Lyme Disease: A Physician’s Perspective

As a board-certified internist and epidemiologist, Daniel Cameron, MD, MPH, is also a nationally recognized expert in the treatment of tick-borne diseases. He has lectured at numerous medical and scientific conferences in the United States, Europe and Canada, and he is often interviewed by the news media, including nationally syndicated radio and television programs. For more than 25 years, he has been treating patients with Lyme and other tick-borne diseases through his private practice in Westchester County, N.Y.

BSTQ: You’ve been called a Lyme disease pioneer. What has driven your passion for treating Lyme disease?

Dr. Cameron: I have patients who have turned their lives around with a more individualized approach to Lyme disease. Having treated thousands of patients, we understand the emotionally devastating toll the illness can have on both the patient and family members, and we offer the highest quality of care in a compassionate, nonjudgmental environment.

BSTQ: Tell us about the International Lyme and Associated Diseases Society (ILADS) and its treatment guidelines.

Dr. Cameron: ILADS is a nonprofit, international, multidisciplinary medical society that promotes understanding of Lyme through research and education and strongly supports physicians and other healthcare professionals dedicated to advancing the standard of care for Lyme and its associated diseases. The ILADS guidelines document the evidence for an individualized approach to treating acute and chronic manifestations of Lyme disease.

BSTQ: What are the most prevalent misconceptions about chronic Lyme disease (CLD)?

Dr. Cameron: CLD has emerged as an umbrella term for the broad range of chronic manifestations of Lyme disease. The National Institutes of Health (NIH) trials enrolled three categories of individuals with chronic manifestations of Lyme disease: Lyme encephalopathy; persistent symptoms after Lyme disease with negative serologies; and post-Lyme disease syndrome (PLDS). PLDS was coined based on the NIH assumption that Lyme disease has been adequately treated after a two- to three-week course of antibiotics. Yet, there are no validated tests to rule out persistent infection. CLD typically does not assume that a short-term course of antibiotics is adequate to cure a patient. Some doctors believe chronic Lyme disease does not exist. Others believe patients suffer from posttreatment Lyme disease syndrome and not a persistent infection. Yet, there is no reliable test to be sure a persistent infection has resolved.

BSTQ: Are there a core set of symptoms with Lyme disease?

Dr. Cameron: The most common symptoms can mimic chronic fatigue and fibromyalgia. In one study, a series of individuals was ill for up to 14 years before being correctly diagnosed. These patients suffered with fatigue, sleep disturbance, poor memory and concentration, headaches, light-headedness, irritability, chest pain, joint pain, fibromyalgia and paresthesias. Physicians may also mistakenly rule out Lyme disease in patients who have had prior treatment for the disease. But those patients can still exhibit symptoms and benefit from antibiotic therapy.

BSTQ: What should practitioners know about coinfections?

Dr. Cameron: Coinfections can be challenging to diagnose since clinical features often overlap with many other tick-borne diseases. However, the importance of identifying and treating polymicrobial infections is critical in getting a patient well. Practitioners should consider coinfections in the diagnosis when a patient’s symptoms are severe, persistent and resistant to antibiotic therapy. Coinfections typically exacerbate Lyme disease symptoms.

BSTQ: What are the core tests you use to diagnose Lyme infections?

Dr. Cameron: I routinely order a Lyme titer, IgG and IgM Western blot test for Lyme disease, and IgG and IgM for babesia, ehrlichia, anaplasmosis and bartonella.

BSTQ: Tell us how you address the emotional symptoms of Lyme disease.

Dr. Cameron: I actually devote much of my office visit to emotional symptoms. There simply is no one-size-fits-all treatment protocol. So, it’s critical to invest time with patients to thoroughly understand their medical history and to closely monitor symptoms and treatment response to determine the best therapy to restore their health.