All Posts Tagged With: "serologic testing"

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=21173795&retmode=ref&cmd=prlinks

Excerpt:

Background A 71-year-old woman presented to a rheumatologist with what she
believed to be a 2-year history of Lyme disease, progressing from erythema
migrans to Lyme arthritis.Investigations History, physical examination and
serologic testing confirmed the diagnosis of Lyme disease.Diagnosis Lyme
disease.Management The patient refused antibiotic therapy during the first 2
years of her illness. During the next 2 years, she consulted a
rheumatologist, but declined antibiotic therapy. She continued to have
recurrent episodes of arthritis, following which she was successfully
treated with doxycycline, given initially for 2 weeks, with a second, 4-week
cycle administered 2 months later.
This case illustrates the natural history of untreated Lyme disease, which
is rarely observed in most patients since diagnosis almost always leads to
successful antibiotic treatment. Furthermore, this case also demonstrates
that infection with Borrelia burgdorferi can persist for years in untreated
patients; however, antibiotic therapy is still likely to be effective,
despite long-term infection.

Clinical practice guidelines are increasing in number. Unfortunately,
when scientific evidence is uncertain, limited, or evolving, as is often
the case, conflict often arises between guideline committees and
practicing physicians, who bear the direct responsibility for the care of
individual patients. The 2006 Infectious Diseases Society of America
guidelines for Lyme disease, which have limited scientific support,
could, if implemented, limit the clinical discretion of treating physicians
and the treatment options available to patients

Introduction

Clinical practice guidelines are now ubiquitous throughout the
United States. The National Guidelines Clearing House, under the
category “diseases,” currently lists 2,126 separate guidelines on its
web site. Clinical guidelines are intended to assist physicians in
patient care by clearly communicating the results of the guideline
committees’ evaluation of available therapeutic options. However,
the processes by which individual guidelines are constructed may be
less clear, leading to disagreements between the issuing committee
and the physicians who treat patients-physicians who may well be
as experienced and knowledgeable as the guideline committee. Continued