I'm going to interrupt as well in case anyone is interested in these notes prepared by the author of the blog "Relative Risk" -- posted just a few hours ago. His highlighting is shown in blue:
http://relative-risk.blogspot.ca/2012/0 ... orway.html
08 AUGUST 2012
"Chronic" Lyme in Norway
Eur J Neurol. 2012 Aug;19(8):1128-35. doi: 10.1111/j.1468-1331.2012.03691.x. Epub 2012 Mar 15. The phenomenon of 'chronic Lyme'; an observational study.
Ljøstad U, Mygland A.
Many patients are confused, and some come forward to newspapers and the internet with their feelings of being misdiagnosed, mistreated, and discouraged. Furthermore, many healthcare providers feel ambivalent when faced with patients who present with disabling symptoms, ambiguous laboratory test results, and an expressed wish of long-term antibiotic treatment. Earlier studies have shown that only a small proportion of patients referred to specialized Lyme disease clinics, have ongoing Bb infection, and a recent review concludes that ‘the assumption that chronic, subjective symptoms are caused by persistent infection with Bb is not supported by carefully conducted laboratory studies or by controlled treatment trials’. The generalizability of these studies is, however, called in question by the spokesmen for existence and severity of persistent Bb infections.
The annual number of reported cases of disseminated Lyme disease in Norway is around 300, with a background seroprevalence of 15–20% in the high-endemic areas.
Our aim was to evaluate possible causes of complaints in Norwegian patients who believe they have ongoing chronic Bb infection, and to assess the patients’ burden of symptoms, psychometric properties, and illness perception.
Patients were eligible if they suffered from symptoms suspected by themselves or their doctor to be caused by ongoing chronic Bb infection. Objective clinical or laboratory manifestations of Lyme disease were not mandatory. They became aware of the study by a small notice in two nationwide newspapers, or by information from others, and were recruited through referral from primary care, other hospitals, or self-referral. They were informed that we wanted to chart symptoms, laboratory results, quality of life, and coping strategies. The first 30 referred patients were included.
Our study population consisted of patients who basically attributed their complaints to chronic Lyme disease. The patients reported many symptoms, 70% were not working, their health-related quality of life was poor, but none met European diagnostic criteria for ongoing Bb infection. Is this a result of dysfunctional diagnostic criteria, dysfunctional patients, or both?
Arguments against ongoing Bb infection are absence of objective neurologic signs, negative CSF findings including CXCL13 and Bb PCR, and no sustained efficacy of a mean antibiotic treatment of 12 weeks. Further, half of our patients were seronegative, and in absence of a clinical picture consistent with ongoing Bb infection, presence of anti-Bb antibodies in the rest can be regarded as ‘serologic scars’ from earlier exposure to Bb.
Nevertheless, even if persistent infection cannot be totally excluded as a differential diagnosis and dysfunctional criteria remains a consideration, we did not find convincing evidences of ongoing Bb infection in any of our patients. Then, what are the causes for the patient’s long-standing complaints?
We could not find more depression, anxiety, or hypochondriasis amongst our patients than reported amongst healthy persons, nor did the three subscores in SF-36 assessing mental health-related quality of life differ between our patients and normative data. Illness perception amongst our patients was, however, characterized by negative beliefs. In summary, we regard ongoing Bb infection as unprobable in our patients, and hypothesize that other well-defined illnesses, permanent tissue damage from earlier infection, autoimmunity, and negative expectations about the symptoms were more important illness predisposing and perpetuating factors than depression, anxiety, and hypochondriasis.
Edited to fix a typo.