To the Editor: Feder et al. (Oct. 4 issue)1 review the greatcontroversy surrounding "chronic Lyme disease." For most patientswith this diagnosis, the authors advocate against the use ofantibiotics.
But before the decision is made not to use antibiotics for patientswith post–tick-bite symptoms, anaplasma, babesia, bartonella,2and ehrlichia must be ruled out. These tick-borne2 intracellularpathogens are difficult to diagnose and can establish long-term,persistent infection.3,4,5 Anaplasma, babesia, and bartonellaare underdiagnosed: the nonspecific symptoms of infections withthese organisms tend to be ascribed to the more easily identifiableLyme disease, which often accompanies them.2,3,4,5,6 Indeed,when . . . [Full Text of this Article]
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