SPIROCHETEMIA AFTER CONTINUOUS HIGH-DOSE ORAL AMOXICILLIN THERAPY

We present a case of Lyme disease that touches on three contemporary c ontroversies. First. the patient discussed is from southern Illinois, not thought to be an endemic area for Lyme disease because of the abse nce 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 expo sure in known endemic areas (California, north central, and north-east ern United States) since 1987. Second, although Amblyomma americanum ( Lone Star) ticks have been implicated as a potential vector of Lyme di sease since 1984 [2], and spirochetes consistent with Borrelia burgdor feri have been observed in A. americanum ticks by numerous researchers [3-8], many experts do not agree that this species can transmit B. bu rgdorferi in humans. The distinctive and unique white dot on the adult female Lone Star tick lends credence to patient anecdotes and histori es because no other tick looks like it. Third, the issue of persistent symptoms in treated Lyme patients (autoimmunity vs. persistent infect ion) is unresolved. We propose that this case may be relevant.