used by the various presenters, the committee presented the terms exactly as transcribed reflecting the use by presenters and other participants. This does not imply that the committee believes that terms such as “post-Lyme disease,” “post-treatment Lyme disease,” “persistent Lyme disease,” and “chronic Lyme disease” are or are not interchangeable, differ in meaning or value, or have differing scientific validity. Similar confusion exists regarding terminology related to recurrent and relapsing Lyme disease with or without reinfection. As highlighted by many presenters, a commonly accepted lexicon of definitions that is consistently applied and understood would improve and advance research efforts regarding Lyme disease and other tick-borne diseases and likely improve patient care. Elucidation of the critical issues of infection and pathogenesis remains to be definitively achieved.

CRITICAL NEEDS AND GAPS IN UNDERSTANDING TICK-BORNE DISEASES: PRACTICING PHYSICIAN PERSPECTIVE

John Aucott, M.D., Park Medical Associates


Most clinicians are aware that an abundant literature exists on classic untreated Lyme disease and its typical early and late manifestations. In contrast, the literature and clinicians’ experience with persistent symptoms following antibiotic treatment of Lyme disease are more limited. Regardless of whether one names it chronic Lyme disease or post-Lyme disease syndrome, patients and clinicians are confused about how to proceed when patients report symptoms after a course of antibiotic treatment. A recent survey reported that 48 percent of Connecticut physicians are undecided as to whether chronic Lyme disease exists (Johnson and Feder, 2010). This controversy leaves clinicians uncertain about how to help patients who continue to report symptoms following antibiotic treatment.

The Centers for Disease Control and Prevention (CDC) “definite criteria” for classical signs and symptoms of Lyme disease include: erythema migrans (EM) rash, joint disease with inflammatory synovitis, and neurological disease with objective findings. Even with these straightforward criteria, a gap exists between the textbook descriptions of the disease and clinical practice. Retrospective studies (Aucott et al., 2009) have shown that frequent misdiagnosis occurs in community practices. For example, 23 percent of EM rashes and 54 percent of patients who did not present with a rash were misdiagnosed. Further complicating the clinical practice, as noted throughout the workshop, are the gaps in understanding the serologic response to the disease—how to use the laboratory tests that exist and what the limitations of these tests are.

The CDC has developed a “probable” case definition of Lyme disease that has a viral-like presentation. These patients present with symptoms and



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