The Fight Against Lyme Disease

COMMENT BOOKS & ARTS

MEDICAL RESEARCH Although antibiotics can clear infection in some cases, Fallon and Sotsky describe how The fight against genetic differences in Borrelia bacteria found on different continents make treatment difficult. There Lyme disease Conquering Lyme are, for instance, three different species in the Disease: Science James G. Logan hails a study of the controversial Bridges the Great complex in Europe. Divide tick-borne condition. The authors note that BRIAN A. FALLON & each can cause differ- JENNIFER SOTSKY ent symptoms in peo- Columbia University t occurs in more than 80 countries and disease has struggled to keep up. ple with Lyme disease Press: 2017. is the most commonly reported vector- The many presentations of an illness who develop neuro- borne disease in the Northern Hemi- known as the “great imitator”, and its inher- logical complications. So a treatment that Isphere. In the United States alone, it spawns ent complexities, are why medical com- works for one species of the bacterium may 300,000 new cases each year. Yet Lyme disease munities have often failed to find common not work for another. — caused by species of Borrelia bacteria car- ground on diagnosis and treatment, as the And spirochaetes can remain in the ried by ticks of the Ixodes genus — remains authors explore. The manifestations range body even after courses of antibiotics one of the most poorly understood infec- from no symptoms, or mild influenza-like (E. Hodzic et al. Antimicrob. Agents Chem- tions. It has divided researchers, clinicians ones, to severe complications such as inflam- other. 52, 1728–1736; 2008). Fallon and and patients, and triggered intense public mation in joints or the brain and persistent Sotsky hypothesize that they may “hide” suspicion and confusion. neurological problems. inside human cells, for instance. A big So what is science’s role in turning the One of the reasons Lyme is difficult question is whether the spirochaetes that corner on what some have labelled a “public to diagnose is that some non-infectious hang on in this way can replicate and cause health failure”? Physicians Brian Fallon and conditions, including fibromyalgia and disease. Jennifer Sotsky tackle this question in their Alzheimer’s disease, present with similar Whatever the mechanism, proof of the insightful study Conquering Lyme Disease, symptoms. The situation is further compli- existence of persistent symptoms will pave in which they journey beyond the history, cated because Ixodes ticks transmit a host of the way for better diagnostics, treatment and biology and symptoms of the illness. Their other pathogens, such as Rickettsia, other care. Some patients have spent years try- greatest accomplishment, by far, is deliver- bacteria, viruses and protozoa, leading to ing to convince medical doctors that their ing multiple viewpoints with minimal bias diseases including typhus, relapsing fever, symptoms remain after treatment. Fallon and great sensitivity: the clinician’s, the babesiosis and meningoencephalitis. Mis- and Sotsky strikingly convey these people’s researcher’s and, particularly, the patient’s. diagnosis is thus all too common. difficulties and frustrations. Clinicians, for Although recent headlines make Lyme Treatment is also far from straightforward. instance, might fail to ask the right ques- disease seem new, probably the first tions. People with chronic Lyme disease can recorded case was in 1909: the Swedish feel abandoned, and even suicidal. That has dermatologist Arvid Afzelius associated led to protests and court hearings, notably a patient’s expanding rash (later named in the United States. But these people, the erythema migrans) with a tick bite. In authors argue, have played a significant the 1970s, a link was made to part in moving understanding beyond EYE OF SCIENCE/SPL bacteria by rheumatologist conventional thinking, and Allen Steere; in 1981, the ultimately driving research biologist Willy Burgdorfer forward. Clinicians are now discovered that the disease beginning to acknowledge was caused by a type of bac- both the complexity of Lyme dis- terium called a spirochaete. ease and patients’ needs. The species complex Fallon and Sotsky was named Borrelia end on a firmly positive burgdorferi in his hon- note, reviewing avenues our. But it was not until for new research across the 1990s that US cases many disciplines, from were properly reported, diagnostics to vaccines through a surveillance and treatments. What’s system set up by the Centers particularly pressing for Disease Control and Preven- is the need for a definitive test to tion in Atlanta, Georgia. detect the spirochaetes that cause Since that decade, the global inci- this devastating disease. ■ dence has increased and reporting has improved, as Fallon and Sotsky describe; James G. Logan is head of the Department in the United States alone, known cases of Disease Control at the London School of have tripled since 1992. There is currently Hygiene and Tropical Medicine. no human vaccine, and research on the Ixodes ticks spread Lyme disease. e-mail: [email protected]