Guidelines for Diagnosis and Treatment German Borreliosis So

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
Post Reply
Margherita
Posts: 192
Joined: Thu 27 Sep 2012 18:22

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Margherita » Sat 29 Sep 2012 17:23

"Spanky"
explain to the rest of the class
No need for that. There are excellent pupils in this class. (So maybe you'ld better speak for yourself)
Please...illuminate me.
Think I'ld better not do so. It might bring you to some bad ideas
I have the whole weekend …
Unfortunately I don't.
But maybe you could spend it by collecting funds for Lymepatients.

Have a nice weekend.

User avatar
Spanky
Posts: 2762
Joined: Sun 20 Jul 2008 19:40

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Spanky » Sat 29 Sep 2012 17:27

"Margherita":
No need for that. There are excellent pupils in this class. (So maybe you'ld better speak for yourself)

Okay.

So you are saying that you don't know what you meant by that? Sounds like it...

Why am I not surprised?

(As I accurately predicted, I would regret asking the question).

Bagge
Posts: 596
Joined: Wed 19 Oct 2011 19:49

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Bagge » Sat 29 Sep 2012 17:42

Margherita wrote:But maybe you could spend it by collecting funds for Lymepatients.
That shouldn't be too hard. At most two, maybe three phone calls to a couple of seemingly well to do Lyme doctors. They should have earned enough money in the past year alone to fund the full treatment of quite a few patients. Heck, I bet one year's worth of their 'bonus' income combined with the million or so spent on JumboTron ads in the past year alone could have built a new research facility dedicated to the diagnosis and treatment of tick-borne diseases. But, that would be too easy, and boring - no conspiracies, no witch hunts and no persecutions to discuss at the dinner table.

The first phone call should go to the one that charges $2,000 just to do, uh, nothing. That charge, as I understand it is in addition to all medical fees. It is in addition to all expenses for prescriptions, supplies, nursing appointments, time with the physician, consultation fees, administrative fees, etc. A $2,000 per month, per IV patient door cover charge should easily add up to millions of dollars in pocket money over the course of just one year.

The second phone call could be to this one, who is "reporting income of as much as $3.3 million a year."
.

User avatar
Spanky
Posts: 2762
Joined: Sun 20 Jul 2008 19:40

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Spanky » Sat 29 Sep 2012 18:54

"Margherita":
But maybe you could spend it by collecting funds for Lymepatients.

If anyone else has any idea on this issue of how the IDSA manages to coerce European doctors into following their Guidelines with "subtle tools"... :roll:

...I would like to hear all about this.

User avatar
inmacdonald
Posts: 977
Joined: Fri 13 Jan 2012 22:32

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by inmacdonald » Sat 29 Sep 2012 19:51

Spanky JD.

I requested a reply from anyone on the forum with an interest in this thread, which I personally
initiated.
If you look through the thread dialogues, you will find the 3 questions that pertain to the
science behind the German Borreliosis Society guidelines and objecions statement which they
submitted to the IDSA about the IDSA guidlines.

While you have contempt for the ILADS guidelines, the members of the forum have a right to
know whether you hold the German Borreliosis Society in Contempt too.

The IDSA guidelines have not been supported by the German Borreliosis Society, and furthermore
the alleged science underlying many of the IDSA guidelines for USA use only, is challenged
on many key points by Learned Colleagues in Germany. Could it be possible that
the IDSA needs to correct the errors pointed out to them by Colleagues in Germany?

link:
http://lymedisease.org/wp-content/uploa ... 774413.pdf

Speak up for your convictions by answering the 3 questions about the Gerrman Borreliosis
Society guidelines. (Google translate will be freely available if you need it. If the German
Borreliosis Guidelines are too difficult for you to comprehend, then tell us)

BEst,
a

Margherita
Posts: 192
Joined: Thu 27 Sep 2012 18:22

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Margherita » Sat 29 Sep 2012 22:02

"Bagge"

On the issue 'speculations' I fully agree with you. That's a shame.

Raising funds for new research facilities for diagnosis and treatment: Good idea

"Spanky"

As 3 important questions are still waiting for an answer, let's finish your subtile way of interrogating on a subtile issue that most probably you know like no other.

By the way, Am I wrong? Did you write something about an Oktoberfest first? Enjoy it, but be aware that Lyme + alcoholics = NOT DONE, you should know that (too).

User avatar
Spanky
Posts: 2762
Joined: Sun 20 Jul 2008 19:40

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Spanky » Sat 29 Sep 2012 23:28

"inmacdonald":
Spanky JD.
MacDonald, 'Emeritus':

I don't know where this "Spanky JD" stuff is coming from, but I think it should probably be: "Spanky, J.D.".

But it actually sounds better reversed, "JD Spanky". Sounds like a good name for a bar or a burger joint...or, both... a bar that serves burgers. Like: "JD Spanky's". What do you think? I mean, let's face it...no one is going to want to eat in a burger place with your last name...
Speak up for your convictions by answering the 3 questions about the Gerrman Borreliosis
Society guidelines.
While I appreciate your efforts to waste your own time...I do not appreciate your efforts to waste mine.

So, I hope you will forgive my ignoring your questions, as trivial and annoying as they may be...

Your questions are irrelevant. The IDSA Guidlines were written for the use of physicians in the United States of America...not Germany. The German Borreliosis Society makes some attempt at justifying their criticisms by stating that the IDSA Guidelines have some acceptance in their country.

If so, my suggestion to them would be that they take their objections to those in their own country that are responsible for that situation.

And, as I have tried to point out to you in another thread, there are some distinct differences between the situations in Europe and North America as noted in the Guidelines themselves.
Last edited by Spanky on Sat 29 Sep 2012 23:42, edited 1 time in total.

User avatar
Spanky
Posts: 2762
Joined: Sun 20 Jul 2008 19:40

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Spanky » Sat 29 Sep 2012 23:37

"Margherita":

"Spanky"
As 3 important questions are still waiting for an answer, let's finish your subtile way of interrogating on a subtile issue that most probably you know like no other.
The common spelling is "subtle".

As to the portion highlighted in blue...

Huh?

User avatar
inmacdonald
Posts: 977
Joined: Fri 13 Jan 2012 22:32

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by inmacdonald » Sun 30 Sep 2012 0:05

Spanky JD

_________________________________________________________
I conclude that spoon feeding of Spanky JD is required so that he will
confront the serious points of objection from the German Borreliosis Society
which were transmittted to the IDSA in critique of the IDSA guidleines....
____________________________________________________________________
o Persistent symptoms of LB with Bb identification despite intensive antibiotic treatment (28-46).

o Members of the Deutsche Borreliose Gesellschaft have documented

150 such cases (ISBN 978-3-640-19378-3, submitted for publication).

Objection excerpted from the white paper from the German Borreliosis Society to the IDSA-------------------Full list of objections is posted below
_________________________________________________________________________
___
Objections from the German Borreliosis Society submitted to the IDSA ( Excerpted fromoriginal document pages 3-6)

_____________________________________________

Our objections relate to diagnosis and treatment of Lyme disease (LD), chronic

Lyme borreliosis (LB) and the so-called “post-Lyme syndrome” (PLS).


1. Objections to the IDSA guidelines for diagnosis of LD and chronic LB:


- Seronegativity is frequent in LD and does not rule out a chronic persistent

Borrelia burgdorferi (Bb) infection (1-18).


- The differential diagnosis between multiple sclerosis and neuroborreliosis based on CSF and serum analysis is not possible in at least 25% of cases (9-11, 21).

- Peripheral neuropathy is not rare but occurs in over 20% of LD cases (22-

25).


- So-called two-tier testing is not suitable to diagnose LB, particularly in the late phase, for the following reasons:

o The test methods available on the market are not standardized with respect to their diagnostic value.

o The sensitivity of ELISA and IFA screening tests varies from 50% to

70%.


o The sensitivity of the Lyme Western blot is around 10% higher than that of the screening test.

o This difference in sensitivity means that there is a risk that the screening test will be negative whereas the Western blot shows positive, and the diagnosis of LD will be missed.

o Neither the screening test nor the Western blot can rule out infection with Bb, i.e., there is a problem of seronegativity (based on the screening test and Western blot) even though the illness persists and has been confirmed by identification of the pathogenic agent (1-18).

2. Objections to the IDSA guidelines for treatment of LD and chronic LB:


- In Europe, LD is often associated with generalized dissemination throughout the entire body, including involvement of the central nervous system (CNS). Treatment should therefore be carried out with antibiotics that penetrate the CNS, irrespective of the various manifestations of the illness (arthritis, neuroborreliosis, neuropathy, acrodermatitis, carditis, encephalopathy).

- The oral antibiotics recommended by IDSA, namely low-dose doxycycline, amoxicillin and cefuroxime, do not penetrate the CNS; in contrast, minocycline, gemifloxacin and intravenous third-generation cephalosporins yield high concentrations in CSF above the minimal inhibitory concentration (MIC) for Bb (19).

- Contrary to the negative opinion of IDSA, the following antibiotics and methods of treatment have proven to be advantageous: carbapenems, ketolides and gemifloxacin (19); pulsed-dosing (20).


- The antibiotic treatment of EM displays a therapeutic failure rate of at least

10% (15, 41, 45, 47, 67-74).


- Bb could still be identified in the skin even after multiple antibiotic treatments with ceftriaxone, doxycycline and cefotaxime (47-49).

- The resistance of Bb to numerous antibiotics has been proven (61).


3. Objections to the proposed IDSA definition of “post-Lyme syndrome”:


- Antibiotic treatment according to the IDSA guidelines does not guarantee elimination of Bb.

- Subjective complaints may reflect ongoing infection with Bb rather than a different illness (PLS).

- The disease situation described by Steere et al (26) as “minor signs and symptoms” and by Bujak (27) as “post-Lyme syndrome” represents serious discomfort for affected patients that is comparable to decompensated cardiac insufficiency, degenerative joint diseases, pronounced diabetes mellitus or a condition after a myocardial infarction according to Klempner et al (2).

- The following facts suggest the existence of chronic LB due to persistent Bb infection:

o Persistent symptoms of LB with Bb identification despite intensive antibiotic treatment (28-46).

o Members of the Deutsche Borreliose Gesellschaft have documented

150 such cases (ISBN 978-3-640-19378-3, submitted for publication).

o There is an extensive body of literature on the existence of chronic

LB (45, 50-55).


o Bb could be cultured in every stage of chronic LB (28-44), even after intensive antibiotic treatment (20, 41, 56-60).


o Numerous publications deal with chronic LB and the problems with its antibiotic treatment (20, 48-49, 62-66).

o There is a high therapeutic failure rate for the antibiotic treatment of

LB in its late phase (52, 54-56, 65, 75-77).


- The so-called (according to the IDSA guidelines) adequate antibiotic therapy is subject to these restrictions:

o Since Bb can possibly resist various antibiotics (including those recommended by the IDSA guidelines) switching antibiotics may be indicated (61).

o While Bb may be resistant to erythromycin, related antibiotics appear to be suitable for treatment of LB (26, 83-85).

o Duration of treatment depends on the organic manifestations, severity and course of disease, as outlined in numerous references (2, 20, 25-26, 41, 45-47, 49, 51, 53-54, 56, 60-66, 71-73, 75, 86-94).

___________________________________________

There you have it.
i do not expect a rebbuttal from learned counsel in fact for the legal postions of the IDSA.
-_______________________________________
Game over.

User avatar
Spanky
Posts: 2762
Joined: Sun 20 Jul 2008 19:40

Re: Guidelines for Diagnosis and Treatment German Borreliosi

Post by Spanky » Sun 30 Sep 2012 1:24

"inmacdonald":
I do not expect a rebuttal from learned counsel in fact for the legal postions of the IDSA.
I have no idea what that is intended to mean.

And certainly don't care.
Game over.
Yes. Ohio State pulled it out. Close, though. Good game.

And speaking of things collegiate...

...just a reminder that an unfinished basement does not an ivory tower make, there, 'Emeritus'...

Post Reply