Post-treatment Lyme disease syndrome?

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Post-treatment Lyme disease syndrome?

Post by X-member » Fri 6 Nov 2015 23:25

Infect Dis Clin North Am. 2015 Jun;29(2):309-23. doi: 10.1016/j.idc.2015.02.012.
Posttreatment Lyme disease syndrome.
Aucott JN1.


http://www.ncbi.nlm.nih.gov/pubmed/25999226

Abstract
The prognosis following appropriate antibiotic treatment of early or late Lyme disease is favorable but can be complicated by persistent symptoms of unknown cause termed posttreatment Lyme disease syndrome (PTLDS), characterized by fatigue, musculoskeletal pain, and cognitive complaints that persist for 6 months or longer after completion of antibiotic therapy. Risk factors include delayed diagnosis, increased severity of symptoms, and presence of neurologic symptoms at time of initial treatment. Two-tier serologic testing is neither sensitive nor specific for diagnosis of PTLDS because of variability in convalescent serologic responses after treatment of early Lyme disease. Optimal treatment of PTLDS awaits more precise understanding of the pathophysiologic mechanisms involved in this illness and future treatment trials.
Last edited by X-member on Fri 9 Nov 2018 13:43, edited 1 time in total.

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Re: Posttreatment Lyme disease syndrome?

Post by X-member » Fri 6 Nov 2015 23:57

I think (but I am not sure since she talk about chronic Lyme*) that it is posttreatment Lyme disease syndrome (after a neuroborreliosis) that a US woman (and her "supporters") are talking about in the thread below:

"Chronic Lyme is post-sepsis syndrome" ?

http://www.lymeneteurope.org/forum/view ... =11&t=5983

* Chronic Lyme borreliosis = late Lyme disease in Sweden and Norway and in many other countries. But you know this already, don't you? ;)
Last edited by X-member on Sat 7 Nov 2015 0:15, edited 1 time in total.

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Re: Posttreatment Lyme disease syndrome?

Post by X-member » Sat 7 Nov 2015 0:01

Professor Ying Zhang has another theory:

Interview with Prof. Ying Zhang at the NorVect Conference 2015

https://www.youtube.com/watch?v=krXSFmk ... e=youtu.be

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Re: Posttreatment Lyme disease syndrome?

Post by X-member » Sat 7 Nov 2015 1:16

Since professor Ying Zhang also talk about relapse (see link in the post above), maybe someone wonder what this is called?

I have posted some information (from ILADS) in the thread/post below:

Chronic/late persistent Lyme borreliosis?

http://www.lymeneteurope.org/forum/view ... 220#p42822

duncan
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Re: Posttreatment Lyme disease syndrome?

Post by duncan » Sat 7 Nov 2015 13:28

If I might try my hand at a loose interpretation of this abstract?

Antibiotic treatment of Lyme is usually successful except that a lot of times the patient doesn't recover.

:shock:

Sound about right?

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Re: Posttreatment Lyme disease syndrome?

Post by X-member » Sat 7 Nov 2015 17:05

The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America

http://www.idsociety.org/uploadedFiles/ ... isease.pdf
Post–Lyme Disease Syndromes
There is no well-accepted definition of post–Lyme disease syndrome.
This has contributed to confusion and controversy and to a lack of firm data on its incidence, prevalence, and pathogenesis.
In an attempt to provide a framework for future research on this subject and to reduce diagnostic ambiguity in study populations, a definition for post–Lyme disease syndrome is proposed in these guidelines. Whatever definition is eventually adopted, having once had objective evidence of B. burgdorferi infection must be a condition sine qua non.
Proposed definition of post–Lyme disease syndrome
Exclusion criteria
An active, untreated, well-documented coinfection, such as babesiosis.
The presence of objective abnormalities on physical examination or on neuropsychologic testing that may explain the patient’s complaints. For example, a patient with antibiotic refractory Lyme arthritis would be excluded. A patient with late neuroborreliosis associated with encephalopathy, who has recurrent or refractory objective cognitive dysfunction, would be excluded.
A diagnosis of fibromyalgia or chronic fatigue syndrome before the onset of Lyme disease.
A prolonged history of undiagnosed or unexplained somatic complaints, such as musculoskeletal pains or fatigue, before the onset of Lyme disease.
A diagnosis of an underlying disease or condition that might explain the patient’s symptoms (e.g., morbid obesity, with a body mass index [calculated as weight in kilograms divided by the square of height in meters] 45; sleep apnea and narcolepsy; side effects of medications; autoimmune diseases; uncontrolled cardiopulmonary or endocrine disorders; malignant conditions within 2 years, except for uncomplicated skin cancer; known current liver disease; any past or current diagnosis of a major depressive disorder with psychotic or melancholic features; bipolar affective disorders; schizophrenia of any subtype; delusional disorders of any subtype; dementias of any subtype; anorexia nervosa or bulimia nervosa; and active drug abuse or alcoholism at present or within 2 years).
Laboratory or imaging abnormalities that might suggest an undiagnosed process distinct from post–Lyme disease syndrome, such as a highly elevated erythrocyte sedimentation rate (150 mm/h); abnormal thyroid function; a hematologic abnormality; abnormal levels of serum albumin, total protein, globulin, calcium, phosphorus, glucose, urea nitrogen, electrolytes, or creatinine; significant abnormalities on urine analysis; elevated liver enzyme levels; or a test result suggestive of the presence of a collagen vascular disease.
Although testing by either culture or PCR for evidence of Borrelia burgdorferi infection is not required, should such testing be done by reliable methods, a positive result would be an exclusion.

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Re: Posttreatment Lyme disease syndrome?

Post by X-member » Sat 7 Nov 2015 17:16

Drug Combinations against Borrelia burgdorferi Persisters In Vitro: Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline
Jie Feng,1 Paul G. Auwaerter,2 and Ying Zhang1,*

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373819/
While PTLDS has only subjective symptom complexes, about 10% of patients with late Lyme arthritis have objective, persistent joint swelling despite antibiotic therapy [5].

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Re: Posttreatment Lyme disease syndrome?

Post by X-member » Sat 7 Nov 2015 18:01

"Chronic Lyme is post-sepsis syndrome" ?

http://www.lymeneteurope.org/forum/view ... =50#p43255

From the thread above, a person from Norway say to me:
We are trying our best to tell you that we have evidence that the disease* ILADS treat is not about spirochetes.
* I guess that they talk about "symptoms after abx treatment".

How can they (the US woman and her Nowegian "supporter") be so sure about this?

duncan
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Re: Posttreatment Lyme disease syndrome?

Post by duncan » Sat 7 Nov 2015 18:08

PTLDS does not only have subjective symptoms. Stating categorically that patients diagnosed with PTLDS ONLY have subjective symptoms is simply incorrect. That table in the IDSA guidelines never got past "proposed".

Some PTLDS might only have subjective symptoms. Some may have objective symptoms. Some have both.

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Re: Posttreatment Lyme disease syndrome?

Post by X-member » Sat 7 Nov 2015 18:16

Perhaps this also belong in this thread?

IT’S CHRONIC FATIGUE, NOT LYME, INFECTIOUS DISEASE DOC TELLS SENATORS
(DR. DANIEL CAMERON)

http://danielcameronmd.com/canada-senate-lyme/

A quote:
The 2014 ILADS guidelines address many of these concerns, except for the definition of chronic Lyme disease. This was not addressed in the document, because the focus was on treatment.
Edit to add:

Burrascanos definition of chronic Lyme:
A very important issue is the definition of “Chronic Lyme Disease”. Based on my clinical data and the latest published information, I offer the following definition. To be said to have chronic LB*, these three criteria must be present:

1. Illness present for at least one year (this is approximately when immune breakdown attains clinically significant levels).
2. Have persistent major neurologic involvement (such as encephalitis/encephalopathy, meningitis, etc.) or active arthritic manifestations (active synovitis).
3. Still have active infection with B. burgdorferi (Bb), regardless of prior antibiotic therapy (if any).
http://www.ilads.org/lyme/B_guidelines_12_17_08.pdf

* Chronic LB = chronic Lyme borreliosis

Ps! He has "forgot" to mention ACA, but this is very rare in US. Ds.

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