Wilderness Medical Society snowmass 2005 Page 268
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III CONTROVERSIES
Recommendations are considered Category 2 by the WMS Panel of Expert Reviewers
The two major controversies about tick-borne infections are related to Lyme disease. The
first concerns prophylactic therapy following a tick bite in high-risk areas? Such therapy
would not be necessary unless the tick is attached and is distended with blood. The
infection is not transmitted until ticks have been attached for thirty-six hours or more. A
single 200 mg dose of doxycycline has been recommended following the finding of a
distended tick, and has the additional benefit of being effective for ehrlichiosis, but even
this treatment is controversial.
The second controversy concerns whether chronic Lyme disease exists and how it should
be treated. A number patients with Lyme disease develop persistent complaints that are
non-specific and include arthralgias, myalgias, cognitive difficulties, fatigue, malaise,
dizziness, stiff neck and photophobia. Some patients are severely disabled. Such
persistent disability is not uncommon and occurs most frequently in individuals who have
not been treated in the early stages of their infection. In some the treatment has been
delayed for as long as a year. The entire problem is further confused by a respected study
that found the frequency of symptoms of pain and fatigue was no greater in patients who
had experienced Lyme disease than in age-matched individuals who had not had this
infection.
Klempner and his colleagues were able to find 129 patients (seventy-eight with IgG
antibodies to B. burgdorferi and fifty-one without) for a study of the effectiveness of
antibiotic therapy. They found no difference between treated individuals and controls that
received only placebo.
Does chronic Lyme disease really exist? If so, how should it be treated? At the present
time no definite answer can be given to the first question, which precludes an answer to
the second.
