Life Sciences

Five Questions With: Dr. Fredric Silverblatt

INFECTIOUS-DISEASE EXPERT Dr. Fredric Silverblatt says many people with suspected Lyme disease are misdiagnosed and don't get the proper treatment.
Posted 6/8/09

Nearly 90 percent of Lyme disease cases occur in the Northeast, according to the R.I. Department of Health, and while early treatment can prevent serious complications, the disease, caused by a bacterium, can lead to long-term problems with memory and concentration, fatigue, joint swelling and more.

In 2007, state figures show, there were 236 confirmed Lyme cases, 12 probable cases, and 995 cases in which it was suspected.

Last Friday, South County Hospital opened a Lyme disease clinic in its emergency department, staffed by Dr. Fredric Silverblatt, an infectious-diseases expert; internist Dr. Jeffery Bandola, and Lee Ann Quinn, the hospital’s manager of infection control.

Silverblatt answered questions about the disease.

PBN: How many different tick-borne diseases do you see, and is Lyme disease the most common and the most serious?

SILVERBLATT: There are three different diseases common in Rhode Island that are carried by the deer tick: Lyme disease, anaplasmosis and babesiosis. One tick can transmit one, two or all three from the same bite. Lyme is by far the most common. Treatment is not the same for each one, so it is important for the physician to consider this when the patient does not respond to what should be adequate therapy. Each can cause serious illness – I was hospitalized two years ago with encephalitis caused by Lyme and babesia – but most often they have flu-like symptoms. Some underlying conditions could make them life-threatening, such as having babesiosis when you’ve had your spleen removed.

PBN: What led you to open this clinic at South County Hospital?

SILVERBLATT: My major reason is that during the course of my infectious disease practice, I have seen many patients who have not received proper diagnosis for suspected Lyme disease and have been receiving inappropriate treatment. The clinic is not for acute cases of Lyme disease, for example at the stage with the typical bullseye rash – that is readily handled by primary care providers. Rather we will see patients who have had symptoms for months and are not responding to therapy. Many do not have Lyme disease and require re-evaluation and re-diagnosis so that they can receive proper treatment for what they do have.

PBN: How treatable is Lyme disease at different stages?

SILVERBLATT: Lyme disease is very treatable during the early stages, and if adequately treated, the disease does not progress. The early stages include the bullseye rash, joint pains, meningitis, Bell's palsy and nerve pains, among others. The later stage is manifested by chronic or recurrent swelling of large joints and central nervous system symptoms such as memory difficulties, chronic fatigue and problems with concentration and mental skills. Treatment is usually successful with a two- to three-week course of doxycycline taken orally twice a day for the earlier stages. For the later stages, a one- to two-month course of intravenous ceftriaxone is recommended.

PBN: Lyme disease has been around for awhile. Have the treatments and diagnostic tools gotten better in the last few years, or are they mostly unchanged?

SILVERBLATT: Treatment hasn’t changed much over the years. We are now recommending that if a person notices an embedded tick that has been there for less than 36 hours, two tablets of doxycycline can prevent subsequent infection. The scientific literature does not support the use of long-term therapy for the later stages.

The tests used for diagnosing Lyme are undergoing evaluation. Currently the screening test requires a second test to make sure that a “positive” is truly due to Lyme. The C6 peptide is being evaluated to see if it is a accurate as the double test. There are many misconceptions about the sensitivity of the tests to diagnose Lyme disease. The test is often negative early in the disease (at the rash stage) and may not turn positive if treatment is prompt, but those people will not go on to develop the later stages.

PBN: What are the best preventive measures that you can recommend to the public?

SILVERBLATT: The best strategy for preventing Lyme disease is to avoid contact with ticks. We have a deer fence around our garden. Ticks do not travel very far from the deer or mice that carry them. Ticks love brushy areas or piles of leaves – you won’t get bitten if you stay on the paths. If you do go into a tick-infested area, these measures are recommended:

  • Wear clothing treated with permethrin, an effective insecticide.
  • Spray DEET on your exposed skin.
  • Wear white socks to better see ticks crawling on them, and tuck your pants into the sock.
  • Inspect yourself after contact, looking in the “crevice” areas: underarms, groin, behind your legs.
  • If you see an embedded tick, remove it with needle-nosed tweezers, grasping the head and pulling out firmly. Ticks won’t inject the bacteria into you for about 24 to 36 hours after they attach, so prompt removal can prevent infection.
  • The Lyme disease clinic will be open Fridays from 9 a.m. to noon and 1 to 3 p.m. Patients will be seen by appointment only and must have a physician referral. To schedule an appointment, call 788-1486. Only adult patients will be treated.

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