IDSA Guidelines...can anyone tell me what this means?

Actually, I am trying to figure out what the LDA is relying upon for
this statement:

"In a nutshell, the reckless new IDSA guidelines forbid doctors from
using clinical discretion in determining whether or not patients have
Lyme disease. Instead, they require that doctors either see a
characteristic rash known to occur in about half the patients, or that
patients register positive on the two tests recommended by the Centers
for Disease Control & Prevention (CDC) -- tests known to miss up to
half the patients. At any stage of disease, as many as half the
patients may remain undiagnosed".

I can't find this...does anyone understand what they mean?

If a correct interpretation, that would seem to place the IDSA squarely
at odds with the CDC, who has consistently maintained that Lyme disease
is primarily diagnosed in accord with clinical observations. And this
seems odd, as the IDSA panel members are also "expert" advisors to the
CDC...and Steere does seem to indicate the same, that is, that
diagnosis is based upon clinical findings.

They are, after all, TREATMENT guidelines...and they specifically
suggest that physicians familiarize themselves with the methods of
properly diagnosing Lyme disease.

But the guidelines themselves seem to contradict the LDA
interpretation:

"Erythema migrans is the only manifestation of Lyme disease in the
United States that is sufficiently distinctive to allow clinical
diagnosis in the absence of laboratory confirmation. In a patient with
a compatible epidemiologic and clinical history, the preferred means of
diagnosis is visual inspection of the skin lesion. Serologic testing is
too insensitive in the acute phase (the first 2 weeks of infection) to
be helpful diagnostically [102, 103, 116]. Patients should be treated
on the basis of clinical findings. In a minority of cases for which
there may be diagnostic uncertainty, both acute-phase and
convalescent-phase (i.e., 2 weeks after the acute-phase) serum samples
should be tested using the 2-tier testing algorithm recommended by the
Centers for Disease Control and Prevention (CDC) and the Association of
State and Territorial Public Health Laboratory Directors [117].
Untreated patients who remain seronegative, despite continuing symptoms
for 6-8 weeks, are unlikely to have Lyme disease, and other potential
diagnoses should be actively pursued".

"Patients should be treated on the basis of clinical findings". Isn't
that fairly clear? Doesn't that contradict what the LDA says, above?

I am not sure, but I suspect that the LDA's statement may have come
from the following statement in the "executive summary" portion of the
text:

"Clinical findings are sufficient for the diagnosis of erythema
migrans, but clinical findings alone are not sufficient for diagnosis
of extracutaneous manifestations of Lyme disease or for diagnosis of
HGA or babesiosis. Diagnostic testing performed in laboratories with
excellent quality-control procedures is required for confirmation of
extracutaneous Lyme disease, HGA, and babesiosis".

In other words, an EM rash is sufficiently unique to diagnose Lyme by
clinical observation, but no other symptom of Lyme disease is
sufficiently unique to Lyme to CONFIRM the diagnosis without a positive
serology according to the CDC standards.

But...is that that "confirmation of the diagnosis" essential before
TREATMENT?

If I am understanding the above statement that "patients should be
treated on the basis of clinical findings"...then that would tend to
indicate the LDA has misread and misinterpreted the menaing and intent.

But I am not at all sure, quite frankly.

.

Relevant Pages

  • Allen Steere NIH funding history
    ... treatment-resistant arthritis patients with a range of MHC alleles ... Lyme disease, arthritis, autoantigen, autoimmune disorder, bacterial ... Abstract: DESCRIPTION: The goal of this grant ... Borrelia, Lyme disease, biomarker, communicable disease diagnosis, ...
    (sci.med.diseases.lyme)
  • Spinning Lyme
    ... An Understanding of Laboratory Testing for Lyme Disease ... While Lyme disease is a clinical diagnosis, ... almost a third of the patients actually do not ...
    (sci.med.diseases.lyme)
  • The Patient as Diagnostician: How the Internet Helped an MS Patient Find Her True Diagnosis
    ... How many of you have surfed the Web to look for a diagnosis to fit the ... when patients come in with a probable diagnosis already in mind and present ... obsess over symptoms and even to imagine new symptoms in order to fit the ... diagnosis and treatment of Lyme disease. ...
    (alt.support.mult-sclerosis)
  • Re: The LDA is wrong about the IDSA Guidelines
    ... Statement from Pat Smith, President, Lyme Disease Association ... the reckless new IDSA guidelines forbid doctors from ... using clinical discretion in determining whether or not patients have ... diagnosis of Lyme disease is primarily a clinical diagnosis. ...
    (sci.med.diseases.lyme)
  • The LDA is wrong about the IDSA Guidelines
    ... Statement from Pat Smith, President, Lyme Disease Association ... the reckless new IDSA guidelines forbid doctors from ... using clinical discretion in determining whether or not patients have ... diagnosis of Lyme disease is primarily a clinical diagnosis. ...
    (sci.med.diseases.lyme)