SPIROCHETEMIA AFTER CONTINUOUS HIGH-DOSE ORAL AMOXICILLIN THERAPY

We present a case of Lyme disease that touches on three contemporary controversies. First. the patient discussed is from southern Illinois, not thought to be an endemic area for Lyme disease because of the absence of the Ixodes dammini deer tick. With the recent evidence that I. dammini is not a valid separate tick species [1], the epidemiology of Lyme borreliosis becomes less clear. This patient has had no tick exposure in known endemic areas (California, north central, and north-eastern United States) since 1987. Second, although Amblyomma americanum (Lone Star) ticks have been implicated as a potential vector of Lyme disease since 1984 [2], and spirochetes consistent with Borrelia burgdorferi have been observed in A. americanum ticks by numerous researchers [3-8], many experts do not agree that this species can transmit B. burgdorferi in humans. The distinctive and unique white dot on the adult female Lone Star tick lends credence to patient anecdotes and histories because no other tick looks like it. Third, the issue of persistent symptoms in treated Lyme patients (autoimmunity vs. persistent infection) is unresolved. We propose that this case may be relevant.