1395
CONCISE COMMUNICATIONS Management of asymptomatic Borrelia burgdorferi infection The recognition of Lyme disease and the subsequent elucidation of its etiology and pathogenesis opened an important new chapter in medicine that has potential relevance to a wide variety of subacute and chronic illnesses (1-4). The guidelines for diagnosis and management of Lyme disease, however, are still being written. In geographic areas where the infection is endemic, there are residual controversies; for example, What is the frequency of seronegative Lyme disease? and How common is chronic fatigue or slight memory loss as solitary manifestations of the illness? One of the treatment controversies is illustrated by the following case. The patient, a 45-year-old management consultant, was examined in April 1968because of a few months' history of migratory polyarthralgia affecting the shoulders, elbows, hands, wrists, and knees. Transient swelling of his left wrist (3 months previously) and right knee (2-3 weeks earlier) had been observed. The patient, who vacationed each summer on Cuttyhunk Island in Long Island Sound, remembered that in September 1967, he had a severe grippe-like illness characterized by fatigue, malaise, and neck pain. An orthopedic surgeon had been consulted, radiographic findings had not been abnormal, and his systemic symptoms decreased in intensity, but did not disappear. The findings of general and musculoskeletal examinations performed in April 1968 were within normal limits, except for possible decreased range of motion of the dorsolumbar spine. The erythrocyte sedimentation rate (Westergren) was 36 mm/hour, and a latex fixation test gave negative results. During the year following this initial consultation, the patient experienced migratory polyarthritis (wrists and knees). Arthrocentesis of the left knee in March 1969yielded moderately cloudy yellow fluid which contained no crystals and was sterile on culture. These manifestations gradually disappeared and have not recurred over the past 23 years. Results of a general health assessment in January 1992 were negative. Findings of routine laboratory studies were within normal limits, but Borrelia burgdorferi serology was strongly positive (464 fluorescent units, control "negative"
CONCISE COMMUNICATIONS Management of asymptomatic Borrelia burgdorferi infection The recognition of Lyme disease and the subsequent elucidation of its etiology and pathogenesis opened an important new chapter in medicine that has potential relevance to a wide variety of subacute and chronic illnesses (1-4). The guidelines for diagnosis and management of Lyme disease, however, are still being written. In geographic areas where the infection is endemic, there are residual controversies; for example, What is the frequency of seronegative Lyme disease? and How common is chronic fatigue or slight memory loss as solitary manifestations of the illness? One of the treatment controversies is illustrated by the following case. The patient, a 45-year-old management consultant, was examined in April 1968because of a few months' history of migratory polyarthralgia affecting the shoulders, elbows, hands, wrists, and knees. Transient swelling of his left wrist (3 months previously) and right knee (2-3 weeks earlier) had been observed. The patient, who vacationed each summer on Cuttyhunk Island in Long Island Sound, remembered that in September 1967, he had a severe grippe-like illness characterized by fatigue, malaise, and neck pain. An orthopedic surgeon had been consulted, radiographic findings had not been abnormal, and his systemic symptoms decreased in intensity, but did not disappear. The findings of general and musculoskeletal examinations performed in April 1968 were within normal limits, except for possible decreased range of motion of the dorsolumbar spine. The erythrocyte sedimentation rate (Westergren) was 36 mm/hour, and a latex fixation test gave negative results. During the year following this initial consultation, the patient experienced migratory polyarthritis (wrists and knees). Arthrocentesis of the left knee in March 1969yielded moderately cloudy yellow fluid which contained no crystals and was sterile on culture. These manifestations gradually disappeared and have not recurred over the past 23 years. Results of a general health assessment in January 1992 were negative. Findings of routine laboratory studies were within normal limits, but Borrelia burgdorferi serology was strongly positive (464 fluorescent units, control "negative"
