Talk:Lyme disease

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Former good articleLyme disease was one of the Natural sciences good articles, but it has been removed from the list. There are suggestions below for improving the article to meet the good article criteria. Once these issues have been addressed, the article can be renominated. Editors may also seek a reassessment of the decision if they believe there was a mistake.
Article milestones
DateProcessResult
October 1, 2006Peer reviewReviewed
February 27, 2007Good article nomineeListed
March 20, 2007Featured article candidateNot promoted
June 20, 2008Good article reassessmentDelisted
March 19, 2013Peer reviewReviewed
Current status: Delisted good article

New photo

Given that many erythema migrans rashes are solid in appearance, I propose to reduce the width of the bulls eye photo and add the new photo I just uploaded. It is from a new public domain case report. If any more experienced editors are able to make it look ok without being too crowded, please feel free. ScienceFlyer (talk) 00:54, 15 February 2024 (UTC)[reply]

@ScienceFlyer:
I think it's a good idea. And thanks for doing the work of getting a photo. From this source (currently ref # 27 in our article) --
DePietropaolo DL, Powers JH, Gill JM, Foy AJ (July 2005). "Diagnosis of lyme disease". American Family Physician. 72 (2): 297–304. doi:10.1093/cid/cir464. PMID 16050454.
'Approximately 19 percent of erythema migrans rashes are a “bull's-eye” rash.'
So yes, most Lyme rashes DO NOT appear to be a bull's eye.
I have a little experience with photos, but not recently. I'll try to jump in within the next couple of days. I know all of our time is limited! FriendlyRiverOtter (talk) 22:21, 28 February 2024 (UTC)[reply]

The following’s an attempt. FriendlyRiverOtter (talk) 16:30, 1 March 2024 (UTC)[reply]

Lyme disease can affect several body systems and produce a broad range of symptoms.

//////

I went ahead and made the change:

https://en.wikipedia.org/w/index.php?title=Lyme_disease&diff=prev&oldid=1211620677

And with this reference, including a link to the highly readable pdf form.

ref name="North Carolina case with delayed diagnosis"

“Delayed Diagnosis of Locally Acquired Lyme Disease, Central North Carolina, USA”, Boyce, Ross; Pretsch, Peyton; Tyrlik, Kay; et. al, Emerging Infectious Diseases, U.S. CDC, Vol. 30, No. 3, March 2024.

I hope that people like it! FriendlyRiverOtter (talk) 15:38, 3 March 2024 (UTC)[reply]

Thank you @FriendlyRiverOtter. I corrected the citation and tightened the caption ScienceFlyer (talk) 17:38, 3 March 2024 (UTC)[reply]
@ScienceFlyer, you’re very welcome! I’m glad I was able to help.
With the photo captions, I think we just need to accept the fact that this will be the only thing a lot of people read, at least for the inner sections of the article. In fact, I think we need to embrace this fact and try to make each caption as succinct, informative, etc, as we can.
With the first photo, I think we need to say that the “classic” bull’s-eye rash is very much the exception not the rule. As our sources say.
With the second photo, I take that the CDC article’s main point is that this lady’s Lyme disease didn’t get a diagnosis for two months. And their 2nd point was that she was in North Carolina. Meaning, a place where her doctor, PA, etc, did not expect Lyme.
Time permitting, I’m going to look at both the captions and this section. I urge you to do the same, time permitting of course. Thanks. FriendlyRiverOtter (talk) 17:09, 4 March 2024 (UTC)[reply]
The terminology in the literature is a little confusing but I am concerned that "bulls eye" rashes (solid central dot) are being elided with general 'target' rashes (concentric circles), which are the classic form, it appears. Bon courage (talk) 17:20, 4 March 2024 (UTC)[reply]
@Bon courage: I think you're probably right, and it puts you in a bind.
Because even if you're the top Lyme expert on the Eastern seaboard, you've got to go with the references, no more, no less. Yes, I personally think a "bull's eye" with center red, concentric clearing, and outer red is more complex than just central clearing. And therefore, probably more rare.
Time permitting, please dive in. Maybe you'll find this exact point in a reference. And/or pick up other good stuff along the way. I recommend, let the process be a little messy, be both bold and reasonable, all that good stuff. :-) FriendlyRiverOtter (talk) 19:20, 5 March 2024 (UTC)[reply]
It doesn't put "me" in a bind. This is what I take from the best sources. So here[1] the CDC refer to the "classic" lyme rash as a "Circular, expanding rash with target-like appearance". It seems there is some POV-pushing lately to try and downplay what sources are saying about this classic presentation. Bon courage (talk) 19:42, 5 March 2024 (UTC)[reply]
@Bon courage: If I push POV, please call me out. Each and every time. Like I said to our colleague just now, I'm actually only medium interested in Lyme, and that's probably a pretty good place to be.
With 3 of us interested in this one brief window of time, we have a chance to make some progress. I want to jump in and make some edits. You might like them, you might not. Please let me know either way, or change the edit if you prefer to save time that way. FriendlyRiverOtter (talk) 21:39, 5 March 2024 (UTC)[reply]


Thanks @FriendlyRiverOtter. I agree things could probably be tightened (e.g. there are probably too many references cited). I'd be cautious about extrapolating or generalizing from a single case report, especially an atypical one like this. It's also not specified when the photo was taken, and it's a snapshot in time. The table in the report documents rash at PCP visit on day 10 but not at 28 days or later. An EM rash may develop clearing in the center over time. For me, chapter 1 of Alan Barbour's book ("Lyme Disease: Why It's Spreading, How It Makes You Sick") was educational. ScienceFlyer (talk) 18:33, 4 March 2024 (UTC)[reply]
@ScienceFlyer: Thanks for the book recommendation. I like books which are well-written, and books in which the author assumes the reader is just as smart as they are. Not every writer has that knack.
I'm actually only medium interested in Lyme! Although I guess that's probably a good place to be as an editor!
It occurs to me that they are two different 80 percents.
80% of Lyme patients have a rash of some type. And then, 80% of Lyme rashes are non-"bull's eye." And if we present these two facts at the same time, it slows down reading. And it takes away from the executive summary style I'm aiming for. FriendlyRiverOtter (talk) 21:30, 5 March 2024 (UTC)[reply]
@ScienceFlyer: I want to challenge you on the photo. It does not show central clearing. It shows central redness and concentric clearing. Look, I don't know whether the current medical lit. makes a big deal between "bull's eye" and "target-like." Maybe we should say both until and unless we get a good source(s) saying otherwise.
And let's go ahead and just state this is the U.S. figure. And really, this "bull's eye" is so textbook or "classic" that it looks like someone drew it on the skin using a shade of lipstick! FriendlyRiverOtter (talk) 23:02, 7 March 2024 (UTC)[reply]
@FriendlyRiverOtter Thank you for your comments. Central clearing as used in the literature appears to include target or bulls eye rash. I do agree it's best to use a term that the most English speakers would understand, though the photo is pretty illustrative regardless.

As the lesion expands over days to weeks, central or paracentral clearing may occur, with the resultant formation of an annular or target-like appearance.
— Dandache and Nadelman 2008

As for the 20% number, I could take it or leave it, but please at least remove the extraneous word "only". I think the 20% number gives a wrong sense that the rashes are static, either with or without clearing, when rashes evolve over time. The data is based on observations, probably at a single time point. I think it's best to emphasize that both types occur rather than particular numbers.

With long duration of lesions (5–6 weeks in one Swedish study), 80% of cases had central clearing. In contrast, most EM seen in the United States over the past 2 decades have been diagnosed and treated within 1 to 2 weeks of onset and most lacked central or paracentral clearing at the time of presentation. Central clearing occurred in only 37% and 9% of cases in two large studies conducted in the northeastern United States involving nearly 200 patients who had culture-confirmed EM.
— Dandache and Nadelman 2008

ScienceFlyer (talk) 00:31, 8 March 2024 (UTC)[reply]
I went ahead and took off the “Only.”
And I think the last quote you show raises a good point — central clearing comes somewhat later. And it sounds like much of the literature doesn’t make much of a distinction between central and para-central clearing.
It’s great discussing with you. It really is!  :-) But I also want us to channel our energy into improving our article.
Sometime during this weekend, I’m going to take a whack at making “Signs and symptoms” a faster read. No guarantees of course.
I’d love to see a time-series of 3 photos, or maybe just 2.
And really, if you have some time, please jump in anywhere you think the article could use some improvement. For example, I think there’s got to be some way of improving on the vague “vector-borne” in our opening sentence, just saying. :-)
FriendlyRiverOtter (talk) 15:32, 15 March 2024 (UTC)[reply]

Should we add a short section on Contrast and Compare with Syphilis?

An encyclopedia is all about placing something in context, right?

And the only other spirochete disease a lot of people know about is syphilis. And in later stages, both Lyme and syphilis can attack the brain and the joints. But here's where I become very cautious.

I certainly could summarize sources on syphilis, as I'm sure you could, too. But I am NOT a medical professional. So, I'm not confident that I'd really be achieving the goal of context.

I say, if we have a good source doing the Contrast and Compare, Yes, then we can summarize that source. FriendlyRiverOtter (talk) 23:11, 7 March 2024 (UTC)[reply]

Find us a source, preferably multiple sources, that do the comparison. We cannot do it ourselves, that's novel synthesis. — The Hand That Feeds You:Bite 23:31, 7 March 2024 (UTC)[reply]
Yes indeed, just what the reference says, no more, no less. :-) FriendlyRiverOtter (talk) 17:08, March 15, 2024‎ (UTC)