By David Brown
Washington Post Staff Writer
Thursday, August 9, 2007
President Bush was treated a year ago for what appears to have been Lyme disease, the White House said yesterday in disclosing the results of his annual physical exam.
A report of the president's recent medical examination said his case had "complete resolution" and was "without recurrence" since being treated last August. The illness, an infection carried by deer ticks that is prevalent in the Northeastern United States, had not been previously revealed.
While untreated Lyme disease can cause arthritis, an abnormal heart rhythm and problems with the nervous system, those complications usually can be prevented by taking antibiotics at an early stage of the infection. The medical record did not describe the details of the president's therapy.
Up to 15 percent of people treated for Lyme disease later complain of symptoms such as fatigue and muscle pain. Whether that is a consequence of the infection is uncertain and a matter of controversy. Chronic pain and tiredness are extremely common in adults; whether people who have had Lyme disease suffer from those problems in higher numbers is unknown.
"I wouldn't expect any problem at all for the president," said Gary Wormser, chief of infectious diseases at New York Medical College and an expert on Lyme disease. "He won't be impacted by this infection in the future."
Lyme disease, named after the town in Connecticut where the first cases were identified in the 1970s, causes a rash that is often its sole manifestation. Classically it is a large reddish oval with a lighter-colored center and is often described as looking like a target.
White House spokesman Scott Stanzel said Bush found a rash on the front of his lower left leg and alerted White House physicians.
While the Lyme organism Borrelia burgdorferi can sometimes be isolated in the skin or bloodstream -- and antibodies to it can also eventually be detected in the blood -- laboratory testing is often not done. That is because a person with a typical rash and a history of outdoor activity will be treated for the disease, regardless of what the tests show.
Without such tests, however, it is impossible to rule out a Lyme disease look-alike called STARI as the cause of the president's illness last summer.
STARI stands for "Southern tick-associated rash illness." It also causes a target-like rash and is associated with a tick bite, but the causative organism has not been found.
STARI is common in Texas. The lone star tick is the species that transmits it. There are no documented cases of Lyme disease in the president's home state, where he spent much of last August on vacation.
"If he got it in Texas, it was undoubtedly STARI," Wormser said.
Stanzel said yesterday that he does not know when Bush's condition was diagnosed. The interval between tick bite and rash appearance in Lyme disease can be as long as 30 days. The president could have been infected with the Lyme organism in the Washington area, with the rash appearing after he left.
STARI seems to be a milder infection than Lyme disease. There is no specific test for it. It is diagnosed primarily if a patient has a Lyme-like rash and a tick bite, but no Lyme organisms or antibodies.
People with STARI almost always take the same antibiotics that are prescribed for Lyme disease. The rash goes away with treatment, as do the flu-like symptoms that sometimes accompany it.
Wormser said it is not known whether treatment of STARI is necessary. There appear to be no long-term consequences of either treated or untreated infection, he added.