Concerns Regarding the Infectious Diseases Society of America Lyme Disease Clinical Practice Guidelines

Reprints or correspondence: Mr. Jim Wilson, Canadian Lyme Disease Foundation, 2495 Reece Rd., Westbank, BC V4T 1N1, Canada (jimwilson@telus.net).

TO THE EDITOR — The Canadian Lyme Disease Foundation has several concerns with the Infectious Diseases Society of America’s Lyme disease clinical practice guidelines [1]. I shall elaborate.

Throughout the guidelines, the erythema migrans rash is referred to 108 times and is claimed to be the predominant diagnostic feature of Lyme disease. Headaches, fatigue, cognitive dysfunction, neuropsychiatric issues, myalgias, tremors, tics, and parasthesias are given little or no attention, although they can be present in all stages of the illness; erythema migrans rash, on the other hand, normally is not, and has been overemphasized in the guidelines as being a predominant indicator of the disease [2]. As reported by Gill et al. [3] in 1995, only 18% of confirmed case patients reported experiencing a rash. The research studies cited in the guidelines [1] in support of percentages relative to rash incidence were not designed specifically to measure incidence of the erythema migrans rash; therefore, minimal value can be given to these data.

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