Talk:Lyme disease/Archive 7

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Lyme disease is inaccurate naming. Rename to Borrelia burgdorferi.

In light of CoVid, which was initially referred to as Wuhan Flu by the media, the WHO changed their stance once Trump started to use their name and their financers Chinese Communist Party wanted to disassociate itself from the virus. Referring to the virus as "Wuhan virus" or Wuhan flu" was considered defamatory and anti-chinese.

In that same light, we should not pander to anti-american sentiment and must rename the virus to not mention Lyme, Connecticut.

Someone please change it.

I refer to the wiki-article: https://en.wikipedia.org/wiki/Xenophobia_and_racism_related_to_the_COVID-19_pandemic — Preceding unsigned comment added by 31.183.139.49 (talk • contribs) 20:00, 4 August 2021 (UTC)

(Out of curiosity, can you cite any instances of anti-Connecticut prejudice associated with Lyme borreliosis?)

Wikipedia's role isn't to assign new names to diseases and pathogens; you would have to find reliable medical sources endorsing and affirming such a renaming, which would then be reflected in our coverage. TenOfAllTrades(talk) 20:19, 4 August 2021 (UTC)

Can you with Wuhan flu? The source of renaming the wuhan flu to "covid" is in the article above and also the WHO. — Preceding unsigned comment added by 31.183.139.49 (talk • contribs) 13:07, 5 August 2021 (UTC)

The article you yourself linked above, Xenophobia and racism related to the COVID-19 pandemic, contains several examples for anti-Chines prejudice associated with COVID.

The demand was not for sources about renaming COVID, it was for sources about renaming Lyme.

Learn how to read articles before you link them, how to read contributions before responding to them, how to use the correct words for diseases and how to WP:SIGN your contributions. --Hob Gadling (talk) 12:51, 5 August 2021 (UTC)

There is an opinion piece suggesting changing the name of Lyme disease to B burgdorferi sensu lato infection, or Bbsl infection for short, but no medical consensus for a name change. Therefore, the article name can't be changed. ScienceFlyer (talk) 02:19, 7 August 2021 (UTC)

New scientific reviews and guidelines

This page could use some cleanup and updates, especially in view of newer guidelines (North America, CDC Treatment, CDC/APHL testing recommendations, and France), and scientific reviews (See reports in Emerging Infectious Diseases, BMJ, and Nature). There is a new FDA-cleared modified two tier testing that is endorsed in the US and Canada. North American treatment guidelines now endorse 10 days of doxycycline or 7 days of azithromycin for early Lyme disease. Hopefully other editors find these resources helpful. ScienceFlyer (talk) 05:14, 10 September 2021 (UTC)

Tick-borne borreliosis

Lyme disease is also known as 'Tick-borne borreliosis' in some scholarly articles. A quick Google headcount shows it's much less common than 'Lyme borreliosis', so I've not added it in the body. But just here, for the record. I refer for instance to Borreliosis: A Hidden Threat For Kazakhstan, Oct 2019, by Bissenbay, Zhigailov, Maltseva and Madaliyev. 116.48.27.189 (talk) 17:41, 12 October 2021 (UTC)

Lyme disease page

Hallo all Just to point out that infections percentages in the introduction and the first phot do not match. That's all Regards Maurizio Andriani — Preceding unsigned comment added by 2.38.66.205 (talk) 22:57, 8 November 2021 (UTC)

New York Times article about possible late stage sufferers

A column appeared on November 11, 2021 By David Leonhardt Title: Good morning. When modern medicine doesn’t cure chronic pain, what comes next? It mentions a source: "One of those sufferers has been my colleague Ross Douthat, a Times Opinion columnist. In 2015, Ross began to experience episodes of searing pain that at times left him unable to sleep or function. He has just published a bracingly honest memoir, “The Deep Places,” about these experiences." I added it under Further Reading24.210.152.37 (talk) 00:44, 12 November 2021 (UTC)24.210.152.37 (talk) 01:00, 12 November 2021 (UTC)

Thank you for this suggestion. Ross Douthat reports that he tested negative but came to believe that he had chronic Lyme disease regardless of the evidence. Also, Ross Douthat is not a reliable source of medical information. ScienceFlyer (talk) 01:26, 12 November 2021 (UTC)

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Recent fringe edits

I've reverted edits by @antoine j that are sourced to promoters of pseudoscience. I'd also like to suggest some informative sources which refute the pseudoscience and may help to improve this article. Lyme neuroborreliosis: known knowns, known unknowns, Comparison of Lyme Disease in the United States and Europe, A Review of Post-treatment Lyme Disease Syndrome and Chronic Lyme Disease for the Practicing Immunologist, Treatment Trials for Post-Lyme Disease Symptoms Revisited ScienceFlyer (talk) 15:49, 28 July 2022 (UTC)

Improving images

I'd like to add an image of the swollen knee typical of Lyme arthritis. Anyone have a preference? I was thinking of using CDC's photo illustration (either light or dark skin) or this one. ScienceFlyer (talk) 20:50, 30 July 2022 (UTC)

I finally added the photo! ScienceFlyer (talk) 07:39, 21 December 2022 (UTC)

Lyme disease in Australia

For a long time, the AMA and all governments were dogmatic that there was no Lyme disease in Australia. Because we did not have either those particular ticks or those particular bacteria. Following an overhwleming flood of (initially albeit) ancdotic evidence, it SEEMS to be the case that we do have a VARIANT of it, with slightly different bacteria in slightly different ticks. Mayvbe someone closer to the field than I can produce some credible references. 2001:8003:E490:7D01:11F1:88CF:3458:37C0 (talk) 09:27, 23 February 2023 (UTC)

If you don't have references, why are you posting here? — The Hand That Feeds You:^Bite 15:50, 23 February 2023 (UTC)

Size of article and lead

The lead is currently approx 582 words. The body of the article is currently approx 12,229 words, or approx 81,972 characters. The total page size is approx 225,807 bytes.

This means that the lead is significantly more intimidating than what makes for a good article. Per WP:LEAD, Most Featured Articles have a lead length of about three paragraphs, containing 10 to 15 sentences, or about 300 words total. This article's lead is twice that.

As for the article itself, for our size WP:SIZERULE suggests "probably should be divided".

Note that this has nothing to do with how WP:LEADLENGTH discusses number of paragraphs. Yes, the article lead currently contains five paras, but I'm not nitpicking here - I am suggesting our lead paragraphs are slimmed down in size, not that we fixate on the number of them. It the overall size of the lead that's so long it's almost an article in itself!

Also note I did read WP:HASTE. In other words, I started by posting this talk section, not by making edits. CapnZapp (talk) 07:52, 7 March 2023 (UTC)

476k is a likely overestimate

@Slimjimwarrior This week, there have been three attempts to claim that the CDC-estimated 476k Lyme cases in the US is an underestimate. These edits are contrary to the referenced CDC web page, which states "This number is likely an over-estimate of actual infections because patients are sometimes treated presumptively in medical practice."

The edits are also contrary to the primary source CDC study, which is based on insurance claim data, not any sort of objective testing or diagnostic standards. In the second to last paragraph of the study, the CDC scientists note the long-established trend of overdiagnosis and overtreatment of Lyme disease in clinical practice. They also note that overdiagnosis could be why 19% of the insurance cases were reported in low-incidence states even though those states only represent ~5% of reported Lyme cases. ScienceFlyer (talk) 18:13, 8 July 2023 (UTC)

The study by Kugeler et al. does use insurance claim data and not direct molecular confirmation but it doesn't invalidate the study. misdiagnoses and mistreatment are not the same as underreporting. Your primary CDC estimate is based on information derived from the national Lyme disease surveillance system whic according to Kugeler et al. is subject to substantial underreporting. In another study [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550147/] with the same authors of Kugeler et al. re-iterate that "The estimated number of clinician-diagnosed LD cases in the United States is higher than the number reported through routine surveillance and consistent with previous estimates of LD underreporting". Another CDC study [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829628/ states again that cases are underreported. Slimjimwarrior (talk) 02:22, 9 July 2023 (UTC)

@Slimjimwarrior It’s important to distinguish between surveillance cases (confirmed, probable, suspect), actual infections, and people who are treated. It is well established in the references that the ~30k annual surveillance cases is an under-report (similar to other infections like COViD). It is also established that the 476k estimate is likely an over-estimate. Bottom line is that there is no support for your edits. ScienceFlyer (talk) 05:58, 9 July 2023 (UTC)

Incorrect claim in etymology section

The claim is made that "Outside of the US and English-speaking world, the disease is known as borreliosis." This is incorrect as evidenced by practically all the translations of this article. 89.135.93.152 (talk) 23:09, 9 July 2023 (UTC)

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Discussion of man made

Why is there no discussion of a possible man made origin of the disease? https://twitter.com/byPeterParadise/status/1692009148484059432 74.143.215.54 (talk) 20:00, 18 August 2023 (UTC)

Because conspiracy theorist Twitter threads are not reliable sources, there was no Lyme disease research on Plum Island, and DNA samples from museum specimens show that Lyme is caused by an old bug. See also No, Lyme disease is not an escaped military bioweapon, despite what conspiracy theorists say ScienceFlyer (talk) 04:56, 19 August 2023 (UTC)

A few years ago the Pentagon was ordered by the House to investigate these claims, so regardless of whether or not it's a "conspiracy theory" (which is more often these days a term used cynically by establishment shills to direct people away from learning about the lies that they're trying to cover up - see also: Covid-19 origins, vaccines, Hunter's laptop etc.), it is clearly notable enough to include in this article on that basis alone. As far as I'm aware, there is no wikipedia rule against mentioning notable "conspiracy theories". There are however rules against intentionally excluding notable information. 2607:FEA8:54DD:AE00:72AC:D7B5:C68:C78F (talk) 00:52, 4 November 2023 (UTC)

So provide reliable, third party sources about this investigation. Congress orders investigations into all kinds of things, that doesn't inherently make them notable. Often, they're political ploys to appeal to their constituents. We'll need actual sources that aren't just a trivial mention of the investigation.

If you can do so, please start a new section with your proposed wording and sources. It's not a good idea to revive months-old discussions. — The Hand That Feeds You:^Bite 12:10, 4 November 2023 (UTC)

Should we add a short section on Contrast and Compare with Syphilis?

An encyclopedia is all about placing something in context, right?

And the only other spirochete disease a lot of people know about is syphilis. And in later stages, both Lyme and syphilis can attack the brain and the joints. But here's where I become very cautious.

I certainly could summarize sources on syphilis, as I'm sure you could, too. But I am NOT a medical professional. So, I'm not confident that I'd really be achieving the goal of context.

I say, if we have a good source doing the Contrast and Compare, Yes, then we can summarize that source. FriendlyRiverOtter (talk) 23:11, 7 March 2024 (UTC)

Find us a source, preferably multiple sources, that do the comparison. We cannot do it ourselves, that's novel synthesis. — The Hand That Feeds You:^Bite 23:31, 7 March 2024 (UTC)

Yes indeed, just what the reference says, no more, no less. :-) FriendlyRiverOtter (talk) 17:08, March 15, 2024‎ (UTC)

New photo

Given that many erythema migrans rashes are solid in appearance, I propose to reduce the width of the bulls eye photo and add the new photo I just uploaded. It is from a new public domain case report. If any more experienced editors are able to make it look ok without being too crowded, please feel free. ScienceFlyer (talk) 00:54, 15 February 2024 (UTC)

@ScienceFlyer:

I think it's a good idea. And thanks for doing the work of getting a photo. From this source (currently ref # 27 in our article) --

DePietropaolo DL, Powers JH, Gill JM, Foy AJ (July 2005). "Diagnosis of lyme disease". American Family Physician. 72 (2): 297–304. doi:10.1093/cid/cir464. PMID 16050454.

'Approximately 19 percent of erythema migrans rashes are a “bull's-eye” rash.'

So yes, most Lyme rashes DO NOT appear to be a bull's eye.

I have a little experience with photos, but not recently. I'll try to jump in within the next couple of days. I know all of our time is limited! FriendlyRiverOtter (talk) 22:21, 28 February 2024 (UTC)

The following’s an attempt. FriendlyRiverOtter (talk) 16:30, 1 March 2024 (UTC)

• 
  bull’s-eye rash
• 
  not a bull’s eye but still Lyme

Lyme disease can affect several body systems and produce a broad range of symptoms.

//////

I went ahead and made the change:

https://en.wikipedia.org/w/index.php?title=Lyme_disease&diff=prev&oldid=1211620677

And with this reference, including a link to the highly readable pdf form.

ref name="North Carolina case with delayed diagnosis"

“Delayed Diagnosis of Locally Acquired Lyme Disease, Central North Carolina, USA”, Boyce, Ross; Pretsch, Peyton; Tyrlik, Kay; et. al, Emerging Infectious Diseases, U.S. CDC, Vol. 30, No. 3, March 2024.

I hope that people like it! FriendlyRiverOtter (talk) 15:38, 3 March 2024 (UTC)

Thank you @FriendlyRiverOtter. I corrected the citation and tightened the caption ScienceFlyer (talk) 17:38, 3 March 2024 (UTC)

@ScienceFlyer, you’re very welcome! I’m glad I was able to help.

With the photo captions, I think we just need to accept the fact that this will be the only thing a lot of people read, at least for the inner sections of the article. In fact, I think we need to embrace this fact and try to make each caption as succinct, informative, etc, as we can.

With the first photo, I think we need to say that the “classic” bull’s-eye rash is very much the exception not the rule. As our sources say.

With the second photo, I take that the CDC article’s main point is that this lady’s Lyme disease didn’t get a diagnosis for two months. And their 2nd point was that she was in North Carolina. Meaning, a place where her doctor, PA, etc, did not expect Lyme.

Time permitting, I’m going to look at both the captions and this section. I urge you to do the same, time permitting of course. Thanks. FriendlyRiverOtter (talk) 17:09, 4 March 2024 (UTC)

The terminology in the literature is a little confusing but I am concerned that "bulls eye" rashes (solid central dot) are being elided with general 'target' rashes (concentric circles), which are the classic form, it appears. Bon courage (talk) 17:20, 4 March 2024 (UTC)

@Bon courage: I think you're probably right, and it puts you in a bind.

Because even if you're the top Lyme expert on the Eastern seaboard, you've got to go with the references, no more, no less. Yes, I personally think a "bull's eye" with center red, concentric clearing, and outer red is more complex than just central clearing. And therefore, probably more rare.

Time permitting, please dive in. Maybe you'll find this exact point in a reference. And/or pick up other good stuff along the way. I recommend, let the process be a little messy, be both bold and reasonable, all that good stuff. :-) FriendlyRiverOtter (talk) 19:20, 5 March 2024 (UTC)

It doesn't put "me" in a bind. This is what I take from the best sources. So here[3] the CDC refer to the "classic" lyme rash as a "Circular, expanding rash with target-like appearance". It seems there is some POV-pushing lately to try and downplay what sources are saying about this classic presentation. Bon courage (talk) 19:42, 5 March 2024 (UTC)

@Bon courage: If I push POV, please call me out. Each and every time. Like I said to our colleague just now, I'm actually only medium interested in Lyme, and that's probably a pretty good place to be.

With 3 of us interested in this one brief window of time, we have a chance to make some progress. I want to jump in and make some edits. You might like them, you might not. Please let me know either way, or change the edit if you prefer to save time that way. FriendlyRiverOtter (talk) 21:39, 5 March 2024 (UTC)

Thanks @FriendlyRiverOtter. I agree things could probably be tightened (e.g. there are probably too many references cited). I'd be cautious about extrapolating or generalizing from a single case report, especially an atypical one like this. It's also not specified when the photo was taken, and it's a snapshot in time. The table in the report documents rash at PCP visit on day 10 but not at 28 days or later. An EM rash may develop clearing in the center over time. For me, chapter 1 of Alan Barbour's book ("Lyme Disease: Why It's Spreading, How It Makes You Sick") was educational. ScienceFlyer (talk) 18:33, 4 March 2024 (UTC)

@ScienceFlyer: Thanks for the book recommendation. I like books which are well-written, and books in which the author assumes the reader is just as smart as they are. Not every writer has that knack.

I'm actually only medium interested in Lyme! Although I guess that's probably a good place to be as an editor!

It occurs to me that they are two different 80 percents.

80% of Lyme patients have a rash of some type. And then, 80% of Lyme rashes are non-"bull's eye." And if we present these two facts at the same time, it slows down reading. And it takes away from the executive summary style I'm aiming for. FriendlyRiverOtter (talk) 21:30, 5 March 2024 (UTC)

@ScienceFlyer: I want to challenge you on the photo. It does not show central clearing. It shows central redness and concentric clearing. Look, I don't know whether the current medical lit. makes a big deal between "bull's eye" and "target-like." Maybe we should say both until and unless we get a good source(s) saying otherwise.

And let's go ahead and just state this is the U.S. figure. And really, this "bull's eye" is so textbook or "classic" that it looks like someone drew it on the skin using a shade of lipstick! FriendlyRiverOtter (talk) 23:02, 7 March 2024 (UTC)

@FriendlyRiverOtter Thank you for your comments. Central clearing as used in the literature appears to include target or bulls eye rash. I do agree it's best to use a term that the most English speakers would understand, though the photo is pretty illustrative regardless.

As the lesion expands over days to weeks, central or paracentral clearing may occur, with the resultant formation of an annular or target-like appearance.
— Dandache and Nadelman 2008

As for the 20% number, I could take it or leave it, but please at least remove the extraneous word "only". I think the 20% number gives a wrong sense that the rashes are static, either with or without clearing, when rashes evolve over time. The data is based on observations, probably at a single time point. I think it's best to emphasize that both types occur rather than particular numbers.

With long duration of lesions (5–6 weeks in one Swedish study), 80% of cases had central clearing. In contrast, most EM seen in the United States over the past 2 decades have been diagnosed and treated within 1 to 2 weeks of onset and most lacked central or paracentral clearing at the time of presentation. Central clearing occurred in only 37% and 9% of cases in two large studies conducted in the northeastern United States involving nearly 200 patients who had culture-confirmed EM.
— Dandache and Nadelman 2008

ScienceFlyer (talk) 00:31, 8 March 2024 (UTC)

I went ahead and took off the “Only.”

And I think the last quote you show raises a good point — central clearing comes somewhat later. And it sounds like much of the literature doesn’t make much of a distinction between central and para-central clearing.

It’s great discussing with you. It really is!  :-) But I also want us to channel our energy into improving our article.

Sometime during this weekend, I’m going to take a whack at making “Signs and symptoms” a faster read. No guarantees of course.

I’d love to see a time-series of 3 photos, or maybe just 2.

And really, if you have some time, please jump in anywhere you think the article could use some improvement. For example, I think there’s got to be some way of improving on the vague “vector-borne” in our opening sentence, just saying. :-)

FriendlyRiverOtter (talk) 15:32, 15 March 2024 (UTC)

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Neuropsychiatric Symptoms

Hi, I am concerned about the information about neuropsychiatric symptoms of lyme disease. On the published wiki article it claims that people with lyme disease are just as likely to experience mental health issues as the general public, however, there is a lot of new research disproving this statement. I want to include more information about how lyme disease can present itself through different psychiatric symptoms, such as depression, anxiety, and suicidal tendencies. I think it would be important to include this information because often times people with Lyme disease and psychiatric presenting symptoms go misdiagnosed and end up with treatments that are unsuccessful. I was wondering if it would be best to include this information under an entirely new header, or just edit and add to the information that already addresses psychiatric symptoms. If I were to include a new header I would discuss how the symptoms present themselves and how they can go about being treated. If any of you are interested in this, here is a recent review addressing the topic: https://assets.cureus.com/uploads/review_article/pdf/244441/20240415-3260-17dkswc.pdf Miafclark (talk) 17:06, 26 April 2024 (UTC)

Hi Miafclark. Can you find some better sources? The journal Cureus has some problems, including suspicions of being a predatory journal. We need to do better than that here. Keep in mind WP:MEDRS. We need reviews and meta-analyses, not single studies, even if they are peer-reviewed. Yes, that means that Wikipedia has stricter requirements for sourcing of medical information than medical journals. -- Valjean (talk) (PING me) 17:36, 26 April 2024 (UTC)

Hi Valjean. Another source I was referring to is linked here: https://www.mdpi.com/2227-9032/6/3/104 Miafclark (talk) 18:16, 29 April 2024 (UTC)

Because this is just one study, and it goes against what other RS say, I'm hesitant to use it. We need more input from other editors. I suggest that you start a thread at Wikipedia:Reliable sources/Noticeboard, point back to this thread, and ask if this source is a WP:MEDRS source and whether it's usable here. -- Valjean (talk) (PING me) 21:19, 29 April 2024 (UTC)

Hi @Miafclark- Thanks for your good faith efforts to improve this article. I reverted your edits because they are based in fringe theories and are not compliant with Wikipedia standards for reliable sources in medicine. These are complicated medical topics that are made even more confusing by prevalent misinformation, misconceptions, and overdiagnosis.

The Cairns reference has been criticized by experts as "uninformative and misleading".

The MDPI article by Robert Bransfield makes many claims, including asserting that Lyme disease is responsible for 25 different disorders, including 1200 suicides per year and autism. These claims are not supported by reliable data and don't pass the smell test. MDPI is known for its low standards, especially in special issues.

If you look at per-state suicide rates, the 1200 number is of similar magnitude to some of the per-state numbers in northeast US (e.g. for 2021, Connecticut reported 401, New York reported 1660, Massachusetts reported 604, and Pennsylvania reported 1885.) You can add up the numbers yourself, but basically, 1200 is a significant percentage of suicides in high-incidence states. If Lyme disease caused suicide (or 1200 suicides!), it would be readily apparent because 90% of Lyme cases are reported in 14 states + DC.

Bransfield's claims about autism are deconstructed here and mentioned in the lengthy article "Antiscience and ethical concerns associated with advocacy of Lyme disease". An analysis of blood samples of autistic children found no evidence of Lyme disease. Bransfield never provided suitable evidence that his patients had Lyme disease at all.

The recent Cureus review by Brackett et al is heavily reliant on the fringe claims of Bransfield (3 papers) plus an unreliable online survey of people claiming to have Lyme disease. Other cited papers include patients with diagnoses of PTLDS, which is not representative of Lyme disease patients and cannot be used to determine causality. The expert source currently used in the Wikipedia article underscores that correlation does not necessarily mean causation:

Although Lyme disease can co-occur with psychiatric illness, as it may with any other illness, there is no systematic evidence supporting a causal relationship that would warrant routine Lyme disease screening of patients with either ongoing or newly diagnosed psychiatric illness."
— 2020 guidelines

Worse than relying on unreliable sources, the Brackett review ignores evidence against its claims. See, for example, a 2022 article, which differentiates between known neurological manifestations of by Lyme disease and psychiatric disorders. Like the Brackett review, the report by Charlotte Huff contradicts expert consensus and contrary data while relying on an internet survey and fringe sources (including co-authors of Bransfield). Given the deficiencies of both sources, they should not be used in this article. The claim that antimicrobials improve psychiatric disorders is also not supported by reliable evidence. ScienceFlyer (talk) 22:51, 6 May 2024 (UTC)

Contradictory info about neuropsychiatric symptoms

Now the article contains contradictory statements regarding the neuropsychiatric aspect of the topic, and that needs to be resolved by discussing it here. More experienced editors can examine the issue and determine if the new content supersedes the older, in which case, the older content will likely be deleted. -- Valjean (talk) (PING me) 20:58, 3 May 2024 (UTC)

@Valjean Reverted the new material and replied above. ScienceFlyer (talk) 22:55, 6 May 2024 (UTC)

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Erythema migrans page

https://en.m.wikipedia.org/wiki/Erythema_migrans is a messy article. Because this is related, does anyone else want to edit the page or merge parts of it? I'm not capable W;ChangingUsername (talk) 09:44, 20 May 2024 (UTC)