The phenomenon of ‘chronic Lyme’; an observational study

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
rlstanley
Posts: 1637
Joined: Mon 3 Dec 2007 2:53

The phenomenon of ‘chronic Lyme’; an observational study

Post by rlstanley » Fri 16 Mar 2012 19:39

http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract

The phenomenon of ‘chronic Lyme’; an observational study

U. Ljøstad1, Å. Mygland1,2,3Article first published online: 15 MAR 2012
European Journal of Neurology. doi: 10.1111/j.1468-1331.2012.03691.x


Author Information

1Department of Neurology, Sørlandet Hospital, Kristiansand, Norway
2Institute of Clinical Medicine, University of Bergen, Bergen, Norway
3Department of Habilitation, Sørlandet Hospital, Kristiansand, Norway
*U. Ljøstad, Sørlandet Hospital HF, N–4604 Kristiansand, Norway (tel.: +47 38073910; fax: +47 38073911; e-mail: unn.ljostad@sshf.no).
Keywords: bacterial infections;post-infectious syndromes

Purposes:  To chart clinical, laboratory, and psychometric profiles in patients who attribute their complaints to chronic Lyme disease.

Methods:  We assessed the patients by clinical examination, laboratory tests, and questionnaires measuring fatigue, depression, anxiety, health-related quality of life, hypochondriasis, and illness perceptions.

Results:  We found no evidence of ongoing Borrelia burgdorferi (Bb) infection in any of the 29 included patients using current diagnostic guidelines and an extended array of tests. Eight (28%) had other well-defined illnesses. Twenty-one (72%) had symptoms of unknown cause, of those six met the suggested criteria for post-Lyme disease syndrome. Fourteen (48%) had presence of anti-Bb antibodies. The patients had more fatigue and poorer health-related quality of life as compared to normative data, but were not more depressed, anxious, or hypochondriacal. Their beliefs about the illness were characterized by negative expectations.

Conclusion:  Our patients, who all attributed their symptoms to chronic Lyme disease, were heterogeneous. None had evidences of persistent Bb infection, but whether current diagnostic criteria are functional in patients with longstanding complaints is controversial. Other well-defined illnesses or sequelae from earlier Lyme disease were probable as main explanatory factor in some cases. The patients were not more depressed, anxious, or hypochondriacal than the normal population, but they had poorer health-related quality of life, more fatigue, and negative expectations about their illness.

X-member
Posts: 7578
Joined: Mon 30 Jul 2007 18:18

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by X-member » Fri 16 Mar 2012 21:11

Removed!
Last edited by X-member on Wed 21 Mar 2012 15:33, edited 3 times in total.

X-member
Posts: 7578
Joined: Mon 30 Jul 2007 18:18

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by X-member » Fri 16 Mar 2012 21:37

Removed!
Last edited by X-member on Sun 18 Mar 2012 20:04, edited 1 time in total.

X-member
Posts: 7578
Joined: Mon 30 Jul 2007 18:18

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by X-member » Fri 16 Mar 2012 22:59

Removed!
Last edited by X-member on Sun 18 Mar 2012 20:05, edited 1 time in total.

rlstanley
Posts: 1637
Joined: Mon 3 Dec 2007 2:53

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by rlstanley » Sat 17 Mar 2012 0:47

.
from Relative Risk Blog:

http://relative-risk.blogspot.com/2012/ ... -lyme.html
...Patients were eligible if they suffered from symptoms suspected by themselves or their doctor to be caused by ongoing chronic Bb infection. Objective clinical or laboratory manifestations of Lyme disease were not mandatory. They became aware of the study by a small notice in two nationwide newspapers, or by information from others, and were recruited through referral from primary care, other hospitals, or self-referral. They were informed that we wanted to chart symptoms, laboratory results, quality of life, and coping strategies. The first 30 referred patients were included.

Patients without evidences of ongoing Bb infection were classified in three categories;

Category 1: Symptoms of unknown cause with presence of anti-Bb antibodies in
serum or CSF.
Category 2: Symptoms of unknown cause without anti-Bb antibodies.
Category 3: Symptoms considered to be caused by another well-defined illness, i.e.,
fulfilling diagnostic criteria for another illness.

Our study population consisted of patients who basically attributed their complaints to chronic Lyme disease. The patients reported many symptoms, 70% were not working, their health-related quality of life was poor, but none met European diagnostic criteria for ongoing Bb infection. Is this a result of dysfunctional diagnostic criteria, dysfunctional patients, or both?

Arguments against ongoing Bb infection are absence of objective neurologic signs, negative CSF findings including CXCL13 and Bb PCR, and no sustained efficacy of a mean antibiotic treatment of 12 weeks. Further, half of our patients were sero-negative, and in absence of a clinical picture consistent with ongoing Bb infection, presence of anti-Bb antibodies in the rest can be regarded as serologic scars from earlier exposure to Bb.

…even if persistent infection cannot be totally excluded as a differential diagnosis and dysfunctional criteria remains a consideration, we did not find convincing evidences of ongoing Bb infection in any of our patients. Then, what are the causes for the patients’ long-standing complaints?

We found no differences in symptoms between patients with and without anti-Bb antibodies. On the other hand, patients with symptoms of unknown cause had more fatigue and less vitality than those with well-defined illnesses. The majority of the patients with symptoms of unknown cause met the criteria for chronic fatigue syndrome.

We could not find more depression, anxiety, or hypochondriasis amongst our patients than reported amongst healthy persons, nor did the three subscores in SF-36 assessing mental health-related quality of life differ between our patients and normative data. Illness perception amongst our patients was, however, characterized by negative beliefs.

In summary, we regard ongoing Bb infection as unprobable in our patients, and hypothesize that other well-defined illnesses, permanent tissue damage from earlier infection, autoimmunity, and negative expectations about the symptoms were more important illness predisposing and perpetuating factors than depression, anxiety, and hypochondriasis.

tosho
Posts: 282
Joined: Sun 16 Dec 2007 0:54
Location: Poland

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by tosho » Sat 17 Mar 2012 10:57

See the comments for what relative-risk blogger advises for "post Lyme disease syndrome":

Anonymous Mar 16, 2012 01:35 PM

Ok, so its not persistent infection. What can people with persisting symptoms after antimicrobial therapy do. Year after year of the same studies yet no recommendations for the poor souls suffering.

Relative Risk Mar 16, 2012 03:02 PM

See:

Gabapentin for the symptomatic treatment of chronic neuropathic pain in patients with late-stage lyme borreliosis: a pilot study. Weissenbacher S, Ring J, Hofmann H. Dermatology. 2005;211(2):123-7. PMID: 16088158.
Funny that relative-risk blogger sees nothing wrong when there is anecdotal improvement of "post Lyme disease" symptoms on Gabapentin whereas when the same happens on longer abx treatment then it is a quackery and placebo...

I don't understand why you guys quote relative-risk blog. It's written by a frustrated person, presents only one sided opinion and does not accept comments under his/her articles that do not follow his/her way of thinking. Have some respect to yourselves.

X-member
Posts: 7578
Joined: Mon 30 Jul 2007 18:18

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by X-member » Sat 17 Mar 2012 14:08

Removed!
Last edited by X-member on Wed 21 Mar 2012 15:34, edited 3 times in total.

X-member
Posts: 7578
Joined: Mon 30 Jul 2007 18:18

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by X-member » Sat 17 Mar 2012 14:24

Removed!
Last edited by X-member on Wed 21 Mar 2012 15:34, edited 2 times in total.

X-member
Posts: 7578
Joined: Mon 30 Jul 2007 18:18

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by X-member » Sat 17 Mar 2012 15:45

Removed!
Last edited by X-member on Sun 18 Mar 2012 20:30, edited 1 time in total.

X-member
Posts: 7578
Joined: Mon 30 Jul 2007 18:18

Re: The phenomenon of ‘chronic Lyme’; an observational study

Post by X-member » Sat 17 Mar 2012 16:04

Removed!
Last edited by X-member on Sun 18 Mar 2012 20:07, edited 1 time in total.

Post Reply