Could You Have This Summer Sickness?

The Right Diagnosis

It is precisely because the symptoms of advanced Lyme resemble those of a number of other illnesses (see "Is It Really Lyme Disease?") that the diagnosis controversy erupted. One group, the Infectious Diseases Society of America (IDSA), a professional organization of physicians and other experts, recently issued updated guidelines for diagnosing Lyme that require the presence of the bull's-eye rash or confirmation from two blood tests -- the ELISA (enzyme-linked immuno-assay) test or the Western blot test -- plus the presence of indisputably Lyme-caused symptoms, such as facial palsy or arthritis.

But another group, the International Lyme and Associated Diseases Society (ILADS) says the guidelines exclude many people with Lyme. ILADS doctors claim that only about half of patients have rashes. The group also says that the ELISA test misses 35 to 50 percent of Lyme cases, and the Western blot misses 20 to 30 percent. These physicians use additional tests to see whether patients who tested negative for Lyme on the commercially available tests show evidence of it.

What's more, a Lyme-carrying tick may transmit other infections at the same time, such as malaria-like babesiosis, HGA (human granulocytic anaplasmosis) and the bacterial infection bartonella. "Lyme disease is really a complex of tick-borne diseases," says Raphael Stricker, MD, a San Francisco Lyme specialist and president of ILADS. These other illnesses, called co-infections, may require different tests and treatments.