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


"the 3rd Man" <derdrittemann2003@xxxxxxxxx> wrote in message
news:1160702036.180233.126370@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Rita Stanley wrote:

"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.

Yes, that's what I thought initially, also...but look at the sentence
that immediately precedes it:

"Serologic testing is too insensitive in the acute phase (the first 2
weeks of infection) to
be helpful diagnostically" .

Why would you be talking about serologic testing in relation to an EM
rash...when you have just acknowledged that a clinical observation of
an EM is sufficient to diagnose?

Because there are docs who want to confirm the EM rash with testing; they
want the security of some lab results. The GL's are telling them not to do
that.

I've got feedback from lots of folks whose docs did testing along with EM
rash presentations. Not uncommon at all. The docs don't care to understand
the tests. Modern docs are dependent on tests. Others feel that the rash is
'something else' like ringworm or a
spider bite' and want to test to show the patient that their concerns about
LD are unnecessary. I've heard tons of these stories. Tons.


Doesn't make sense...

Makes sense to me.

Think like a doc presented with a recipe to follow.




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

What's your source for this, please?

No source. That's how I read it. Maybe I read it wrong, but who else is
reading it the way I do?

Not trying to be argumentative,

No problem with argument....


but just trying to understand this...don't doctors frequently treat on
"presumptive diagnoses"? In other words, if a diagnosis is not
"confirmed"...I always thought they had the latitude to treat .

Yes, but I think that this GL is trying to discourage that with LD. They
give you the steps. If you are unsure of the diagnosis (EM), run the tests a
few weeks later.


And...if the "clinical" aspect is over-ruled...countered by a blood
test...isn't that really pure serodiagnosis?

Yes. Call it a 'confirmation' though. Goes on all the time for lots of
diseases. No thinking required. If you can read a recipe (granted, this one
is confusing), you can diagnose and treat disease.

Rita


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