Tuesday, January 27, 2009

Hard to catch?

Many have characterized the IDSA and ILADS dispute with the simple dichotomy: Hard to catch easy to cure, versus easy to catch hard to cure. A snappy little sound bite.
I saw one of my delightful patients today. He is a 23 year old male with cerebral palsy. He has been quadriplegic since birth. He has minimal use of his left hand and motors around the house with an electric wheel chair. He suffers with severe cognitive impairments. He rarely leaves the house and never goes anywhere without his elderly grandmother. He lives in an apartment complex. One year ago he had several tick bites. His grandmother thought it was from the mulching of the trees around the entrance to his apartment complex. He is difficult to communicate with because of his handicaps.
Nonetheless, his care giver could easily see a change in his demeanor. He became sullen, less mobile and in general, appeared uncomfortable. His lab tests were positive for Lyme disease by CDC surveillance criteria. He was treated with two months of antibiotics and got better. Two months later he was ill again. He had malaise, low grade fevers, decreased mobility and a change once more, in his normally cheerful demeanor. After 3 additional months of antibiotic therapy he became well and he remains well to this day.

This young man lives in an apartment with his elderly grandmother. He is permanently confined to a wheel chair. For all intents and purposes, he virtually never leaves his home and he certainly never goes outside to enjoy bucolic scenery. He developed classic Lyme disease with positive CDC serology.

The disease is hard to catch???
We can deal with easy to cure another day.

1 comment:

Paula said...

May I also add (and you may have this is another entry already) It's January on the east coast and pets are still bringing in ticks. It's a year round thing anymore with this milder climate..