The Curbsiders Internal Medicine Podcast #105: Lyme Disease and Tick-Borne Illness with ID Expert Paul Sax
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Jul 23, 2018 Paul E. Sax, infectious diseases expert and Harvard professor known for clinical teaching and writing, guides a tour of Lyme and tick-borne illnesses. He covers recognizing rashes and where ticks bite. He explains limits of testing, when to treat, doxycycline tips, co-infections like Babesia and Anaplasma, tick removal, prophylaxis decisions, and practical prevention steps.
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Early EM Treated Immediately After Boston Run
- Paul Sax described treating an asymptomatic man with an early erythema migrans seen 24 hours after a run without waiting for tests.
- The patient improved with prompt treatment, illustrating immediate clinical therapy over early serology.
Limitations Of Lyme Serology And IgM Pitfalls
- Lyme serology is unreliable early and IgM Western blots are prone to false positives.
- Many early Lyme patients lack antibodies, and a lone positive IgM after months of symptoms likely reflects a false positive, not active infection.
No Serologic Test Of Cure For Lyme
- There is no serologic test of cure for Lyme disease.
- Antibodies may remain positive for months to years after effective treatment and don't indicate active infection.