Re: Lyme disease surveillance and clinical diagnosis


the 3rd Man wrote:

"Given other compelling evidence, a
physician may choose to treat a patient for Lyme disease when their
condition does not meet the case definition."


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Statement by
Paul Mead, M.D., M.P.H.
Medical Epidemiologist
Division of Vector-Borne Infectious Diseases
National Center for Infectious Diseases,
Center for Disease Control and Prevention,
U.S. Department of Health and Human Services
on
Hearing: CDC's Lyme Disease Prevention and Control Activities
before the
Connecticut Department of Public Health and the Connecticut Attorney
General's Office

January 29, 2004


(text edited)


Lyme Disease Case Definition and Clinical Diagnoses


A clinical diagnosis is made for the purpose of treating an individual

patient and should consider the many details associated with that
patient's illness. Surveillance case definitions are created for the
purpose of standardization, not patient care; they exist so that
health
officials can reasonably compare the number and distribution of
"cases"
over space and time. Whereas physicians appropriately err on the side
of over-diagnosis, thereby assuring they don't miss a case,
surveillance case definitions appropriately err on the side of
specificity, thereby assuring that they do not inadvertently capture
illnesses due to other conditions.


As adopted by the Council of State and Territorial Epidemiologists, a
case of Lyme disease is defined for national surveillance purposes as
physician diagnosed erythema migrans > 5 cm in diameter or at least
one
objective manifestation of late Lyme disease (musculoskeletal,
cardiovascular, or neurological) with laboratory confirmation of B.
burgdorferi infection using a 2-tiered assay. Laboratory confirmation
is considered critical for late stage Lyme disease because the
symptoms
mimic many other common conditions. Without firm objective evidence of

B. burgdorferi infection, persons with other diseases would be counted

erroneously as having Lyme disease.


No surveillance case definition is 100% accurate. There will always be

some patients with Lyme disease whose illness does not meet the
national surveillance case definition. For this reason, CDC has stated

repeatedly that the surveillance case definition is not a substitute
for sound clinical judgment. Given other compelling evidence, a
physician may choose to treat a patient for Lyme disease when their
condition does not meet the case definition.


http://www.hhs.gov/asl/testify/t040129.html

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