Friends and colleagues, The following article appeared today in the Rockland Journal News, in Rockland County, N.Y.

Early treatment best in fighting Lyme disease


Richard Brand, M.D. and Jane Kelman, M.D.

We would like to thank you again for your continuing interest in Lyme disease (recent article: "Lyme cases may soar this summer" ).

However, the article contained several areas of misinformation with potentially harmful consequences.

It states that the nymphal ticks "must remain on a person for 36 to 48 hours to transmit the disease." This is not so, and there are reports of disseminated Lyme disease where the tick had been detected and removed in fewer than six hours.

Second, in the "If Bitten" section, the recommendation to "watch the (bitten) spot for signs of infection, mainly the bull's-eye rash," and to consult a doctor "if any symptoms appear," is falsely reassuring.

The erythema migrans rash ('Bull's-eye") is only one among many possible areas of infection. In some studies of chronic lyme, up to 40 percent of patients never had the rash and still went on to develop neurological, cardiac, rheumatologic, and other complications. Relying on the development of a rash will miss many affected people.

Our recommendation, based on our work with numerous patients affected by the neuropsychiatric complications of chronic, disseminated Lyme disease, is that anyone bitten by a tick should be tested immediately, and six weeks later, but that an antibiotic should be started immediately and continued for no fewer than four weeks, unless the tests come back negative, at which time it might be safe to discontinue the treatment.

While antibiotic treatment carries risk, it pales in comparison to the serious danger of developing late stage illness that may develop within weeks, and even before the first lyme tests have returned. Lyme may spread rapidly to the central nervous system, joint capsules, heart muscle, and other places where antibiotics, even powerful intravenous antibiotics, will never treat it, once the infection takes hold.

The spirochete which causes lyme disease changes forms and may become cyst-like in the presence of antibiotics, defending itself from attack. This is a complex illness, and early treatment is a small risk when weighed against the benefit of prevention.

----------------------- Internet Header --------------------------------
Received: from ( [])
by (8.9.3/8.9.3/SUN-1.9) with ESMTP id AAA16700
for; Sat, 13 May 2000 00:36:20 -0400 (EDT)
Received: (from majordomo@localhost)
by (8.8.5/8.8.5) id XAA28385
for mmi-list.kraken; Fri, 12 May 2000 23:51:23 -0500
Received: from ( [])
by (8.8.5/8.8.5) with ESMTP id XAA28381
for; Fri, 12 May 2000 23:51:22 -0500
Received: from ( [])
by (8.8.5/8.8.5) with ESMTP id XAA04601
for; Fri, 12 May 2000 23:29:43 -0500
Received: from LOCALNAME ( by with SMTP
(Eudora Internet Mail Server 3.0); Sat, 13 May 2000 00:29:47 -0400
Message-Id: <>
X-Mailer: QUALCOMM Windows Eudora Light Version 3.0.2 (16)
Date: Fri, 12 May 2000 23:12:35
From: "Richard Brand, M.D."
Subject: mmi Lyme article
Mime-Version: 1.0
Content-Type: text/plain; charset="us-ascii"
Precedence: bulk

Version: May 14, 2000.
The address of this page is
The home page of this website is
Send comments to: Joachim Gruber or Richard Brand, M.D.