Talk:Lyme disease/Archive 6

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Typo?

"Although it was known that Lyme disease was a tick-borne disease as far back as 1978, the cause of the disease remained a mystery until 1981" 'as far back' with three years of difference in time seems a bit of a weird choice of words. Maybe 1798 or another year was meant? — Preceding unsigned comment added by 217.233.215.150 (talk) 10:15, 12 September 2013 (UTC)

Copy-edit

I was indirectly directed to this article via BBC:Lyme disease risk from dogs 'higher than thought' and found our Lyme disease article interesting. However, there appears to be a mistake in the cause section thus "At least eleven Borrelia species have been discovered, twelve of which are known to be Lyme-related" --Senra (talk) 12:29, 25 January 2012 (UTC)

Wiki Entry: "Bell's palsy"

For whomever most regularly writes and edits the Lyme (borrelia) information, I wanted to call attention to the Wiki article on Bell's palsy wherein it's stated, "Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood or erythema migrans. In endemic areas Lyme disease may be the most common cause of facial palsy." The incorrect information being, "...easily diagnosed by looking for Lyme-specific antibodies in the blood or erythema migrans." I suspect that "in endemic areas" is also questionable, given the great geographical range/distribution of borrelia. Thanx, 07:43, 6 March 2012 (UTC) — Preceding unsigned comment added by Pillartopost (talk • contribs)

The current facts remain - Lyme disease in it's disseminated stages; typically after 8 weeks of onset and post erythema migrans, is EASILY diagnosed using modern sensitive ELISA testing. There is currently a TON of misinformation citing the ineffective nature of ELISA testing for lyme disease. Understand that this misinformation is a parroting by a few "lyme activists" of grossly outdated information on testing modalities of lyme disease. In the modern world of 2012, if one were to examine the blood of 100 confirmed lyme disease patients and subject it to modern ELISA testing, ALL 100 patients would test positive for lyme antibodies. Hope this helps. 72.77.73.2 (talk) 23:01, 7 May 2012 (UTC)

Cardiac manifestations

I've just read this for the first time, and know nothing about Lyme disease or cardiology.

The article mentions "heart palpitations and dizziness caused by changes in heartbeat" and "The disease may also have cardiac manifestations such as AV block" in the section on early disseminated infection. Both statements are unsourced. This source

Lelovas P, Dontas I, Bassiakou E, Xanthos T (2008). "Cardiac implications of Lyme disease, diagnosis and therapeutic approach". Int. J. Cardiol. 129 (1): 15–21. doi:10.1016/j.ijcard.2008.01.044. PMID 18508142. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

says

Cardiac manifestations in LB appear to be rare. Most frequently they can be observed with or shortly after an EM, or in association with neurological symptoms or arthritis. Conduction abnormalities with varying degrees of atrioventricular conduction defects are typical manifestations.^10,43 In particular, Lyme carditis should be suspected in younger individuals showing conduction abnormalities without other apparent risk factors, and who have a history of recent exposure to ticks. Other rhythm disturbances, endomyocarditis and pericarditis have also been reported.^44,45 Alternative explanations for the cardiac condition presented must be excluded. Palpitations, bradycardia, or bundle branch block alone are not sufficient for diagnosis. Antibodies to B. burgdorferi s.l. should be evident in serum but positive serology alone is not confirmatory and appropriate clinical signs must also be taken into account. Chronic cardiac conditions, such as long-lasting dilated cardiomyopathy, have occasionally been associated with borrelial infection but the causal relationship is still unproven despite direct detection of borreliae from endomyocardial biopsies in single cases.⁴⁶

This source

Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD (2008). "Diagnosis and treatment of Lyme disease" (PDF). Mayo Clin. Proc. 83 (5): 566–71. doi:10.4065/83.5.566. PMID 18452688. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

says

Cardiovascular symptoms are less common (present in 8% of those infected) but may include temporary atrioventricular blocks of varying degree. Although temporary pacing may be necessary in more than 30% of patients with cardiac involvement, complete heart block rarely develops.¹⁵

Could we improve on our present description of the cardiac implications? I'll re-read this in a few days and compose something if no one else has - and if it still looks like it needs improvement after a second reading. --Anthonyhcole (talk) 06:47, 2 April 2012 (UTC)

Magazine article moved to Media section

Self-explanatory: magazine is media, doesn't need its own section. I'll check back late next week (going on vacation). Postpostmod (talk) 21:40, 7 April 2012 (UTC)

Placement in the "Media" subsection does not make sense; the media section should describe how it is perceived or reported in the media. The material you moved is about harassment, not media coverage, and therefore does not belong in the media section and probably deserves its own subsection. I have therefore reverted your move. That it was reported by a magazine doesn't make it a "media" related material. Yobol (talk) 23:29, 7 April 2012 (UTC)

Well, the WP:MED team will always prevail. But someone has to speak up for the patients, who are being accused of serious crimes here, and tried in the press.

The story itself is the media event. It was planted by a PR agency hired by Steere (see the article itself). Read the whole article, and note the hyperbollic, sensationalized use of language, and the extreme bias toward Steere.

It doesn't meet journalistic standards for news. It's a "human interest story" in a magazine. And an 11-year-old one, at that. Postpostmod (talk) 11:02, 8 April 2012 (UTC)

Disagree with your characterization. That it was reported in the media doesn't make it about the "media". Yobol (talk) 13:34, 8 April 2012 (UTC)

I agree with Yobol. Axl ¤ [Talk] 20:01, 8 April 2012 (UTC)

I too agree with Yobol. -- Brangifer (talk) 20:26, 8 April 2012 (UTC)

What is the evidence that Steere (or a PR agency working on his behalf) "planted" the New York Times Magazine story? That's a contentious assertion about a living person, and it's not contained in the article itself. MastCell ^Talk 04:02, 9 April 2012 (UTC)

Hi MastCell,

From the Grann story:

When I called the public-relations firm that he had recently hired, the spokeswoman told me that he was afraid for his life. "He's been getting death threats," she said. "These people won't leave him alone." Initially, she set up a luncheon for the three of us to get together in New York...

Here is some information to get people started on understanding what PR agencies do. It's important for Wikipedians to get up to speed on this; we seem to be acting on a naive model of how news stories, let alone magazine articles, get written and published.

About public-relations ("PR") agencies and the NYT:

http://publiceditor.blogs.nytimes.com/2011/07/14/p-r-professionals-bane-or-boon/

About PR agencies and the media in general:

http://www.propublica.org/article/pr-industry-fills-vacuum-left-by-shrinking-newsrooms/single

About "Pseudo-events":

http://www.nku.edu/~turney/prclass/readings/events.html

Best regards, Postpostmod (talk) 23:53, 14 April 2012 (UTC)

Thanks; I'm familiar with how public-relations agencies operate, but was trying to understand the basis for your belief that a PR agency "planted" the Grann story. I still don't see the basis for your claim in the article. Quite the opposite; it sounds like Steere declined to be interviewed because he didn't want publicity. You carefully placed an ellipsis in your quote from the article; here's the context you chose to omit:

Initially, [Steere's PR agent] set up a luncheon for the three of us to get together in New York, but on the day before the meeting, Steere backed out. "He's worried that any publicity will only make him more of a target," the publicist said. Finally, after several more entreaties, he agreed to meet in his office at the New England Medical Center.

It doesn't exactly sound like he was desperate to get his side of the story into the Times. And there is definitely nothing remotely supporting your claim that the Times story was "planted" by Steere and his henchmen. Am I missing something? MastCell ^Talk 00:15, 15 April 2012 (UTC)

Modified part of "Tick removal"

Modified "avoiding ... removing the head from the body" to "avoiding ... removing the head from the tick's body". Initially might have meant avoiding to remove the head from the victim's body. It most probably refers to the tick's body. I know letting the tick's head into the victim's body is dangerous. Nevertheless, if you have arguments I might have been wrong, please post them here. Ferred (talk) 18:46, 4 May 2012 (UTC)

Controversy and Politics

Hi. Under the Controversy and Politics section there reads: "The campaign of Mitt Romney and Paul Ryan favors a law that will provide "physicians with protection from lawsuits to ensure they can treat the disease with the aggressive antibiotics that are required.". Now, though this does fall under the section of politics, the statement sounds a bit controversial itself. First off, it only giving one party's candidates opinion on the matter. Do other parties have an opinion on the protection of doctors or the course of proper treatment in regards to Lyme disease? Second of all, given that it is nearing election time, the statement seems suspect. Finally, the statement is a partial representation of the information in the source material (a campaign flyer by Romney for President, Inc). I propose the deletion of this statement until an assessment of other party's platforms on Lyme disease can be completed and summarized. I would greatly appreciate the input of others, including the original contributor, so that we may discuss and resolve this query. Helihax (talk) 23:46, 7 October 2012 (UTC)

When I first saw this edit go in, I also thought it didn't fit in the article and should come out. However, I took a close look at the rest of the items in the "Controversy and politics" section, and came to the conclusion it fits in there easily. I had no idea how heavily politicized this issue was. The fact that the Romney campaign has sent out this literature isn't under question, what might be questioned is the noteworthiness of the item, so we're looking to see if reliable secondary sources are reporting on it. The sourcing for the content isn't the best, but it's not terrible: one is a blog post, but it's a blog post of John McCormack, a staff writer at the Weekly Standard; and the other is a regular news article from Slate. The Slate article is fine, and I'm only lukewarm about a news-blog, but given the other stuff in this section, it passes and I don't see a policy-based reason to remove it. I doubt this campaign item will have a lasting effect worthy of inclusion in an encyclopedia article, but because of WP:NOTPAPER I can't come up with a good enough reason to see it removed. Zad68 14:26, 8 October 2012 (UTC)

Prolonged therapy - edits reverted

These edits, which I reverted, are problematic. First, the claim of "Several...textbooks..." is unsupported. More clearly, the reference used as an example does not appear to support this; to wit, in the chapter on Lyme disease (242, Borrelia burgdorferi...), the section about conventional treatment is followed by this paragraph:

Following appropriately treated Lyme disease, a small percentage of patients continue to have subjective symptoms, primarily musculoskeletal pain, neurocognitive difficulties, or fatigue, in some instances, for years.[107] Among such patients, three double-blind, placebo-controlled trials failed to show a benefit from additional courses of antibiotic treatment.[116-118] In the largest of these studies, patients with post–Lyme disease syndrome received intravenous ceftriaxone for 30 days followed by oral doxycycline for 60 days or intravenous and oral placebo preparations for the same duration. However, there were no significant differences between the groups in the percentage of patients who felt that their symptoms had improved, worsened, or remained the same.[116] Such patients are best treated symptomatically rather than with prolonged courses of antibiotic therapy. Prolonged ceftriaxone therapy for unsubstantiated Lyme disease has resulted in biliary complications;[107] in one reported case, prolonged cefotaxime administration resulted in death.[107]

References 107 (<ref name="idsa guideline"/>) and 116 (<ref name="Klempner"/>) are already cited in the article; references 117 (Krupp, PMID 12821734) and 118 (Fallon, PMID 17928580) could be added; however, for now I've added reference to the Mandell chapter to a relevant statement in the article. -- Scray (talk) 19:57, 3 November 2012 (UTC)

Conflicting info on deer population reduction

Prevention:
'A community can prevent Lyme disease by reducing the numbers of primary hosts on which the deer tick depends, such as rodents, other small mammals, and deer. Reduction of the deer population may, over time, help break the reproductive cycle of the deer ticks and their ability to flourish in suburban and rural areas.'

Ecology:
'The risk of acquiring Lyme disease does not depend on the existence of a local deer population, as is commonly assumed. New research suggests eliminating deer from smaller areas (less than 2.5 ha or 6 acres) may in fact lead to an increase in tick density and the rise of "tick-borne disease hotspots".'
—Darxus (talk) 22:45, 26 November 2012 (UTC)

Great catch. Let's check the citations to see if one is actually supported by more research per WP:MEDRS. SkepticalRaptor (talk) 22:50, 26 November 2012 (UTC)

Ticks are also responsible for transmitting 2 other serious tick borne diseases: Babesiosis which can be fatal to those with compromised immune systems and ehrlichiosis or Rocky Mountain Spotless fever. Both are difficult to diagnose as there is no rash and the babesiosis can only be found via blood slides by someone trained to identify it - usually an infectious disease specialist. — Preceding unsigned comment added by 173.2.200.14 (talk) 21:02, 30 January 2013 (UTC)

Lyme Disease Spirochete Needs High Manganese Level

Lyme Disease Spirochete Needs High Manganese Level

A study was released today by Johns Hopkins -- the Lyme spirochete is manganese-based, not iron-based!!!

Scientists reveal quirky feature of Lyme disease bacteria

http://phys.org/news/2013-03-scientists-reveal-quirky-feature-lyme.html

"To cause disease, Borrelia burgdorferi requires unusually high levels of manganese, scientists at Johns Hopkins University (JHU), Woods Hole Oceanographic Institution (WHOI), and the University of Texas reported. Their study, published March 22, 2013, in the Journal of Biological Chemistry, may explain some mysteries about why Lyme Disease is slow-growing and hard to detect and treat. The findings also open the door to search for new therapies to thwart the bacterium by targeting manganese.. ......" — Preceding unsigned comment added by 71.224.145.215 (talk) 01:50, 22 March 2013 (UTC)

In other words: Borrelia bacteria are anaerobe...because aerobe bacteria need iron. So therefore you need to target anaerobic bacteria with any treatment. --178.197.229.27 (talk) 12:56, 4 December 2013 (UTC)

Alternative treatment

Because the section on alternative treatment offers no insights, I have removed it for the following reasons:

• There is no proof that any of these treatments work, in vivo
• There are no published data to confirm any evidendence that these treatments work
• The suggested remedies may give false hope or delay treatment in appropriate cases

IMHO this section was added as part of an agenda, for the article to appear balanced or for the article to appear politically correct. As long as there are no hard data or that the medical community has accepted any of the claims made, I would suggest that this section does not remain part of the article. I have moved the offending section to the area below, should anybody take offence and wish to put it back into place.
Also I would like to point out that initial treatment of Lyme disease varies over time (although most of the antibiotics remain the same). The fact that most children should not be treated with doxycyclin is a matter of dispute. The basis for this is purely hypothetical, wheras the consequences of contracting Lyme disease are not.

Alternative therapies

A number of other alternative therapies have been suggested, though clinical trials have not been conducted, so the therapies are not known to be scientifically sound. For example, the use of hyperbaric oxygen therapy has been discussed by CAM enthusiasts as an adjunct to antibiotics for Lyme. Though there are no published data from clinical trials to support its use, preliminary results using a mouse model suggest its effectiveness against B. burgdorferi both in vitro and in vivo. Anecdotal clinical research has suggested antifungal azole medications, such as fluconazole, could be used in the treatment of Lyme, but the use of these drugs has yet to be tested in a controlled study.

Alternative medicine approaches include bee venom, because it contains the peptide melittin, which has been shown to exert inhibitory effects on Lyme bacteria in vitro; however, no clinical trials of this treatment have been carried out.

References

77.167.212.162 (talk) 17:46, 5 April 2013 (UTC)

I agree with the removal not necessarily for the reason stated but rather all of these sources are quite outdated, and some of them are primary sources. Certainly by now if any of these treatments had any traction, they'd have been evaluated in clinical testing and be picked up in review articles. Maybe we can find a recent review article that mentions them and also reviews the evidence for their effectiveness and safety. Zad68 17:55, 5 April 2013 (UTC)

The root of Japanese Knot Weed is used in eastern medicine to treat Lyme disease if someone wants to add it94.172.127.37 (talk) 02:27, 22 May 2013 (UTC)

FYI

The edit was reverted as a good faith edit (within five minutes). As I have no interest in starting an edit war. I will leave it here. 77.167.212.162 (talk) 18:03, 5 April 2013 (UTC)

Well your edit looked like this: An anonymous IP removed well-sourced but controversial content without an edit summary. That often looks like vandalism or some form of POV editing. To give your edit a better chance of staying, next time try providing a complete, detailed edit summary, cite the Wikipedia policy or guideline supporting your edit, and you could have linked to this Talk page discussion explaining why you were making your edit. Also, consider creating an account... like it or not, IP editors don't often get the same level of respect as logged-in editors. I'll try making the edit and leaving a summary and a link here. Zad68 18:16, 5 April 2013 (UTC)

Oldest known case of Lyme disease

I read that researchers studying the Ice Man found that he had Lyme disease. Is this relevant enough to include in the article?--Ambiesushi (talk) 17:16, 27 May 2013 (UTC)

Yes, IMHO.

World map of infections

The current world map showing countries with reports of the disease does NOT agree with the text of the article; specifically, no map indication in S.America, but the article mentions a case in Brazil. Steve8394 (talk) 05:53, 30 May 2013 (UTC)

2013 University of North Florida Research

In June 2013, Dr. Kerry Clark, University of North Florida associate professor of public health, and his colleagues published research of several significant findings in The International Journal of Medical Sciences:

• They found two species of Lyme disease bacteria that infect human patients but were previously unknown to infect humans: Borrelia americana and Borrelia andersonii
• The commonly found lone star tick, formerly believed by many to be incapable of transmitting Lyme disease, was implicated in some of these cases.
• Because current testing methods and interpretation criteria detect just one previously-discovered species, the new discoveries may explain complaints about Lyme disease test reliability and possibly about the existence of the chronic form of Lyme in general.

References

I added information about this to the Lyme Disease page.

Soon after, Wikipedia editor Scray removed it with message:

too soon - WP is not a news source and a finding like this needs secondary sourcing in WP:MEDRS; primary sourcing in a third-tier journal, and secondary sourcing from non-medical sources, is insufficient

The paper is here in the International Journal of Medical Sciences. The International Journal of Medical Sciences is peer-reviewed and available in MEDLINE and PubMed. This is the long list of peers on the editorial board of the journal.

Editor "Scray" quoted https://en.wikipedia.org/wiki/Wikipedia:MEDRS . That page says:

Peer reviewed medical journals are a natural choice as a source for up-to-date medical information in Wikipedia articles.

I understand and respect Scray's desire to properly identify the information as new.

However, it seems like the complete removal of every character I touched on both this Lyme Disease page and also the other Lyme page was too heavy handed. This was a peer-reviewed journal. It seems like the appropriate thing to have done would have been to add clarifications about it being early research, not to remove it entirely, full stop.

Therefore I will re-add a subset of this material and add more clarifications as to the research status, and reduce the strength of the language.

Please keep an eye out for editors trying to remove all reference to the new study in a peer reviewed medical journal. I hope that the softer language and less-prominent placement will satisfy all.

Garkbit (talk) 21:06, 30 June 2013 (UTC)

---

Your addition is based on a primary report - most such reports turn out to be wrong (particularly in a journal like IJMS). Until it's reflected in high-quality secondary medical sources, this should not be added except perhaps in a "Research" section (even that may violate WP:UNDUE). Furthermore, there's no need to promote the "discoverers" and their institution by naming them in our article, and commenting on the journal title is unencyclopedic. -- Scray (talk) 22:26, 30 June 2013 (UTC)

--

The Wikipedia:Identifying reliable sources (medicine) page says:

As mentioned above, the biomedical literature contains two major types of sources: primary publications describe novel research for the first time while review articles summarize and integrate a topic of research into an overall view. In medicine, primary sources include clinical trials, which test new treatments; secondary sources include meta-analyses, which combine the results of many clinical trials in an attempt to arrive at an overall view of how well a treatment works. It is usually best to use reviews and meta-analyses where possible, as these give a balanced and general perspective of a topic—and are usually easier to understand!

Peer reviewed medical journals are a natural choice as a source for up-to-date medical information in Wikipedia articles. They contain a mixture of primary and secondary sources as well as less technical material such as biographies. Although almost all such material will count as a reliable source for at least some purposes, not all the material is equally useful, and some, such as a letter from a non-expert, should be avoided. Journal articles come in many types: original research, reviews, case reports, editorials and op-ed pieces, advocacy pieces, speculation, book reviews, letters to the editor and other forms of commentary or correspondence, biographies, and eulogies.

I'm not super experienced with WP protocols, but from my reading, this does not say that primary sources are disallowed as sources and should be removed from Wikipedia if there aren't followups. It says use reviews and meta-analyses where possible, which is hardly the same thing. It's not as if in this case we are trying to balance conflicting views and weighting the May 2013 research and a later-published meta analysis that disagrees with it. The "Identifying reliable sources" section goes on to recommend peer reviewed medical journals and the exceptions they mentioned (e.g. a letter from a non-expert) do not apply here.

Your comment on *this* page that says "most such reports turn out to be wrong" seems to be a form of "original research".

I totally get why you wanted the original article to be toned down in terms of stating things factually, but it seems like the now revised article wording including nothing in the intro paragraph and adding "but has not yet been confirmed by other teams, and may be controversial until then" takes care not mislead the reader about the status of the research.

Frankly, so much is controversial about Lyme Disease, that if everything that were potentially controversial were removed from Wikipedia entirely there would be only a handful of words in the entire article. :-)

As for mentioning the guy's name, I don't know him and have no stake in his promotion, but it seems like an odd claim that it's inappropriate to mention his name in the context of the article. Nearly every paragraph in the history section mentions someone's name who did some research:

• "Carl Lennhoff, who worked at the Karolinska Institute in Sweden"
• "In 1970, a dermatologist in Wisconsin named Rudolph Scrimenti"
• "In 1980, Steere, et al., began to test"
• "At a 1909 research conference, Swedish dermatologist Arvid Afzelius presented a study"

I should also note that your reversion contained an explicit link in your reversion quoting the policy for "Wikipedia is not a newspaper" ( https://en.wikipedia.org/wiki/Wikipedia:NOTNEWS). I read it and does not seem to support your case for complete reversion. It mentions things like "Wikipedia does not constitute a primary source" and discouraging "routine news reporting on things like announcements, sports, or celebrities", but this doesn't seem to apply in either case. This was pointing to research in a peer reviewed medical journal as a primary source.

I'll reduce the references to the journal name, i don't feel strongly about it, and since you do, I'll comply.

After I've made these changes, I request that the information not be deleted entirely. Perhaps I'm mistaken, and if so I apologize, but I don't see what you've pointed to to support the idea that a peer reviewed medical journal is by definition NOT a valid source to be mentioned in some form, especially when there are various caveats in the revised version I made to reflect your feedback. From the guidelines "Peer reviewed medical journals [...] almost all such material will count as a reliable source for at least some purposes". I'm trying in good faith to address your issues and comply with WP guidelines, and i hope that you will let the revised version stand. Thank you, Garkbit.

Garkbit (talk) 23:45, 30 June 2013 (UTC)

No, we can't use it. It's primary research. Wait for reviews. Also, per WP:BRD, don't restore that material before you have a consensus of editors for such content. Restoring it is edit warring which can get you blocked. See WP:3RR. -- Brangifer (talk) 23:56, 30 June 2013 (UTC)

My reading of WP:PRIMARY shows that primary sources can be used, but with great care. As such, mention of tentative findings that are awaiting replication may be noteworthy, as if nothing else, it shows that further research is still ongoing. This is noteworthy, as the efficacy of Lyme titer is rather variable in some cases. This may explain the otherwise inexplicably high number of negatives that respond to presumptive treatment. That said, I'd suggest mention of a tentative discovery of additional organisms, with the primary source listed and reinforcing the tentative nature, as well as no replication of results has been attempted as of yet.Wzrd1 (talk) 00:28, 1 July 2013 (UTC)

It is indeed interesting when there's new research uncovering a previously unreported, possibly important new finding regarding a still-mysterious disease like Lyme. It's tempting to want to get this research out there as soon as possible, using a primary study result like this, but this is absolutely not the kind of primary source we want to include in an encyclopedia, at least not yet. The research is far too tentative to include: Clark 2013 only discusses findings of DNA of related tick species of Lyme victims or people who just live in areas where Lyme is found, there is absolutely no causative finding. The study states only "several B. burgdorferi sensu lato species may be associated with Lyme disease-like signs and symptoms" based on a handful of individuals. Lyme is extremely well-studied and has the attention of the most influential medical organizations. It's inappropriate to include this primary research so early, we need to please wait for the findings to be reproduced and picked up in reliable secondary sources before including. If the findings are indeed significant they'll be picked up in the next year, and we can use the information then. Zad68 02:31, 1 July 2013 (UTC)

It sounds like you read the paper. A small sample size is already something of concern. It also sounds like a correlation is not causation error may be present as well. Didn't get the chance to try to read the paper due to my father's ill health challenging my available time significantly, as well as distracting me, as he is currently hospitalized secondary to a sudden loss of consciousness during his pre-operative screening on Friday. Fortunately, I had brought his hypotensive state at that time to the attention of the physicians evaluating the cause of his LOC. The consensus now is that his anti-hypertension medications need to be lowered in dosage, as he's now in ESRD and on dialysis. Hopefully, once he's released from the hospital, I'll have the time available to read papers as I hear of them.Wzrd1 (talk) 02:58, 1 July 2013 (UTC)

Wzrd1, very sorry to hear about your father's health, I wish for a speedy recovery for him. Taking care of your family takes far higher priority. Don't worry, Wikipedia and this article will still be here in a few weeks or months, or whenever you have time later. Zad68 13:36, 1 July 2013 (UTC)

US-centered?

The intro says that Borrelia afzelii and Borrelia garinii are the main cause in Europe and Borrelia burgdorferi sensu stricto in the US. But the pathophysiology section appears to be solely about the latter.
Also, the article says "Many of the signs and symptoms of Lyme disease are a consequence of the immune response to the spirochete in those tissues." But from the Dutch article I understand that an important difficulty in diagnosing the disease is that there are often no anti-bodies. Now I have little medical knowledge, but don't those two statements contradict each other? Might they be about the different strains?
Confusingly, the Europe-section only mentions burgdorferi. And it says that here, the disease is a European genospecies of bugdorferi. But isn't it the other way around, the American version being a variation of the originally European disease? At least, the Dutch article suggests that (Scottich immigrants taking the disease with them).

I haven't read much of the article because I spend a lot of time walking off-track in forests and therefore absolutely don't wish to be misinformed.
Am I getting something wrong here? If not, this is a rather serious omission since it is a rather common disease that (in Europe) is difficult to diagnose and may have very serious consequences. Which makes this a very important article. At the very least, where there are any differences between Europe and the US, this should be made clear. DirkvdM (talk) 08:03, 16 July 2013 (UTC)

Wright 2012 - second round?

In this edit, it is suggested that Wright 2012 advocates a second round of treatment for "arthritis symptoms" that "fail to respond". My guess is that this is based on Wright's Table 4, which restricts this suggestion to persistent or recurrent joint swelling (an objective sign, not just a symptom). Our article currently makes a much broader recommendation than the cited source, IHMO. -- Scray (talk) 03:47, 8 August 2013 (UTC)

I tried to reuse previous wording, possibly inappropriately. Thanks for catching, will fix tomorrow (if you don't get to it first!). Zad68 03:56, 8 August 2013 (UTC)

I took a shot - if not quite right we can refactor again. -- Scray (talk) 04:10, 8 August 2013 (UTC)

Lyme Disease in Australia

I'm a bit concerned about this section, as while most of the references appear to be the work of a single GP who specialises in the treatment of "Chronic Lyme Disease" - indeed an ad for his clinic is the first (sponsored) link that comes up when searching from Google's Australia portal. Also one of the sources (Piesman 1991) seems to contradict the statement it is being used for - it actually found that the ticks being tested were unable to act as a vector for the strain of B. burgdorferi used. I'm happy to do a bit of research to find some better references, but as a complete Wikipedia novice I'm not quite sure what the process is to change this. Thank you.118.208.108.75 (talk) 13:07, 7 September 2013 (UTC)

The process is very simple: you just remove the section entirely :)

It seems pretty cut and dried. If you search on google, it's basically all patients saying "lyme disease exists". The Australian government just says they are monitoring it. Also there are a few results from Dr Mayne. If you look in google scholar it basically says the vectors don't exist. If anyone does want to put it into the article again you will need a good review as per WP:MEDRS. --sciencewatcher (talk) 13:35, 12 September 2013 (UTC)

http://www.abc.net.au/news/2015-10-17/study-could-end-lyme-disease-debate-in-australia/6860688 http://www.abc.net.au/local/stories/2015/07/01/4265291.htm http://www.abc.net.au/news/2015-06-30/lyme-disease-murdoch-tick-research-bacteria-discovery/6582288 http://www.abc.net.au/news/2015-08-20/federal-parliament-calls-for-lyme-disease-recognition/6710810 http://www.abc.net.au/radionational/programs/backgroundbriefing/2013-05-12/4675072 27.33.21.68 (talk) 01:20, 19 October 2015 (UTC)

Safety of antibiotics

The sentence I removed is a quite classic case of original synthesis. "However, blah blah", the sentence is clearly intended to oppose the position of the IDSA, AAN, CDC, and NIH. But that was clearly not the intention of the authors of the cited studies. Antibiotic safety is not an absolute matter; it's a cost benefit analysis, and the NIH and others are quite clearly saying in their citations that the potential benefit is not worth the potential cost. If you want to suggest that the NIH, CDC, AAN, and IDSA are wrong in their opinion, you'll have to find a source that actually suggests that, rather than finding a tangetially relevant paper and making the leap from A+B to C. Someguy1221 (talk) 07:36, 27 July 2011 (UTC)

I'm sorry, but you're wrong. This section of the article deals with "Controversy and politics" and part of the controversy is the implied suggestion that long term treatment with antibiotics is unsafe, when clearly there are differing opinions within the medical community about this, especially in regards to to oral antibiotics. Doxycycline cannot be "safe" for long term treatment of acne, and "unsafe" for long term treatment of LD; this is part of the "controversy" regarding LD. I am going to undo your changes. Damwiki1 (talk) 08:54, 27 July 2011 (UTC)

The above exchange was copied from Damwiki1's talk page. The text in question can be seen here: [1]. I believe my actions were a straightforward application of WP:MEDRS and WP:OR; the cited references do not discuss Lyme disease, but are used to create an illusion of scientific controversy regarding this aspect of Lyme disease treatment. I would appreciate others' input on this. Someguy1221 (talk) 09:27, 27 July 2011 (UTC)

The section under discussion is entitled: "Controversy and politics". "Controversy" implies conflicting points of view, and if there were no conflicting points of view regarding the safety of long term antibiotic therapy, it would not be a topic in this section of the article. I have presented citations showing that long term treatment with doxycycline and minocycline is common practice for the treatment of adult acne, and that it is considered safe. This doesn't imply that long term mino/doxycycline therapy should or should not be used to treat LD, only that the risks of doing so are extremely low. In any event, you should have started this discussion prior to your edits.Damwiki1 (talk) 10:06, 27 July 2011 (UTC)

Hello, Someguy and Damwiki. Maybe you'd both be interested in the thread above this one, which has diffs supporting my observations below. Damwiki, I do think WP:SYNTHESIS, as it is customarily applied by WP:MED, is a technical problem with your particular edit. However, even if you cite an impeccable WP:MEDRS in which one, or a group of, dissenting doctors makes your point about the relative safety of oral antibiotics compared to the dangers of undertreated Lyme disease, it will either be disallowed entirely, or call forth additional citations from, um, higher ranking sources, saying that the dissenters can't be trusted and should be disregarded.

As to why this is, I'll say it again, another way, as I think one needs to understand the politics in order to edit this article effectively. The bottom line is, WP:MED's current membership will not support edits that document credible challenges to the "mainstream view", even in the "Controversy" section. In medical articles, WP:MED can trump WP:NPOV. The preferred solution to controversy seems to be, to identify the more politically powerful side, and then follow it and have faith that it is scientifically correct. This faith makes it more powerful, and so on ad infinitum. A situation where big influential organizations like those mentioned by Someguy, are demonstrably wrong, is thought to be practically impossible, and hence subject to WP:FRINGE. (I'm not suggesting that WP:MED members are acting in bad faith. I can see that if you're going to edit a lot of articles, thus providing medical information on many subjects to millions of people, this would be the quickest way to do it. We all share the hope that the mainstream is usually right, even when we are unfortunate enough to encounter a case where it isn't. ;-)

These are my personal observations, of course; everyone needs to read at least the article and talk-page histories, if not the primary Lyme disease literature and criticism upon which the mainstream view depends. We can each form our own impression of how the politics works.

One might think there is no point in trying to make the article meet WP:NPOV, under these conditions. On the other hand, the areas of the article (and of the LD field) where dissenters are acknowledged to exist, even when they are disparaged, may be useful in alerting readers that there is some kind of problem with the status quo, thus motivating them to investigate further. The templates at the top of the talk page help in this regard, particularly the sarcastic one about the "manifold evils of ..."). So, proceed as you think best; just thought I'd put in my two cents worth. My best regards to all involved in working on this difficult article, Postpostmod (talk) 16:50, 27 July 2011 (UTC)

I fully understand that there is an orthodox view regarding treatment of LD. It is not my intent nor does my edit imply that long term oral antibiotic treatment is preferable to shorter courses of treatment. However, it is not synthesis or OR to suggest that the proven safety of long term oral antibiotic therapy to treat acne demonstrates its safety (but not efficacy) to treat other diseases. For example here: Adverse events associated with prolonged antibiotic use the authors explicitly use medical databases to examine the rate of adverse events with doxycycline (and others) to determine its safety in potentially treating a rare disease (anthrax). The problem of synthesis does arise when it is implied that long term oral antibiotic therapy creates a greater likelihood of serious adverse events while treating LD, than in the general population, yet there are no studies that suggest this, yet the article, as written implies that this is the case.Damwiki1 (talk) 18:05, 27 July 2011 (UTC)

You may be missing the point that Someguy made in his initial post. "Safety" is a relative term and generally depends on the context in which a drug is used. Cisplatin is acceptably safe for treating someone with testicular cancer, but absolutely unsafe to treat, say, acne. Since long-term antibiotic therapy has no proven efficacy in "chronic" Lyme disease, even rare side effects make it unacceptably unsafe. Moreover, the major concern is not necessarily individual adverse reactions, but the generation of antibiotic resistance, which is typically not easily quantified in the studies you're describing.

The underlying point is that we need to accurately convey the state of knowledge in the field. Right now, major medical bodies feel that long-term antibiotic use for "chronic" Lyme disease is unacceptably unsafe. Trying to "rebut" those expert bodies by selecting and juxtaposing individual studies is exactly the sort of editorial intrusion that WP:MEDRS warns against. MastCell ^Talk 18:53, 27 July 2011 (UTC)

I am trying to "...accurately convey the state of knowledge in the field..." and the long term safety of oral antibiotics is part and parcel of that state of knowledge. The study I linked to, above, shows an overall rate of serious adverse events of .9/100,000 person years of treatment for doxycycline, by way of contrast the probability of a US resident being hit by lightning is .13/100,000 person years: [2]. Perhaps these figures should be included in the article to adress the absolute safety of oral antibiotic therapy? Some US States have laws allowing physicians to treat LD via long term antibiotic therapy, in specific defiance of mainstream LD treatment protocols and the safety of such therapy needs to be addressed within this article. Long term treatment of LD with antibiotics is an established fact, as is the safety of long term oral treatment via antibiotics. The decision as to whether "...long-term antibiotic use for "chronic" Lyme disease is unacceptably unsafe..." is a decision that patients and doctors must make, based upon the available literature, rather than solely on the treatment opinions of any medical association. Again, this is a simple fact, established by law in many jurisdictions, and the article will be remiss if it does not address the issue of the long term safety of antibiotic therapy, especially since legal authority to prescribe long term therapy is part of the "controversy and politics" surrounding LD. Whether long term antibiotics should be used to treat LD and the merits or drawbacks to doing so is a separate issue.Damwiki1 (talk) 19:54, 27 July 2011 (UTC)

If the risks outweigh the benefits with the use of antibiotics, then let's see actual reviews saying that. We should not be committing clear synthesis by implying safety using studies of other conditions. There are clear safety concerns outside of mere adverse events to the patients, including the development of resistance to antibiotics. Please find reviews per WP:MEDRS that state it in the context of this disease before putting any information like this back in. Yobol (talk) 20:29, 27 July 2011 (UTC)

Since this edit has been in the article for some time and is under active discussion, I would strongly urge you to undo your previous edit until consensus has been reached here.This is wikipedia policy.Damwiki1 (talk) 20:36, 27 July 2011 (UTC)

At this point, I see 3 editors noting they think this is inappropriate, with a 4th also noting significant OR problems here. Consensus appears to be coalescing against this material, and should stay out until you such time as consensus is reached it is appropriate. That bad material has stayed in the article for all of two months does not make it immune to removal, especially when it is a clear violation of our policies. Yobol (talk) 20:43, 27 July 2011 (UTC)

That's not how wikipedia is supposed to work and the policy is for disputed articles to remain as is until consensus. However, to return to the topic of antibiotic safety, there are a number of sources that discuss the use of long term antibiotic therapy for LD, with tetracycline class antibiotics, and none of them state safety as an issue: [3], [4],[5]. I have previously provided large scale studies showing a very low rate of severe adverse events: .9/100,000 person years of treatment for doxy, and to draw another comparison, the rate of fatal MVAs in the USA is about 14/100,000 person years[6]. The State of Connecticut is on very solid ground in granting Drs the right to prescribe long term antibiotic therapy, since the science and statistics of long term therapy is well known. Again, it is clearly misleading for this article to remove all references to long term antibiotic safety statistics, from large scale databases, and it clearly violates a NPOV.Damwiki1 (talk) 00:55, 28 July 2011 (UTC)

Agree with others here who have expressed concern about WP:SYNTH with respect to the content regarding long-term antibiotic safety. This has nothing to do with orthodoxy. -- Scray (talk) 01:33, 28 July 2011 (UTC)

Additionally, I don't think the references cited by Damwiki1 actually mean what he thinks they mean.

PMID 8740119 does note that, 15 years ago, many physicians used long-term antibiotics for "chronic" Lyme disease, but the paper explicitly attributes long-term antibiotic use to poor physician education, not as a desirable practice.

PMID 9233665 (which, incidentally, is a 14-year-old conference presentation, not a regular journal article) explicitly states that randomized, controlled trials need to be performed to definitively evaluate the safety and efficacy of long-term antibiotic therapy. Such trials were, of course, subsequently performed, and the negative results of these trials heavily influenced the positions of the IDSA, AAN, CDC, etc. It seems a bit misleading (at best) to cite the observational 1997 conference presentation without acknowledging the subsequent randomized, controlled trials which it called for.

PMID 14586290 is very interesting. The author apparently took patients with vaguely defined symptom constellations and gave them tetracycline and Plaquenil "until patients' symptoms were resolved or improved." Ten points for Gryffindor if you spot the logical flaw here. Hint: if I have a sprained ankle and you treat me with tetracycline "until symptoms resolve", you would (using this paper's logic) conclude that tetracycline heals ankle sprains. The success rate of any treatment is going to be high if it's continued "until symptoms resolve", and if any resolution of symptoms is attributed to the intervention.

But I digress, I suppose. MastCell ^Talk 23:31, 29 July 2011 (UTC)

I find it interesting that you are willing to find logical flaws in the treatment plans of Drs who use long term antibiotic therapy, but are unwilling to apply the same logic tests to Drs who insist on very short courses of antibiotics.However, it is not our place as wikipedia editors to sit in judgement of Drs, but only to present a neutrally written article for public consumption. Yet it would seem from your comments that you have a non-neutral POV. First off, there are no studies that show that LD patients are more likely to to suffer adverse effects from long term antibiotic therapy than the general population - if such studies existed they would be presented, but it would also be simply amazing and would indicate a severe underlying condition unique to chronic lyme sufferers. The rate of serious adverse effects with the most common antibiotics used are so low, that the patient literally has a much higher chance of dying while driving to see the physician than having a severe adverse event. "Do no harm" is the first rule in medical practise and even if giving antibiotics is no better than placebo in terms of treatment effect, they are also no less safe than placebo, since the rate of adverse events is so low. This is the key point that needs to be addressed since even if oral antibiotics don't work, they are also very "safe", and trying to argue otherwise is complete nonsense, with no scientific validity.
Secondly, antibiotics such as tetracycline, doxycycline and minocycline are noted for their anti-inflammatory and neuroprotective properties. Again, it would be amazing if they did not have some therapeutic effect on a population suffering from neurocognitive and arthritic symptoms. If someone is suffering from 'brain fog' and joint pain subsequent to an LD infection, why wouldn't minocycline be therapeutic? And long term trials do show that patients felt better on antibiotics, only to relapse once they are withdrawn. What's the harm in treating a patient with an antibiotic that makes them feel better, and is safe to use for extended periods and coincidently will destroy any remaining spirochaetes that might be trying to evade destruction in areas of the body with low blood flow? This is a digression as well but it points out the glaring logical fallacy in insisting on very short courses of antibiotics to treat LD since as the length of treatment declines, the rate of incompletely treated patients will increase, but the key point is that there is no scientific basis for disallowing long term oral antibiotic treatment, on the basis of safety and tangentially there are a myriad of studies showing that certain antibiotics have anti-inflammatory and neuroprotective therapeutic properties in addition to their antimicrobial properties. The final point is that the growth in antibiotic resistance is mainly driven by the misuse and overuse of antibiotics in the global livestock industry, and forced animal consumption of antibiotics dwarfs the direct use of antibiotics in humans: farm-animals-get-80-of-antibiotics-sold-in-us.Damwiki1 (talk) 08:44, 30 July 2011 (UTC)

WP:NOTFORUM. At this point, there should be no further discussion about this on this talk page unless you can provide sources that speak to the safety of long term antibiotics use in the context of treating lyme disease. Everything else is WP:SYNTH, as has been noted by several editors already. Yobol (talk) 14:11, 30 July 2011 (UTC)

Like I said...  :-), Postpostmod (talk) 21:38, 30 July 2011 (UTC)

I re-added this from the archive. This is just too good. To the extent possible, I think we should take a deep breath and embrace the controversy.Cool Nerd (talk) 18:47, 27 September 2013 (UTC)

additional references

Correspondence, "Reinfection versus Relapse in Lyme Disease", New England Journal of Medicine, March 14, 2013. — Preceding unsigned comment added by Cool Nerd (talk • contribs)

Hi Cool Nerd, the NEJM is a great journal, but we don't really use correspondence (letters to the editor, etc.) as a source for biomedical info. Can you point to a literature review or a systematic review? Zad68 18:59, 27 September 2013 (UTC)

As information, true. As far as illustrating the existence of controversy, I think this exchange of three letters is very good. It very nicely illustrates that the controversy is still existing, at least as recently as March 2013.

And while we're both here, what do you think of the following idea: Medical associations have recommended . . . However, a minority of doctors . . . <--And if we move too far past this, we risk trying to resolve the issue ourselves. Cool Nerd (talk) 19:04, 27 September 2013 (UTC)

---

Lyme Culture Test Causes Uproar, Medscape, Janis C. Kelly, Jan 30, 2013.

---

"Improved Culture Conditions for the Growth and Detection of Borrelia from Human Serum," International Journal Of Medical Sciences (Int J Med Sci), Eva Sapi, Namrata Pabbati, Akshita Datar, et al., Feb. 18, 2013.

Introduction

" . . . The current recommended standard for Lyme disease testing employs an indirect 2-step serological assay that detects host immune reactivity to the Lyme disease bacteria. In a significant number of cases the serologic assays are not sufficiently sensitive or specific in part due to the presence of immune suppressive and modulating agents transmitted by the tick and secreted by the Borrelia spirochete and antigen-antibody complex formation. . . "

posted by Cool Nerd (talk) 17:24, 28 September 2013 (UTC)

Regarding Medical associations have recommended . . . However, a minority of doctors - this may be true but we really cannot use opinions of individual doctors to support a statement like this in the article. It'd be an inappropriate use of primary sources. Can you locate a secondary source that provides a commentary like this in reviewing the primary literature? Regarding the tests, what's the article content change you're looking to make? Zad68 03:17, 1 October 2013 (UTC)

The Int J Med Sci article is above my level, and for my own learning, I'm reading / skimming it. Other reference articles I like to read section by section, pulling and summarizing information, and then I compare my summary to our wiki article. And in particular, do we have any ommissions?

On ezinearticles(dot)com
" . . . About half of the patients have either no rash at all or they have ones that look different. . . "
And yes, I would like something more authoritative. Cool Nerd (talk) 21:01, 21 October 2013 (UTC)

rash not always present (only present 70 to 80% of the time)

Arthritis and Lyme Disease, WedMD Rheumatoid Arthritis Health Center, reviewed by David Zelman, MD on Oct. 1, 2012.

"Erythma migrans. Erythema migrans is the telltale rash which occurs in about 70% to 80% of cases and starts as a small red spot that expands over a period of days or weeks, forming a circular, triangular, or oval-shaped rash. Sometimes the rash resembles a bull's-eye because it appears as a red ring surrounding a central clear area. The rash, which can range in size from that of a dime to the entire width of a person's back, appears between three days and a few weeks of a tick bite, usually occurring at the site of a bite. As infection spreads, several rashes can appear at different sites on the body.
"Erythema migrans is often accompanied by symptoms such as fever, headache, stiff neck, body aches, and fatigue. These flu-like symptoms may resemble those of common viral infections and usually resolve within days or a few weeks."

---

Signs and Symptoms of Lyme Disease, CDC, page last reviewed: April 12, 2011.
• "Rash occurs in approximately 70-80% of infected persons[1] and begins at the site of a tick bite after a delay of 3-30 days (average is about 7 days).
• "Rash gradually expands over a period of several days, and can reach up to 12 inches (30 cm) across. Parts of the rash may clear as it enlarges, resulting in a “bull's-eye” appearance.
• "Rash usually feels warm to the touch but is rarely itchy or painful.
• "EM lesions may appear on any area of the body."

[1] Correspondence. The Presenting Manifestations of Lyme Disease and the Outcomes of Treatment. N Engl J Med 2003; 348:2472-2474, June 12, 2003.

We should add this, probably to the photo captions. Like most things in medicine, not 100%. Some people have Lyme even if they don't have the bull's-eye rash. Cool Nerd (talk) 21:33, 30 September 2013 (UTC)

The article currently states "The erythema migrans rash associated with early infection is found in approximately 80% of patients and can have a range of appearances including the classic target bull's-eye lesion and nontarget appearing lesions. The 20% without the erythema migrans and the nontarget lesions can often cause mis-identification of Lyme disease." so there's already mention of this, but the current source in the article supporting this is a primary source. I'd be happy to see the sourcing updated to the CDC and make the article content match. Zad68 03:12, 1 October 2013 (UTC)

Okay, range of appearances including target and nontarget. Why do we then have two pictures of the "classic" bull's-eye, one close-up of the central area, and then one picture we acknowledge is very uncommon? Cool Nerd (talk) 03:38, 1 October 2013 (UTC)

and not always a bull's-eye

Since it sometimes looks this way and sometimes doesn't, for the time being, I'm going to demote one of the two.

An estimated 70% to 80% of persons infected with Lyme disease have a rash 3-30 days after being bitten by an infected tick. The rash DOES NOT ALWAYS look like the classic bull's eye.

We really need to find some additional photos, to illustrate how broadly it can look. Cool Nerd (talk) 03:45, 1 October 2013 (UTC)

Agree it'd be great to have a non-bullseye image to illustrate the range of rash presentations, if such an image can be found. Zad68 03:53, 1 October 2013 (UTC)

Let's keep a look out and hope for the best. And either public domain or a credible (non-stretched) fair use. Cool Nerd (talk) 04:03, 1 October 2013 (UTC)

How often does the rash (when present) look like a bull's-eye, really?

Signs and Symptoms of Lyme Disease, CDC, page last reviewed: April 12, 2011.
• "Rash occurs in approximately 70-80% of infected persons[1] and begins at the site of a tick bite after a delay of 3-30 days (average is about 7 days).
• "Rash gradually expands over a period of several days, and can reach up to 12 inches (30 cm) across. Parts of the rash may clear [emphasis added] as it enlarges, resulting in a “bull's-eye” appearance. . . "

may clear, that's kind of some weasel words and some hedge language. And the reality is, even on this straightforward point, health care practitioners may not have a really good handle on the percentages. Cool Nerd (talk) 17:24, 1 October 2013 (UTC)

Arthritis and Lyme Disease, WedMD Rheumatoid Arthritis Health Center, reviewed by David Zelman, MD on Oct. 1, 2012.
"Erythma migrans. Erythema migrans is the telltale rash which occurs in about 70% to 80% of cases and starts as a small red spot that expands over a period of days or weeks, forming a circular, triangular, or oval-shaped rash. Sometimes the rash resembles [emphasis added] a bull's-eye because it appears as a red ring surrounding a central clear area. The rash, which can range in size from that of a dime to the entire width of a person's back, appears between three days and a few weeks of a tick bite, usually occurring at the site of a bite. As infection spreads, several rashes can appear at different sites on the body. . . "

Sometimes the rash resembles, that's quite a bit more definite. And so, although the bull's-eye is very memorable, it is by no means a 100% deal.

Okay, WedMD is not a review article in JAMA. But . . . I'd say it's a good middle-brow source, and we'd should be a little cautious saying something different. Or, showing something different. So, the question remains, why have we been carrying two photographs showing the "classic" bull's-eye rash, even though it's far from a 100% deal? Cool Nerd (talk) 17:39, 1 October 2013 (UTC)

If you do a google image search you'll find various ones, such as this. However just be careful - you can't put images on wikipedia unless you have permission from the copyright holder. --sciencewatcher (talk) 18:32, 1 October 2013 (UTC)

Okay, thank you. http://hardinmd.lib.uiowa.edu/dermnet/lymedisease1.html
Okay, so this is the University of Iowa Libraries, Hardn Library for the Health Sciences.
DermNet.com is developed & maintained by Alan N. Binnick & Thomas P. Habif, Dartmouth Medical School, New Hampshire.

Or perhaps fair use in a legitimate way without over stretching it. I am working on other projects. But thanks for the lead. Cool Nerd (talk) 18:47, 1 October 2013 (UTC)

And this CDC page (also discussed below) has one example of an atypical rash.
http://wwwnc.cdc.gov/eid/article/19/5/12-0796-f1.htm

And from The Lyme Disease Foundation, here's a "Uniform color oval EM rash."
http://www.lyme.org/gallery/em_sk7.html
Cool Nerd (talk) 17:51, 3 October 2013 (UTC)

---

http://wwwnc.cdc.gov/eid/article/19/5/12-0796_article.htm To the Editor:
Yes, this is a letter to the editor CDC, but it sure looks like the first report of a study, appended by the names and professional affliations of six doctors and/or researchers. I'm not really sure how to take it. I myself would really hesitate before including it as a reference, other than perhaps illustrating the controversy surrounding Lyme disease. But, but . . . it includes a number of references :>)
.
.
6. Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans. Ann Intern Med. 2002;136:421–8 . DOI

7. Nadelman RB, Wormser GP. Recognition and treatment of erythema migrans: are we off target? Ann Intern Med. 2002;136:477–9 . DOI

8. Eshoo MW, Crowder CC, Rebman AW, Rounds MA, Matthews HE, Picuri JM, Direct molecular detection and genotyping of Borrelia burgdorferi from whole blood of patients with early Lyme disease. PLoS ONE. 2012;7:e36825. DOI

9. Berger BW, Lesser RL. Lyme disease. Dermatol Clin. 1992;10:763–75.
.

Some of these have links on the CDC page. And from the letter, it seems like reference 6 is particularly good. And this illustrates the twin problems with research. One, you might not be able to find any information in response to a specific question. Two, you ask for a drink of water and you get sprayed by a water hose! Cool Nerd (talk) 18:56, 1 October 2013 (UTC)

seeking non-bulleye's eye sample pictures

Lyme Disease Picture 1, Hardin MD Super Site Sample, from DermNet.com (developed & maintained by Alan N. Binnick & Thomas P. Habif, Dartmouth Medical School, New Hampshire), Last updated Wednesday, Dec 8, 2010.

It seems like non-bulleye's rashes are common enough that we should include at least one picture. (and some Lyme patient's have no rash at all). And let's follow the general principles with fair use without trying to make a political point one way or the other. We don't need to be over-strict, we don't need to be under-strict. Instead, just right down the middle. Cool Nerd (talk) 22:04, 27 February 2014 (UTC)

Covering the controversy without feeling we have to decide one way or the other.

Lyme disease debate moves to San Francisco as advocates call for treatment, diagnoses changes, San Francisco Examiner, Alex Emslie, Sept. 30, 2013.

' . . . The Infectious Diseases Society of America is joining other medical associations for a conference at the Moscone Center from Wednesday to Sunday. At the same time, advocacy groups who want the IDSA to broaden Lyme disease diagnosis and treatment guidelines are planning their own events. . . '

' . . . “The controversy is basically centered around the question of whether or not ‘chronic’ Lyme disease exists,” said Dr. David Margolius, a resident in internal medicine at UC San Francisco. The IDSA has not recognized that Lyme disease bacteria can live through the 28-day treatment and instead calls lingering symptoms “post-treatment Lyme disease syndrome.” . . . '

So, we just present information. We don't need to decide. Cool Nerd (talk) 19:33, 4 October 2013 (UTC)

OK I am not an editor. And I research a lot and am being treated and am not sure..... But I can say that the article is way too much on the side of the CDC. The evidence that I have that the dissenting parties are gaining ground: 1. Blumenthal lawsuit, 6 states passed laws. I am guessing there are fewer than 5 diseases that have any kind of legal history in this scale. 2. Vast amounts of European studies are in conflict with US positions (In reading your notes it sounds like proof is only possible through NEJM and such which is narrowly controlled) I can provide them, but again I think they wouldn't meet the standard. 3. The folks at IDSA have softened their position (again not usable for the same reason) to "And even if chronic lyme disease did exist, so what? We can't be giving long term antibiotics out." I can get the interview. IDSA seems to be focused on the antibiotic crisis because they are losing the Lyme microbiology wars. 4. There are numbers of studies that have shown disease surviving repeated antibiotics in animal studies. It is the belief of Scientists (for example Burgdorfer in an interview) that research is being prevented in the main US medicine(the only parts the Wikipedia will cite) despite enormous data elsewhere. Again the conflict is about the use of antibiotics, not the disease. 5. There are studies showing Lyme in brains of 7/9 Alzheimers brains from the Harvard brain bank. In 30% of serology of committed mental patients (I have the links, they just are not from NEJM. 6. There are some serious doctors and researchers (Fallon, Columbia, and others.) openly speaking out. 7. There are open letters of disagreement in NEJM of strong tone. Very. Rare. Indeed. 8. The use of the word advocacy group is imbalanced. The primary advantage that IDSA has is that the CDC cites it. The Advocacy group has more doctors and is spending more money on Lyme research. The 'majority' view is not with the IDSA, the 'official' view is with the IDSA. The 'majority' of doctors are not involved one way or the other, and follow the processes of their employers. It is truly possible for a small number doctors to corner a debate, and the antibiotic overuse debate is really a good reason for the corner. 9. There were attempts at pulling the medical licenses of a half a dozen doctors (you want sources? This is fact, and relevant.) all done on behalf of the IDSA and this was entirely predicated on doctors not following IDSA rules to limit Antibiotic treatments of Lyme to 30 days. 10. Your article does not discuss Herxheimer's reaction, which is the primary means that chronic Lyme is an accepted clinical diagnosis in Lyme clinics. It comes from Syphyllis treatment a hundred years ago. Syphyllis and Lyme are the only two spirochetes that live in humans. Herxheimer's reaction is a well documented Immune response to dying bacteria. 11. if you read the position of the IDSA on published research they are defending 1984 medicine based on inadequate proof. But they also dismiss all animal models and microbiology as proof, and dispute all human samples as having sampling errors because of clinical diagnosis, and want laboratory testing instead. But when new laboratory testing comes out they dispute that for lack of controls on the human samples. There is clearly a lack of good intent. 12. There are large conferences held annually about chronic Lyme and a growing number of legal specialties growing from the conferences. There is an Ivy league medical school department completely focused on Chronic Lyme. How is it possible that the Wikipedia article allows this to be suppressed based on the control of a few doctors? 13. For me, I see lots of very sick people who are having Herxheimer reactions and who are getting better. 14. Despite ALL of this, I don't think the other side has a strong argument either. I have met people in treatment who have been through too much, and I think it is terrible. But your article says nothing useful at all, except that the IDSA recommends the 1984 treatment, and there a bunch of greedy quacks out there. I know my positions 1-14 seem like advocacy, but I also know the other side. What drives me crazy is that the other side is doing no research. They are just debunking all the research that is done. IDSA are good Doctors. They are right that Antibiotics are a poor cure for chronic Lyme disease. It would be better to break down biofilm colonies (which are absent in your article) - but no such break through can happen when a few people control the consensus. Sometimes it takes a Generational change of Doctors to get re-grounded. Wikipedia is supporting people who are limiting debate.

--- I think I know how to write a balanced approach, but I am a patient so would be disqualified, but I don't think you are capturing the true tone of the issue. 24.16.135.152 (talk) 06:52, 24 December 2013 (UTC) Robert_lovejoy_Goodwin@yahoo.com

History - FIRST penicillin Tx of ACA must be corrected to 1946

Nanna Svarts. Penicillinbehandling vid dermatitis atrophicans Herxheimer. Nord Med 1946;32:2783. Describes very positive effect of treatment with penicillin on 2 patients with ACA lasting 5-6 years (plus one with uncharacteristic chronic dermatitis). Translation from Swedish of the authors last remarks: "The effect of penicillin in these cases of chronic dermatitis of several years duration is remarkable. The explanation for the good effect must be that an ongoing infection is cause of the dermatitis. This relationship is of great theoretic as well as practical importance".

Above is the note I saved in my http://LymeRICK.net article database. I see I have to add a few more articles I was not aware of, Thank you! Svarts findings were mentioned in both my powerpoint/pdf prints of European Borrelia history presentations from lectures given: 1. Hull, UK, 2001 http://lymerick.net/Bb-history.pdf 2. Kassel, Germany, 2006 http://lymerick.net/Bb-historyG.pdf /Marie Kroun, MD, Denmark — Preceding unsigned comment added by 37.205.127.144 (talk) 12:18, 23 October 2013 (UTC)

List of notable people diagnosed with Lyme Disease

Please see the page I helped develop for Chronic Fatigue list of notable people diagnosed with chronic fatigue syndrome for an example of the structure to replicate for a potential inclusion - for a List of notable people diagnosed with Lyme Disease (this is to be a link in template "Lyme disease – Related navpages" (note am not proposing page to be listed in general overview of Lyme Disease but a separate page - see the link list of notable people diagnosed with chronic fatigue syndrome for proposed example) see also Template:Chronic fatigue syndrome as a guide to develop the "Lyme disease – Related navpages" template at the bottom of the Lyme Disease Wikipedia page (am proposing link to separate page for list of notable Lyme patients to be placed here), "Lyme disease microbiology" can also be placed within the "Lyme disease – Related navpages", and also Neuroborreliosis, Weather and climate effects on Lyme disease exposure, and any other Lyme related pages with aim to build easy navigational structure.

Please see other lists of notable people with other Diseases: https://en.wikipedia.org/wiki/Category:Lists_of_people_by_medical_condition Some other examples: https://en.wikipedia.org/wiki/List_of_breast_cancer_patients_by_occupation https://en.wikipedia.org/wiki/List_of_people_diagnosed_with_Parkinson%27s_disease

Lyme Disease Treatment: also think inclusion of some of the information from this page Lyme Disease: Two Standards of Care by Lorraine Johnson, JD, MBA Executive Director, CALDA (California Lyme Disease Association) under the Lyme Disease Treatment section may add value to the page potentially?

SpringSummerAutumn (talk) 17:06, 24 October 2013 (UTC)SpringSummerAutumn (talk) 04:18, 5 November 2013 (UTC)

Proposed "List of notable people diagnosed with Lyme Disease" (would need accurate/reliable 3rd party references for all of these if propose to include in list)

collapsed large list that is very questionable per WP:BLP

Karl McManus A reported death of Lyme Disease patient in NSW, Australia which lead to setup of a prominent Lyme Disease foundation in Australia. Has been featured also in media both print and television. References http://www.karlmcmanusfoundation.org.au/ http://www.smh.com.au/nsw/court-grants-lyme-disease-autopsy-20100719-10hyx.html http://www.smh.com.au/national/lyme-mystery-ticks-all-the-boxes-20100723-10ora.html http://www.youtube.com/watch?v=K0uljQewenE Angeli VanLaanen Professional Freeskier who was the focus of a high quality References: 30 minute documentary on her journey through Lyme disease she is the spokesperson for the Lymelightfoundation Yolanda Foster Dutch-born former model and cast-member, "The Real Housewives of Beverley Hills;" wife of music producer David Foster. Has related her difficulty being diagnosed and lent public support to Lyme organizations as a spokesperson at various fundraising events. references: http://lymedisease.org/news/touchedbylyme/yolanda-shell.html Yolanda Foster Lyme Disease LRA GALA | Starlight Award Mail online 29 January 2013, Yolanda Foster on how she realized she had Lyme disease Karen Allen American actress best known for her role as Marion in Raiders of the Lost Ark; also featured in Animal House, Starman, Scrooged and other films. After unsuccessful treatment with antibiotics, says she cured herself with a "zapper." references: http://phiyakushi.com/miracles/2010/05/16/karen-allen-lyme-disease/ Jane Alexander Tony award-winning Broadway and film actress and author; former chair of the National Endowment for the Arts. Has had Lyme twice and campaigned for Lyme documentary Under Our Skins to win an Oscar. references: http://goldderby.latimes.com/awards_goldderby/2010/01/under-our-skin-oscars.html Alec Baldwin Is mentioned to have lyme disease he was also in a movie that features lyme disease called Lymelife "Mr. Baldwin, who has had Lyme disease, was clearly interested in the topic." "His Lyme disease was chronic. “At the same time of year, I get really tired,” Mr. Baldwin said." Reference new York times: http://www.nytimes.com/2011/06/30/nyregion/guest-appearance-by-alec-baldwin-at-a-hamptons-dinner.html?_r=0 Christie Brinkley American supermodel. Now keeps guineafowl at her East Hampton estate to control the local tick population. references: http://articles.philly.com/1990-09-05/news/25877088_1_guinea-hens-lyme-disease-deer-ticks George W. Bush In 2007, the annual report on the president's health revealed that in August of 2006 Bush had been treated for Lyme disease. A White House spokesman said the president likely was bitten during a bike ride. He noticed a rash that doctors treated, and he had no other symptoms or any recurrence, according to CNN. "I wouldn't expect any problem at all for the president," Gary Wormser, chief of infectious diseases at New York Medical College and an expert on Lyme disease, told the Washington Post. "He won't be impacted by this infection in the future." references CNN and Washington post: http://www.washingtonpost.com/wp-dyn/content/article/2007/08/08/AR2007080802268.html and http://edition.cnn.com/2007/POLITICS/08/08/bush.health/index.html?_s=PM:POLITICS Meg Cabot American author of children's, young adult and adult titles, including The Princess Diaries. Has over 15 million copies of her works in print worldwide. Supporter of Lyme Disease Awareness. references: http://www.megcabot.com/2003/12/107220375057631455/ Jennifer Capriati American. Former world number one tennis player, three-time Grand Slam champion. Has struggled with Lyme for years. references: http://www.healthline.com/health/daryl-hall-lyme-disease Nick Esasky Former first- and third-baseman, Cincinnati Reds. Signed a $5.6 million contract with the Atlanta Braves, but was forced to retire after playing nine games for them after developing vertigo. references: http://www.people.com/people/archive/article/0,,20114741,00.html Michael J. Fox Canadian-born film and television actor known for roles on "Family Ties" and "Spin City" as well as starring in blockbuster "Back to the Future" franchise. Developed Lyme prior to being diagnosed with Parkinson's disease. references: (text of story from National Examiner, May 27, 1997) https://www.facebook.com/michaeljfoxfoundation/posts/10151138875313540 Bonnie Fuller Canadian-born editor of Hollywoodlife.com, former editor of US Weekly. Developed Bell's Palsy, a partial paralysis of the face, before diagnosis. references: http://www.today.com/klgandhoda/lyme-disease-victim-it-looked-i-had-stroke-8C11410699 Richard Gere American actor known for roles in "American Gigolo," "Pretty Woman," "Chicago," and many other films. Has said, "This is one scary disease. I felt as though every ounce of strength had gone from my body." references: http://ticktalkireland.wordpress.com/lyme-links/celebrities/ Daryl Hall American musician, formerly of Hall & Oates. Has spoken out frequently about his battle with chronic Lyme. Co-infected with ehrlichiosis. references: http://www.healthline.com/health/daryl-hall-lyme-disease Pete Harnisch Former Major League Baseball starting pitcher for the Baltimore Orioles, Houston Astros, New York Mets and Cincinnati Reds. references: http://www.nytimes.com/1997/04/08/sports/troubled-harnisch-put-on-disabled-list.html Ally Hilfiger Daughter of American clothing designer Tommy Hilfiger; suffered with Lyme arthritis for over a decade before diagnosis. The Hilfiger family is now involved in fundraising for the Lyme Disease Association. references: http://www.greenwichtime.com/local/article/Hilfiger-s-experience-with-Lyme-far-from-1311863.php David Letterman American talk show host. Has said he has had Lyme and was also diagnosed with anaplasmosis, another tick-borne infection, in 2009. references: http://www.thebraiser.com/martha-stewart-on-david-letterman/ http://en.wikipedia.org/wiki/Anaplasmosis Mary McDonnell Academy and Emmy Award-nominated American film and television actress (E/R, Battlestar Galactica, The Closer; Oscar nominated for her role in Dances With Wolves) who acts a spokesperson for the Lyme Disease Association and wrote the forward for the book Coping With Lyme Disease: A Practical Guide to Dealing With Diagnosis and Treatment. Tara McMenamy Three-time American cross-country skiing champion. Developed severe Lyme arthritis. Treated for three years and apparently made full recovery. references:http://devononeil.com/Stories/sheahan.pdf George Pataki Former Governor of New York. references: http://news.google.com/newspapers?nid=1957&dat=19970607&id=eGBGAAAAIBAJ&sjid=_-cMAAAAIBAJ&pg=1156,1506358 Parker Posey American actress known for her roles in independent movies including "Party Girl." "The House of Yes" and "Best in Show." Pursued natural treatment of her infection after IDSA-mandated single course of antibiotics failed to eradicate it. references: http://www.lyme-disease-research-database.com/lyme_disease_blog_files/rethinking-lyme-treatment.html Peter Sarsgaard American film and stage actor, known for roles in "Boys Don't Cry," "The Man in the Iron Mask," "Shattered Glass," and others. references: http://www.upi.com/Entertainment_News/2007/08/14/Actor-Sarsgaard-contracts-Lyme-disease/UPI-58501187122244/ Tom Seaver Former Major League Baseball pitcher for New York Mets and Cincinatti Reds; Baseball Hall of Fame member; Rookie of the Year; winner of three Cy Young awards. Has suffered with chronic Lyme since 1991, when he developed Bell's Palsy, a partial paralysis of the face. references: http://www.nydailynews.com/sports/baseball/mets/madden-mets-legend-seaver-set-all-star-game-pitch-article-1.1394430 http://www.nydailynews.com/sports/baseball/mets/madden-tom-nearing-terrific-day-mets-legend-winning-battle-lyme-disease-article-1.1289293 Jamie-Lynn Sigler American actress best known for her role on "The Sopranos." Developed paralysis of her legs before being diagnosed. references: http://www.nj.com/sopranos/ledger/index.ssf?/sopranos/stories/050301cinderella.html Martha Stewart American media executive and television personality; has reportedly had several separate cases of Lyme. references: http://www.thebraiser.com/martha-stewart-on-david-letterman/ Ben Stiller American actor, comedian, producer and writer. Diagnosed with Lyme when fluid biopsied from his knee joints revealed the presence of Borrelia spirochetes. references: http://www.lymediseasetoronto.org/galleries.php?id=44 Amy Tan The author most famous for her hit novel "The Joy Luck Club" suffered mysterious hallucinations, confusion, neck and joint pain, numbness and insomnia for more than two years before she was diagnosed with Lyme disease. By that time, she had consulted 11 different doctors and paid $50,000 in medical bills, People reported. After researching her symptoms on the Internet, Tan told the magazine that everything clicked -- she had taken many hiking trips in parts of California where Lyme disease is common and she even remembered pulling ticks off of her dogs. While her symptoms were advanced, her doctor told People, antibiotics helped, and she started a charity organization called Lyme Aid4Kids to help raise awareness for the disease. reference people magazine: http://www.people.com/people/archive/article/0,,20148516,00.html Randy Travis American musician. Temporarily lost his singing voice to Lyme. Suffered stroke and was hospitalized with viral cardiomyopathy. Has pursued conventional (antibiotics) and alternative (herbal, etc.) treatments for his chronic Lyme. reference: http://www.youtube.com/watch?v=ErV19f5uSNc Christy Turlington American model. Her case of Lyme was apparently caught early and treated with antibiotics. reference http://www.contactmusic.com/news/turlington-diagnosed-with-lyme-disease_1044941 Rebecca Wells American author of The Divine Secrets of the Ya-Ya Sisterhood; honorary board member of Lyme Disease Association. Suffered neurological symptoms. ""By the time the movie came out, I was falling down sick. I kept getting misdiagnosed and misdiagnosed, "Maybe you have a brain tumor, maybe you have Parkinson's, maybe you have ALS...."" references: http://www.goodreads.com/interviews/show/46.Rebecca_Wells Christine Todd Whitman Former governor of New Jersey; administrator at Environmental Protection Agency under President George W. Bush. references: http://articles.latimes.com/1996-07-24/news/mn-27421_1_lyme-disease

some rough sources that can start process to check reliability of to possibly include any notable people who are confirmed have had or still have Lyme Disease:

http://blog.petcarerx.com/10-celebrities-with-lyme-in-the-lyme-light/ 
http://www.huffingtonpost.com/2012/04/23/lyme-disease-celebrities_n_1438726.html#slide=886443 
http://hausfeldaboutlyme.wordpress.com/2010/06/30/celebrities-with-lyme-we-cant-all-be-crazy/
http://celebritieswithyourdisease.com/lymeease-2013224
http://www.usmagazine.com/celebrity-news/news/yolanda-foster-recovering-from-surgery-related-to-lyme-disease-2013224

SpringSummerAutumn (talk) 10:59, 24 October 2013 (UTC)

I'd generally oppose adding this sort of information to a general overview about Lyme, unless the fact that the individual has Lyme is particularly noteworthy and pertinent, adding to the reason that the individual is notable in the first place. For example, a mention of George W. Bush is not at all warranted in this article from the source given. Absolutely no part of Bush's notability is due to Lyme disease, and the source makes it sound like the treatment was precautionary only. Zad68 15:26, 24 October 2013 (UTC)

If adequately referencing, I think maybe including eight or ten famous people will add to our article. Cool Nerd (talk) 19:27, 24 October 2013 (UTC)

SpringSummerAutumn filling up this article with a huge list of people who may or may not have actually contracted Lyme, with sketchy sourcing per BLP standards, is not a good idea. Why not pick just two or three of the most notable individuals who are well-known because of their involvement with Lyme. These people should be notable because of their involvement with Lyme. As it stands right now even this poorly-sourced list of people on this Talk page might be a BLP problem. Zad68 19:27, 24 October 2013 (UTC)

I agree with Zad68 about maybe mentioning two or three of the most notable individuals who are also most strongly linked to Lyme. I do not think a separate list article should be created. If anything, a category may be in order. —C.Fred (talk) 22:47, 24 October 2013 (UTC)

Agree also with Zad68; we should only include those who have changed public perception of Lyme disease or is otherwise strongly linked. Random lists of people with diseases are awfully unencyclopedic. Yobol (talk) 16:30, 25 October 2013 (UTC)

Depending on what the goal of compiling this list is, I disagree, because I think part of what we're fighting is a stigma of Lyme (and particularly chronic Lyme) as being either imaginary or a trendy "new" diagnosis. If there's a question of whether the person actually did have Lyme (e.g. Christie Brinkley is on many lists of celebrities who've had Lyme, yet I agree there is no solid sourcing) then yes, let's take that name off the list. But I wouldn't want to decide who is most notable. To some people a former MLB player is more notable than an actress. I think it helps to demonstrate that plenty of well-regarded people have had this illness -- and it also provides hope to those of us who are recently diagnosed, because a number of them seem to have made good recoveries. It also helps to show the vast and confusing range of symptoms of Lyme (e.g. this list includes people with everything from paralysis to insomnia.) Sorry, I have no user ID here but I added a lot of names yesterday.

P.S. Can no-one else see the irony in taking someone off the list because their diagnosis of Lyme is disputed?

We do want each person to be well-sourced, and then I'm thinking maybe about a dozen people from different walks of life? To me, this adds richness to the article, as well as breadth of coverage. Cool Nerd (talk) 16:20, 26 October 2013 (UTC)

No consensus to include either 8-10 people, as you suggested above, or a dozen for that matter, as you've upped it to here. How about 2-3 people for which reliable sourcing can be provided that demonstrates that their notability is in significant part because of their involvement with Lyme. Zad68 16:10, 27 October 2013 (UTC)

Why not a list of notable persons having chronic lyme disease? Because this can certainly fight the stigma of chronic lyme while not reporting about every infection of a celeb. And moreover you could also mention celebs doing activism against lyme, like Ally Hilfiger. --178.197.229.27 (talk) 13:50, 4 December 2013 (UTC)

I suggest below "Chronic Lyme disease (CLD) and post-Lyme syndrome" a new section "11.4 Celebrities and activism" to put in some of your information. --178.197.236.127 (talk) 14:22, 4 December 2013 (UTC)

"Chronic" Lyme isn't recognized by the medical community so it would not be possible to reliably source such a list. Zad68 14:26, 4 December 2013 (UTC)

That's exactly the problem: Every lyme disease is chronic if not treated appropriately. Acute lyme would be fever, sepsis, death. Chronic lyme is an organism being infected by Borrelia bacteria, not being able to fight it off, with no fever but strongly affected by the produced toxins (e.g. Bbtox1) causing joint swelling, neck stiffness, headache, aso. This btw is scientifically proved through animal testing. So if you're not able to distinguish between an acute and a chronic infection, why you guys attend a medicine school for 6-8 years? --178.197.236.127 (talk) 14:57, 4 December 2013 (UTC)

In our articles all we do is summarize what the best-available reliable sourcing has to say. If the best-available reliable sourcing says that "chronic Lyme" isn't recognized by the medical community, that's what we put into our articles. We keep our own views on the subject out of it. Zad68 15:00, 4 December 2013 (UTC)

No, you summarize only what orthodox medical university professors say. This has nothing to do with real research and scientific knowledge. It seems more like a religion, so orthodox is certainly the most appropriate word...otherwise you should start to use research results as "sources" and not only what university professor say or write in their "secondary source" books. Real science is primary source whatsoever. --178.197.236.127 (talk) 15:16, 4 December 2013 (UTC)

Take a look at WP:MEDRS to see how Wikipedia defines what a reliable source is for biomedical information, that's what we use. If you'd like to phrase it as "orthodox medical sources," that doesn't bother me, personally-- Wikipedia values orthodox medical sources for biomedical content. Zad68 15:28, 4 December 2013 (UTC)

Another proof that todays othodox medicine isn't evidence-based or scientific: http://www.ncbi.nlm.nih.gov/pubmed/2172819 (med guys you must overcome your religion and deal with the facts only...) --178.197.236.9 (talk) 10:32, 25 May 2014 (UTC)

Zad, you're right. I initially said 8 to 10, and then I said about a dozen. I'm largely undecided. If most people want to go with 2 to 3, that's an improvement from where we are now.Cool Nerd (talk) 21:46, 5 December 2013 (UTC)

Okay, wow, on the question of 'Chronic Lyme,' some members of the medical community, some bona fide MDs do diagnose and treat chronic Lyme. True, the orthodox medical community does not, I think viewing these symptoms as most likely being something autoimmune.

We like review articles in peer-reviewed publications. I think that's the wiki standard, and we want to meet that. But there's a problem. I AM NOT A DOCTOR. I've said that before and I'll say that again. Because, even though I'm good at research, I don't want there to be any misunderstanding. I suspect most of us are not doctors, much less specialists in the relevant fields. So, by all means, let's use review articles and do our dead level best to summarize them. In addition, let's use what could be called middlebrow sources like Mayo Clinic or WebMD. And even pages posted by CDC or WHO could be viewed as middlebrow sources. This acts as a check, because since we are not doctors, we may at times missumarrize the review articles.

And as far as the controversies regarding Lyme, straight journalistic sources like CNN, LA Times, BBC, etc. Cool Nerd (talk) 22:28, 5 December 2013 (UTC)

Sorry to be rude but you don't seem to have a clue about lyme disease. You shouldn't post here because you don't argue with facts, but opinions. Journalists aren't scientists and shouldn't be considered when dealing with science. Not sure who you are working for anyway. But posting anything else than facts is just unscientific, non-empiric blablah, not cool at all. --178.197.236.9 (talk) 10:42, 25 May 2014 (UTC)

11.3 Media

A 2008 article in The New England Journal of Medicine argued media coverage of chronic Lyme disease ignored scientific evidence in favor of anecdotes and testimonials: "The media frequently disregard complex scientific data in favor of testimonials about patients suffering from purported chronic Lyme disease and may even question the competence of clinicians who are reluctant to diagnose chronic Lyme disease. All these factors have contributed to a great deal of public confusion with little appreciation of the serious harm caused to many patients who have received a misdiagnosis and have been inappropriately treated."

This sentence doesn't make sense. First it says that the media coverage about lyme disease is inappropriate, and then it talks about the "little appreciation of the serious harm caused to many patients who have received a misdiagnosis and have been inappropriately treated". I'd say the exact opposite is true and especially the "non-scientific" media contributed to the acknowledge of lyme as a serious disease, through coverage of how severe it can be.

And finally most of the confusion is primarily caused by the orthodox medicine, because the tests for lyme disease are totally unreliable. So a negative test result doesn't mean anything, while orthodox doctors usually rely on these tests and won't treat a patient without a positive diagnosis.

Only if there would be a reliable test for lyme and a good orthodox treatment program, there wouldn't be any confusion at all. So the mistake happens to be within the orthodox medicine and not the media coverage. --178.197.236.127 (talk) 14:45, 4 December 2013 (UTC)

Articles only include statements that can be supported by reliable sources, even if we personally don't agree with them. If by "orthodox" medicine you mean evidence-based medicine, that is exactly what Wikipedia finds authoritative and medical content is based on it. Do you have a particular change to the article you are proposing? Zad68 14:51, 4 December 2013 (UTC)

No, I really mean orthodox medicine. Evidence-based is something else, and although the orthodox medicine claims to be evidence based, I can assure you that in many cases this isn't true. Thanks to the internet it's possible to know everything about lyme disease, all research results aso. So as long as the orthodox medicin doesn't approve the scientific results, and as long as it doesn't approve its inability to accurately test lyme disease, there won't be any improvements in treating lyme patients. However, what I meant with above post: Critisising the media while not being able to correctly diagnose or treat lyme disease isn't fair, but embarrassing. --178.197.236.127 (talk) 15:09, 4 December 2013 (UTC)

Alright, sorry I can't work with you unless you can make a specific proposal for a change to the article, something along the lines of "Change where the article currently says this to that, using this source." You're making general statements based on your general feeling about the topic, but again we don't base article content on that. All we do is summarize the best-available reliable sources. Zad68 15:17, 4 December 2013 (UTC)

Harassment of Researchers

The removed remarks about "poisonous atmosphere" referenced the aftermath of the Connecticut Attorney General's antitrust action, and--I'm assuming--other non-harassment controversies about Lyme Disease. It was made in 2008, several years after the harassment. It was an intellectually dishonest and manipulative attempt to associate legitimate controversy with a particular instance of inappropriate behavior. As such, it deserved to be deleted. Tapered (talk) 16:27, 7 January 2014 (UTC)

In the future, it would probably be better to move appropriate material to the correct section, rather than outright deletion (which I have done). Yobol (talk) 19:11, 8 January 2014 (UTC)

Agreed that you moved this to the right section. I have been in conversations with Dr A. The war is a big problem. Putting it in the same paragraph as a lawsuit implies a context which is not explicit. Hope this was an appropriate correction. If not, would love to understand.Bob the goodwin (talk) 03:49, 16 January 2014 (UTC)

Actually, I wonder. How is a lawsuit by a state against a medical society a harassment of researchers? I know there is a lot of harassment, and I do know there is a problem with fear amongst MDs, but I think lawsuits are in a different category than harassment. No interest in starting a fight on this one, just wondered if you had thought about it.Bob the goodwin (talk) 03:55, 16 January 2014 (UTC)

controversy and politics

This section can be found under the heading "controversy and politics"

A minority view holds that chronic Lyme disease is responsible for a range of unexplained symptoms, sometimes in people without any evidence of past infection.[239] This viewpoint is promoted by many patient advocates, notably an advocacy organization,[228] the International Lyme And Associated Diseases Society.[229] Groups of patients, patient advocates, and the small number of physicians who support the concept of chronic Lyme disease have organized to lobby for recognition of this diagnosis, as well as to argue for insurance coverage of long-term antibiotic therapy, which most insurers deny, as it is at odds with the guidelines of major medical organizations.[239][241]

A minority view sounds bias?! I think this section should be removed. What is a minority? 10,100,100 000 people? — Preceding unsigned comment added by 46.194.26.146 (talk) 20:13, 21 January 2014 (UTC)

The first thing to do is to check the reference and see what it says. --sciencewatcher (talk) 22:42, 21 January 2014 (UTC)

By the way the symptoms aren't unclear at all. Joint swelling, neck stiffness, headaches, spasms, aso. And there is a lot of evidence that chronic lyme can't be treated by antibiotics at all. I sometimes read that doctors give amoxicillin, but this doesn't work. A long term therapy by tetracycline or high-dosed doxycycline may work, but only if there is no resistancy. And I must warn from long-term penicillin treatment, it destroys renal function. Finally, I think any people else than dealing with lyme personally or professionally should just be quite about lyme disease. They have no clue what lyme is like, so they can't contribute anything except their unscientific opinions. And would I ask a blind person how a picture looks like? No. However, what is most sad in respect to lyme disease are those many unscientifc statements from so called "scientists" - but in fact usually NOT scientists, only health practioners or pharmacy sellers. Scientists already discovered anything about lyme, only the medical establisment still have the blinders on. It's a sociological phenomen already, because the view that "chronic lyme doesn't exist" is considered to be "appropriate" by the medical establishment. That's not science, that's stupidness and incompetence, only. --178.197.236.9 (talk) 11:09, 25 May 2014 (UTC)

Climate change implementation

This has been resolved for the most part. Click show to read anyway.

See also sections are typically not recommended per WP:MEDMOS. The other issue I have with Weather_and_climate_effects_on_Lyme_disease_exposure is that much of the article is simply a duplication of Lyme disease. For example "Generally, a course of antibiotics for several weeks provides successful treatment of Lyme disease." is not about weather and climate effects on Lyme disease exposure. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:49, 27 January 2014 (UTC) To add to my concerns. If this student were to have written this article and published it as a blog we would not link to it per WP:ELNO. Much of this article need deletion. Not linking to. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:54, 27 January 2014 (UTC) Do you prefer a new section then for climate change or do you rather have the other article updated and then linked? On a sidenote i can not follow you with your claim that a student wrote the article, also i can't see how this would be relevant. If you read the page you can find the data referenced, though i did not looked at the details of said article yet but overall impression is ok. Prokaryotes (talk) 10:58, 27 January 2014 (UTC) I am seeing a lot of this from the education program. People rather than adding to the main article, go off and write an essay which more or less duplicates the main article but with a slightly different bent. In other words a WP:Content fork. The last thing we need is a see also section full of WP:Content forks. What needs to be done is either 1) merge the article (which would require deleting much of the duplicate content) 2) deleting the article in question. Not sure if there is anything salvageable. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:02, 27 January 2014 (UTC) Anyway I am trimmed content that has nothing to do with weather or climate. And have requested further opinions from those at WT:MED. If one looks at the creators edits it becomes clear that they are a student. This is end of term. Massive edit and never edits again. [7] Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:04, 27 January 2014 (UTC) Again, do you rather have an extra article for that topic or add the related parts into this one, decide now - if we keep the other article you have to re-add my link - which you removed for a 3rd time, before discussion took place. Relevant latest science can be obtained here http://scholar.google.com/scholar?q=lyme+disease+climate+change&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X Prokaryotes (talk) 11:15, 27 January 2014 (UTC) I see you started to rework the other article, good. Now when you finished add the link to that article. I think now the best would be to add the link under causes with a new section for CC, with a short paragraph for the introduction to the impacts of climate change and diseases like Lyme disease. I will later update the CC LD article with some more recent research. Prokaryotes (talk) 11:29, 27 January 2014 (UTC) Actually the discussion was started here after the second revert rather than the third. Additionally we should give others time to comment. Currently the article is not encyclopedic in format. Thus I disagree with linking to it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:49, 27 January 2014 (UTC) Ok, then we could add a CC section into this article. I will do this later today. Prokaryotes (talk) 11:59, 27 January 2014 (UTC) Also with respect to references for medical topics we follow WP:MEDRS and WP:RS which strongly recommends secondary sources.Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:51, 27 January 2014 (UTC)

I added a CC section, this can be expanded further. I suggest we start a deletion process for the other page. Prokaryotes (talk) 13:38, 27 January 2014 (UTC)

Sounds like a good idea. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:40, 27 January 2014 (UTC)

I will start a talk for the deletion process of page https://en.wikipedia.org/wiki/Weather_and_climate_effects_on_Lyme_disease_exposure if anyone here is against it say so on the talk page of "Weather and climate effects on Lyme disease exposure". Prokaryotes (talk) 16:44, 27 January 2014 (UTC)

Layout

Here [8] the history section was moved to first. This is against the recommended ordering of sections for disease of current significance as found here WP:MEDMOS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:43, 27 January 2014 (UTC)

Yes, i have acknowledged this already since you brought this to my attention on my talk page as well. Do you want me to revert the moving of sections, then say so. However, my impression is that this particular article here does not necessarily has to begin with the symptoms. Prokaryotes (talk) 16:34, 27 January 2014 (UTC)

Yes would appreciate it if you reverted. There was no discussion on changing this layout. For diseases like small pox we start with history but that is because the disease no longer exists. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:04, 28 January 2014 (UTC)

Done. Prokaryotes (talk) 12:42, 28 January 2014 (UTC)

Thanks Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:06, 28 January 2014 (UTC)

Two Recent Animal Studies

It's hypocritical to refuse to publish studies in the established journals and then say that there's no dissenting studies in "the medical literature". The lines "A review looked at several animal studies that found persistence of live but disabled spirochetes following treatment of B. burgdorferi infection with antibiotics. The authors noted that none of the lingering spirochetes were associated with inflamed tissues and criticized the studies for not considering adequately the different pharmacodynamics and pharmacokinetics of the antibiotics used to treat the animals in the trials versus what would be expected to be used to treat humans. The authors concluded, "There is no scientific evidence to support the hypothesis that such spirochetes, should they exist in humans, are the cause of post-Lyme disease syndrome." Haven't been true since January 2012.

Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection Published in PlosOne in January 2012 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029914

"... offer proof of the principle that intact spirochetes can persist in an incidental host comparable to humans, following antibiotic therapy. Additionally, our experiments uncover residual antigen associated with inflammatory foci. ..."

Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in Mice Published in PlosOne in January 2014 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0086907

"... our results indicated that mice were responding to the presence of persisting non-cultivable B. burgdorferi. ..."

05:49, 10 February 2014 (UTC) — Preceding unsigned comment added by 68.81.196.253 (talk)

Those don't look like reviews to me. Have a look at WP:MEDRS. --sciencewatcher (talk) 00:01, 14 February 2014 (UTC)

Game Over

Lyme Disease has been passed on in humans, despite antibiotic treatment.

Test for persistent Lyme infection using live ticks shown safe in clinical study Published today, and "Findings appear online in Clinical Infectious Diseases." http://www.sciencedaily.com/releases/2014/02/140212132901.htm

".... Xenodiagnosis was positive for B. burgdorferi DNA in the person with erythema migrans who underwent xenodiagnosis early during therapy and in a volunteer with PTLDS. ...." (Not to mention the two "indeterminate" cases.)

The original study (which is still open) is Searching for Persistence of Infection in Lyme Disease at http://clinicaltrials.gov/ct2/show/NCT01143558

Also today U.S. launches new global initiative to prevent infectious disease threats at http://www.washingtonpost.com/national/health-science/us-launches-new-global-initiative-to-prevent-infectious-disease-threats/2014/02/12/afd9863c-936d-11e3-b46a-5a3d0d2130da_story.html -- they couldn't possibly be related.

23:43, 13 February 2014 (UTC) — Preceding unsigned comment added by 68.81.196.253 (talk)

Dubious lyme tests from igenex

Just wondering how we should discuss this (see also here and here. --sciencewatcher (talk) 23:45, 22 April 2014 (UTC)

Igenex has been often criticized but nothing has ever really born out. The medscape article looks promising though. - Technophant (talk) 14:49, 21 July 2014 (UTC)

Repeated removal of well sourced content in short time

Repeated removal of sourced content without discussion and consensus here is vandalism and edit warring. This is against WP policy and can result in blocking of involved editors. - - MrBill3 (talk) 10:12, 24 October 2014 (UTC)

Silly edit

I would just like to draw someone's attention to some very silly text in the description. After listing the symptoms, it says 'and could possibly cause death, especially if your name is Garrett'. I have never edited an article on Wikipedia. Can someone who knows how to do this remove that stupid line.83.161.147.103 (talk) 21:50, 28 April 2015 (UTC)

That edit has now been reverted - sometimes people add false information to Wikipedia which is something we call vandalism. -=# Amos E Wolfe ^talk #=- 21:53, 28 April 2015 (UTC)

tick population

the deer tick population is growing in a large number of sizes. — Preceding unsigned comment added by 107.0.17.251 (talk) 16:04, 28 September 2015 (UTC)

Avril Lavigne

This is an important medical article and not something I would edit. I note however the paragraph on Lavigne which is covered in both the Telegraph and the Independent has been removed. Is there any consensus for a one line section, avoiding wp:undue, simply noting that she had/has the disease? Regards JRPG (talk) 22:08, 21 November 2015 (UTC)

Use of tweezers questionable, at the least.

I am referring to the statement in the article which says that ticks may be removed with tweezers.

But I heard a discussion with a doctor on the radio last night, and he said that this may not be a good idea, apparently because the act of grasping the tick with tweezers tends to squeeze any toxins out of the tick and into the surrounding flesh, thus compounding any infection. Instead, he recommended some kind of unit that freezes them, so that they will drop off easily (not quite sure what that was).

Perhaps this should be incorporated into the article, but I'm not sure I could do it properly, since I have no references, other than the radio interview with the doctor (not sure if that would be an acceptable reference or not, since the interview will be on-line only for a week after broadcast). Perhaps other more durable references for this may exist, although I would have no idea where to find them.

Anyway, just a point I thought worth adding for consideration... M.J.E. (talk) 08:09, 19 January 2016 (UTC)

We would need a decent reference. The CDC supports the tweezer bit [9] Doc James (talk · contribs · email) 13:41, 19 January 2016 (UTC)

Ref

This ref looks good but does not support the content attached to it.[10] Doc James (talk · contribs · email) 07:49, 15 February 2016 (UTC)

Chronic symptoms following antibiotic treatment

There seems to be confusion about the source supporting the claim that 10-20% of patients treated with antibiotics have symptoms that persist for months to years. This figure comes from the CDC, which unfortunately changed their website last year. Here is the link to the archived site: [11]. The link to the archived site was one of the two links present in the citation originally inserted by another user. The other link goes to the current CDC page, which unfortunately doesn't provide the 10-20% figure, even though it provides information about symptoms persisting following antibiotic treatment. CatPath (talk) 20:56, 25 March 2016 (UTC)

Yes the archive supports the text in question.[12] Doc James (talk · contribs · email) 23:38, 25 March 2016 (UTC)

Archived links are not appropriate: the CDC no longer provides this information, and this should be respected. If you wish to add this claim, please provide a link to a reliable source. I notice James that you have also removed additional information: "Patients treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. There is no convincing microbiological evidence that patients with chronic symptoms following antibiotic treatment are persistently infected.[2]" As I'm not an autoconfirmed user, I can't do this myself—can you help? Thanks. — Preceding unsigned comment added by 2601:801:200:7F00:6962:F4A4:F52C:B18F (talk) 19:45, 26 March 2016 (UTC)

I added another source that supports the "10-20%..." claim: [13]. If there are no objections to the new source, I will go ahead and restore the sentence, "There is no convincing microbiological evidence...." CatPath (talk) 02:03, 27 March 2016 (UTC)

"Chronic Lyme disease". Infectious Disease Clinics of North America. 29 (2): 325–40. 2015. doi:10.1016/j.idc.2015.02.006. PMID 25999227. {{cite journal}}: Cite uses deprecated parameter |authors= (help)

I was unable to verify the claim using the new source. QuackGuru (talk) 02:28, 27 March 2016 (UTC)

That's the correct journal and issue, but wrong article. It's on page 310 of this article:

Aucott JN (2015) "Posttreatment Lyme disease syndrome." Infectious Disease Clinics of North America 29 (2):309-323. PMID25999226 [14] CatPath (talk) 03:14, 27 March 2016 (UTC)

Does (PMID 25999226) verify "There is no convincing microbiological evidence...."? QuackGuru (talk) 04:42, 27 March 2016 (UTC)

No, it does not mention it. The lack of microbiological evidence is verified by PMID 25999227 (Lantos 2015, "Chronic Lyme disease"). CatPath (talk) 09:09, 27 March 2016 (UTC)

Yes an archive link is appropriate. The CDC simple likes to move around their content. Doc James (talk · contribs · email) 11:36, 27 March 2016 (UTC)

User:CatPath, you previously said that's the wrong article. I previously cited [15] (PMID 25999227). I am confused. QuackGuru (talk) 17:51, 27 March 2016 (UTC)

I may have been confused about which of the two claims you were referring to when you responded, "I was unable to verify the claim using the new source." [16] If you were referring to the claim about the lack of microbiological evidence, then I should have directed you to page 329 of the article that you cited (PMID 25999227) instead of responding that it was the wrong article. My initial statement about adding another source [17] may have created some confusion. CatPath (talk) 19:09, 28 March 2016 (UTC)

Are you interested in adding content using the sources (PMID 25999226) or (PMID 25999227)? QuackGuru (talk) 19:14, 28 March 2016 (UTC)

Not at this time. I already added (PMID 25999226) as a second source to support the "10-20%..." claim since an IP was unhappy about the CDC source. Regarding PMID 25999227, I was originally interested in restoring this content [18], but I just noticed that the last paragraph in the lead already has a similar passage that cites PMID 25999227. CatPath (talk) 19:54, 28 March 2016 (UTC)

Thanks. It is currently ref 16 in the lede. QuackGuru (talk) 20:02, 28 March 2016 (UTC)

chronic lyme disease cognitive dysfunction treatment?

For all the people in medicine, is there a possible treatment for cognitive dysfunction arguably caused by chronic lyme disease? Could anyone post links to information regarding this? Research reports are fine.— Preceding unsigned comment added by 109.247.249.8 (talk) 17:19, 31 December 2015 (UTC)

See Neuroborreliosis. --sciencewatcher (talk) 21:16, 10 April 2016 (UTC)

Notable cases

Is the case of Yolanda Hadid and two of her three children notable? Emir of Wikipedia (talk) 16:49, 11 August 2016 (UTC)

Antibiotics for long term symptoms

A new high quality RCT does not find support [19] Doc James (talk · contribs · email) 12:01, 31 March 2016 (UTC)

CDC / NIOSH reference here [20] Brock-brac (talk) 20:45, 15 July 2016 (UTC)

It seems bias to reference that source so early on in the article “In those who develop persistent symptoms, long-term antibiotic therapy has not been found to be useful.”. There is obviously a lot of controversy around treatment for Lyme, but this is only one side of the argument. I have lyme disease, and long-term antibiotic therapy has significantly helped me. Alexmb1993 (talk) 17:06, 16 September 2016 (UTC)

Update external link for NAIAD

In the External Links section, the link out to the NAIAD page on Lyme disease is broken. Please change it to https://www.niaid.nih.gov/diseases-conditions/lyme-disease Pipitone (talk) 21:10, 24 September 2016 (UTC)

 Done I just removed the link, as it is used as a ref, per WP:ELNO Jytdog (talk) 21:36, 24 September 2016 (UTC)

new SciAm article: "Long-Forgotten Research Unearths New Mystery about Lyme Disease"

"Discovery sparks questions about factors that may make ailment harder to cure or lead to misdiagnosis By Charles Piller, STAT on October 13, 2016"

https://www.scientificamerican.com/article/long-forgotten-research-unearths-new-mystery-about-lyme-disease/#

Just thought I'd post this here so that you folks who have the background & interest can extract from it what you think worthwhile to add to this page (or the Lyme Disease Controversy page).

Phantom in ca (talk) 02:04, 17 October 2016 (UTC)

Diagnosis: does it refer mostly to B. burgdorferi?

This is the last phrase of the 3rd paragraph: "As all people with later-stage infection will have a positive antibody test, simple blood tests can exclude Lyme disease as a possible cause of a person's symptoms.[91]"

Also, in the next subsection on "Laboratory testing": "Several forms of laboratory testing for Lyme disease are available, some of which have not been adequately validated. The most widely used tests are serologies, which measure levels of specific antibodies in a patient's blood. These tests may be negative in early infection as the body may not have produced a significant quantity of antibodies, but they are considered a reliable aid in the diagnosis of later stages of Lyme disease.[92] Serologic tests for Lyme disease are of limited use in people lacking objective signs of Lyme disease because of false positive results and cost.[93]"

1) The first quote is contradicted in the subsection "Laboratory testing"; serologic tests do not give sure results.

2) This is the main issue I have here: references [91] and [92] mention the bacteria B. burgdorferi, not the other types of Borrelia. Then I ask, can one blood test work for all Borrelia bacteria? From what I read lately, this is not the case and it may be one of the reasons why blood tests fail in many cases in Europe - the tests are designed for B. burgdorferi and they may fail to recognize other types of Borrelia. I read this in an issue of Science&Vie, a French science popularizing journal, so not a definite reference on the subject (but a pretty good one in its category).

I think some mentions to the specific type of bacteria the tests address should be inserted, but I'm out of my field of expertise with this.Ferred (talk) 15:40, 29 October 2016 (UTC)

Needs ref that supports

"Persistence

The National Institutes of Health have supported research into bacterial resistance which has demonstrated persistence after antibiotic therapy in several animal models, including mice and primates. However, it was not possible to culture these bacteria and it is not known if they are infectious, or if they contribute to symptom persistence post-treatment. "

Doc James (talk · contribs · email) 20:23, 11 November 2016 (UTC)

References

The existing cite is not only dead, an archived version I found fails to verify the claim - no mention of persisters or culture. (It does say: "In patients who have non-specific symptoms after being treated for Lyme disease, and no evidence of active infection (patients with PLDS), studies have shown that more antibiotic therapy is not helpful and can be dangerous.")

Separately, "Kim Lewis, director of the antimicrobial discovery center at Northeastern University, and his colleagues grew B. burgdorferi in the laboratory, treated them with various antibiotics and found that whereas most of the bacteria died within the first day, a small percentage—called persister cells—managed to survive the drug onslaught." The research has been reproduced too - per https://www.scientificamerican.com/article/lyme-disease-may-linger-for-1-in-5-because-of-persisters/--Elvey^(t•c) 20:29, 11 November 2016 (UTC)

Update: I found a new URL for the apparent source: https://www.niaid.nih.gov/diseases-conditions/chronic-lyme-disease. (Wow, some folks at the NIH are too ignorant to not break URLs gratuitously during a reorg. Makes me wonder how often they fuck up complicated medical science.) It has an additional paragraph that shows the text is somewhat verifiable... it has one RS behind it.

However, the claim remains dubious. If the persisters don't really persist, why are researchers searching for cocktails to kill them : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876775/ and many more. paper says: "Although the cause for post-treatment Lyme disease syndrome (PTLDS) is unclear, one possibility is the presence of bacterial persisters not effectively cleared by the current Lyme antibiotics." That's well put. I propose this replace the second sentence: ♦Current mainstream research thinking is that <quote>. That would justify removing the tag, IMO.

(Skimmed http://www.akademiai.com/doi/pdf/10.1556/1886.2015.00049 ; looks like some very through, high quality research. CC, positive and negative controls, detailed methods description... BUT, I don't see any indication that the biofilms were isolated from patients with PTLDS. Claims: "Culture negativity of biofilms from different patho-gens is one of the cornerstone concepts for the behavior of true biofilms [50, 51] as it was shown in biofilms in culture-negative orthopedic and endocardiatic biofilm infections [51, 52] and therefore cannot be used to dismiss the idea that Borrelia can make biofilm in vivo."). Alternative proposal: ♠we could present this view and the one in the current second sentence. --Elvey^(t•c) 22:04, 11 November 2016 (UTC)

Any secondary sources that discuss this? Have trimmed the primary source and moved it to a section on research. Doc James (talk · contribs · email) 17:08, 12 November 2016 (UTC)

I think that made a mess of it, because persisters and resistant mutants are not the same thing, User:Doc James. --Elvey^(t•c) 08:14, 15 November 2016 (UTC)

So how about "The National Institutes of Health have supported research into bacterial persistence."? Doc James (talk · contribs · email) 17:19, 15 November 2016 (UTC)

Semi-protected edit request on 9 January 2017

Dr. Nevena Zubcevik is an attending physician at Harvard Medical School and she gave a recent speech during rounds and much of what she said is current knowledge is different from what your page on Lyme disease is saying, especially the treatment part. This makes me think that your page needs editing. Perhaps you could ask her to contribute also. 45.47.51.32 (talk) 02:22, 9 January 2017 (UTC)

• If Zubcevik has published a paper, then we could look into citing that as a source and using it to update the article. —C.Fred (talk) 02:24, 9 January 2017 (UTC)

facial palsy

please add wikilink to facial palsy in the article. thx. 176.63.176.112 (talk) 18:20, 2 March 2017 (UTC).

"Borrelia burgdorferi sensu stricto and Borrelia mayonii " Does 'sensu stricto' really belong in this statement, let alone a link to it's explanation? Seems an unnecessary distraction. I know it's rather a small and maybe petty thing, but it really stands out as strange. 2001:569:7738:5000:9EC:9F43:DAC:699A (talk) 14:17, 30 April 2017 (UTC)

AGree and removed. Doc James (talk · contribs · email) 19:20, 30 April 2017 (UTC)

EM rash

The erythema migrans rash appears in approximately 25%-40% of Lyme disease infections, not 50%-75%, as the introduction suggests. References to all supporting Internet sources would be quite long.

just a couple of MEDRS sources would be fine, thanks.Jytdog (talk) 01:10, 1 May 2017 (UTC)

Diagnosis

The article contains the standard line that serological tests are effective in diagnosing Lyme disease, whether early or late/chronic. This is simply false. Borrelia have multiple means of "flying under the radar" such that the immune system fails to recognize them, i.e., since the body doesn't recognize the bacteria as antigenic, it does not create antibodies. This is one major reason the two-step testing protocol (ELISA and confirmatory Western blot) yield false negatives over 50% of the time. That's right - they are accurate less than half the time.

Many sources not associated with IDSA will confirm this. — Preceding unsigned comment added by 97.87.62.51 (talk) 22:46, 30 April 2017 (UTC)

MEDRS sources? Jytdog (talk) 01:10, 1 May 2017 (UTC)

Nepal & India

we have a number of confirmed cases in Nepal (info here) I think it is important for people to be informed about this I can not edit the page please help

Nepal reference https://www.reddit.com/r/Lyme/comments/65k698/scratches_again_a_year_later_normal/

Chitwan National park is in lowlands - on border with India - which would put Indian territory in that proximity in guaranteed list as well — Preceding unsigned comment added by Ingearx (talk • contribs) 15:29, 28 May 2017 (UTC)

Transmission of antigen usually takes 36-48 hours

There is no citation for this data. It points to a CDC page that does not have a citation for this statement. It is decidedly false. Surprise surprise. More stupidity from CDC.

Here is a fun fact from pubmed: "The claims that removal of ticks within 24 hours or 48 hours of attachment will effectively prevent LB are not supported by the published data, and the minimum tick attachment time for transmission of LB in humans has never been established." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278789/ — Preceding unsigned comment added by 71.62.158.216 (talk) 20:17, 11 June 2017 (UTC)

"Michael J Cook, Independent researcher, Dorset, UK". When I do my own 30 second literature review, I can see studies confirming the CDC statement. I wonder why Mike couldn't manage it? --sciencewatcher (talk) 23:56, 11 June 2017 (UTC)

Apparently you can't manage to post the studies, just like the CDC can't. — Preceding unsigned comment added by 173.69.134.168 (talk) 23:32, 21 June 2017 (UTC)

Vaccine

The passage "A previous vaccine is no longer available 'because of poor sales'. Research is ongoing to develop cheaper new vaccines." was reverted to remove the word "cheaper". The source cited between those two sentences implies no other reason for the vaccine's current unavailability than its cost. Unless someone can posit an alternate reason for any ongoing efforts that might be underway to develop a new vaccine, I suggest adding the word "cheaper" back into the passage. Hgd4th (talk) 16:18, 21 December 2017 (UTC)

If the source says it, then okay. What words imply it? Please provide an exact quote. -- BullRangifer (talk) 17:05, 21 December 2017 (UTC)

Sourced content in the body of the article makes it clear that after it was approved, uptake was slow because insurance companies weren't paying for it, and then sales really tanked due to rumors that it was dangerous. The price, per se, was not the issue. The lead needs to summarize the body of the article; we never look at it in isolation. Jytdog (talk) 17:29, 21 December 2017 (UTC)

If you would, please reference aforementioned sourced content after your edit. Hgd4th (talk) 06:15, 23 December 2017 (UTC)

Unanswered talk

I asked at Talk:Lyme_disease/Archive_6#Notable_cases, but nobody replied. Anybody have a view on this? Emir of Wikipedia (talk) 14:24, 2 September 2017 (UTC)

Seems notable to me, as they are all famous enough to have their own Wikipedia pages and they are all public advocates of chronic Lyme disease awareness. Hgd4th (talk) 16:18, 21 December 2017 (UTC)

we generally don't do this as it becomes a gossip fest. it is useful to name such cases if their having it, contributed to the history of the disease. otherwise, no. Jytdog (talk) 06:53, 23 December 2017 (UTC)

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Transmission

I made a good faith edit an added a reference to an overview paper about the possibility of sexual transmission of Lyme Disease Stricker (2015). My edit was reverted. Rather than doing yet another reversion, I thought it would be helpful to have a discussion on the talk page. My point here is that Stricker (2015) is more recent than the CDC Lyme FAQ, which cites sources from 2001, 1999 and 1991. I'm somewhat skeptical of Stricker (2015), but feel that it is a citable source and deserves citation in this article. If there are citable refutations to the points in Stricker (2015), I would like to know about them and definitely think they should be included. I'd really like to reach some text that we can agree on. I think it is appropriate to include both the CDC FAQ and other, more recent research. What say you? Cxbrx (talk) 10:19, 6 February 2018 (UTC)

The CDC is a review from 2015 / 2017. Thus more recent than the 2014 / 2015 source. The Sticker paper is just a commentary and not a review and thus IMO not needed and not sufficiently notable enough. Doc James (talk · contribs · email) 23:36, 6 February 2018 (UTC)

agree w/ point(s) raised by Doc James--Ozzie10aaaa (talk) 00:21, 7 February 2018 (UTC)

I also agree with excluding the Stricker source. It's an editorial commentary, not a secondary review (despite the journal name). If people who are experts in Lyme (i.e. not me) take sexual transmission seriously it'll start appearing in reviews and we can include it then. Ajpolino (talk) 19:37, 7 February 2018 (UTC)

I agree that the Stricker source is an editorial and not peer reviewed. I see it as a secondary source suitable for inclusion in an article, commenting on primary sources. However Stricker (2015) led me to Middleveen et al., "Culture and identification of Borrelia spirochetes in human vaginal and seminal secretions," last published 27 Apr 2015, which is after the CDC page was last review on March 4, 2015. Presumably a review is much more thorough than an update and we have no evidence that the CDC page included a review of Middleveen (2015). Middleveen (2015) has some good discussion from the referees, clearly there are differences of opinion. However, Middleveen (2015) is a primary source, has been peer reviewed and deserves mention here so that readers can make their own informed decisions based on research and discussion. The CDC FAQ section about sexual transmission includes references from 1991, 1999 and 2001, it would be helpful if there was more recent research that confirmed the results of these papers. I would prefer to have a link to the Middleveen (2015) paper, perhaps with commentary that states that not all reviewers agreed with the paper. I appreciate the time other editors have taken in reviewing my edit and will let it rest here. Cxbrx (talk) 20:40, 7 February 2018 (UTC)

Middelveen and Stricker are problematic generally, authoring papers that are well out on the fringe and dealing with the not-accepted diagnoses of "chronic Lyme disease" and "Morgellons disease". F1000 Research is not a good journal to cite for medical claims on Wikipedia as it does not employ pre-publication peer review or revision. F1000 Research is also not indexed in MEDLINE. TenOfAllTrades(talk) 00:38, 8 February 2018 (UTC)

Treatment

User Jytdog issued me an "alt med" warning for referencing information from a book written by Jonathan Edlow, Professor of Medicine at Harvard Medical School. This information concerned the insufficiency of standard guidelines for the duration of treatment that is necessary in some cases for antibiotic regimens for Lyme disease. Shortly beforehand, said user deleted an entire quotation from elsewhere in the page (included by another user at some previous date) that mentioned this same failure of Lyme treatment guidelines, saying that it should be summarized and not quoted in full. My referencing this information was an attempt to summarize a small part of this quotation. What is the rationale here for completely removing a source and all references to it that was previously allowed as acceptable? - Hgd4th (talk) 14:27, 9 March 2018 (UTC)

References

• That's this book right? Seems pretty fringey ("Unfortunately, his apparent sympathies for the alternative camp cause him to deviate from the scientific tenor established earlier in the book") - so best avoided. Alexbrn (talk) 14:49, 9 March 2018 (UTC)

First of all, his sympathies may be apparent to the reviewer you quoted, but can you justify privileging said reviewer's viewpoint above the author he is reviewing? The reviewer is a doctor at the University of Connecticut, and the author of the book is a Harvard Med School Professor of Medicine, so as far as I can tell, the latter trumps the former in terms of credentials. More importantly, the quotation to which I am referring comes from Ed Masters, the researcher who discovered STARI, a close cousin to Lyme disease. There's no question that Masters' credentials outweigh the reviewer you cited. - Hgd4th (talk) 15:33, 9 March 2018 (UTC)

I can justify not using a sources which has had an iffy review, that's a red flag. Why risk it? Best to stick to strong WP:MEDRS like review articles and position statements from major medical bodies. Alexbrn (talk) 15:41, 9 March 2018 (UTC)

The reviewer of the book may be a doctor at U Conn, but he is also a professor and an expert on Lyme disease. He has published a number of research articles about Borrelia burgdorferi and other spirochetes: [21][22]. CatPath (talk) 16:29, 9 March 2018 (UTC)

This is a history book. It can be used in the history section but should not be used in any medical section. Sources there should be high quality literature reviews or statements from major medical/scientific bodies. Besides being a history book, we shouldn't be using for medical information per WP:MEDDATE as it is 15 years old. Jytdog (talk) 17:01, 9 March 2018 (UTC)

Better sources

We need better sources for this IMO

"People that have been infected with Lyme disease and which were treated, develop immunity against the particular strain of Lyme's disease they were infected with. The immunity lasts for 6 to 9 years. Some people are also better in fighting the disease depending on their genetic makeup.

In addition, some animals (such as wild mice) sometimes have immunity against Lyme disease from birth."

Doc James (talk · contribs · email) 17:43, 29 May 2018 (UTC)

References

This review is interesting.[23] Doc James (talk · contribs · email) 17:49, 29 May 2018 (UTC)

Semi-protected edit request on 20 June 2018

It is believed that less than 5% of people have lingering symptoms of fatigue Change "less" to "fewer". "Less than 5% of people" is grammatically incorrect Fuhndhu (talk) 20:59, 20 June 2018 (UTC)

 Not done for percentages like this, it could be either. Alexbrn (talk) 21:08, 20 June 2018 (UTC)

Lyme disease spread to all 50 states

Hey there, Jytdog. Based on your reversion, I have to ask how you see the information in question (simply that, as of 2018, Lyme disease has been found in all 50 states) necessitating a MEDRS source. Based on my research, the only biomedical information that this might include would be "Population data and epidemiology: Number of people who have a condition, mortality rates, transmission rates, rates of diagnosis (or misdiagnosis), etc." Even then, I'm not talking about any number beyond the states, any rates of death or transmission, any projections, etc. Just looking for a more thorough explanation. Anyone else is welcome to weigh in with their thoughts. Thanks. PcPrincipal (talk) 21:54, 10 August 2018 (UTC)

Epidemiology is biomedical information. The gizmodo piece was reporting on a primary source (see WP:MEDDEF) published by Quest, a company that sells diagnostic tests. (It is here) Nice marketing piece for Quest. The Quest source is not a MEDRS source and the gizmodo article is not either. When I went to read the Gizmodo piece i was hoping they were reporting on something by say the CDC; that would have been fine. (btw here is the CDC's page on Lyme epidemiology in the US. Jytdog (talk) 22:28, 10 August 2018 (UTC)

As I said, I understand that epidemiology is biomedical information. See my original post. Since the New York Times is now reporting on this 50 state spread, I went ahead and restored my prior edit, supplementing it with the NYT source. PcPrincipal (talk) 14:51, 16 August 2018 (UTC)

The NYT is not a MEDRS source either. This is not a difficult concept - use high quality literature reviews in the biomedical literature, or statements by major medical/scientific bodies. Like the CDC. Jytdog (talk) 14:53, 16 August 2018 (UTC)

According to the CDC, as of 2016, LD has been confirmed in 45 of 50 states.Damwiki1 (talk) 22:37, 16 August 2018 (UTC)

Additionally, LD has been confirmed in 49 of 50 states during the period of 2006-2016, according to the above CDC data.Damwiki1 (talk) 22:44, 16 August 2018 (UTC)

The really key thing is "Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC". going all Oh! over "all fifty states" obscures that, as does the overall US incidence from the table being 8/100,000 or 0.00008%. Jytdog (talk) 00:37, 17 August 2018 (UTC)

The incidence from the table is 8/100000 but the CDC freely admits that the actual rate is about 80/100,000 or about 300,000 cases year. Regardless the stats from the NYTimes article seem well founded.Damwiki1 (talk) 02:26, 17 August 2018 (UTC)

You are missing the point. The hype is "its in all 50 states!!!!". We don't follow hype. One reason we use MEDRS refs is to get the WEIGHT right, like what the CDC says I quoted above - 14 states account for over 96% of lyme. Jytdog (talk) 02:36, 17 August 2018 (UTC)

The Gizmodo article isn't saying that disease-carrying insects are present in all 50 states. Lyme is only "spread" to all 50 states because people already exposed have traveled there.

As the authors themselves admit, a positive result for Lyme isn’t a diagnosis of the disease—that can only be made by a doctor. The test, which relies on finding specific antibodies produced by the body in response to the bacteria that causes Lyme (Borrelia burgdorferi), also can’t tell us when or where an infection actually happened. Some results might be detecting undiagnosed cases of Lyme that happened long before someone visited the doctor, or even cases that had already been treated with antibiotics. And some cases, particularly in states with low numbers, might have been caught while the person was traveling elsewhere, rather than represent a native infection.

So this really isn't worth adding here. — The Hand That Feeds You:^Bite 16:40, 17 August 2018 (UTC)

Thanks for weighing in, everyone. I think considering the "weight" is an interesting way of looking at it. PcPrincipal (talk) 14:52, 11 September 2018 (UTC)

Tick attachment time error

The current article states that "Usually, the tick must be attached for 36 to 48 hours before the bacteria can spread". I see no reference or study from the CDC Website that is referenced to substantiate this metric. I did some searching through recent medical journals and found https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278789/ stating from 2015 "It is frequently stated that the risk of infection is very low if the tick is removed within 24–48 hours, with some claims that there is no risk if an attached tick is removed within 24 hours or 48 hours. A literature review has determined that in animal models, transmission can occur in <16 hours, and the minimum attachment time for transmission of infection has never been established. Mechanisms for early transmission of spirochetes have been proposed based on their presence in different organs of the tick. Studies have found systemic infection and the presence of spirochetes in the tick salivary glands prior to feeding, which could result in cases of rapid transmission. Also, there is evidence that spirochete transmission times and virulence depend upon the tick and Borrelia species. These factors support anecdotal evidence that Borrelia infection can occur in humans within a short time after tick attachment." I also found https://www.frontiersin.org/articles/10.3389/fmicb.2018.01722/full showing transmission in mice within 12 hours. I think this statistic for 36 to 48 hours either needs to be removed/changed or better referenced with medical sources. Can anyone help me with this? I am fairly new to Wikipedia and don't want to screw things up. ---- — Preceding unsigned comment added by Sharky905 (talk • contribs) 14:11, 26 September 2018 (UTC) I added the fact sheet for the European Center for Disease Prevention and control which states " Infected ticks are unlikely to transmit the organisms in the early hours of feeding, but the risk rises steadily with increasing duration of the blood meal, so early removal of attached ticks within the first hours is very useful in reducing transmission risk." I believe this better outlines the increasing risk over time instead of the CDC statement of 36-48 hours. Sharky905 (talk) 20:24, 28 September 2018 (UTC)

CDC website says "In most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted."[24]

ECDC says "Infected ticks are unlikely to transmit the organisms in the early hours of feeding, but the risk rises steadily with increasing duration of the blood meal, so early removal of attached ticks within the first hours is very useful in reducing transmission risk."[25]

The "International Journal of General Medicine" has an very low impact factor (0.75)[26] Doc James (talk · contribs · email) 00:28, 29 September 2018 (UTC)

This is a better review[27] and says

"The frequency of the infection after an I. scapularis bite has been shown to be 1–4% in the United States134, presumably because the tick must usually be attached for >36 hours before transmission occurs135...In Europe, the frequency of clinically symptomatic infection after I. ricinus bites is 1–5%, as in the United States. On the basis of animal studies, the transmission of Borrelia might occur in <36 hours with I. ricinusthan with I. scapularis12."

Adjusted to match Doc James (talk · contribs · email) 00:48, 29 September 2018 (UTC)

If you go back to the study that is referenced - https://tickencounter.org/PDF/TimeToTransmission/JClinMicrobiol1987Piesman5578.pdf the time frames were 24 hours, 48 hours and >72 hours. The study was done on both hamsters and mice. At 24 hours 1 of 6 hamsters and 0 of the 8 mice were infected, 3 of 6 hamsters and 2 of 8 mice after 48 and and 5 of 6 hamsters and 8 of 8 mice after 72 hours. This does not equal the current statement at >36 hours to be infected (as one hamster our of 6 was infected in under 24 hours.) It appears the author "presumed" wrong. The reference https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278789/ is also from the Journal of Medicine that studies the effects of transmission from partially fed ticks showing that transmission time is significantly less if previous attachment exists. My take is that quoting any specific number here does not due the amount of research and qualifications given in studies justice as there are many variables in the real world. Even the study you reference shows a transmission in under 36 hours with a hamster. What about something like "Infected ticks are unlikely to transmit the organisms in the early hours of feeding (24 to 36 hours), but the risk rises steadily with increasing duration of the blood meal, so early removal of attached ticks is very useful in reducing transmission risk." Sharky905 (talk) 14:31, 1 October 2018 (UTC)

We don't use what we call primary sources (please read WP:MEDDEF and the rest of WP:MEDRS)) to generate content. Please don't cite them on the talk page.

Also please stop making changes only to the lead (the part above the table of contents) -- all that we do there is summarize content in the body of the article. See WP:LEAD) So please make changes in the body of the article first and then consider whether they belong in the lead or not. Thanks.Jytdog (talk) 15:10, 1 October 2018 (UTC)

Sorry about that - new to Wikipedia and learning. I will change to summarize what is stated in the below sections as they appear to be valid information originally - it was only the summary that presented inaccurately. Sharky905 (talk) 15:38, 1 October 2018 (UTC)

OK, thanks.Jytdog (talk) 18:19, 1 October 2018 (UTC)

What was wrong with this "In the United States, ticks of concern are usually of the Ixodes scapularis type, and must be attached for at least 36 hours before the bacteria can spread."? As stated we use high quality secondary sources and this was supported by two of them. Doc James (talk · contribs · email) 21:29, 1 October 2018 (UTC)

The issue is that this statement does not clearly outline all the facts that support that opinion. The article that is referenced shows that 1 of the hamsters that was tested was infected in under 36 hours. Many other studies show that the longer the tick is attached the higher the risk - but setting an arbitrary value of 36 hours is incorrect.

Agreed - I have undo your removal as I believe the facts are adequately addressed in the new wording. Also the request was to move this type of detailed information into the body of the article and not in the summary. This was also done. Sharky905 (talk) 01:23, 2 October 2018 (UTC)

Also - single course of doxy recommendation does not follow WP:MEDRS as it is a single study source. Please move to body of document (should not be in the summary) and reference according to WP:MEDRS Sharky905 (talk) 01:33, 2 October 2018 (UTC)

What are you talking about? This https://www.ncbi.nlm.nih.gov/pubmed/?term=24785207 that you call a single study is a review article in a major medical journal.

The 36 hrs being usually required is from the CDC[28] No other digging is required. We as editors do not double check the CDC (though we of course can email the CDC and ask them to change their mind)Doc James (talk · contribs · email) 02:38, 2 October 2018 (UTC)

Source

This text

"However, a 2012 review article states that since the Lyme spirochete can be intracellular and in more resistant pleomorphic forms "combined antibiotic treatment for a longer period of time should be considered, in a similar way that it is established for the treatment of tuberculosis and leprosy." This article also draws an analogy between Lyme and syphilis since both are spirochetal diseases and states that since "cortisone was a common way to reactivate syphilitic infection in experimental animals," corticosteroids or other immunosuppressive agents by themselves are not recommended for the treatment of Lyme disease in human patients."

If from the "Open Neurology Journal" with an impact factor of less than 1.[29] Not a great source. Doc James (talk · contribs · email) 11:04, 13 October 2018 (UTC)

Here are the editors and editorial board. Seems pretty standard. https://benthamopen.com/TONEUJ/editorial-board/ FriendlyRiverOtter (talk) 16:25, 16 October 2018 (UTC)

However-- please see Who's Afraid of Peer Review? A spoof paper concocted by Science reveals little or no scrutiny at many open-access journals., Science, John Bohannon, 4 Oct. 2013. This article makes the case that "open access" journals are often dishonest enterprises which say they do peer review and then either go through the motions or do no peer review at all. Instead, their business model is simply to get publication fees from authors. In one case, an Italian professor was asked to review a paper which had serious problems. The journal ignored her review and published the article anyway. The professor asked to be removed from the masthead, but more than a year later, the "journal" still lists her as a reviewer.

On the other hand-- I have skimmed sources which say that the impact factor is used way inappropriately simply because it is an available number. In particular, some of these say it is not designed to evaluate particular articles. Will try to pull some of these sources as well. FriendlyRiverOtter (talk) 17:03, 19 October 2018 (UTC)

Nor is the journal MEDLINE-indexed. WP:REDFLAG. We don't use junk journals. Alexbrn (talk) 17:17, 19 October 2018 (UTC)

I'm against junk journals, too! In fact, from my diving into the above and trying to evaluate Open Neurology Journal, you can probably safely assume that I'm pretty keen on using good sources. But still haven't decided about this one. FriendlyRiverOtter (talk) 20:07, 25 October 2018 (UTC)

And from the source giving Open Neurology Journal an impact factor less than 1, it also seems to list the subject as "Gynaecology. Obstetrics." Now, that is both funny and spectacularly wrong! Even acknowledging that the brain is the most important sex organ, it's still funny.  :~) FriendlyRiverOtter (talk) 20:24, 25 October 2018 (UTC)

Why does our lead photograph show a minority case?

Why does it show an adult tick if humans are most commonly infected by nymphal ticks?

And I can accept the answer of legacy. Hey, this is just the picture we have. In zen-like fashion, Wiki is always becoming, never quite there, and you, too, are very welcome and highly invited to jump in and help to make it better. I can accept this.

Tilly K, Rosa PA, Stewart PE (June 2008). "Biology of infection with Borrelia burgdorferi". Infectious Disease Clinics of North America. 22 (2): 217–34, v. doi:10.1016/j.idc.2007.12.013. PMC 2440571. PMID 18452798.

' . . Both nymphs and adults occasionally feed on humans, but the small size of the nymphs makes them difficult to detect and, hence, more likely to feed long enough to transmit the spirochete and cause Lyme disease. . '

So, yes, if we can find it, I think we should lead with a photo of a nymphal tick. FriendlyRiverOtter (talk) 16:12, 3 November 2018 (UTC)

Lyme rash photos

Raised, red borders around indurated central portion

How do we know that the Lyme rash photo is actually a lyme rash? It was uploaded by "Just some guy" and doesn't seem typical. I'm removing and hope a better photo can me added. ScienceFlyer (talk) 04:10, 6 December 2018 (UTC)

Removed the photo. Apologies for forgetting a comment. ScienceFlyer (talk) 04:17, 6 December 2018 (UTC)

User:ScienceFlyer no worries. Not all rashes are classic like the first one. Here is another picture.[30] The CDC also links to a bunch of others https://www.cdc.gov/lyme/signs_symptoms/rashes.html Doc James (talk · contribs · email) 18:09, 9 December 2018 (UTC)

Misleading headline.

Section 'Signs and symptoms' doesn't tell anything about signs and symptoms of the Lyme disease. It only tells that there are broad range of symptoms, without specifying any of them. Not a single one.

Just unbelievable. Who writes this stuff? Amateurs, would be my guess. — Preceding unsigned comment added by 130.185.150.94 (talk) 18:24, 12 January 2019 (UTC)

Taxonomic changes for Borrelia, 2014 onwards

Just noting that the Lyme-related Borrelia species have been separated in a new genus, Borreliella Adeolu & Gupta, 2015, a move which has been disputed by some (Margos et al., 2017) but reaffirmed by Barbour et al., 2017. References are:

• Adeolu, M.; Gupta, R. S. (2014). A phylogenomic and molecular marker based proposal for the division of the genus Borrelia into two genera: the emended genus Borrelia containing only the members of the relapsing fever Borrelia, and the genus Borreliella gen. nov. containing the members of the Lyme disease Borrelia (Borrelia burgdorferi sensu lato complex). Antonie van Leeuwenhoek. 105(6): 1049-1072., available online at https://doi.org/10.1007/s10482-014-0164-x
• Margos, G.; Marosevic, D.; Cutler, S.; Derdakova, M.; Diuk-Wasser, M.; Emler, S.; Fish, D.; Gray, J.; Hunfeldt, K.-P.; Jaulhac, B.; Kahl, O.; Kovalev, S.; Kraiczy, P.; Lane, R. S.; Lienhard, R.; Lindgren, P. E.; Ogden, N.; Ornstein, K.; Rupprecht, T.; Schwartz, I.; Sing, A.; Straubinger, R. K.; Strle, F.; Voordouw, M.; Rizzoli, A.; Stevenson, B.; Fingerle, V. (2017). There is inadequate evidence to support the division of the genus Borrelia. International Journal of Systematic and Evolutionary Microbiology. 67(4): 1081-1084.
• Barbour, A. G.; Adeolu, M.; Gupta, R. S. (2017). Division of the genus Borrelia into two genera (corresponding to Lyme disease and relapsing fever groups) reflects their genetic and phenotypic distinctiveness and will lead to a better understanding of these two groups of microbes (Margos et al. (2016) There is inadequate evidence to support the division of the genus Borrelia. Int. J. Syst. Evol. Microbiol. doi: 10.1099/ijsem.0.001717). International Journal of Systematic and Evolutionary Microbiology. 67(6): 2058-2067.

Since the ramifications are somewhat wide ranging (and also subject to some dispute as noted above), (and I am also a bit busy with other things at present) I have not changed the current article text but may do in the future, or others are welcome to do so. Regards - Tony Tony 1212 (talk) 20:42, 25 January 2019 (UTC)

Lyme Bacteria (or Signs of Their Presence?) Found in Alzheimer's Brains

This article has links to studies, if anyone would like to research and write about this:

https://www.bayarealyme.org/blog/new-study-provides-insight-related-to-lyme-brain-fog/

Also search Google for "lyme brain".

Seems like more information is coming out lately about bacteria (not just Lyme bacteria) being found in people's brains, beyond previously known acute diseases like meningitis:

https://www.newscientist.com/article/2191814-we-may-finally-know-what-causes-alzheimers-and-how-to-stop-it/

https://www.sciencemag.org/news/2018/11/do-gut-bacteria-make-second-home-our-brains

Heyo speaker (talk) 04:36, 15 March 2019 (UTC)

Orphaned reference names

Greetings and felicitations. My apologies, but I don't have the patience or time tonight to fix this problem (I'm past a deadline for a work project, which I've now promised to complete before the beginning of business today ET). At the end of the article's references there are eight "list-defined references" that no longer have a reference associated associated with their names. Would someone else please be so kind as to look into this? (@DocJames: You've been editing this article recently...) —DocWatson42 (talk) 05:33, 14 May 2019 (UTC)

Lyme suspected of being an STD

The reference is: --- "Erosive Vulvovaginitis Associated With Borrelia burgdorferi Infection" --- https://journals.sagepub.com/doi/full/10.1177/2324709619842901

2601:8A:C100:84CC:F842:29D4:175B:B3B7 (talk) 13:20, 15 May 2019 (UTC)

Well, I suppose — be bold and change the article as you see fit. -- Document hippo (talk) 08:12, 18 May 2019 (UTC)

Testing of ticks

Currenty there has been some disagreement regarding testing ticks.

I wonder if there's more of a story. As the American ticks take much more time to transmit the Lyme disease compared to European ticks, it might make sense to discourage Americans from testing their ticks, while encouraging Europeans to test their ticks.

For example, Russian official sources actually recommend testing a tick.

I mean, it's unlikely that Russians would use the English Wikipedia page on Lyme disease as a basis for deciding whether to test the tick after a tick bite.

But if there's any source taking into account geographical variations as a basis for deciding the proper strategy of dealing with a removed tick, it might actually make sense to discuss that point in the article.

-- Document hippo (talk) 10:49, 20 May 2019 (UTC)

Biological weapon?

Is this just a conspiracy theory?

• David Swanson: Where Lyme Disease Came From and Why It Eludes Treatment, CounterPunch, 17 May 2019.

Swanson mentions these books:

• Kris Newby: Bitten: The Secret History of Lyme Disease and Biological Weapons. Harper Wave, 2019; ISBN 006289627X.
• Michael C. Carroll: Lab 257: The Disturbing Story of the Government’s Secret Germ Laboratory. HarperCollins, 2004; ISBN 0060011416.

Is this useful information? --Babel fish (talk) 14:31, 18 May 2019 (UTC)

It's nonsense. Has it been discussed in RS? If not, it shouldn't be mentioned or linked to. -- BullRangifer (talk) 15:48, 18 May 2019 (UTC)

There is an extensive review of Bitten in the magazine Outside, May 20, 2019.[31] Other reviews are numerous.[32][33][34][35][...] The claim of Carroll's bestselling book Lab 257 about the lab's role in the spread of Lyme's disease is also discussed in many RS: [36][37][38][39][40][...] Nonsense or not, there is enough attention to these theories to warrant spending a paragraph or so on it under a heading like "Conspiracy theories". If there are RS setting forth why this is all nonsense – the review in Outside considers it to rest "on shaky ground" but does not straightforwardly dismiss it –, we should of course also mention that point of view. Note that the book Lab 257 is already referenced in several articles: Building 257, Erich Traub, Fort Terry, Operation Paperclip, Plum Island (New York), Plum Island Animal Disease Center, United States biological weapons program and Vigo Ordnance Plant.  --Lambiam 10:48, 2 June 2019 (UTC)

Today Congress asked/told the Pentagon to examine this claim. One reason why the focus is on the northern hemisphere is that Australia has no testing facilities. Patients have to send samples to the US and pay for them privately. This would mean that not all cases are properly diagnosed. 2001:8003:AC99:3B00:188C:7C36:D76F:8384 (talk) 01:29, 17 July 2019 (UTC)

As the user above mentioned the US Congress passed an amendment to the provisional National Defense Authorization Act (NDAA) for the fiscal year 2020 which would require the Pentagon inspector general to initiate a formal review regarding US involvement with weaponised ticks.[41] Regardless of whether or not the amendment makes it into the final bill the weaponised tick theory deserves a mention in the article, with a WP:NPOV of course. --94.142.77.80 (talk) 11:12, 17 July 2019 (UTC)

Multiple changes

To what the references DO NOT say. For example

"Less than half of infected people develop a rash."

Well the ref says "Rash occurs in approximately 70-80% of infected persons"

Doc James (talk · contribs · email) 03:47, 23 July 2019 (UTC)

Need to further reconcile the "late disseminated infection" section with the "controversy" section.

The article is really thoughtful now, and nicely resolves what had been a painful controversy in the literature.

Here is an (the only?) outstanding issue, which has to do with consistency and emphasis: On the ONE hand, we have to compare the section title with the text of the symptoms list in this paragraph of "late disseminated infection." The symptoms list is correctly precise and well-referenced, while the language is informal and imprecise

Lyme can cause a chronic encephalomyelitis that resembles multiple sclerosis. It may be progressive and can involve cognitive impairment, brain fog, migraines, balance issues, weakness in the legs, awkward gait, facial palsy, bladder problems, vertigo, and back pain. In rare cases, untreated Lyme disease may cause frank psychosis, which has been misdiagnosed as schizophrenia or bipolar disorder. Panic attacks and anxiety can occur; also, delusional behavior may be seen, including somatoform delusions, sometimes accompanied by a depersonalization or derealization syndrome, where the patients begin to feel detached from themselves or from reality.

The symptoms list has language like "resembles" and "...can begin to feel detached."

It might help an emphasis issue if the well-referenced symptoms were just named rigorously; using words like "resembles" and "can begin to feel" may gives an incorrect sense that this is just anecdotal or un-established.

Yet, crucially, the title of the same section "late disseminated infection" is needlessly precise, and *incorrectly precise*, about the cause of these symptoms. No article has attempted to attribute the late symptoms to existence of ongoing bacterial infection as opposed to things like nerve damage or auto-immune response (and there are references out there for the various suggested causes).

Now, on the OTHER HAND in the "controversy" section the language

"non-specific symptoms (such as fatigue, musculoskeletal pain, and cognitive complaints)" 

refers to 'cognitive complaints' which were so carefully analyzed in the other section, but all that is carried forward is the vague and un-referenced language that was there.

The problem is that the detailed list of psychiatric/neurological symptoms in one section is relegated to 'non-specific complaints' in the other.

Crucially, in one section it is stated authoritatively that these are not due to continued infection, in the other section the title refers to continued infection!

My guess for the discrepany is that medical science literature focusses on conditions which have a treatment. For conditions without any treatment (e.g. paralysis, some terminal illnesses) there are sometimes mitigating strategies such as physical therapy or palliative care. Lyme disease sequelae are too new for doctors to have come up with any strategies, and the controversy surrounds patients asking for continued antibiotics with occasional doctors incorrectly saying they are healthy and all doctors correctly withholding long-term antibiotics.

This article clarifies things a lot, but the "continued infection" title of one section and the "nonspecific complaints" language of the other are in stark opposition with the truth of what the references say.

The references state and establish both that the complaints are not "nonspecific" and at the same time, the infection is not "continued." Createangelos (talk) 23:19, 26 July 2019 (UTC)

Justin Bieber ...

... suffers from Lyme desease - perhaps the WP-article should mention it. 79.219.94.75 (talk) 09:31, 10 January 2020 (UTC)

It would be better to bring up his diagnosis in his own article. We really don't have a need to list every famous person diagnosed with the disease here. — The Hand That Feeds You:^Bite 13:10, 10 January 2020 (UTC)

Covering patient activism

With the Epilepsy Foundation or the American Heart Association, for example, you don't have patients in trenchant and vocal opposition to the medical establishment.

But with many Lyme patients, you do.

And this should be covered as matter-of-factly and as evenly as any other major controversy. For example:

Lyme Loonies, Part 1: When People With Lyme Disease Are Crazy, Huffington Post, David Michael Conner, May 4, 2017. Please see also Part 2: When Mental Illness Is Physical Illness, May 5, 2017.

The author David Conner is saying that when a patient presents with both physical and mental symptoms, the patient is often treated dismissively. And the doctor seems to jump to the conclusion that it's pure mental illness. He's saying this is relatively common. But even if it's not, it seems like something which medical practice should acknowledge and address.

The Huffington Post is a reputable news organization, but as always, I'm happy to find additional sources.FriendlyRiverOtter (talk) 19:12, 25 January 2020 (UTC)

---

And here's what looks like a community newspaper talking about a coalition of various patient groups planning multiple protests during an upcoming 2015 IDSA convention (IDSA = Infectious Diseases Society of America).

LOCAL LYME DISEASE PATIENTS PLAN PROTEST AT MAJOR MEDICAL MEETING IN SAN DIEGO OCT. 7-11 OVER DIAGNOSTIC “DENIALISM”, East County Magazine, Sept. 27, 2015:
"•The traveling Lyme Quilt—which has green squares to commemorate individuals who have died from Lyme, and red ones for those who are still with us—will be displayed for the first time on the west coast."

Protesters Rally Against Infectious Disease Society of America, NBC San Diego, Brie Stimson, Oct. 9, 2105:
"Lyme disease patients and advocates demonstrated outside of the Infectious Diseases Society of America's (IDSA) Annual Conference . . . "

Again, organized patients protesting a medical meeting. I find this . . . stunning. But as always, YMMV (Your mileage may vary). FriendlyRiverOtter (talk) 18:33, 3 February 2020 (UTC)

I have Lyme 23.5 bands

Help on testing and info Collier county refused to treat me . Any help ? CDC also Sarajane1490 (talk) 00:29, 12 April 2020 (UTC)

Corrections? Always mention applicable locations of experiments and medical research, borreliosis happens worldwide, but the bacterial activity differs between locations and seasons!

The section "Preventive antibiotics" contains obvious errors. It suggests that "It requires between 36 and 48 hours of attachment for the bacteria that causes Lyme to travel from within the tick into its saliva.[22] If a...", and that's okay, but people who had a european deet tick for just 4 to 9 hours have developed Erythema Migrans! Not to mention other reladed symptoms. Simply, a wild, live tick finding a host is different than one bred and fed in laboratory conditions. Also, there are reported variations of results between the ticks and infections in USA, Scotland or central europe. The whole article needs to take the location of the experiments and medical investigations into consideration and mention it actively, as the results are not always completely applicable to other locations. Back to the example: a tick that has been sucked on a thigh for less than 12 hours was already surrounded by erythema migrans of 2" diameter. That very much contradicts the statement that for 36 hours "nothing can happen". — Preceding unsigned comment added by 90.64.16.57 (talk) 13:56, 13 April 2020 (UTC)

Change Name

This name is stigmatizing the people of Lyme. Should we consider changing it to something more scientific and less offensive? Jameslasalle2 (talk) 15:15, 21 March 2020 (UTC)

Not us, we're just wikipedia editors.

Kurtdriver (talk) 18:06, 29 April 2020 (UTC)

South America

Despite a section on Lyme-like illness in South America focusing on Brazil and a stand-alone article, there is still no evidence of Lyme disease in Brazil. See discussion here. How to handle this? --ScienceFlyer (talk) 04:45, 13 June 2020 (UTC)

In Australia.

The official position of all Australian governments and of the Australian Medical Association is that "There is NO Lyme disease in Australia". Having said that, there appears to be strong anecdotal evidence that there is indeed in Australia a tick spread bacterium, PROBABLY similar to Borrelia, that causes a disease with similar symptoms.— Preceding unsigned comment added by 2001:8003:e414:3a01:5c01:2fa3:f7a3:b55e (talk • contribs) 03:06, June 27, 2020 (UTC)

We'd need some citations to add that to the article. 16:06, 27 June 2020 (UTC)

Medical student peer review

Hello Marifer. Please see my feedback below. I have noted that your contribution is still in the sandbox so I will review it separately.

Peer review of the existing article

Lead section: The introductory sentence is strong and defines the article topic. However, I believe that the lead section isn’t truly a summary because of its length and the depth of information it contains. I would recommend shortening it to include key points as an introduction to what the article entails. The length is a bit daunting at first and I think readers will be encouraged to read an introduction that is succinct.

Article: Based on our style guidelines, I believe that the article contains all of the headings it should have to qualify as medicine related. It is evenly balanced as all sections have been well developed. The content is relevant but I don’t think the writing style is suitable for the non medical reader. The article contains a lot of jargon in some areas that has not been broken down for persons without medical knowledge. Wikipedia is accessible to the layman and should therefore be well understood by that population.

Citations: The article is well cited.

Peer review of sandbox contribution

I think you’ve identified that there was a need to outline the lifecycle of the tick. It’s a useful addition, making that section easier to understand. I don’t agree with the source you’ve chosen. I think a literature review on the topic conducted within the last ten years would be a more suitable choice. Additionally, I think you should be careful with the rewording of the information you’ve obtained from your source. I think your contribution is a bit too similar to the original text. It says the same thing but in a different order. The Wikipedia asynchronous classes we did at the beginning of the course should assist you in figuring out how to avoid such similarities. I wish you all the best for the rest of the course and it was nice meeting and working with you. TeHilla98 (talk) 13:33, 5 July 2021 (UTC)