March 1, 2017
Lyme disease Expert
Dr. Richard Horowitz Responds to Arkansas Department of Health
Why should you be concerned with "fake news" on Lyme and associated tick-borne disorders? Although I do not usually report articles on the internet that have inaccurate information (there are many), here is a report from Pressreader about Lyme and co-infections in Arkansas that deserves a detailed response. They recently found 2 cases of Lyme disease in Arkansas that met DOH surveillance criteria, and report that they needed the patient to have a classical bullseye rash, followed by positive two tiered testing to make the diagnosis. The article also discusses how ticks don't transmit borrelia to eggs; that birds don't transmit multiple infections to ticks; Rocky Mountain Spotted Fever (RMSF) causes a rash all over your body, and finally, you don't have to treat STARI, (it goes away on its own). Unfortunately, the situation is a lot more complex, and there is a lot of misinformation in this article.
First of all, Lyme is a clinical diagnosis, and I suspect there is a lot more Lyme in Arkansas than reported. Only 25% (or less) of patients get EM rashes, and in one prior NIH double-blind study (Dr Brian Fallon), only 1% of patients with neurological Lyme had positive two tiered testing but were still ill, and many responded to treatment with antibiotics. If the DOH was to use my recently validated HMQ (Horowitz MSIDS questionnaire) in patients with CFS/M.E./S.E.I.D., FM, autoimmune illness (RA, MS) or in those with resistant neurological disease (early dementia, resistant psychiatric cases with a multisystemic disorder), they probably would find many more cases in their state.
Secondly, certain species of borrelia, like borrelia miyamotoi, can be transmitted transovarially (from the mother to the eggs), and in NYS, 10-20% of the ticks contain B. miyamotoi, causing a Lyme-like illness. Symptoms can include an EM rash, Bell's palsy, and meningitis. These patients are usually negative on two-tiered testing, so don't assume because there is no rash or positive ELISA or Western blot that you don't have Lyme or a Lyme-like relapsing fever bacteria!
Third inaccuracy: birds do transmit multiple species of borrelia and other co-infections (including Bartonella) to ticks, explaining in part the spread of these illnesses worldwide. There are many scientific articles proving this. Fourth, RMSF can be devoid of a rash in 40% of patients (and 60% of the time, it is on the hands and feet), and can be associated with low white cell counts (leucopenia), low platelet counts (thrombocytopenia), and elevated liver functions (transaminitis) which helps a clinician to make the diagnosis. Finally, STARI has been determined to be due to a borrelia sensu lato species (Dr Kerry Clark discovered that years ago) and there are individuals who have severe manifestations of STARI, including death from Lyme carditis. One young man in our area, Joseph Elone, died years ago from Lyme carditis, and he had a negative ELISA test. So you DO treat STARI, as you would treat Lyme, and do not assume it is necessarily a more benign form of borreliosis.
Take home message: learn the truth about Lyme and associated co-infections and read articles critically. My new book "How Can I Get Better?" discusses some of most important scientific updates on Lyme and the 16 point MSIDS map that I have found to be helpful in improving patient's health.
Link to Dr. Horowitz Facebook page:
Link to article from Arkansas Department of Health