Lyme disease mystery targeted

Albany -- Researcher armed with $1.8M federal grant seeks to learn why some patients suffer for years despite treatment

By MATT PACENZA, Staff writer
First published: Thursday, May 27, 2004

All things considered, Marcia Fabiano was lucky.
Sure, her case of Lyme disease knocked her flat on her feet for a few weeks last summer, causing her to sleep 20 hours a day. But a few months after the Columbia County Health Department epidemiologist took antibiotics to kill bacteria from a tick bite, she was OK.

Not everyone with Lyme disease recovers that way. Some, exhausted and weak, develop Lyme complications that persist for months and even years: arthritis, neurological problems and occasionally, heart damage.
The question of why individuals experience Lyme so differently has generated tremendous controversy, often pitting patients against researchers.

One scientist looking to solve the Lyme puzzle is Albany Medical College professor Dr. Timothy Sellati, who is newly armed with a $1.8 million federal grant to support his study of immune system differences.

It's a question that isn't just academic, as the number of cases of Lyme locally continues to rise, particularly along the eastern side of the Hudson River.

Columbia County, which has had more than 900 cases of Lyme for each of the last two years, has the highest per capita rate of the disease in the country. Its northern neighbor is following steadily on its heels.

"Probably about five years from now, I wouldn't be surprised to see Rensselaer County have the highest incidence rates," said Fabiano.

"It's here!" concurred Rensselaer County Public Health Director Denise Ayers, where the number of cases rose nearly 30 percent in 2003. "There are people who see ticks who say they've never seen ticks in their back yard before."

Outside Rensselaer County, Lyme cases were down slightly across the Capital Region in 2003. However, both Fabiano and Ayers said that early returns from this year tick season typically starts in March, once the snow melts suggests that this year could be the worst yet.

Here's how people get Lyme disease: a deer tick infected with the bacteria Borrelia burgdorferi, which they usually get from deer or mice, bites and stays attached to a person.

Symptoms, which can include a tell-tale bull's-eye rash, fever, headache, fatigue, and muscle and joint pain, appear within several days or weeks.

Interestingly, it's not the bacteria that damages the body. "It's our inflammatory response to the bacteria that causes the symptoms," said Sellati, an assistant professor in the Center for Immunology and Microbial Disease at Albany Med who has been studying Lyme disease for more than a decade. "It's our own immune system causing the trouble."

About 90 percent of patients with Lyme disease, like Fabiano, take a course of antibiotics which will kill the bacteria, quieting their immune response. But for some, the antibiotics don't work.

Sellati surmises that's because those people lack certain proteins on their white blood cells.

"We've identified the proteins," said Sellati. "Mice who are genetically deficient in the proteins have a more severe clinical case of Lyme disease."

The ultimate hope for Sellati's five-year, $1.8 million grant from the National Institute of Allergy and Infectious Diseases is to be able to figure out how to manipulate those proteins, thereby quieting the immune systems "to alleviate the chronic symptoms associated with infection with Borrelia," said Sellati.

The researcher is confident in his approach, but some people who have suffered from chronic Lyme disagree. They advocate months or even years of antibiotics to wipe out the last remnants of the bacteria.

Sellati dismisses that approach, pointing to a 2001 New England Journal of Medicine study which found that placebos were just as effective as long-term antibiotics in treating chronic Lyme infections.

Others believe that those who resist antibiotic treatment may have a secondary infection. "Ticks can be co-infected," said Kathy Sen, supervising community health nurse in Schenectady County. "There may be another infection that's never been diagnosed or treated."

Whatever the cause of chronic Lyme disease, the main tool that public health professionals have against Lyme -- as infection rates rise in the Capital Region -- is education.

They urge the public to check carefully for ticks after spending time outdoors: if a tick is removed within 36 hours after it bites, the possibility of getting the infection goes way down.

Rensselaer County officials recently distributed 14,000 fliers to residents. They not only urge regular tick checks, but also recommend keeping grass cut short, keeping deer out of gardens and other measures, to discourage the deer and mice that carry the ticks from inhabiting back yards.

Fabiano knows she is fortunate to be rid of Lyme disease and the months of pain and fatigue she suffered.

"It's not a disease I would want to have twice," she said.