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John Meyerhoff- Sinai

John Meyerhoff, Rheumatologist
Sinai Hospital of Baltimore

NOT RECOMMENDED

Meyerhoff’s 2016 article (here) mentions ILADS Lyme disease guidelines, but also attempts to dismantle their recommendations piece by piece, often with no documentation or science offered for the opinions shared.  

Meyerhoff, educated at Hopkins and currently at Sinai Hospital in Baltimore, still follows Steere’s line of thought in some areas (making some sense because they are both rheumatologists).  He also follows IDSA/CDC outdated and unsuccessful recommendations in other places, which is natural because he is a long-time IDSA Lyme guideline supporter.  Neither failed schools of thought are acceptable for our patients.  

Even when the IDSA/CDC guidelines were past their 5 year "expiration date" Meyerhoff felt they were perfectly fine for use for Maryland patients and should be incorporated into Maryland’s Lyme Disease Task Force Plan.  He also fought hard against ILADS recommendations at the time and by way of this article- published 9 years later in 2016- it appears he still does.

Then there are many other comments in his article (some quoted below) that are either very questionable or leave a lot to be desired. 

QUOTES From Meyerhoff's Article

"The species of tick is important because non-Ixodes ticks (and other insects), although they can contain the organism, are highly unlikely to cause disease.

"Even in areas where about 15-30% of ticks are infected with Borrelia burgdorferi, tick bites rarely result in Lyme disease.

"If PCR is negative, the patient should be given symptomatic treatment with nonsteroidal anti-inflammatory drugs NSAIDs.

"In most patients with erythema migrans, no consultation is needed. However, consultation with appropriate specialists (eg, rheumatologist, neurologist, cardiologist) may be indicated to ensure that other diseases are not the cause of unusual presenting symptoms in a patient with a positive Lyme titer."

"The existence of PTLDS has been called into question as a result of a lack of direct evidence of persistent infection.” [Perhaps he missed these scientific publications? 700Peer-Reviewed Studies With Evidence of Persistence of Lyme Disease Spirochetes]

"Hassett and colleagues reported that rates of psychiatric comorbidity and other psychological factors (eg, depression, anxiety, tendency to catastrophize pain) were higher in patients with “chronic Lyme disease” ... than in other patients commonly seen in Lyme disease referral centers, and that those factors were related to poor functional outcomes.

"With any regimen, neurologic symptoms may take 6 months to reach maximum improvement."

"Response to treatment is usually slow and may be incomplete. Retreatment is not recommended unless relapse is shown by reliable objective measures."

"Conjunctivitis and photophobia in stage 1 Lyme disease require no therapy. Bell palsy in stage 2 Lyme disease is self-limited, but patients require supportive therapy to prevent the complications of exposure keratitis.

"The best approach for these patients might be a trial of antibiotic therapy, in which patients receive 2-3 weeks of intravenous penicillin or ceftriaxone. If patients respond to treatment, the trial is successful, ocular Lyme disease is diagnosed, and no further therapy is needed. Recurrences of Lyme uveitis, once adequate intravenous therapy has been given, can be treated with judicious corticosteroids.

"Penicillins provide effective treatment of Lyme disease.

"Inadequate concentrations of this drug [penicillin] may produce a bacteriostatic effect only.”  [You picked a fine time to tell me Lucille.]

"Despite appropriate antibiotic treatment, patients with Lyme disease may experience lingering symptoms similar to fibromyalgia (eg, fatigue, pain, joint and muscle aches). This condition has been termed chronic Lyme disease or, more precisely, post-treatment Lyme disease syndrome (PTLDS). [64]  These symptoms have not been shown in any controlled trials to be responsive to antibiotic therapy.

"Acrodermatitis chronica atrophicans is usually treated with 1-month course of oral antibiotics, usually a beta-lactam or doxycycline. One study showed fewer relapses with 30 days compared with 20 or fewer days of therapy. In the same study, 30 days of oral antibiotics were more effective than 15 days of intravenous ceftriaxone (2 g/d). [63It is important to ensure that no neurologic manifestations are present before embarking on oral therapy.

"Co-transmitted infective organisms can include the following:
  • Babesia microti, the primary cause of babesiosis
  • Anaplasma phagocytophilum and Ehrlichia chaffeensis, which cause ehrlichiosis
  • Flavivirus, the cause of tick-borne encephalitis
  • Powassan or tick-borne encephalitis-like virus"
"Transmission of infection is unlikely if the duration of tick attachment is less than 24 hours, but is very likely for ticks attached for longer than 72 hours."

"The use of forceps and gloves represents an optimal method of removal. However, removal of the tick should not be delayed in order to obtain forceps and it is extremely unlikely that one can become infected by touching an engorged tick even if the tick is carrying Borrelia (which most of them are not, even in endemic areas).

"Routine prophylaxis after a recognized tick bite is not recommended.

"Consultation with a neurologist is recommended in patients with persistent or chronic manifestations of Lyme disease, such as chronic fatigue syndrome.

"In early Lyme disease, lack of prompt resolution should lead the physician to question the original diagnosis.

"Cefuroxime is a second-generation cephalosporin that is the only drug approved by the Food and Drug Administration (FDA) for use in Lyme disease. Cefuroxime is approved for use in adults. Its principal limitation is its expense."

Link Here

John Meyerhoff- Maryland Rheumatologist

Quote- “We often have patients sent to us because their doctors are concerned they may have serious diseases, which I get to tell them they don’t have.”
Meyerhoff- 2 minute video 

Co-editor, Gerald Zaidman- NY Medical College- Ophthalmology Department

It appears (??) Zaidman had the same study published on ocular manifestations of Lyme disease 4 years apart. [Gregory Glass at Johns Hopkins was doing similar studies over and over again, basically because for a long time there was no oversight.  That fact was eventually brought to the attention of those controlling the State’s budget and it appears he has not published on Lyme since, but instead is listed on a number of rat studies, many from outside the USA.]  

Zaidman GW.
Int Ophthalmol Clin1997 Spring;37(2):13-28. Review.
PMID:
 
9269595
Select item 8349429
Zaidman GW.
Int Ophthalmol Clin1993 Winter;33(1):9-22. Review.
PMID:
 
8349429
Link Here

Link Here


More from Meyerhoff

"Unfortunately, this study may not convince proponents of long-term therapy who believe post–Lyme-disease symptoms may represent concurrent symptoms of ehrlichiosis and babesiosis (8), both of which should be treated with antibiotics. … For patients with post–Lyme-disease symptoms, the best recommendation is referral to a rheumatologist or infectious-disease specialist knowledgeable about Lyme disease and experienced in fibromyalgia.






Lucy Barnes






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