2. Medical and scientific abstracts on Lyme disease and fibromyalgia ************************************************************************ as of 26 October 1999 Sources: Welcome to PubMed http://www.ncbi.nlm.nih.gov/PubMed/ The Lyme Disease Network of NJ, Inc. Lyme Disease Network Medical / Scientific Literature Database Search Form http://www2.lymenet.org/domino/abstract.nsf/$$Search Abstracts: Contents -------- - Abstracts supportive of a connection between fibromyalgia and Lyme disease. - Abstracts not supportive of a connection between fibromyalgia and Lyme disease. - Other abstracts pertaining to Lyme disease and fibromyalgia. --------------- Abstracts supportive of a connection between fibromyalgia and Lyme disease: TITLE: Pathogenesis of Lyme neuroborreliosis in the rhesus monkey: the early disseminated and chronic phases of disease in the peripheral nervous system. AUTHORS: Roberts ED; Bohm RP Jr; Lowrie RC Jr; Habicht G; Katona L; Piesman J; Philipp MT AUTHOR AFFILIATION: Tulane Regional Primate Research Center, Tulane University Medical Center, Covington, Louisiana 70433, USA. SOURCE: J Infect Dis 1998 Sep;178(3):722-32 CITATION IDS: PMID: 9728541 UI: 98396713 ABSTRACT: The histopathologic and immunohistochemical features of early and late neuroborreliosis of the peripheral nervous system were investigated in rhesus macaques infected with the JD1 strain of Borrelia burgdorferi. Infection was proven by culture or polymerase chain reaction analysis of skin biopsies and indirectly by Western blot analysis. Three months after infection, neuritis involving multiple nerves was the most consistent neurologic manifestation. Both macrophages and B lymphocytes but not T lymphocytes were present in the cellular infiltrates. Axonal structures surrounding infiltrates had changes consisting of demyelination and axonal phagocytosis. Some of the Schwann cells in lesions stained with anti-nitrotyrosine and anti-tumor necrosis factor- alpha antibodies. B. burgdorferi, or antigens thereof, were visualized immunohistochemically within macrophages. Forty-six months after infection, the most common changes were regenerative, whereas neuritis was infrequent. Aberrant axonal regeneration, irregularly sized myelinated fibers, and fibrosis were frequently observed. Possible mechanisms to explain the appearance and subsidence of Lyme neuritis are discussed. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9728541&form=6&db=m&Dopt=b ----- TITLE: Detection of Borrelia burgdorferi DNA in muscle of patients with chronic myalgia related to Lyme disease [see comments] AUTHORS: Frey M; Jaulhac B; Piemont Y; Marcellin L; Boohs PM; Vautravers P; Jesel M; Kuntz JL; Monteil H; Sibilia J AUTHOR AFFILIATION: Service de Medecine Physique et Readaptation, Hopitaux Universitaires de Strasbourg, and the Institut de Bacteriologie, Faculte de Medecine, Universite Louis Pasteur, France. SOURCE: Am J Med 1998 Jun;104(6):591-4 CITATION IDS: PMID: 9674723 UI: 98337480 COMMENT: Comment in: Am J Med 1999 Apr;106(4):491-2 [No abstract available] MESH Headings Adult ; Aged ; Antibodies, Bacterial BL ; Borrelia burgdorferi GE/IM/*IP ; Case-Control Studies ; Chronic Disease ; DNA, Bacterial *IP ; Female ; Fibromyalgia *MI ; Human ; Lyme Disease *CO/DT ; Male ; Middle Age ; Muscle, Skeletal *MI ; Polymerase Chain Reaction ; Time Factors http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9674723&form=6&db=m&Dopt=b ----- TITLE: Differentiation of orofacial pain related to Lyme disease from other dental and facial pain disorders. AUTHORS: Heir GM AUTHOR AFFILIATION: Department of Oral Pathology, Biology and Diagnostic Sciences, University of Medicine and Dentistry, New Jersey Dental School, Newark, USA. SOURCE: Dent Clin North Am 1997 Apr;41(2):243-58 CITATION IDS: PMID: 9142482 UI: 97287390 ABSTRACT: The diagnostic process for the orofacial pain patient is often perplexing. Compounding the process of solving a diagnostic mystery is the multiplicity of etiologic factors. The propensity for Lyme disease to present with symptoms mimicking dental and temporomandibular disorders makes the task even more complex. It is hoped that the reader is cognizant of the fact that a pathologic process of dental structures- -the teeth and their attachments to the mandible and maxilla, the temporomandibular joints, masticatory musculature, and vascular supply and sensory innervation of the oromandibular anatomy--may also be the source of facial pain. Although unique, similar complaints may also be manifestations of other causes, including pain associated with Lyme disease. The informed and fastidious clinician does not overlook these possibilities when evaluating the headache and facial pain patient. The clinician should be equipped with the knowledge and minimal armamentarium to evaluate the patient appropriately. To paraphrase from Sherlock Holmes, we must first eliminate the impossible, whatever is left is the truth, no matter how unlikely. A differential diagnosis must be achieved based on clinical experience, unbiased observations, and probability. MESH Headings Diagnosis, Differential ; Facial Pain *ET ; Fibromyalgia DI ; Headache ET ; Human ; Lyme Disease CO/*DI ; Myofascial Pain Syndromes DI ; Neuralgia DI ; Stomatitis, Denture DI ; Temporomandibular Joint Disorders CO/*DI/ET ; Toothache ET http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9142482&form=6&db=m&Dopt=b ----- TITLE: [Detection of Borrelia burgdorferi DNA by gene amplification in the muscle of a patient with fibromyalgia (letter)] VERNACULAR TITLE: Detection d'ADN de Borrelia burgdorferi par amplification genique dans le muscle d'un patient atteint de fibromyalgie. AUTHORS: Frey M; Jaulhac B; Sibilia J; Monteil H; Kuntz JL; Vautravers P SOURCE: Presse Med 1995 Nov 11;24(34):1623 CITATION IDS: PMID: 8545375 UI: 96142452 No abstract available. MESH Headings Borrelia burgdorferi *IP ; Case Report ; Fibromyalgia *MI ; Human ; Lyme Disease *MI ; Male ; Middle Age ; Polymerase Chain Reaction http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8545375&form=6&db=m&Dopt=b ----- TITLE: Juxta-articular fibrotic nodules in Borrelia infection--ultrastructural details of therapy-induced regression. AUTHORS: Marsch WC; Wolter M; Mayet A AUTHOR AFFILIATION: Department of Dermatology, Martin-Luther-Universitat, Halle (Saale)- Wittenberg, Germany. SOURCE: Clin Exp Dermatol 1994 Sep;19(5):394-8 CITATION IDS: PMID: 7955495 UI: 95043514 ABSTRACT: Juxta-articular fibrotic nodules in chronic Borrelia burgdorferi infection commonly regress rapidly under antibiotic therapy. They may therefore serve as a good in vivo model for studying the development and regression of cutaneous fibrotic processes. As shown in a typical case of acrodermatitis chronica atrophicans, this spirochete-induced fibrosis in the upper subcutis of the elbow region is histologically characterized by broad hyalinized collagen tracts interspersed with prominent perivascular lymphocytes and plasma cells. These immune cells vanish completely after 5 days of antibiotic treatment, while fibroblasts discharge matrix vesicles and form elastic fibres. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7955495&form=6&db=m&Dopt=b ----- TITLE: Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. AUTHORS: Goldenberg DL AUTHOR AFFILIATION: Newton-Wellesley Hospital, Massachusetts. SOURCE: Curr Opin Rheumatol 1994 Mar;6(2):223-33 CITATION IDS: PMID: 8024971 UI: 94296866 ABSTRACT: No major pathophysiologic or therapeutic findings have appeared over the past year regarding fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome, three poorly understood, controversial, and overlapping syndromes. The frequent prevalence of these disorders in association with Lyme disease and other medical and psychiatric illness was emphasized. New studies demonstrated the potential role for central nervous system activation in fibromyalgia and chronic fatigue syndrome. MESH Headings Fatigue Syndrome, Chronic */EP/PP/TH ; Fibromyalgia */EP/PP/TH ; Human ; Myofascial Pain Syndromes */EP/PP/TH ; Prevalence http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8024971&form=6&db=m&Dopt=b ----- TITLE: Do infections trigger fibromyalgia? [editorial; comment] AUTHORS: Goldenberg DL SOURCE: Arthritis Rheum 1993 Nov;36(11):1489-92 CITATION IDS: PMID: 8240426 UI: 94059187 COMMENT: Comment on: Arthritis Rheum 1993 Nov;36(11):1493-1500 No abstract available. MAIN MESH HEADINGS: Fibromyalgia/*etiology Lyme Disease/*complications [Overview of the syndrome of fibromyalgia. Consideration is given to infectious agents as possible triggers of the development of the signs and symptoms associated with this disorder. Lyme disease as a possible infectious trigger is discussed in depth.] http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8240426&form=6&db=m&Dopt=b ----- TITLE: Lyme disease. AUTHORS: Brier SR AUTHOR AFFILIATION: Division of Clinical Sciences, New York Chiropractic College, Glen Head. SOURCE: J Manipulative Physiol Ther 1990 Jul-Aug;13(6):337-9 CITATION IDS: PMID: 2394950 UI: 90369241 ABSTRACT: A 29-year-old male tennis player was examined for neck pain, limited mobility, and right elbow pain. The patient was treated for cervical facet syndrome by chiropractic manipulative therapy (CMT) for a period of 6 weeks. After this time the patient had a relapse of cervical pain, spinal myofascitis, dermatitis and migratory arthropathy. Several specialists were consulted throughout the case including a rheumatologist, and a tentative diagnosis of psoriatic arthritis and fibromyalgia was made. A follow-up blood evaluation led to a new diagnosis of Lyme disease. MESH Headings Adult ; Arthritis, Infectious DI ; Case Report ; Cervical Vertebrae ; Chiropractic ; Diagnosis, Differential ; Human ; Lyme Disease *DI ; Male ; Spinal Diseases *DI/TH http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2394950&form=6&db=m&Dopt=b ----- TITLE: [Lyme borreliosis in neurology and psychiatry] VERNACULAR TITLE: Die Lyme-Borreliose in Neurologie und Psychiatrie. AUTHORS: Kohler J AUTHOR AFFILIATION: Neurologische Klinik mit Poliklinik, Universitat Freiburg. SOURCE: Fortschr Med 1990 Apr 10;108(10):191-3, 197 CITATION IDS: PMID: 2187778 UI: 90256076 ABSTRACT: Neurological manifestations of Lyme disease are as multifarious as the entire spectrum of this common infection. In stage I, fibromyalgia and, more rarely, painful muscular fasciculation, dominate the clinical picture. In the individual case, mild psychic abnormalities may already be observed. Characteristic of the 2nd stage is lymphocytic meningopolyneuritis. Involvements of the CNS are expressed not so much in focal deficits, as in diffuse psychopathological disorders. In stage 3, CNS manifestations are characterized by chronic, in part multifocal, encephalitides and encephalomyelitides, isolated transverse myelitides and cerebral vasculitic disorders. The clinical symptomatology may be dominated by severe psychiatric syndromes. Connatal and subclinical latent infections of the nervous system with Borrelia represent special forms. MESH Headings Diagnosis, Differential ; English Abstract ; Human ; Lyme Disease CO/*DI ; Mental Disorders *DI/ET ; Nervous System Diseases *DI/ET http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2187778&form=6&db=m&Dopt=b ----- TITLE: Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node [published erratum appears in Postgrad Med J 1990 Mar;66(773):258] AUTHORS: Cary NR; Fox B; Wright DJ; Cutler SJ; Shapiro LM; Grace AA AUTHOR AFFILIATION: Department of Histopathology, Charing Cross and Westminster School, London, UK. SOURCE: Postgrad Med J 1990 Feb;66(772):134-6 CITATION IDS: PMID: 2349186 UI: 90272586 ABSTRACT: A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia ('mesothelioma') of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2349186&form=6&db=m&Dopt=b ----- TITLE: Demonstration of spirochaetes in patients with Lyme disease with a modified silver stain. AUTHORS: De Koning J; Bosma RB; Hoogkamp-Korstanje JA SOURCE: J Med Microbiol 1987 May;23(3):261-7 CITATION IDS: PMID: 2438410 UI: 87226085 ABSTRACT: Spirochaetes were demonstrated in material from patients with Lyme disease by short-time high-concentrate silver impregnation after treatment with amylase. Removal of mucoid material was essential to visualise Borrelia burgdorferi. Lyme spirochaetes were demonstrated in material from 23 patients with Lyme disease--erythema chronicum migrans (ECM) 10, lymphadenosis benigna cutis (LABC) 7, arthritis 4 and Bannwarth's syndrome 2. Spirochaetes were localised in the subepidermal zone, peri- and intravascularly, and in collagen fibres in ECM and LABC, and beneath the synovial lining cells in arthritis, producing marked vascular changes with fibrosis and synovial hyperplasia. Spirochaetes were also demonstrated in CSF from a patient with Bannwarth's syndrome. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2438410&form=6&db=m&Dopt=b --------------- Abstracts not supportive of a connection between fibromyalgia and Lyme disease: TITLE: Lyme disease update. Current approach to early, disseminated, and late disease. AUTHORS: Rahn DW; Felz MW AUTHOR AFFILIATION: Section of General Internal Medicine, Medical College of Georgia School of Medicine, Augusta 30912-3104, USA. deptmed.drahn@mail.mcg.edu SOURCE: Postgrad Med 1998 May;103(5):51-4, 57-9, 63-4 passim CITATION IDS: PMID: 9590986 UI: 98253211 ABSTRACT: A rational approach to diagnosis and treatment of Lyme disease requires an understanding of the endemic range of the tick vectors for B burgdorferi, the epidemiologic risk factors, and the spectrum of clinical manifestations. A two-step approach to serologic testing (ELISA followed by Western blot analysis of positive or equivocal results) can be useful if the pretest likelihood of Lyme disease is higher than 20%. Consideration should be given to the possibility of (1) a noninfectious disease with clinical features similar to those of Lyme disease or (2) coinfection with a second tick-transmitted organism. Late Lyme disease must be distinguished by clinical characteristics from fibromyalgia (the commonest source of misdiagnosis in several studies). Antibiotic therapy should be tailored to the extent of disease and limited to 4 weeks in most cases. Human vaccines based on an outer-surface protein from B burgdorferi have been tested in large-scale US clinical trials and may soon be approved for use in persons whose occupational or recreational activities place them at risk for B burgdorferi exposure. MESH Headings Animal ; Antibiotics *TU ; Arachnid Vectors ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Human ; Lyme Disease *DI/*DT/ET/TM ; Prevalence ; Risk Factors ; Ticks ; Time Factors Publication Type http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9590986&form=6&db=m&Dopt=b ----- TITLE: A "minority" opinion about the diagnosis and treatment of Lyme arthritis. AUTHORS: Graninger W AUTHOR AFFILIATION: Klinische Abt. fur Rheumatologie, Universitatsklinik fur Innere Medizin III, Wien, Austria. SOURCE: Infection 1996 Jan-Feb;24(1):95-7 CITATION IDS: PMID: 8852481 UI: 97005170 ABSTRACT: Historically, arthritis was the main symptom which led to the description of the disease called Lyme borreliosis. However, a relatively high awareness of doctors and patients of tick-borne diseases seems to cause a trend to frequently diagnose this antibiotic-sensitive disease. A case can be defined as borreliosis only if either the typical erythema migrans is reliably identified by a physician or if a characteristic late manifestation of Lyme disease is accompanied by unequivocal serological and/or bacteriological evidence of Borrelia infection. Within the musculoskeletal system, the only reliably characteristic symptom is true synovitis, as defined by the palpable swelling of a joint. Mere joint pain or the subjective pain syndrome of fibromyalgia do not constitute a defining symptom for borreliosis. An evaluation of the frequency of Borrelia-associated arthritis in our Viennese rheumatology outpatient clinic revealed only six well-defined cases among 1,673 subsequent referrals. Based on "serological" suspicion, the question had been asked about possible borreliosis in 87 of these patients. In order to avoid unnecessary anxiety about possible long-term complications of Lyme disease among (actually misdiagnosed) patients, the diagnosis of Lyme arthritis should only be made according to the stringent criteria mentioned above. The antibiotic treatment, which is given to many questionable cases of borreliosis ex iuvantibus, although possibly of benefit to a few cases of otherwise undiagnosed reactive arthritis due to infections with microbes other than Borrelia burgdorferi, has to be termed irrational. MESH Headings Arthritis, Infectious CO/*DI/PP/*TH ; Human ; Lyme Disease CO/*DI/PP/*TH http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8852481&form=6&db=m&Dopt=b ----- TITLE: "Chronic Lyme disease" as the incorrect diagnosis in patients with fibromyalgia [see comments] AUTHORS: Hsu VM; Patella SJ; Sigal LH AUTHOR AFFILIATION: Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903-0019. SOURCE: Arthritis Rheum 1993 Nov;36(11):1493-500 CITATION IDS: PMID: 8240427 UI: 94059188 COMMENT: Comment in: Arthritis Rheum 1993 Nov;36(11):1489-92 ABSTRACT: OBJECTIVE. To evaluate a large number of patients referred with persistent symptoms thought to represent chronic Lyme disease. METHODS. We retrospectively reviewed the charts of nearly 800 patients referred with persisting nonspecific musculoskeletal and/or neurologic symptoms thought to represent chronic Lyme disease. RESULTS. Seventy-seven patients were found to have fibromyalgia, not ongoing Lyme disease, as the explanation of their chronic symptoms. Many had received multiple courses of antibiotic therapy for symptoms of fibromyalgia mistakenly attributed to chronic Lyme disease. No patient reported permanent and/or total resolution of fibromyalgia symptoms following antibiotic therapy. Appropriate therapy for fibromyalgia in those who remained compliant, however, was often effective in improving some if not all of the chronic symptoms. CONCLUSION. Fibromyalgia is a treatable and potentially curable disorder, and should be considered in the evaluation of patients with "refractory Lyme disease." Keywords: Adult, Aged, Antibiotics, THERAPEUTIC USE, Chronic Disease, Diagnostic Errors, Female, Fibromyalgia, DIAGNOSIS, Human, Lyme Disease, DIAGNOSIS, DRUG THERAPY, Male, Middle Age http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8240427&form=6&db=m&Dopt=b ----- TITLE: Experience at a referral center for patients with suspected Lyme disease in an area of nonendemicity: first 65 patients. AUTHORS: Burdge DR; O'Hanlon DP AUTHOR AFFILIATION: Department of Medicine, University of British Columbia, Vancouver, Canada. SOURCE: Clin Infect Dis 1993 Apr;16(4):558-60 CITATION IDS: PMID: 8513065 UI: 93291347 ABSTRACT: A multidisciplinary referral center was established at a university hospital for prospectively assessing patients with possible Lyme disease. Borrelia burgdorferi is not known to be endemic in this region, but considerable anxiety about Lyme disease has developed among the general public. Sixty-five patients were referred for suspected Lyme borreliosis. Detailed histories were obtained and physical examinations were performed; patients were investigated aggressively in accordance with their symptom complexes. Strict diagnostic criteria consistent with published standards were applied. Only two of the 65 patients were judged to have probable Lyme disease. Definite major alternate diagnoses were made for 50 patients (77%); firm medical diagnoses (11 dermatologic, 9 rheumatologic, 9 infectious disease, 6 gastrointestinal, 4 neurological, and 2 miscellaneous) were made for 41 patients (63%); and major psychiatric diagnoses were made for 9 patients (14%). Probable diagnoses of chronic fatigue syndrome and fibromyalgia were made for 11 patients (17%). The conditions of four patients (6%) were undiagnosed. A referral center for patients with suspected Lyme disease can be useful even in an area of nonendemicity, and careful clinical assessment will reveal treatable alternate diagnoses for many patients with suspected Lyme disease. Keywords: Adolescence, Adult, Aged, Antibodies, Bacterial, BLOOD, Blotting, Western, Borrelia burgdorferi, IMMUNOLOGY, Canada, Child, Child, Preschool, Diagnosis, Differential, Female, Fluoroimmunoassay, Human, Immunoenzyme Techniques, Lyme Disease, DIAGNOSIS, Male, Middle Age, Prospective Studies, Referral and Consultation, Support, Non-U.S. Gov't http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8513065&form=6&db=m&Dopt=b ----- TITLE: Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia. AUTHORS: Sigal LH; Patella SJ AUTHOR AFFILIATION: Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick. SOURCE: Pediatrics 1992 Oct;90(4):523-8 CITATION IDS: PMID: 1408503 UI: 93026860 ABSTRACT: In areas endemic for Lyme disease there is increasing concern and anxiety about possible chronic and untreatable manifestations of the disease. The authors have diagnosed fibromyalgia in many patients with chronic musculoskeletal complaints in whom chronic Lyme arthritis had previously been diagnosed as the cause of their joint pains. Fibromyalgia is a common disorder, causing arthralgia (not true arthritis), fatigue, and debility. The repeated and/or long-term antibiotic therapy prescribed for "chronic Lyme disease" is not successful in curing the symptoms of fibromyalgia. Especially in areas where anxiety about Lyme disease is great, it is important to be careful in diagnosing chronic Lyme disease. Fibromyalgia is a potentially treatable and curable cause of chronic complaints and should be considered in the differential diagnosis of "refractory Lyme arthritis." MESH Headings Adolescence ; Child ; Diagnostic Errors ; Female ; Fibromyalgia *DI ; Human ; Lyme Disease *DI ; Male ; Retrospective Studies http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1408503&form=6&db=m&Dopt=b ----- TITLE: Summary of the first 100 patients seen at a Lyme disease referral center. AUTHORS: Sigal LH AUTHOR AFFILIATION: Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019. SOURCE: Am J Med 1990 Jun;88(6):577-81 CITATION IDS: PMID: 2346158 UI: 90266835 ABSTRACT: PURPOSE AND PATIENTS AND METHODS: Lyme disease is a major clinical problem in a number of endemic areas in the United States. In areas where anxiety about the disease is high, patients and physicians often ascribe clinical concerns to Lyme disease. Incorrect diagnosis often leads to unnecessary antibiotic treatment (often prolonged or repeated intravenous therapy). This report summarizes the cases of the first 100 patients referred to the Lyme Disease Center at Robert Wood Johnson Medical School. RESULTS: In only 37 of the patients referred was Lyme disease, either current or preceding, the explanation for the complaints. Many of the patients had another definable arthropathy. Twenty-five of the patients had fibromyalgia, which has not previously been reported in Lyme disease. Three of these patients had active Lyme disease at the time of evaluation, and 17 had a history suggesting preceding Lyme disease. Approximately half of the 91 courses of antibiotic therapy given to these 100 patients before referral were probably unwarranted. CONCLUSIONS: Anxiety about possible late manifestations of Lyme disease has made Lyme disease a "diagnosis of exclusion in many endemic areas. Persistence of mild to moderate symptoms after adequate therapy and misdiagnosis of fibromyalgia and fatigue may incorrectly suggest persistence of infection, leading to further antibiotic therapy. Attention to patient anxiety and increased awareness of these musculoskeletal problems after therapy should decrease unnecessary therapy of previously treated Lyme disease. MESH Headings Adolescence ; Adult ; Aged ; Antibiotics TU ; Antibodies, Bacterial AN ; Arthritis, Infectious DI ; Borrelia burgdorferi IM ; Child ; Child, Preschool ; Diagnosis, Differential ; Erythema Chronicum Migrans DI ; Female ; Fibromyalgia DI ; Human ; Lyme Disease BL/*DI/DT ; Male ; Middle Age ; Referral and Consultation ; Retrospective Studies http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2346158&form=6&db=m&Dopt=b --------------- Other abstracts pertaining to Lyme disease and fibromyalgia: TITLE: Lyme disease. Shift the paradigm! AUTHORS: Ellenbogen C SOURCE: Arch Fam Med 1997 Mar-Apr;6(2):191-5 CITATION IDS: PMID: 9075458 UI: 97229895 MESH Headings Blotting, Western ; Borrelia burgdorferi * ; Cefotaxime TU ; Ceftriaxone TU ; Cephalosporins TU ; Chronic Disease ; Diagnosis, Differential ; Fatigue Syndrome, Chronic DI/MI ; Fibromyalgia DI/MI ; Human ; Lyme Disease */DI/DT/IM ; Severity of Illness Index http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9075458&form=6&db=m&Dopt=b ----- TITLE: Complaints attributed to chronic Lyme disease: depression or fibromyalgia? [letter; comment] AUTHORS: Berman DS; Wenglin BD SOURCE: Am J Med 1995 Oct;99(4):440 CITATION IDS: PMID: 7573105 UI: 96006095 COMMENT: Comment on: Am J Med 1994 Apr;96(4):365-74 No abstract available. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7573105&form=6&db=m&Dopt=b ----- TITLE: Musculoskeletal manifestations of Lyme disease. AUTHORS: Steere AC AUTHOR AFFILIATION: Division of Rheumatology/Immunology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. SOURCE: Am J Med 1995 Apr 24;98(4A):44S-48S; discussion 48S-51S CITATION IDS: PMID: 7726191 UI: 95243253 ABSTRACT: Musculoskeletal involvement, particularly arthritis, is a common feature of Lyme disease. Early in the illness, patients may experience migratory musculoskeletal pain in joints, bursae, tendons, muscle, or bone in one or a few locations at a time, frequently lasting only hours or days in a given location. Weeks to months later, after the development of a marked cellular and humoral immune response to the spirochete, untreated patients often have intermittent or chronic monoarticular or oligoarticular arthritis-primarily in large joints, especially the knee-during a period of several years. The diagnosis of Lyme arthritis is usually based on the presence of this characteristic clinical picture, exposure in an endemic area, and an elevated immunoglobulin G antibody response to Borrelia burgdorferi. In addition, spirochetal DNA can often be detected in joint fluid by polymerase chain reaction. Lyme arthritis can usually be treated successfully with 1- month courses of oral doxycycline or amoxicillin or with 2- to 4-week courses of intravenous ceftriaxone. However, patients with certain genetic and immune markers may have persistent arthritis, despite treatment with oral or intravenous antibiotics. B. burgdorferi may occasionally trigger fibromyalgia, a chronic pain syndrome with diffuse joint and muscle symptoms. This syndrome does not appear to respond to antibiotic therapy. MESH Headings Arthritis, Infectious *MI/TH ; Diagnosis, Differential ; Human ; Lyme Disease *CO/*DI/TH ; Support, U.S. Gov't, P.H.S. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7726191&form=6&db=m&Dopt=b ----- TITLE: Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. AUTHORS: Goldenberg DL AUTHOR AFFILIATION: Newton-Wellesley and Tufts University School of Medicine, Massachusetts, USA. SOURCE: Curr Opin Rheumatol 1995 Mar;7(2):127-35 CITATION IDS: PMID: 7766493 UI: 95283902 ABSTRACT: Two important studies in which nuclear magnetic resonance spectroscopy was used convincingly demonstrated that muscle is not the primary pathologic factor in fibromyalgia. There were further studies reporting that fibromyalgia-chronic fatigue syndrome may follow well treated Lyme disease or mimic Lyme disease. The longest therapeutic trial to date in fibromyalgia demonstrated an initial modest effect of tricyclic medications, but at 6 months that efficacy was no longer evident. Investigation in both fibromyalgia and chronic fatigue syndrome now focuses on the central nervous system. The use of new technology, eg, neurohormonal assays and imaging such as single-photon emission computed tomography scan, may be important in understanding these elusive conditions. MESH Headings Fatigue Syndrome, Chronic */DI/ET/TH ; Fibromyalgia */DI/ET/TH ; Human ; Myofascial Pain Syndromes */DI/TH http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7766493&form=6&db=m&Dopt=b ----- TITLE: [The classification of Lyme borreliosis (Lyme disease)] VERNACULAR TITLE: O klassifikatsii Laim-borrelioza (laimskoi bolezni). AUTHORS: Lesniak OM; Belikov ES SOURCE: Ter Arkh 1995;67(11):49-51 CITATION IDS: PMID: 8571252 UI: 96151296 ABSTRACT: A new version of Lyme's disease classification based on the authors' experience and other classifications is proposed. It distinguishes periods of the disease (acute, subacute, chronic) and stages (I--isolated erythema migrans, II--local disseminated infection, III--generalized disseminated infection) as well as the signs which are significant in Lyme's disease diagnosis: erythematous and nonerythematous form, seropositivity or seronegativity against Borrelia burgdorferi. Subclinical (latent) infection, complications of Lyme's disease (fibromyalgia syndrome, chronic fatigue syndrome, etc.) and mixed-infection with tick-borne viral encephalitis are included as well. MESH Headings Acute Disease ; Case Report ; Chronic Disease ; English Abstract ; Erythema Chronicum Migrans CL/DI ; Female ; Human ; Lyme Disease *CL/DI ; Male ; Middle Age http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8571252&form=6&db=m&Dopt=b ----- TITLE: Lyme disease: a growing threat to urban populations. AUTHORS: Steere AC AUTHOR AFFILIATION: Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111. SOURCE: Proc Natl Acad Sci U S A 1994 Mar 29;91(7):2378-83 CITATION IDS: PMID: 8146126 UI: 94195749 ABSTRACT: Lyme disease or Lyme borreliosis, which is caused by three groups of the spirochete Borrelia burgdorferi, is transmitted in North America, Europe, and Asia by ticks of the Ixodes ricinus complex. The primary areas around the world that are now affected by Lyme disease are near the terminal moraine of the glaciers 15,000 years ago. The emergence of Lyme disease in the United States in this century is thought to have occurred because of ecological conditions favorable for deer. From 1982 through 1991, 40,195 cases occurring in 47 states were reported to the Centers for Disease Control, but enzootic cycles of B. burgdorferi have been identified in only 19 states. During the last several decades, the disease has spread to new areas and has caused focal outbreaks, including locations near Boston, New York, and Philadelphia. Lyme disease is like syphilis in its multisystem involvement, occurrence in stages, and mimicry of other diseases. Diagnosis of late neurologic abnormalities of the disorder has created the most difficulty. A recent phenomenon is that a number of poorly understood conditions, such as chronic fatigue syndrome or fibromyalgia, are misdiagnosed as "chronic Lyme disease." Part of the reason for misdiagnosis is due to problems associated with diagnostic tests. The various manifestations of Lyme disease can usually be treated successfully with oral doxycycline or amoxicillin, except for objective neurologic manifestations, which seem to require intravenous therapy. Vector control of thick-borne diseases has been difficult and, therefore, reduction of the risk of infection has been limited primarily to personal protection measures. MESH Headings Animal ; Borrelia burgdorferi CL/PY ; Deer PS ; Human ; Lyme Disease DI/*EP/MI/TH ; Support, U.S. Gov't, P.H.S. ; Ticks MI ; United States ; Urban Population http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8146126&form=6&db=m&Dopt=b ----- TITLE: Lyme disease [published erratum appears in Curr Opin Rheumatol 1994 Jan;6(1):117] AUTHORS: Evans J; Schoen RT AUTHOR AFFILIATION: Section of Rheumatology, Yale University School of Medicine, New Haven, CT 06510-8056. SOURCE: Curr Opin Rheumatol 1993 Jul;5(4):454-60 CITATION IDS: PMID: 8043045 UI: 93363507 ABSTRACT: In 1992, reported Lyme disease cases increased, but the majority remained clustered in the northeast and midwest, and in California. The clinical syndromes associated with infection are better understood, and this information can calm public anxiety. The concept of fibromyalgia occurring after infection with Borrelia burgdorferi allows more appropriate treatment in late Lyme disease. The polymerase chain reaction is being applied to gain insights into the pathogenic mechanisms of Lyme disease. Progress has been made toward developing a vaccine through the use of animal models. Together, these advances provide clinicians with more confidence in the diagnosis and treatment of Lyme disease. MESH Headings Diagnosis, Differential ; Fibromyalgia DI ; Human ; Lyme Disease *CO/DI/DT/PC ; Nervous System Diseases *CO http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8043045&form=6&db=m&Dopt=b ----- TITLE: The overdiagnosis of Lyme disease [see comments] AUTHORS: Steere AC; Taylor E; McHugh GL; Logigian EL AUTHOR AFFILIATION: Division of Rheumatology/Immunology, New England Medical Center, Boston, MA 02111. SOURCE: JAMA 1993 Apr 14;269(14):1812-6 CITATION IDS: PMID: 8459513 UI: 93210851 COMMENT: Comment in: JAMA 1993 Dec 8;270(22):2682; discussion 2683 Comment in: JAMA 1993 Dec 8;270(22):2682-3 Comment in: JAMA 1993 Dec 8;270(22):2683 ABSTRACT: OBJECTIVE--To analyze the diagnoses, serological test results, and treatment results of the patients evaluated in a Lyme disease clinic, both prior to referral and from current evaluation. DESIGN-- Retrospective case survey of prescreened patients. SETTING--Research and diagnostic Lyme disease clinic in a university hospital. PATIENTS--All 788 patients referred to the clinic during a 4.5-year period who were thought by the referring physician or the patient to have a diagnosis of Lyme disease. MAIN OUTCOME MEASUREMENTS--Symptoms and signs of disease, immunodiagnostic tests of Lyme disease, and tests of neurological function. RESULTS--Of the 788 patients, 180 (23%) had active Lyme disease, usually arthritis, encephalopathy, or polyneuropathy. One hundred fifty-six patients (20%) had previous Lyme disease and another current illness, most commonly chronic fatigue syndrome or fibromyalgia; and in 49 patients, these symptoms began soon after objective manifestations of Lyme disease. The remaining 452 patients (57%) did not have Lyme disease. The majority of these patients also had the chronic fatigue syndrome or fibromyalgia; the others usually had rheumatic or neurological diseases. Of the patients who did not have Lyme disease, 45% had had positive serological test results for Lyme disease in other laboratories, but all were seronegative in our laboratory. Prior to referral, 409 of the 788 patients had been treated with antibiotic therapy. In 322 (79%) of these patients, the reason for lack of response was incorrect diagnosis. CONCLUSIONS--Only a minority of the patients referred to the clinic met diagnostic criteria for Lyme disease. The most common reason for lack of response to antibiotic therapy was misdiagnosis. MESH Headings Adolescence ; Adult ; Aged ; Child ; Child, Preschool ; Diagnostic Errors ; Fatigue Syndrome, Chronic DI ; Female ; Fibromyalgia DI ; Human ; Lyme Disease *DI/DT ; Male ; Massachusetts ; Middle Age ; Outpatient Clinics, Hospital SN ; Recurrence ; Retrospective Studies ; Serologic Tests SN ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8459513&form=6&db=m&Dopt=b But see below: Doctors on Lyme disease and fibromyalgia: Letter to the editor by Joseph J. Burrascano, Jr., MD from The Journal of the American Medical Association Dec. 8 1993 p.26829(2) http://groups.google.com/groups?hl=en&lr=lang_en&safe=off&ic=1&th=492f427c43af27ad,3&seekm=19971114042601.XAA21044%40ladder02.news.aol.com#p Also see comments: The Lyme Disease Network LymeNet Newsletter Volume: 1 Issue: 10 Date: 05/04/93 Response To "The Overdiagnosis Of Lyme Disease" Journal of the American Medical Association, 1993;269:1812-1816 By: Carl Brenner, Marc C. Gabriel, John S. O'Donnell . . . III. ***** RESPONSE TO "THE OVERDIAGNOSIS OF LYME DISEASE" ***** . . . "Yet under the study protocols, lack of responsiveness to antibiotic therapy is a primary criterion for the determination that active Lyme disease is not present: "We did not find age, sex, or duration of symptoms to be of help in diagnosing fibromyalgia, but the presence of tender points upon examination and lack of response to antibiotic therapy were important clues in diagnosing fibromyalgia." These criteria are clearly not consistent with the authors' own findings regarding the prevalence of treatment failures among patients whom they determined to harbor active disease; further, it is well known that every one of the primary symptoms associated with fibromyalgia or chronic fatigue syndrome (persistent headache, fatigue, myalgias, arthralgias, sleep disturbance, etc.) are common in active Lyme disease and cannot be used for differential diagnosis. Finally, in cases where the patient did improve with antibiotic therapy but relapsed afterwards, the authors conclude anecdotally that the positive response was probably due to the placebo effect." "We strongly take issue with the fact that the alternate interpretation for these treatment responses -- that borrelial infection persisted after antibiotic treatment -- is completely ignored. There are now culture-confirmed treatment failures in the medical literature for all stages of Lyme disease [9,12,16-19], sometimes even after long term, high-dosage antibiotic therapy [17-19]. Other studies employing the polymerase chain reaction have indicated the persistence of B. burgdorferi-specific DNA in the cerebrospinal fluid of many patients who remain symptomatic after antibiotic therapy [15]. In light of these findings, the authors' exclusive interpretation that treatment failure was due to misdiagnosis seems rather reckless. Although persistent symptoms after treatment by no means implies the continued presence of B. burgdorferi, unresponsiveness to short term antibiotic therapy cannot be interpreted to exclude it." . . . LymeNet Newsletter Volume 1 Issue 10 http://www2.lymenet.org/domino/nl.nsf/UID/1-10 ----- TITLE: Lyme disease associated with fibromyalgia. AUTHORS: Dinerman H; Steere AC AUTHOR AFFILIATION: Tufts University School of Medicine, Boston, Massachusetts. SOURCE: Ann Intern Med 1992 Aug 15;117(4):281-5 CITATION IDS: PMID: 1637022 UI: 92344153 ABSTRACT: OBJECTIVE: To describe the clinical and laboratory findings as well as results of treatment in patients with Lyme disease associated with fibromyalgia. DESIGN: Observational cohort study. The mean duration of observation was 2.5 years (range, 1 to 4 years). SETTING: Diagnostic Lyme disease clinic in a university hospital. PATIENTS: Of 287 patients seen with Lyme disease during a 3.5-year period, 22 (8%) had fibromyalgia associated with this illness, and 15 (5%) participated in the observational study. MEASUREMENTS: Symptoms and signs of fibromyalgia, immunodiagnostic tests for Lyme disease, and tests of neurologic function. RESULTS: Of the 15 patients, 9 developed widespread musculoskeletal pain, tender points, dysesthesias, memory difficulties, and debilitating fatigue a mean duration of 1.7 months after early Lyme disease; the remaining six patients developed those symptoms during the course of Lyme arthritis. At the time of our evaluation, late in the course of their illness, 11 patients had positive immunoglobulin (Ig) G antibody responses to Borrelia burgdorferi by enzyme-linked immunosorbent assay (ELISA), one had a positive Western blot, and the three seronegative patients had positive cellular immune responses to borrelial antigens. Four patients had abnormal cerebrospinal fluid analyses that showed an elevated protein level, a slight pleocytosis, or intrathecal antibody production to the spirochete. The signs of Lyme disease resolved with antibiotic therapy, usually intravenous ceftriaxone, 2 g/d for 2 to 4 weeks, except in one patient with persistent knee swelling. However, 14 of the 15 patients continued to have symptoms of fibromyalgia. Currently, only one patient is completely asymptomatic. CONCLUSIONS: Lyme disease may trigger fibromyalgia, but antibiotics do not seem to be effective in the treatment of the fibromyalgia. MESH Headings Adult ; Antibiotics TU ; Blotting, Western ; Case Report ; Cohort Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibromyalgia DT/*ET ; Human ; Lyme Disease *CO/DI/DT ; Male ; Middle Age ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Time Factors http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1637022&form=6&db=m&Dopt=b But see comments: The Lyme Disease Network LymeNet Newsletter Volume: 2 Issue: 08 Date: 05/25/94 I. LYMENET ANALYSIS: The Experts Speak Sender: LymeNet-L@Lehigh.EDU Authors: Carl Brenner, Marc Gabriel, Frank Demarest, John O'Donnell "The persistence of tired Lyme disease myths despite overwhelming evidence of their inadequacy is perhaps the greatest obstruction to progress in the field. Although these myths exist in all facets of Lyme disease research, they are still most evident in the area of treatment, where legitimate concern about the sometimes indiscriminate use of antibiotics has apparently hardened into an across-the-board anti-treatment zealotry. Certain researchers have become so intent on attacking the use of longer antibiotic treatment regimens that they end up ignoring their own observations on its efficacy. This phenomenon may have reached its zenith with the 1992 publication of a paper on Lyme disease and fibromyalgia in the Annals of Internal Medicine [4], in which the authors clearly noted that a majority of 15 post-treatment Lyme disease patients with persistent symptoms responded positively to retreatment with antibiotics and did not respond to treatment for fibromyalgia syndrome. Somehow, they still managed to convince themselves that the patients had fibromyalgia without active Lyme disease." LymeNet Newsletter Volume 2 Issue 08 http://www2.lymenet.org/domino/nl.nsf/UID/2-08 ----- TITLE: Memory impairment and depression in patients with Lyme encephalopathy: comparison with fibromyalgia and nonpsychotically depressed patients. AUTHORS: Kaplan RF; Meadows ME; Vincent LC; Logigian EL; Steere AC AUTHOR AFFILIATION: Department of Neurology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111. SOURCE: Neurology 1992 Jul;42(7):1263-7 CITATION IDS: PMID: 1620329 UI: 92319273 ABSTRACT: Lyme encephalopathy, primarily manifested by disturbances in memory, mood, and sleep, is a common late neurologic manifestation of Lyme disease. We compared 20 patients with Lyme encephalopathy with 11 fibromyalgia patients and 11 nonpsychotically depressed patients using the California Verbal Learning Test, Wechsler Memory Scale, Rey- Osterrieth Complex Figure Test, Minnesota Multiphasic Personality Inventory (MMPI), and Beck Depression Inventory. Compared with patients with fibromyalgia or depression, the Lyme encephalopathy group showed mild, but statistically significant, memory deficits on two of the three memory tests. In contrast, the patients with fibromyalgia scored significantly higher than both other groups on the MMPI scale most sensitive to somatic concerns (scale 1), while the depressed patients scored higher than the Lyme patients on the scales most sensitive to depression (scale 2) and anxiety (scale 7). Physical complaints and depression were not major factors in memory performance among Lyme patients. These data support the hypothesis that Lyme encephalopathy is caused by CNS dysfunction and cannot be explained as a psychological response to chronic illness. MESH Headings Adult ; Analysis of Variance ; Brain Diseases CO/*PX ; Comparative Study ; Depressive Disorder ET/*PX ; Female ; Fibromyalgia *PX ; Human ; Lyme Disease CO/*PX ; Male ; Memory Disorders ET/*PX ; Middle Age ; Psychiatric Status Rating Scales ; Support, U.S. Gov't, P.H.S. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1620329&form=6&db=m&Dopt=b ----- TITLE: Special concerns in Lyme disease. Seropositivity with vague symptoms and development of fibrositis. AUTHORS: Schned ES; Williams DN AUTHOR AFFILIATION: Park Nicollet Medical Center, Minneapolis, MN 55416. SOURCE: Postgrad Med 1992 May 15;91(7):65-8, 70 CITATION IDS: PMID: 1589369 UI: 92270531 ABSTRACT: Fear of Lyme disease may be as powerful as the disease itself. Patients may insist on being tested for infection although little evidence of it exists, and a positive result in the face of vague symptoms can add to the problem. Physicians should explain to these patients the differences in "background seropositivity in various geographic locations and the drawbacks of instituting unnecessary treatment. Fibrositis may evolve over time after Lyme disease infection. Many factors may trigger this disorder, but some investigators propose that it is a result of musculoskeletal pain, sleep disturbance, and anxiety over the disease. MESH Headings Antibodies, Bacterial *AN ; Borrelia burgdorferi *IM ; Fibromyalgia DI/*ET/TH ; Human ; Lyme Disease CO/*DI/TH http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1589369&form=6&db=m&Dopt=b ----- TITLE: Current recommendations for the treatment of Lyme disease. AUTHORS: Sigal LH AUTHOR AFFILIATION: Lyme Disease Center, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick. SOURCE: Drugs 1992 May;43(5):683-99 CITATION IDS: PMID: 1379147 UI: 92347202 ABSTRACT: Lyme disease is a multisystem inflammatory disease caused by infection with Borrelia burgdorferi. Soon after the tick bite which transmits the infection, the pathognomonic skin rash erythema chronicum migrans occurs in 50 to 70% of patients, often with associated symptoms resembling a 'summer cold' or viral infection. Therapy for this stage of disease consists of 3 to 4 weeks of oral therapy. The agents currently used are: amoxicillin (500 mg 3 or 4 times daily) with or without probenecid 500 mg 3 times daily, doxycycline (100 mg twice daily), or tetracycline (500 mg 4 times daily). Longer duration therapy has never been evaluated and therefore is not currently indicated. Even patients with severe early manifestations of Lyme disease should be treated orally. Later features of Lyme disease include carditis and neurological disease, which can occur days to approximately 9 months after the onset of illness, and arthritis and neurological disease which can occur weeks to years after the onset of the illness. Treatment at this stage is with 2 to 3 weeks of intravenous antibiotics, currently cefotaxime (3 g every 12 hours), ceftriaxone (1 g every 12 hours or 2 g every day) and benzylpenicillin (14 g in divided doses). There is no evidence that longer duration therapy is indicated or more efficacious. The exception to this suggestion is the patient with isolated facial seventh cranial nerve palsy; if such a patient has no other signs or symptoms to suggest Lyme disease and has normal spinal fluid, oral therapy is usually sufficient, although some physicians will give concomitant corticosteroids to hasten the resolution of the palsy. Of major consequence to the practitioner and patient is the possibility that persistent symptoms (e.g. fibromyalgia) may be caused by a process which is no longer antibiotic-sensitive. Special care in the management of so- called 'chronic Lyme disease' is crucial lest the clinician prescribes prolonged or unending courses of antibiotics for such noninfectious problems. MESH Headings Animal ; Human ; Lyme Disease DI/*TH http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1379147&form=6&db=m&Dopt=b ----- For more and up-to-date MEDLINE medical and scientific articles on fibromyalgia and Lyme disease see: Links to MEDLINE abstracts on Lyme Disease and fibromyalgia http://www.geocities.com/HotSprings/Oasis/6455/fms-links.html#MEDLINE --------------- Also see: Lyme Disease Misdiagnosed as fibromyalgia http://www.geocities.com/HotSprings/Oasis/6455/fms-index.html Lyme Disease Misdiagnosed as fibromyalgia - Links Only http://www.geocities.com/HotSprings/Oasis/6455/fms-links.html Lots Of Links On Lyme Disease http://www.geocities.com/HotSprings/Oasis/6455/lyme-links.html --------------- Prepared by Art Doherty Lompoc, California doherty@utech.net