhaime RJ, Mather TN. Assessing Public Tick Identification Ability and Tick Bite Riskiness Using Passive Photograph-Based Crowdsourced Tick Surveillance. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:837-846. [PMID: 33146378 DOI: 10.1093/jme/tjaa196] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Tick identification is critical for assessing disease risk from a tick bite and for determining requisite treatment. Data from the University of Rhode Island's TickEncounter Resource Center's photo-based surveillance system, TickSpotters, indicate that users incorrectly identified their submitted specimen 83% of the time. Of the top four most commonly submitted tick species, western blacklegged ticks (Ixodes pacificus Cooley & Kohls [Ixodida: Ixodidae]) had the largest proportion of unidentified or misidentified submissions (87.7% incorrectly identified to species), followed by lone star ticks (Amblyomma americanum Linneaus [Ixodida: Ixodidae]; 86.8% incorrect), American dog ticks (Dermacentor variabilis Say [Ixodida: Ixodidae]; 80.7% incorrect), and blacklegged ticks (Ixodes scapularis Say [Ixodida: Ixodidae]; 77.1% incorrect). More than one quarter of participants (26.3%) submitted photographs of ticks that had been feeding for at least 2.5 d, suggesting heightened risk. Logistic regression generalized linear models suggested that participants were significantly more likely to misidentify nymph-stage ticks than adult ticks (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.23, 0.68, P < 0.001). Ticks reported on pets were more likely to be identified correctly than those found on humans (OR = 1.07, 95% CI: 1.01-2.04, P < 0.001), and ticks feeding for 2.5 d or longer were more likely to be misidentified than those having fed for one day or less (OR = 0.43, 95% CI: 0.29-0.65, P < 0.001). State and region of residence and season of submission did not contribute significantly to the optimal model. These findings provide targets for future educational efforts and underscore the value of photograph-based tick surveillance to elucidate these knowledge gaps.
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Affiliation(s)
- Heather L Kopsco
- Department of Plant Sciences and Entomology, University of Rhode Island, Kingston, RI
- URI TickEncounter Resource Center, University of Rhode Island, Kingston, RI
| | - Roland J Duhaime
- URI TickEncounter Resource Center, University of Rhode Island, Kingston, RI
- Environmental Data Center, University of Rhode Island, Kingston, RI
| | - Thomas N Mather
- Department of Plant Sciences and Entomology, University of Rhode Island, Kingston, RI
- URI TickEncounter Resource Center, University of Rhode Island, Kingston, RI
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Kopsco HL, Xu G, Luo CY, Rich SM, Mather TN. Crowdsourced Photographs as an Effective Method for Large-Scale Passive Tick Surveillance. JOURNAL OF MEDICAL ENTOMOLOGY 2020; 57:1955-1963. [PMID: 32812635 DOI: 10.1093/jme/tjaa140] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 06/11/2023]
Abstract
As tick vector ranges expand and the number of tickborne disease cases rise, physicians, veterinarians, and the public are faced with diagnostic, treatment, and prevention challenges. Traditional methods of active surveillance (e.g., flagging) can be time-consuming, spatially limited, and costly, while passive surveillance can broadly monitor tick distributions and infection rates. However, laboratory testing can require service fees in addition to mailing and processing time, which can put a tick-bite victim outside the window of potential prophylactic options or under unnecessary antibiotic administration. We performed a retrospective analysis of a national photograph-based crowdsourced tick surveillance system to determine the accuracy of identifying ticks by photograph when compared to those same ticks identified by microscopy and molecular methods at a tick testing laboratory. Ticks identified by photograph were correct to species with an overall accuracy of 96.7% (CI: 0.9522, 0.9781; P < 0.001), while identification accuracy for Ixodes scapularis Say (Ixodida: Ixodidae), Amblyomma americanum Linnaeus (Ixodida: Ixodidae), and Dermacentor variabilis Say (Ixodida: Ixodidae), three ticks of medical importance, was 98.2% (Cohen's kappa [κ] = 0.9575; 95% CI: 0.9698, 0.9897), 98.8% (κ = 0.9466, 95% CI: 0.9776, 0.9941), and 98.8% (κ = 0.9515, 95% CI: 0.9776, 0.9941), respectively. Fitted generalized linear models revealed that tick species and stage were the most significant predictive factors that contributed to correct photograph-based tick identifications. Neither engorgement, season, nor location of submission affected identification ability. These results provide strong support for the utility of photograph-based tick surveillance as a tool for risk assessment and monitoring among commonly encountered ticks of medical concern.
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Affiliation(s)
- Heather L Kopsco
- Department of Plant Sciences and Entomology, University of Rhode Island, Kingston, RI
- TickEncounter Resource Center, University of Rhode Island, Kingston, RI
| | - Guang Xu
- Department of Microbiology, University of Massachusetts, Amherst, MA
| | - Chu-Yuan Luo
- Department of Microbiology, University of Massachusetts, Amherst, MA
| | - Stephen M Rich
- Department of Microbiology, University of Massachusetts, Amherst, MA
| | - Thomas N Mather
- Department of Plant Sciences and Entomology, University of Rhode Island, Kingston, RI
- TickEncounter Resource Center, University of Rhode Island, Kingston, RI
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18
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Focus on patients receiving long-term antimicrobial treatments for lyme borreliosis: No lyme but mostly mental disorders. Infect Dis Now 2020; 51:300-303. [PMID: 33098950 DOI: 10.1016/j.medmal.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/12/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Overdiagnosis of lyme borreliosis leads to unnecessary and increasingly common antimicrobial treatments. We aimed to evaluate patients receiving long-term antimicrobial treatment for lyme borreliosis. METHODS We included patients referred to a Parisian teaching hospital between January 1st, 2014 and June 30th, 2019, with a presumed diagnosis of lyme borreliosis for which they were treated with antimicrobials for at least 6 months. RESULTS Fifteen patients were included (11 women and mean age 44 years). The mean antimicrobial treatment duration was 476 days (180-942). The mean number of antimicrobials was 6.8 per patient (1-18). None of the 15 patients had lyme borreliosis. Nine patients were diagnosed with a mental disorder. CONCLUSION Overdiagnosis and overtreatment of lyme borreliosis put patients at risk of undiagnosed illnesses and multiple adverse effects of unjustified treatments. The clinical management of such patients requires a comprehensive approach including expertise in mental disorders.
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19
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GP coding behaviour for non-specific clinical presentations: a pilot study. BJGP Open 2020; 4:bjgpopen20X101050. [PMID: 32636202 PMCID: PMC7465576 DOI: 10.3399/bjgpopen20x101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022] Open
Abstract
Background Clinical coding is an integral part of primary care. Disease incidence studies based on primary care electronic health records (EHRs) rely on the accuracy of these codes. Current code validation methods are not appropriate for non-specific conditions and provide limited information about GPs' decision-making behaviour around coding. Qualitative methods could offer insight into decision-making behaviour around coding of patients with non-specific conditions. Aim To investigate the decision-making behaviour of GPs when applying Read codes to non-specific clinical presentations, using Lyme disease as a case example. Design & setting A pilot study was undertaken, involving masked semi-structured interviews of eight GPs in the North West of England. Method Semi-structured interviews were carried out based on 11 clinical cases representative of Lyme disease presentations. Discrete answers were described descriptively. Interview transcripts were analysed using a thematic approach. Results Themes underpinning GPs’ coding behaviour included: GP personal and professional experience; clinical evidence; diagnostic uncertainty; professional integrity and defensive practice; and patient-sourced health information and beliefs. GPs placed Lyme disease on their differential diagnosis list for five cases; in only two cases would GPs select a Lyme disease related Read code. Conclusion GPs were reluctant to code with specific diagnostic Read codes when they were presented with patients with vague or unfamiliar symptomology. This masked questionnaire methodology offers a new approach to validate incidence figures, based on Read codes of non-specific conditions. The reluctance to code poses many problems for primary care EHRs research. Further research is needed to understand what drives GPs’ coding behaviour.
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20
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Bamm VV, Ko JT, Mainprize IL, Sanderson VP, Wills MKB. Lyme Disease Frontiers: Reconciling Borrelia Biology and Clinical Conundrums. Pathogens 2019; 8:E299. [PMID: 31888245 PMCID: PMC6963551 DOI: 10.3390/pathogens8040299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022] Open
Abstract
Lyme disease is a complex tick-borne zoonosis that poses an escalating public health threat in several parts of the world, despite sophisticated healthcare infrastructure and decades of effort to address the problem. Concepts like the true burden of the illness, from incidence rates to longstanding consequences of infection, and optimal case management, also remain shrouded in controversy. At the heart of this multidisciplinary issue are the causative spirochetal pathogens belonging to the Borrelia Lyme complex. Their unusual physiology and versatile lifestyle have challenged microbiologists, and may also hold the key to unlocking mysteries of the disease. The goal of this review is therefore to integrate established and emerging concepts of Borrelia biology and pathogenesis, and position them in the broader context of biomedical research and clinical practice. We begin by considering the conventions around diagnosing and characterizing Lyme disease that have served as a conceptual framework for the discipline. We then explore virulence from the perspective of both host (genetic and environmental predispositions) and pathogen (serotypes, dissemination, and immune modulation), as well as considering antimicrobial strategies (lab methodology, resistance, persistence, and clinical application), and borrelial adaptations of hypothesized medical significance (phenotypic plasticity or pleomorphy).
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Affiliation(s)
| | | | | | | | - Melanie K. B. Wills
- G. Magnotta Lyme Disease Research Lab, Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada; (V.V.B.); (J.T.K.); (I.L.M.); (V.P.S.)
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21
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Cheema J, Huynh AC, Prat SS. Multiple Sclerosis and psychosis: A case report. Mult Scler Relat Disord 2019; 34:158-161. [PMID: 31302591 DOI: 10.1016/j.msard.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 11/25/2022]
Abstract
Psychiatric symptoms resulting from Multiple Sclerosis (MS) itself or its treatment are well known. However, the relationship between psychotic episodes and Multiple Sclerosis remains debated. In this paper, we present the case of a woman who developed a chronic psychotic disorder a few months after the onset of MS. We describe the process which led us to make the diagnosis of Psychotic Disorder due to Medical Condition (Multiple Sclerosis). Because her criminal charges brought significant attention to her case, we also address the difficulty in treating a neurological condition with psychiatric features within the forensic context. Moreover, one of the main concerns of the patient was that Lyme Disease was the correct diagnosis as opposed to MS. We also report the difficulty of treating and initiating successful follow-up for a patient whose paranoia is enabled by the opinions of certain health advocacy groups.
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Affiliation(s)
- Jasreen Cheema
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | | | - Sébastien S Prat
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada; Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
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22
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Kobayashi T, Higgins Y, Samuels R, Moaven A, Sanyal A, Yenokyan G, Lantos PM, Melia MT, Auwaerter PG. Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic. Open Forum Infect Dis 2019; 6:5527068. [PMID: 31363774 PMCID: PMC6663506 DOI: 10.1093/ofid/ofz299] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background Although Lyme disease is the most common vector-borne infection in the United States, diagnostic accuracy within community settings is not well characterized. Methods A retrospective observational cohort study of patients referred to an academic center with a presumed diagnosis or concern for Lyme disease between 2000 and 2013 was performed to analyze diagnoses and treatments. Characteristics of those with Lyme disease and those misdiagnosed as having Lyme disease were compared. Results Of 1261 patients, 911 (72.2%) did not have Lyme disease, 184 (14.6%) had active or recent Lyme disease, 150 (11.9%) had a remote history of Lyme disease, and 16 (1.3%) were identified as having possible Lyme disease. Patients without current Lyme disease were more likely to be female (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.08–2.45), to have had symptoms for >3 months (OR, 8.78; 95% CI, 5.87–13.1), to have higher symptom counts (OR per additional symptom, 1.08; 95% CI, 1.02–1.13), to have had more Lyme-related laboratory testing (OR per additional laboratory test, 1.17; 95% CI, 1.03–1.32), and to have been diagnosed with what were regarded as coinfections (OR, 3.13; 95% CI, 1.14–8.57). Of the 911 patients without Lyme disease, 764 (83.9%) had received antimicrobials to treat Lyme disease or their coinfections. The percentage of patients established to have Lyme disease was lower than in earlier studies of referred populations. Conclusions Among patients referred to an academic Infectious Diseases practice for Lyme disease, incorrect diagnoses and unnecessary antibiotic treatment were common, both for Lyme disease and for coinfections.
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Affiliation(s)
- Takaaki Kobayashi
- Infectious Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yvonne Higgins
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger Samuels
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aurasch Moaven
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Abanti Sanyal
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul M Lantos
- Medicine and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Michael T Melia
- Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul G Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Wormser GP. Should Patients Infected with Borrelia burgdorferi No Longer Be Referred to as Having Lyme Disease? Am J Med 2019; 132:11-12. [PMID: 30012359 DOI: 10.1016/j.amjmed.2018.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla.
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24
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Somatic symptoms and fatigue in a Norwegian population with high exposure to ticks. Ticks Tick Borne Dis 2018; 10:156-161. [PMID: 30337264 DOI: 10.1016/j.ttbdis.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is heavily debated whether tick-borne infections cause chronic subjective health complaints. If the hypothesis of a major causal connection is true, one would expect to find more subjective health complaints in a population with high exposure to ticks than in a population with less exposure. In the current study we aimed to assess somatic symptoms and fatigue in a Norwegian population with high exposure to ticks, compare our findings to normative data, and assess predictors of somatic symptom load. MATERIAL AND METHODS All individuals aged 18-69 years with residential address in Søgne municipality in southern Norway were in the period June 2015 to June 2016 invited to participate in the study. Somatic symptoms were assessed by the Patient Health Questionnaire-15 (PHQ-15) and fatigue by the Fatigue Severity Scale (FSS). A multivariable regression analysis was performed to assess predictors of somatic symptom load. RESULTS Out of 7424 invited individuals, 2971 (40.0%) returned the questionnaire. 85.1% of 2950 responders reported exposure to tick-bite. PHQ-15 mean sum score was 5.3, and 16.5% reported moderate to severe somatic symptom load (i.e. ≥ 10). FSS mean score was 3.2, and 29.8% scored above the cut-off value for fatigue (i.e. ≥ 4.0). All gender and age groups in our study population had equal or lower mean sum score on PHQ-15 than reported in Swedish normative data, and lower mean score on FSS than reported in Norwegian normative data. In multivariable regression the following factors were associated with higher somatic symptom load (listed in order of descending beta coefficient): Anxiety and depression, number of other diseases, female gender, younger age, recruitment when visiting general practitioner's office, ≤ 6 years education after primary school, tick-bite earlier in life, erythema migrans earlier in life, less physical activity, and modern health worries. CONCLUSION The study population reported high exposure to tick-bites, but less or equal level of somatic symptoms and less fatigue than found in normative data. There was a weak association between somatic symptom load and exposure to tick-bite and erythema migrans, possibly related to selection bias. Our findings do not support the hypothesis of a major causal connection between tick-borne infections and subjective health complaints.
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25
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Brown JD. A description of 'Australian Lyme disease' epidemiology and impact: an analysis of submissions to an Australian senate inquiry. Intern Med J 2018; 48:422-426. [PMID: 29363839 DOI: 10.1111/imj.13746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Many Australian patients are diagnosed and treated for the scientifically and politically controversial diagnosis of an endemic form of 'Australian Lyme Disease'. Patient advocacy led Senator John Madigan to propose an Australian Senate Inquiry into this illness. AIM To describe the symptomology and outcomes of patients diagnosed and treated with Lyme disease in Australia. METHODS All public, first-person submissions (n = 698) to the inquiry were reviewed and responses analysed for epidemiology, symptoms and impact against structured criteria. RESULTS The most common symptoms described were fatigue (62.6%), disordered thinking (51.9%) and sensory disturbance (46.1%). Respondents reported experiencing symptoms for a median of 10 years and spent a median of $30 000 on diagnosis and treatment. Almost 10% of respondents self-diagnosed after being exposed to a media report of Australian Lyme disease. CONCLUSIONS Patients diagnosed with Lyme disease in Australia display a symptomology similar to 'medically unexplained physical symptoms' syndromes, experience social and financial harms, and are at risk of nosocomial harms. Negative medical interactions and the media may contribute to patients seeking alternative and potentially non-evidence-based diagnoses and treatments.
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Affiliation(s)
- Jeremy D Brown
- Institute for Clinical Pathology and Medical Research, Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, New South Wales, Australia.,Nepean Hospital, Nepean Blue Mountains Health District, Sydney, New South Wales, Australia.,Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
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26
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Massot E, Epaulard O. Midwives' perceptions of vaccines and their role as vaccinators: The emergence of a new immunization corps. Vaccine 2018; 36:5204-5209. [PMID: 29970300 DOI: 10.1016/j.vaccine.2018.06.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND In France, midwives have recently been authorized to administer various vaccines to women (including pregnant women), newborns, and their family members. This is expected to enhance vaccine coverage. However, the French high level of vaccine hesitancy is also observed in some healthcare workers. We thus aimed to determine the perceptions of French midwives concerning vaccines. METHODS We distributed an anonymous online questionnaire between September and December 2017, targeting midwives who were still in training or working in the public or private sector. RESULTS A total of 917 questionnaires were analyzed (median age 26 years). Almost half of participants (44.5%) were students. On a scale of 0-100, the median perception of the usefulness, safety, and trust of vaccinations were 92, 80, and 85, respectively. The mean scores of students were significantly higher for each perception, whereas in professional midwives, age and perceptions were negatively correlated. When asked whether there were scientific, philosophical, or religious arguments not to vaccinate, 83.2%, 69.8%, and 77.8% of participants disagreed, respectively. The vast majority (91.6%) was very or mostly favorable to the pertussis vaccine after delivery, but only around half (51.5%) to the influenza vaccine during pregnancy; those favorable to the pertussis vaccine were younger. A high proportion of participants (88.3%) considered that midwives were in a good position to vaccinate, with this proportion being even higher among students. CONCLUSIONS These results suggest that the recent authorization regarding vaccine administration will result in better vaccine coverage of pregnant women and their families by midwives. The better perceptions of younger participants are also encouraging. However, the level of trust in vaccinations (only 80.1%) and the low number of participants favorable to the influenza vaccine during pregnancy suggest that initial and continuous training should be reinforced.
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Affiliation(s)
- Estelle Massot
- Midwifery School, University Grenoble-Alpes, Grenoble, France
| | - Olivier Epaulard
- Department of Infectious Diseases - Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin - Université Grenoble-Alpes, Grenoble, France.
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27
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Arnold MH, Kerridge I. Rejecting Reality and Substituting One?'s Own; Why Bioethics Should Be Concerned With Medically Unexplained Symptoms. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:26-28. [PMID: 29697335 DOI: 10.1080/15265161.2018.1445315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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28
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Forestier E, Gonnet F, Revil-Signorat A, Zipper AC. [Pathway to diagnosis and real-life experience of patients believing they are affected by "chronic Lyme disease"]. Rev Med Interne 2018; 39:912-917. [PMID: 29706237 DOI: 10.1016/j.revmed.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Chronic Lyme disease is a subject of scientific and social controversy in both Europe and the United States. The aim of our study was to analyze the pathway to diagnosis of patients believing they were affected by the disease, and to describe their real-life experience. METHOD A qualitative study was performed with 13 patients declaring themselves to be affected by chronic Lyme disease. Interviews were analyzed by 2 general medical practice interns, supervised by a general practitioner with a diploma in socio-anthropology and an infectious diseases specialist. RESULTS Internet and other media played a major role in informing the patients or their doctor about the existence and the characteristics of chronic Lyme disease. The diagnosis was confirmed by features considered objective (chronic infection by Borrelia, tick bite, positive serology, beneficial or worsening effects of antibiotics). The long medical diagnosis and treatment process of those interviewed was marked by a conflicted relationship with the medical profession, caused by a feeling of non-recognition and abandonment. They reported their experience as being very painful, both because of the physical pain and also the psychological consequences of their condition. CONCLUSION Improving the diagnosis and therapeutic management of patients believing themselves to be affected by chronic Lyme disease appears highly necessary both to limit their search for diagnosis and their experience of pain. It could be based on existing guidelines concerning medically unexplained symptoms to which the chronic Lyme disease issue appears quite similar on several points.
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Affiliation(s)
- E Forestier
- Service de maladies infectieuses, centre hospitalier métropole Savoie, BP 31125, 73011 Chambéry cedex, France.
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29
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Märker-Hermann E, Voormann AJ. [Choosing wisely recommendations in rheumatology : One year after their first publication]. Internist (Berl) 2018; 58:580-584. [PMID: 28488054 DOI: 10.1007/s00108-017-0247-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Almost 1 year after publication of the Choosing wisely recommendations ("Klug-entscheiden-Empfehlungen," KEE) for rheumatology, it is evident that they have found their way into specialist and lay publications, the media used by self-help groups, online media, and continuing education congresses. As such, a broad target audience has been reached. In the meantime, newly established or updated guidelines have been published which incorporate the KEE for rheumatology. The KEE provide a gateway into clinical Standard Operating Procedures or recommendations.
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Affiliation(s)
- E Märker-Hermann
- Klinik für Innere Medizin IV (Rheumatologie, klinische Immunologie, Nephrologie), HELIOS Dr. Horst Schmidt Kliniken Wiesbaden GmbH, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland.
| | - A J Voormann
- Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland
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30
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Jung N, Koop H, Riessen R, Galle JC, Jany B, Märker-Hermann E. ["Choosing wisely" in infectious diseases : Overuse of antibiotics - too few vaccinations]. Internist (Berl) 2017; 57:527-31. [PMID: 27193347 DOI: 10.1007/s00108-016-0063-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The "choosing wisely" recommendations of the German Society of Internal Medicine (DGIM) and its specialist societies address diagnostic and therapeutic procedures, which are of particular medical importance but applied too often or too rarely in clinical practice. The aim is to further improve treatment of patients. Important topics of overuse and insufficient treatment related to the diagnostics, therapy, prevention and exclusion of infectious diseases could be identified. These topics not only play an important role in the discipline of infectious diseases but are also relevant for other internal medical disciplines. These topics related to infectious diseases have also been integrated into the recommendations of the German Society of Gastroenterology, Digestive and Metabolic Diseases as well as the German Societies for Internal Intensive Care and Emergency Medicine, for Pneumology, for Nephrology and for Rheumatology. The pivotal issues of the recommendations are the inappropriate use of antibiotics and insufficient vaccination rates.
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Affiliation(s)
- N Jung
- Klinik 1 für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50935, Köln, Deutschland. .,Geschäftsstelle Berlin, Deutsche Gesellschaft für Infektiologie (DGI), Berlin, Deutschland.
| | - H Koop
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Berlin, Deutschland
| | - R Riessen
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
| | - J-C Galle
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Nephrologie (DGfN), Berlin, Deutschland
| | - B Jany
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - E Märker-Hermann
- Geschäftsstelle Berlin, Deutsche Gesellschaft für Rheumatologie (DGRh), Berlin, Deutschland
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Naktin JP. "Late You Come: Legislation on Lyme Treatment in an Era of Conflicting Guidelines". Open Forum Infect Dis 2017; 4:ofx152. [PMID: 29308398 PMCID: PMC5751036 DOI: 10.1093/ofid/ofx152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/14/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jaan Peter Naktin
- Practice Leader, Lehigh Valley Physicians Group - Infectious Diseases, Lehigh Valley Health Network, Allentown, Pennsylvania
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Abstract
The Centers for Disease Control and Prevention estimates that more than 300 000 new cases of Lyme disease occur each year in the United States and that 10% to 20% of these patients will remain symptomatic despite receiving appropriate antibiotic therapy. Many elements of the disease are poorly understood and have generated considerable controversy. This paper discusses the medical controversies related to posttreatment manifestations and their potential impact on infusion nurses.
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Tseng YJ, DeMaria A, Goldmann DA, Mandl KD. Claims-Based Diagnostic Patterns of Patients Evaluated for Lyme Disease and Given Extended Antibiotic Therapy. Vector Borne Zoonotic Dis 2016; 17:116-122. [PMID: 27855040 DOI: 10.1089/vbz.2016.1991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A Lyme disease (LD) diagnosis can be far from straightforward, particularly if erythema migrans does not develop or is not noticed. Extended courses of antibiotics for LD are not recommended, but their use is increasing. We sought to elucidate the patient patterns toward a diagnosis of LD, hypothesizing that a subset of patients ultimately receiving extended courses antibiotics may be symptomatic for an extended period before the first LD diagnosis. METHODS Claims submitted to a nationwide U.S. health insurance plan in 14 high-prevalence states were grouped into standardized diagnostic categories. The patterns of diagnostic categories over time were compared between patients evaluated for LD and given standard antibiotic therapy (PLDSA) and patients evaluated for LD and given extended antibiotic therapy (PLDEA) in 2011-2012. RESULTS The incidence of PLDSA was 40.45 (N = 3207) and that of PLDEA was 7.57 (N = 600) per 100,000 insured over 2011-2012. 50.3% of PLDEA were diagnosed in the nonsummer months. Seven diagnostic categories were associated with PLDEA. From 180 days before the first LD diagnosis, the risks of having claims associated with back problems (odds ratio [OR], 2.1; confidence interval [95% CI], 1.4-2.9; p < 0.001) and connective tissue disease (OR, 1.6; 95% CI, 1.1-2.3; p < 0.01) complaints were higher among PLDEA. From 90 days before the diagnosis, malaise and fatigue (OR, 1.7; 95% CI, 1.1-2.6; p < 0.05), other nervous system disorders (OR, 2.0; 95% CI, 1.3-3.1; p < 0.01), and nontraumatic joint disorder (OR, 1.4; 95% CI, 1.0-2.0; p < 0.05) were more likely found among PLDEA than PLDSA. From 30 days before the diagnosis, the risk for mental health (OR 1.6; 95% CI, 1.1-2.0; p < 0.01) and headache (OR 1.5; 95% CI, 1.1-2.0; p < 0.05) among PLDEA was elevated. CONCLUSIONS Among patients evaluated for LD and ultimately receiving an extended course of antibiotics for LD, 15.8% of them were symptomatic and seeking care for several months before their first LD diagnosis.
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Affiliation(s)
- Yi-Ju Tseng
- 1 Computational Health Informatics Program, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Information Management, Chang Gung University , Taoyuan, Taiwan .,3 Department of Laboratory Medicine, Chang Gung Memorial Hospital , Taoyuan, Taiwan
| | - Alfred DeMaria
- 4 Bureau of Infectious Disease and Laboratory Sciences , Massachusetts Department of Public Health, Boston, Massachusetts
| | - Donald A Goldmann
- 5 Institute for Healthcare Improvement , Cambridge, Massachusetts.,6 Division of Infectious Diseases, Boston Children's Hospital , Boston, Massachusetts
| | - Kenneth D Mandl
- 1 Computational Health Informatics Program, Boston Children's Hospital , Boston, Massachusetts.,7 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts.,8 Department of Biomedical Informatics, Harvard Medical School , Boston, Massachusetts
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Murphy M, Kontos N, Freudenreich O. Electronic Support Groups: An Open Line of Communication in Contested Illness. PSYCHOSOMATICS 2016; 57:547-555. [PMID: 27421707 PMCID: PMC5529167 DOI: 10.1016/j.psym.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/22/2016] [Accepted: 04/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with functional somatic syndromes are often difficult to treat. The relationship between doctors and patients can be strained, which limits communication. Instead, patients often communicate with each other over the Internet in electronic support groups. OBJECTIVE This perspective summarizes studies of patient-to-patient communication over the Internet and uses the concept of contested illness to provide insights into the experiences of patients with functional somatic disorders. DISCUSSION Conflict between a patient and their physician is a key feature of functional somatic syndromes. Physicians and patients do not have a shared understanding or appreciation of the patient's experiences. Patients with functional somatic syndromes often value their own embodied experience over medical knowledge. At the same time, they remain deeply invested in finding a "good doctor" who believes that the patient is suffering, agrees with their conception of the cause, and assents to the treatment as directed by the patient. Electronic support groups reinforce these beliefs. CONCLUSION Patients may benefit from a compromising, collaborative approach that is realistic about the limitations of medical knowledge. However, physicians should not engage in unsafe treatment practices. Electronic support groups exist for a wide range of illnesses and the issues that rise to the surface in functional somatic syndromes likely occur to some extent with almost every patient.
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Affiliation(s)
- Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; McLean Hospital, Belmont, MA.
| | - Nicholas Kontos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Vogt H, Hofmann B, Getz L. Personalized medicine: evidence of normativity in its quantitative definition of health. THEORETICAL MEDICINE AND BIOETHICS 2016; 37:401-16. [PMID: 27638683 PMCID: PMC5035650 DOI: 10.1007/s11017-016-9379-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as 'P4 medicine' (predictive, preventive, personalized, and participatory). In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness-that is, normativity-of previous health definitions. We do so by examining the most concrete and relevant evidence for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future.
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Affiliation(s)
- Henrik Vogt
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Bjørn Hofmann
- Section for Health, Technology, and Society, Norwegian University of Science and Technology, Gjøvik, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Linn Getz
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Mallet M, King E, White PD. A UK based review of recommendations regarding the management of chronic fatigue syndrome. J Psychosom Res 2016; 88:33-5. [PMID: 27521650 DOI: 10.1016/j.jpsychores.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chronic fatigue syndrome (CFS) is a controversial illness, with apparent disagreements between medical authorities and patient support organisations regarding safe and effective treatments. The aim of this study was to measure the extent of different views regarding treatments, comparing patient support organisations and medical authorities in the UK. METHODS Two independent raters analysed two groups of resources: UK patient support websites and both medical websites and textbooks. A 5-point Likert scale was developed with the question 'With what strength does the source recommend these treatments?' The various treatments were divided into the following four groups: complementary and alternative medicine (CAM), pharmacological, rehabilitative, and pacing therapies. RESULTS There were significant differences between the scores for patient support organisations and medical sources for all 4 treatment groups. The results for supporting CAM were 74% (patient group) vs 16% (medical source) (p<0.001), 71% vs 42% for pharmacological (p=0.01), 28% vs 94% for rehabilitative (p<0.001) and 91% vs 50% for pacing treatments (p=0.001). CONCLUSIONS There were substantially different treatment recommendations between patient support organisations and medical sources. Since expectations can determine response to treatment, these different views may reduce the engagement in and effectiveness of rehabilitative therapies recommended by national guidelines and supported by systematic reviews.
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Affiliation(s)
- Miriam Mallet
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eleanor King
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Peter D White
- Wolfson Institute of Preventive Medicine, Barts and the London School of medicine and Dentistry, Queen Mary University of London, London, UK.
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Live Attenuated Borrelia burgdorferi Targeted Mutants in an Infectious Strain Background Protect Mice from Challenge Infection. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:725-31. [PMID: 27335385 DOI: 10.1128/cvi.00302-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/11/2022]
Abstract
Borrelia burgdorferi, B. garinii, and B. afzelii are all agents of Lyme disease in different geographic locations. If left untreated, Lyme disease can cause significant and long-term morbidity, which may continue after appropriate antibiotic therapy has been administered and live bacteria are no longer detectable. The increasing incidence and geographic spread of Lyme disease are renewing interest in the vaccination of at-risk populations. We took the approach of vaccinating mice with two targeted mutant strains of B. burgdorferi that, unlike the parental strain, are avirulent in mice. Mice vaccinated with both strains were protected against a challenge with the parental strain and a heterologous B. burgdorferi strain by either needle inoculation or tick bite. In ticks, the homologous strain was eliminated but the heterologous strain was not, suggesting that the vaccines generated a response to antigens that are produced by the bacteria both early in mammalian infection and in the tick. Partial protection against B. garinii infection was also conferred. Protection was antibody mediated, and reactivity to a variety of proteins was observed. These experiments suggest that live attenuated B. burgdorferi strains may be informative regarding the identification of protective antigens produced by the bacteria and recognized by the mouse immune system in vivo Further work may illuminate new candidates that are effective and safe for the development of Lyme disease vaccines.
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38
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Abstract
Within the framework of the Choosing wisely initiative of the German Society for Internal Medicine, all scientific societies associated with internal medicine were requested to highlight the unnecessary or underused medical tests or procedures out of the 60 defined examples, which are of immediate relevance within the doctor-patient interaction. Each of the 12 scientific internal medicine societies compiled and substantiated 2 recommendations. This resulted in a spectrum of important recommendations covering the entire field of internal medicine. In difficult situations these recommendations should contribute to developing and supporting the dialogue with patients on an evidence-based level.
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Affiliation(s)
- U R Fölsch
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 12, 24105, Kiel, Deutschland.
| | - G Hasenfuß
- Klinik für Kardiologie und Pneumologie, Zentrum für Innere Medizin, Georg-August-Universität Göttingen, Göttingen, Deutschland
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Czupryna P, Moniuszko-Malinowska A, Pancewicz S, Garkowski A, Gościk J, Siemieniako A, Zajkowska J. Lyme disease in Poland - A serious problem? Adv Med Sci 2016; 61:96-100. [PMID: 26641887 DOI: 10.1016/j.advms.2015.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated the clinical picture of patients hospitalized with Lyme disease (LD). Additionally, we analyzed the possible cause of sudden rise in LD incidence in Poland. MATERIALS AND METHODS We retrospectively analyzed medical documentation of patients admitted to the Department of Infectious Diseases and Neuroinfections, Medical University in Bialystok in 2013 with suspicion of LD. The collected data featured patients' age, gender, occupation, symptoms, clinical form of LD and final diagnosis. Additionally 38 patients with diagnosed LD and chronic joint pain, with no improvement after previous antibiotic treatment, completed the survey. RESULTS In 2013 overall 378 patients were admitted to our Department with suspicion of LD. Neuroborreliosis (NB) was confirmed in 10 out of 42 patients. Acrodermatitis chronica atrophicans (ACA) was confirmed in 5 cases. As far as patients with joint pains are concerned - in 4 cases Lyme arthritis (LA) was diagnosed, in 174 the serology and clinical symptoms indicated possibility of active infection, in 153 patients no features of active infection were found. The majority of surveyed patients had BMI over 25, they suffered from many chronic diseases, e.g. osteoarthrosis, hypertension, diabetes. CONCLUSIONS The reported incidence of LD in Poland, in our opinion, may be biased by overreporting and overdiagnosis. Nonspecific musculoskeletal and joint pain are the most frequent cause of LD suspicion and hospitalization. There is a necessity of better tests for active LD confirmation (especially in patients with musculoskeletal pain) as seroprevalence of anti Borrelia burgdorferi antibodies is high in endemic regions.
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Affiliation(s)
- Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland.
| | - Sławomir Pancewicz
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Adam Garkowski
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Gościk
- Software Department, Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - Agnieszka Siemieniako
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland
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40
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Abstract
The prognosis following appropriate antibiotic treatment of early or late Lyme disease is favorable but can be complicated by persistent symptoms of unknown cause termed posttreatment Lyme disease syndrome (PTLDS), characterized by fatigue, musculoskeletal pain, and cognitive complaints that persist for 6 months or longer after completion of antibiotic therapy. Risk factors include delayed diagnosis, increased severity of symptoms, and presence of neurologic symptoms at time of initial treatment. Two-tier serologic testing is neither sensitive nor specific for diagnosis of PTLDS because of variability in convalescent serologic responses after treatment of early Lyme disease. Optimal treatment of PTLDS awaits more precise understanding of the pathophysiologic mechanisms involved in this illness and future treatment trials.
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41
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Markowicz M, Kivaranovic D, Stanek G. Testing patients with non-specific symptoms for antibodies against Borrelia burgdorferi sensu lato does not provide useful clinical information about their aetiology. Clin Microbiol Infect 2015; 21:1098-103. [DOI: 10.1016/j.cmi.2015.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/05/2015] [Accepted: 08/15/2015] [Indexed: 11/16/2022]
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42
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Dersch R, Sarnes AA, Maul M, Hottenrott T, Baumgartner A, Rauer S, Stich O. Quality of life, fatigue, depression and cognitive impairment in Lyme neuroborreliosis. J Neurol 2015; 262:2572-7. [DOI: 10.1007/s00415-015-7891-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 11/28/2022]
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Dersch R, Freitag MH, Schmidt S, Sommer H, Rauer S, Meerpohl JJ. Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis - a systematic review. Eur J Neurol 2015; 22:1249-59. [DOI: 10.1111/ene.12744] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- R. Dersch
- German Cochrane Centre; Medical Center - University of Freiburg; Freiburg Germany
- Department of Neurology; Medical Center - University of Freiburg; Freiburg Germany
| | - M. H. Freitag
- Division of General Practice; Department of Health Services Research; Carl von Ossietzky University Oldenburg; Oldenburg Germany
| | - S. Schmidt
- German Cochrane Centre; Medical Center - University of Freiburg; Freiburg Germany
- UroEvidence@Deutsche Gesellschaft für Urologie; Berlin Germany
| | - H. Sommer
- German Cochrane Centre; Medical Center - University of Freiburg; Freiburg Germany
- Institute of Medical Biometry and Statistics; Medical Center - University of Freiburg; Freiburg Germany
| | - S. Rauer
- Department of Neurology; Medical Center - University of Freiburg; Freiburg Germany
| | - J. J. Meerpohl
- German Cochrane Centre; Medical Center - University of Freiburg; Freiburg Germany
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Abstract
Lyme borreliosis is a multisystem infectious disease affecting mainly the skin, nervous system, joints and heart. It is caused by spirochetes of the Borrelia burgdorferi sensu lato complex which are transmitted by ticks. The diagnosis of Lyme borreliosis is based primarily on typical clinical symptoms and signs with serological confirmation. Antibiotic therapy is beneficial for all manifestations and treatment refractory cases are rare. The diagnosis "chronic Lyme borreliosis" is increasingly being misused for all conceivable medically unexplained symptoms.
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Affiliation(s)
- P Herzer
- Internistisch-rheumatologische Schwerpunktpraxis, Tal 6, 80331, München, Deutschland,
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45
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New-onset panic, depression with suicidal thoughts, and somatic symptoms in a patient with a history of lyme disease. Case Rep Psychiatry 2015; 2015:457947. [PMID: 25922779 PMCID: PMC4397473 DOI: 10.1155/2015/457947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/14/2015] [Indexed: 11/22/2022] Open
Abstract
Lyme Disease, or Lyme Borreliosis, caused by Borrelia burgdorferi and spread by ticks, is mainly known to cause arthritis and neurological disorders but can also cause psychiatric symptoms such as depression and anxiety. We present a case of a 37-year-old man with no known psychiatric history who developed panic attacks, severe depressive symptoms and suicidal ideation, and neuromuscular complaints including back spasms, joint pain, myalgias, and neuropathic pain. These symptoms began 2 years after being successfully treated for a positive Lyme test after receiving a tick bite. During inpatient psychiatric hospitalization his psychiatric and physical symptoms did not improve with antidepressant and anxiolytic treatments. The patient's panic attacks resolved after he was discharged and then, months later, treated with long-term antibiotics for suspected “chronic Lyme Disease” (CLD) despite having negative Lyme titers. He however continued to have subsyndromal depressive symptoms and chronic physical symptoms such as fatigue, myalgias, and neuropathy. We discuss the controversy surrounding the diagnosis of CLD and concerns and considerations in the treatment of suspected CLD patients with comorbid psychiatric diagnoses.
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46
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[Diagnosis and treatment of Lyme arthritis. Recommendations of the Pharmacotherapy Commission of the Deutsche Gesellschaft für Rheumatologie (German Society for Rheumatology)]. Z Rheumatol 2015; 73:469-74. [PMID: 24924733 DOI: 10.1007/s00393-014-1370-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
These guidelines summarize the current evidence for diagnosis and treatment of Lyme arthritis and the most frequent skin manifestations of Borrelia burgdorferi infections. Lyme arthritis is a monoarticular or oligoarticular form of arthritis that typically involves the knee. A positive enzyme-linked immunosorbent assay (ELISA) for IgG antibodies should be followed by an IgG immunoblot. A positive PCR test from synovial fluid adds increased diagnostic certainty. Serum positivity for antibodies to Borrelia burgdorferi without typical symptoms does not justify antibiotic treatment. Oral antibiotic treatment for erythema migrans is recommended using doxycycline, 200 mg once per day for 10-21 days, alternative choices are amoxicillin, cefuroxime and azithromycin. For children below 8 years of age, amoxicillin is recommended.Lyme arthritis can usually be successfully treated with orally administered antimicrobial agents. Doxycycline, 1 × 200 or 2 × 100 mg for 30 days is the antibiotic agent of choice. Amoxicillin (3 × 500-1000 mg) can be alternatively chosen. Patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be treated intravenously. In this situation, ceftriaxone at 2 g per day for 14-21 days is recommended. There is no evidence to recommend long-term and combined treatments.
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Goddard J, Embers M, Hojgaard A, Piesman J. Comparison of Tick Feeding Success and Vector Competence for Borrelia burgdorferi Among Immature Ixodes scapularis (Ixodida: Ixodidae) of Both Southern and Northern Clades. JOURNAL OF MEDICAL ENTOMOLOGY 2015; 52:81-5. [PMID: 26336283 PMCID: PMC4817621 DOI: 10.1093/jme/tju005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Northern and southern Ixodes scapularis Say populations differ greatly in density, host utilization, and especially questing behavior of the immatures. Haplotypes of I. scapularis in North America can be divided into two major clades-the All American Clade (haplotypes A through J) and the Southern Clade (M through O). This genetic variation may affect feeding success and vector competence. This study compared feeding success of larval I. scapularis measured by time-to-drop-off and subsequent transmissibility success of Borrelia burgdorferi to mice using ticks from Mississippi, Connecticut (both F haplotype), and Louisiana (haplotype O). Northern ticks (CT) fed to repletion much faster than MS and LA ticks: overall, 73.6% of CT ticks had dropped off mice at Day 3 compared to only 1.7% and 6.6% of ticks dropped off for MS and LA ticks at that same time point. As for vector competence, 4 of the 4 mice in each case (MS or CT) that had been fed on by infected nymphs tested positive for B. burgdorferi. In a second experiment, 5 of the 6 mice tested positive for B. burgdorferi after exposure to infected LA ticks as compared with 3 of the 4 mice exposed to infected CT ticks. These data demonstrate that there is no difference in northern and southern populations of I. scapularis in their ability to transmit B. burgdorferi, but the ability of the northern populations to feed rapidly on rodents exceeds that of southern populations.
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Affiliation(s)
- Jerome Goddard
- Department of Biochemistry, Molecular Biology, Entomology and Plant Pathology, 100 Twelve Lane, Clay Lyle Entomology Bldg., Mississippi State University, Mississippi State, MS 39762.
| | - Monica Embers
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA
| | - Andrias Hojgaard
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Ft. Collins, CO
| | - Joseph Piesman
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Ft. Collins, CO
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Aguero-Rosenfeld ME, Wormser GP. Lyme disease: diagnostic issues and controversies. Expert Rev Mol Diagn 2014; 15:1-4. [PMID: 25482091 DOI: 10.1586/14737159.2015.989837] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The diagnosis of Lyme disease is a controversial topic. Most practitioners and scientists recognize that Lyme disease is associated with certain objective clinical manifestations supported by laboratory evidence of infection with Borrelia burgdorferi sensu lato (the etiologic agent). There are others, however, who believe that patients with Lyme disease may have a wide variety of entirely nonspecific symptoms without any objective clinical manifestation and that laboratory evidence of infection by B. burgdorferi is not required to support the diagnosis. In reality, this perspective is not evidence based and would inevitably lead to innumerable misdiagnoses, given the high frequency of medically unexplained symptoms, such as fatigue and musculoskeletal pains, in the general population. Although those espousing this viewpoint do not believe that a positive laboratory test is required, nevertheless, they often seek out and promote alternative, unapproved testing methods that frequently provide false-positive results to justify their diagnosis. Herein, we provide a brief overview of Lyme disease testing, emphasizing current usage and limitations. We also discuss the use of nonvalidated procedures and the prospects for a reduction in such testing practices in the future.
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Affiliation(s)
- Maria E Aguero-Rosenfeld
- Department of Pathology, New York University School of Medicine, New York University Langone Medical Center and Bellevue Hospital Center, New York, NY 10016, USA
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Ticking the right boxes: classification of patients suspected of Lyme borreliosis at an academic referral center in the Netherlands. Clin Microbiol Infect 2014; 21:368.e11-20. [PMID: 25658524 DOI: 10.1016/j.cmi.2014.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 11/05/2014] [Accepted: 11/14/2014] [Indexed: 11/24/2022]
Abstract
To provide better care for patients suspected of having Lyme borreliosis (LB) we founded the Amsterdam Multidisciplinary Lyme borreliosis Center (AMLC). The AMLC reflects a collaborative effort of the departments of internal medicine/infectious diseases, rheumatology, neurology, dermatology, medical microbiology and psychiatry. In a retrospective case series, characteristics of 200 adult patients referred to the AMLC were recorded, and patients were classified as having LB, post-treatment LB syndrome (PTLBS), persistent Borrelia burgdorferi sensu lato (s.l.) infection despite antibiotic treatment or no LB. In addition, LB, PTLBS and persistent B. burgdorferi s.l. infection cases were classified as 'definite,' 'probable' or 'questionable.' Of the 200 patients, 120 (60%) did not have LB and 31 (16%) had a form of localized or disseminated LB, of which 12 were classified as definite, six as probable and 13 as questionable. In addition, 34 patients (17%) were diagnosed with PTLBS, of which 22 (11%) were probable and 12 (6%) questionable. A total of 15 patients (8%) were diagnosed with persistent B. burgdorferi s.l. infection, of which none was classified as definite, three as probable and 12 as questionable. In conclusion, in line with previous studies, the number of definite and probable (persisting) LB cases was low. The overall high number of questionable cases illustrates the fact that it can sometimes be challenging to either rule out or demonstrate an association with a B. burgdorferi s.l. infection, even in an academic setting. Finally, we were able to establish alternative diagnoses in a large proportion of patients.
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Gerstenblith TA, Stern TA. Lyme Disease: A Review of Its Epidemiology, Evaluation, and Treatment. PSYCHOSOMATICS 2014; 55:421-9. [DOI: 10.1016/j.psym.2014.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
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