Studies or research on late complicated Lyme

[X-member]

IDSA say:

http://www.uphs.upenn.edu/bugdrug/antib ... lyme06.pdf

These guidelines were developed and issued on behalf of the Infectious
Diseases Society of America.

It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The Infectious
Diseases Society of America considers adherence to these guidelines to be
voluntary, with the ultimate determination regarding their application to be made
by the physician in the light of each patient’s individual circumstances.

Burrascano say:

http://betterhealthguy.com/joomla/blog/ ... conference

•Dr. B considers a person to be "chronic" if they have had the condition over 1 year.

He also say:

•"I don't know of any sick Lyme patient that does not have coinfections if they have chronic Lyme". Coinfections are pretty much universal. They "change the character of the disease much like mixing different colors results in a new color".

Henry said (in another topic)

I neglected to mention that the NIH now spends more that $25M on basic research on Lyme disease. Furthermore, a Congressional mandate requires that it interact closely and regularly with ALL federal agencies doing work on Lyme disease. That's a whole lot of effort for a disease that is not life threatening and has an incidence of about 30,000 reported cases per year. The major problem is not that we don't have sufficient information about Lyme disease. Rather, it is the lack of trust, on the part of vocal activists, with respect to accepting the facts derived from excellent work done by outstanding research scientists and physicians. Compare their credentials and accomplishments to those of the LLMDs and "self-proclaimed" experts on Lyme disease and tell me who ought to be believed and trusted?

So, now I want to see those studies (or research) on what we, who suffer from chronic (or late if you prefer), Lyme, talk about.

We need NO MORE studies on acute (=early) uncomplicated and easy-to-cure Lyme! And absolutely not any more studies on cured uncomplicated Lyme!

[X-member]

Henry said:

it is the lack of trust, on the part of vocal activists

Let us now see who we can trust!

[X-member]

Henry also said:

That's a whole lot of effort for a disease that is not life threatening

Look in the topic about chronic (=late) European Lyme!

http://www.lymeneteurope.org/forum/view ... f=7&t=3528

And read about the 16 year old Swedish boy that died from Late Lyme! And this is far from the only case! I can give you more! But I will do that later in the topic about European Lyme!

But I will give you some info from that topic:

The lack of coordination, holistic, systematic and accountable to the incident demonstrates, according to the National Board is not acceptable. National Board of Health now requires that the county establish and clarify where responsibility lies in keeping the investigation and treatment of children and adolescents that repeatedly seeking care with unclear and multifocal symptomatology.

[X-member]

This is a very important question, that still isn't answered:

Henry said:

it is the lack of trust, on the part of vocal activists

Let us now see who we can trust!

We say in Sweden:

"If you already have said A you must say B too!"

[X-member]

I don't know if this study (or summary) really is on complicated Lyme, but it is on (what they consider) to be the type of Lyme (B Afzelii) that is the hardest to "knock out" with Abx (source regarding B Afzelii: Öystein Brorsons articles, Norway):

http://www.grin.com/en/e-book/166179/pr ... me-disease

Prolonged antibiotic therapy in PCR confirmed persistent Lyme disease

Wolfgang Klemann, MD, PhD Bernt-Dieter Huismans, MD, PhD Stephan Heyl, MD, PhD

Abstract:

We examined a sample of 90 individuals that had previously received a course of appropriate antibiotics for Lyme disease without experiencing full resolution of their symptoms and had evidence of persistent infection documented by PCR analysis. Mean duration of symptoms was 9.5 years (range 1 - 40 years). The treatment was adapted to the individual case according to clinical response. Long term antibiotic therapy was initiated and patients were treated continuously for at least 6 months, in some cases several years of intermittent therapy was administered. About 38,8% of the patients experienced full remission of symptoms while about 56,7% reported a significant improvement, 5,6% of patients were deemed refractory to therapy. Therapeutic modalities are discussed in detail.

[X-member]

I have to add:

I could be different explanations why European late Lyme in some cases is more hard-to-cure (=need longer treatment), compared with Lyme in US.

Maybe co-infections are more common in US?

[RitaA]

Carina,

It's possible that co-infections are more common in the U.S. than Europe, but I'd have to take a closer look. I've done a bit of research, and it seems that co-infections are becoming more frequent in both the U.S. and Europe. This may be due to increased awareness and better testing methods, as well as other factors I can't think of right now. One reason for the increased survival of the ticks themselves (at least in cold weather conditions) is the tick "antifreeze" associated with one possible co-infection. I posted about this on another forum, but you might find this interesting as well:

http://www.ncbi.nlm.nih.gov/pubmed/20739755

J Clin Invest. 2010 Sep 1;120(9):3179-90. doi: 10.1172/JCI42868. Epub 2010 Aug 25.

Anaplasma phagocytophilum induces Ixodes scapularis ticks to express an antifreeze glycoprotein gene that enhances their survival in the cold.

Neelakanta G, Sultana H, Fish D, Anderson JF, Fikrig E.

Source

Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8022, USA.

Abstract

In the United States, Ixodes scapularis ticks overwinter in the Northeast and Upper Midwest and transmit the agent of human granulocytic anaplasmosis, Anaplasma phagocytophilum, among other pathogens. We now show that the presence of A. phagocytophilum in I. scapularis ticks increases their ability to survive in the cold. We identified an I. scapularis antifreeze glycoprotein, designated IAFGP, and demonstrated via RNAi knockdown studies the importance of IAFGP for the survival of I. scapularis ticks in a cold environment. Transfection studies also show that IAFGP increased the viability of yeast cells subjected to cold temperature. Remarkably, A. phagocytophilum induced the expression of iafgp, thereby increasing the cold tolerance and survival of I. scapularis. These data define a molecular basis for symbiosis between a human pathogenic bacterium and its arthropod vector and delineate what we believe to be a new pathway that may be targeted to alter the life cycle of this microbe and its invertebrate host.

Comment in
J Clin Invest. 2010 Sep 1;120(9):3087-90.

PMID: 20739755 [PubMed - indexed for MEDLINE] PMCID: PMC2929727 Free PMC Article

The tick "antifreeze" is associated with Anaplasma phagocytophilum, which has also been found in Europe, as shown here:

http://www.ncbi.nlm.nih.gov/pubmed/19367099

Curr Probl Dermatol. 2009;37:130-54. Epub 2009 Apr 8.

Other tick-borne diseases in Europe.

Bitam I, Raoult D.

Source

Unité des Rickettsies CNRS-IRD UMR 6236, Faculté de Médecine, Université de la Méditerranée, Marseille , France.

Abstract

Ticks are obligate blood-sucking arthropods that transmit pathogens while feeding, and in Europe, more vector-borne diseases are transmitted to humans by ticks than by any other agent. In addition to neurotoxins, ticks can transmit bacteria (e.g. rickettsiae, spirochetes) viruses and protozoa. Some tick-borne diseases, such as Lyme disease and ehrlichiosis, can cause severe or fatal illnesses. Here, we examine tick-borne diseases other than Lyme disease that are found in Europe; namely: anaplasmosis, relapsing fever, tularemia, tick-borne encephalitis, tick-borne babesiosis and tick-borne rickettsiosis. Each disease is broken down into a description, epidemiology, signs and symptoms, diagnosis and treatment, providing clear overviews of each disease course and the interventions required. Furthermore, in the section concerning tick-borne rickettsiosis, a clear summary of the Rickettsia conorii complex and its role in the disease is provided.

Copyright 2009 S. Karger AG, Basel.

PMID: 19367099 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/20209806

Wiad Parazytol. 2009;55(4):341-7.

[Effect of coinfections in Ixodidae ticks on transmission of blood microparasites].

[Article in Polish]

Siński E.

Source

Zakład Parazytologii, Instytut Zoologii, Wydział Biologii, Uniwersytet Warszawski, ul. Ilji Miecznikowa 1, 02-096 Warszawa. esinski@biol.uw.edu.pl

Abstract

The purpose of this review was to describe and discuss the current spectrum of coinfections in Ixodidae ticks and their effects on the transmission of blood microparasites. Coinfections with Borrelia burgdorferi s. l. and Anaplasma phagocytophilum and/or Babesia sp. in ticks from Poland appear to be common, however, the potential influence on transmission dynamics, the mechanism of genetic variation and the ecology of interactions between pathogens remain poorly understood compared with infections by single pathogen.

PMID: 20209806 [PubMed - indexed for MEDLINE]

Edited to add: I probably should have started a new thread, but I might forget the possible connection to late complicated Lyme disease if I do. Here are more articles related to co-infections in Europe. Keep in mind, these are about infections found in ticks -- not rates of human infection:

http://www.ncbi.nlm.nih.gov/pubmed/19943915

Acta Vet Scand. 2009 Nov 27;51:47.

Prevalence of Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum in questing Ixodes ricinus ticks in relation to the density of wild cervids.

Rosef O, Paulauskas A, Radzijevskaja J.

Source

Telemark University College, Bø i Telemark, Norway. olav.rosef@hit.no

PMID: 19943915 [PubMed - indexed for MEDLINE] PMCID: PMC2788566 Free PMC Article

cervid = any member of the deer family, Cervidae, comprising deer, caribou, elk, and moose, characterized by the bearing of antlers in the male or in both sexes

http://www.ncbi.nlm.nih.gov/pubmed/21919727

Vector Borne Zoonotic Dis. 2011 Dec;11(12):1595-7. Epub 2011 Sep 15.

Prevalence of Anaplasma phagocytophilum and Coinfection with Borrelia burgdorferi Sensu Lato in the Hard Tick Ixodes ricinus in the City of Hanover (Germany).

Schicht S, Junge S, Schnieder T, Strube C.

Source

Institute for Parasitology, University of Veterinary Medicine Hannover , Hannover, Germany .

Abstract

Abstract The castor bean tick Ixodes ricinus has been found to be the main vector for Lyme borreliosis spirochetes and Anaplasma phagocytophilum in Central Europe. 1646 I. ricinus ticks from Hanover, a city located in Northern Germany, were examined for infection with A. phagocytophilum and coinfection with Borrelia burgdorferi sensu lato (sl) to obtain so far missing prevalence data for this region. The total A. phagocytophilum infection rate was 3.2% (52/1646 ticks), divided into 4.1% (32/777) adults and 2.3% (20/869) nymphs. Coinfections with B. burgdorferi sl were found in 0.9% of all tick stages. The detected genospecies were B. afzelii, B. garinii, B. burgdorferi sensu stricto (ss), and B. garinii, which was the most frequent species in coinfected ticks.

PMID: 21919727 [PubMed - in process]

[X-member]

http://www.ncbi.nlm.nih.gov/pubmed/11559306

Arch Neurol. 2001 Sep;58(9):1357-63.
Concurrent infection of the central nervous system by Borrelia burgdorferi and Bartonella henselae: evidence for a novel tick-borne disease complex.
Eskow E, Rao RV, Mordechai E.
SourceHunterdon Medical Center, Flemington, NJ, USA.

Abstract
OBJECTIVES: To investigate Bartonella henselae as a potential human tick-borne pathogen and to evaluate its role as a coinfecting agent of the central nervous system in the presence of neuroborreliosis.

DESIGN: Case report study.

SETTING: A primary health care center in Flemington, NJ, and the Department of Research and Development at Medical Diagnostic Laboratories LLC in Mt Laurel, NJ.

SUBJECTS: Two male patients (aged 14 and 36 years) and 2 female patients (aged 15 and 30 years, respectively) with a history of tick bites and Lyme disease.

MAIN OUTCOME MEASURES: Laboratory and diagnostic findings before and after antimicrobial therapy.

RESULTS: Patients residing in a Lyme-endemic area of New Jersey with ongoing symptoms attributed to chronic Lyme disease were evaluated for possible coinfection with Bartonella species. Elevated levels of B henselae-specific antibodies were found in these patients using the immunofluorescent assay. Bartonella henselae-specific DNA was detected in their blood. None of these patients exhibited the clinical characteristics of cat-scratch disease. Findings of cerebrospinal fluid analysis revealed the presence of both B henselae- and Borrelia burgdorferi-specific DNA. Bartonella henselae-specific DNA was also detected in live deer ticks obtained from the households of 2 of these patients.

CONCLUSIONS: Our data implicate B henselae as a potential human tick-borne pathogen. Patients with a history of neuroborreliosis who have incomplete resolution of symptoms should be evaluated for B henselae infection.

[Henry]

Doxycycline, given orally, is the antibiotic of choice for treating Lyme disease. It should be noted that Anaplasma phagocytophilium and Bartonella hensellae are also responsive to doxycycline. Babesia microti is not responsive since it is a parasite, not a bacterium.

[X-member]

http://aac.asm.org/content/48/6/1921.full

Complicated CSD.

Various antibiotic regimens have been used to treat patients with complicated CSD (retinitis, encephalopathy, and visceral forms) (56, 108). The combination of doxycycline (100 mg p.o. or i.v. twice daily) with rifampin (300 mg p.o. twice daily) has been successful in treating patients with retinitis (Table 6, recommendation AII) (56, 84, 108). If treatment is chosen for patients with central nervous system (CNS) disease, the combination of doxycycline and rifampin is preferred. The optimum duration of antibiotic therapy for immunocompetent patients with complicated CSD has not been determined. Of note, there is a marked difference between the dramatic clinical response to antibiotics observed in immunocompromised patients with CSD and the minimal response observed in immunocompetent patients.

Complicated B. quintana:

http://aac.asm.org/content/48/6/1921.full

Consequently, patients with chronic B. quintana bacteremia or trench fever should be treated with gentamicin (3 mg/kg i.v. once daily) for the first 14 days, in addition to doxycycline (200 mg daily) for 28 days (Table 6, recommendation AI) (36). Doxycycline could be given either as a single daily dose of 200 mg every 24 h or as a twice-daily dose of 100 mg every 12 h. Patients with chronic bacteremia should be carefully evaluated for endocarditis, because the presence of this complication will necessitate a longer duration of therapy and closer monitoring.

More info on the site!