An Appraisal of “Chronic Lyme Disease”

To the Editor: Feder et al. (Oct. 4 issue) 1 review the great controversy surrounding “chronic Lyme disease.” For most patients with this diagnosis, the authors advocate against the use of antibiotics. But before the decision is made not to use antibiotics for patients with post–tick-bite symptoms, anaplasma, babesia, bartonella, 2 and ehrlichia must be ruled out. These tick-borne 2 intracellular pathogens are difficult to diagnose and can establish long-term, persistent infection. 3 – 5 Anaplasma, babesia, and bartonella are underdiagnosed: the nonspecific symptoms of infections with these organisms tend to be ascribed to the more easily identifiable Lyme disease, which often accompanies them. 2 – . . .