Allen Steere - Lyme Disease Research

Lyme Disease Research

In 1975, the Connecticut State Health Department received complaints from Polly Murray, a mother living in the small town of Lyme, Connecticut. Two of her children had been diagnosed with juvenile rheumatoid arthritis, but she knew of others in the area with similar symptoms.

An epidemic intelligence officer assigned to the Connecticut state health department, David R. Snydman, MD contacted Allen Steere, MD who was studying rheumatology at Yale University, after he had performed a preliminary investigation and thought that there was some symptom complex worth investigating. He knew Allen Steere since they were together in Atlanta the year before at the Centers for Disease Control, when both were in the Epidemic Intelligence Service, a CDC program set up in the 1950s to track epidemics worldwide.

Steere met with Ms. Murray, who gave him a list of children who shared a set of symptoms. Steere called each affected family, representing 39 children in all, and he found an additional twelve adults suffering from what was thought to be juvenile rheumatoid arthritis.

A quarter of the people Steere interviewed remembered getting a strange, spreading skin rash (erythema migrans) before experiencing any other symptoms. A European doctor happened to be visiting Yale at the time, and he pointed out that the rash was similar to one frequently encountered in northern Europe and known to be associated with tick bites. Most of the rashes were found somewhere on the torso, suggesting a crawling vector rather than a flying one or a spider, but most patients did not remember being bitten.

In 1976, Steere began testing blood from disease victims for specific antibodies against 38-known tick-transmitted diseases and 178 other arthropod-transmitted viruses. Not one came out positive. When the broader definition of the disease was applied, more cases were discovered, in Connecticut, adjoining states, and the upper Midwest.

Steere then learned about the work of the Swedish dermatologist Arvid Afzelius, who in 1909 had described an expanding, ring-like lesion and speculated that it was caused by the bite of an Ixodes tick. The rash described by Afzelius was later named erythema migrans. Research in Europe had found that erythema migrans and acrodermatitis chronica atrophicans, another rash caused by tics in Europe, responded to penicillin, suggesting that the cause was bacterial, not viral. Yet no microorganisms could be found in fluid from the joints of Lyme disease patients.

The recognition that the patients in the United States had erythema migrans led to the recognition that "Lyme arthritis" was one manifestation of the same tick-borne disease known in Europe. The syndrome first found in and around Lyme and Old Lyme, Connecticut came to be called "Lyme Arthritis" and later "Lyme Disease".

In 1980, Steere and colleagues began to test antibiotic regimens in adult patients with Lyme disease.

Steere first published about neurological and cardiac symptoms involved in his early studies of Lyme disease in 1977. Steere first published work about chronic manifestations of the disease in 1979.

Steere later worked with Frank Dressler; the CDC later adopted their work for its Lyme Disease surveillance case definition. Using primarily sera from early, acute Lyme patients, Steere formulated serodiagnostic criteria for Western blotting, a technique which identifies antibodies in the serum directed against foreign antigen, in this case, B. burdorferi, the causative agent of Lyme disease.

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