Dr. Stephen Malawista, an infectious-disease researcher who orchestrated the detective work that in the mid-1970s led to the discovery of Lyme disease, died on Wednesday at his home in Hamden, Conn. He was 79.
The cause was metastatic melanoma, his wife, Tobé, said.
Lyme disease begins with the transmission of bacteria through the bite of a black-legged tick and can spread to muscles, joints, the heart and even the brain. Last month, the Centers for Disease Control and Prevention said Lyme disease is diagnosed in 300,000 Americans each year.
Many scientists contributed to today's understanding of Lyme disease. But a team led by Dr. Malawista, as chief of rheumatology at the Yale School of Medicine, and Allen C. Steere, then a postdoctoral student, is widely credited with defining the ailment. Their work was recognized in 1985 with the Ciba-Geigy-ILAR Rheumatology Prize, a prestigious honor in arthritis research.
In presenting the award, Dr. George E. Ehrlich, a vice president at Ciba-Geigy, the pharmaceutical giant, hailed the achievement as "a truly magnificent piece of medical detective work."
"There are few examples in modern times of a single team accomplishing so much in such an elegant way," Dr. Ehrlich said.
The story began in fall 1975, when two mothers — one from Lyme, Conn., the other from adjacent Old Lyme — were distressed by the odd rashes, neurological symptoms and swollen joints that their families and others were experiencing. Unable to find answers and frustrated, each approached Yale independently.
The initial diagnosis was juvenile rheumatoid arthritis, but that disease had never been known to appear in bunches. Doctors at Yale counted 51 cases, a rate about 100 times what would have been expected to occur in a combined population of 12,000 in the towns of Lyme, Old Lyme and East Haddam. The cases had also occurred almost exclusively in warm-weather months.
"Here was a disease that by its clustering — it was clustering in time, it was clustering in space, it was clustering in families and on roads — it really looked like there was a vector, something that transmits the disease, such as an insect," Dr. Malawista was quoted as saying in the book "Bull's-Eye: Unraveling the Medical Mystery of Lyme Disease" (Yale University Press, 2003), by Dr. Jonathan A. Edlow.
The researchers reported on the peculiar clustering and named it Lyme arthritis — Dr. Malawista's idea — in the journal Arthritis and Rheumatism in January 1977. A second article six months later suggested that antibiotics could help in some cases but not in others, which is still medicine's essential view.
Dr. Malawista and his team made the compelling link between ticks and the disease by noting that cases were 30 times more frequent on the east side of the Connecticut River, where Lyme is situated, than on the west side. Ticks feed and breed on deer, and there are far more deer on the east side.
Dr. Steere told Dr. Edlow that their success had derived largely from Dr. Malawista's management style. "He does allow people at least the potential for a lot of autonomy," Dr. Steere said.
But the Yale researchers were wrong in their initial judgment that the disease is caused by a virus — and even wrong that it was truly a new disease. Their announcement that it was caused by only one type of tick did not bear out. When symptoms turned out to be much more diverse than arthritis, they changed the name to Lyme disease.
Nonetheless, their effort to study a malady that was soon causing anguish well beyond Connecticut put them at the center of Lyme disease research. In 1984, Yale held the first international conference on the disease.
Dr. Willy Burgdorfer, working for the National Institutes of Health in Montana, found the bacterium that causes Lyme disease in 1982. Yale scientists then developed a vaccine, which was licensed in 1998. It was taken off the market in 2002.
Lyme disease remains treatable if not always curable. An antibiotic treatment usually wipes out the infection. If it does not, another course of antibiotics might be administered, sometimes intravenously. But bacteria can persist in the body, causing harm and illness months or even years after treatment has ended.
Stephen Evan Malawista was born on April 4, 1934, in Manhattan. His father, Lawrence, was a real estate developer. His mother, Ann Marlowe Straus, was a theatrical producer and chairwoman of the Berkshire Theater Festival in Massachusetts.
He was accepted at Harvard at 15 and studied experimental psychology with the behavioral psychologist B.F. Skinner. Mr. Malawista graduated magna cum laude and earned his medical degree from the Columbia University College of Physicians and Surgeons. After deciding to focus on inflammation, he spent two years at the National Institute of Arthritis and Metabolic Diseases. He joined the Yale faculty in 1966 and was chief of rheumatology for 21 years.
After his team discovered Lyme disease, he was described as thrilled that it could lead to an understanding of how joint inflammation can arise from infection. He was considered a leader in furthering understanding of how the interaction of different kinds of white blood cells drives inflammation.
In 1994, the American College of Rheumatology presented Dr. Malawista with its Distinguished Basic Investigator Award, praising his creativity in addressing problems. "He recognizes the kernels of the unknown in them," the citation said, "surrounds them with the known, and searches through this mechanism for insight in how to answer the questions that exist."
Dr. Malawista, who shared his mother's love of theater and music, started a vocal chamber music group with his wife, the former Tobé Anne Miller.
Dr. Malawista is also survived by his half-brother, David Malawista; and his stepsister, Penny Ritscher Staccioli.
Dr. Malawista remained fascinated by Lyme disease, about which many questions remain. One puzzle is how the disease can reappear more than a dozen years after the initial infection. He compared that phenomenon to the dog that did not bark in a Sherlock Holmes mystery. "What is the immune system if not a guard dog?" he asked. "Why has it stopped responding to the spirochetes in its midst?"
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