Section 1: Introduction

   A most distinctive and disturbing epidemic is growing in America, and few can agree on what it is and how it should be tracked. Lyme Disease (LD) is caused by the tick-borne spirochete Borrelia burgdorferi (Bb) and is acknowledged as the most common vectorborne disease in the United States. According to a recent CDC report, 17,730 Lyme Disease (LD) cases were reported in year 2000 and there have been more than 100,000 cases overall - but there is a common perception among LD activists, LD patients, and students of this disease that LD is underreported by a factor of 10 or more. Furthermore, the most debilitating form of LD, the persistent or chronic form, often referred to as neuroborreliosis, is debunked, or at least felt to be grossly over-diagnosed by powerful factions in academic medicine. Unfortunately, this attitude filters down to most treating physicians, especially in a low prevalence region for LD like the Carolinas, whose physicians thereby tend to trivialize or deny the existence of persistent LD, or neuroborreliosis.

   For surveillance purposes, the CDC employs a definition for LD as the presence of a physician-diagnosed erythema migrans (EM) rash > 5 cm in diameter or at least one manifestation of musculoskeletal, neurologic, or cardiovascular disease with laboratory confirmation of Bb infection. A number of confounding factors, ranging from physician or patient failure to recognize EM, to inaccurate laboratory testing, serve to disguise the true magnitude of this epidemic. In addition, there is growing evidence that coinfections with other microbes, such as Bartonella hanselae, Babesiosis microti, and Ehrlichiosis chafeensis may occur in as many as 25% of recognized LD cases. Coinfection with any of these pathogens tends to confound the clinical course and present difficult treatment issues. In our experience, patients with a coinfected state tend to have more difficult and complicated illnesses.

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