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


"the 3rd Man" <derdrittemann2003@xxxxxxxxx> wrote in message
news:1160681602.181862.209500@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

"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?

That is for em rashes only. That is the context of this paragraph.

I don't think it does contradict LDA statement.


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?

Confirmation of the diagnosis by testing is required before treatment for
anything other than EM diagnosis.



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.

That's just for EM rash (see first para above). If the doc is uncertain of
early disease, wait and do testing a few weeks later. If the patient is
seronegative, then consider 'something else'.

That's what I read.

Rita


.

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