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The
Lyme Wars: time to listen
Raphael B Stricker & Andrew Lautin
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Assertion
(7): To date, there is no evidence for the existence
of any antibiotic-resistant strains of B. burgdorferi.
Comment (7): A serious understatement. B. burgdorferi is an extremely complex organism. The Lyme disease spirochete contains at least 132 functioning genes, in contrast to T. pallidum, the spirochete that causes syphilis, which contains only 22 such genes [41]. Although B. burgdorferi may not be 'resistant' to antibiotics by conventional laboratory methods, we know that the spirochete can enter cells such as fibroblasts, synovial cells, endothelial cells and macrophages [42-47]. In these cells, B. burgdorferi becomes functionally resistant to treatment, partly due to 'camouflage' proteins produced by the organism or adsorbed from the cell and partly due to the altered morphology and replication of the spirochetal cyst form (see above) [34,40,43]. Stricker & Lautin Expert Opin. Investig. Drugs (2003) 12(10) 3
This functional resistance leads to persistent infection despite supposedly adequate treatment for Lyme disease. The immune evasion strategy of B. burgdorferi is reminiscent of mycobacterial infections such as tuberculosis or leprosy [38-40].
Assertion (8): It is unclear whether a concurrent Anaplasma or Babesia infection can influence the outcome of a standard course of treatment for Lyme disease.
Comment (8): Animal models of co-infection with B. burgdorferi and either Babesia microti or Anaplasma phagocytophila (the agent of human granulocytic ehrlichiosis) have demonstrated an altered immune response and clinically worse disease in these animals [48-50]. Similar exacerbation of clinical symptoms and resistance to treatment has been observed in humans [16,51].
Assertion (9): A single dose of doxycycline given within 72 h after a recognisable tick-bite was highly effective in preventing early Lyme disease.
Comment (9): The study that showed the alleged benefit of prophylactic single-dose doxycycline had inadequate follow up to prove the absence of clinical infection following this simple treatment [52]. Furthermore, the authors used development of an EM rash as an end point in the study. Since 41 -65% of Lyme disease patients do not develop an EM rash, the study may have missed more than half the patients who eventually came down with Lyme disease after this theoretically inadequate prophylaxis. The use of single-dose doxycycline also raises concern about antibiotic resistance following this microbiologically unsound therapy.
Assertion (10): Healthcare providers who deal with Lyme disease can be divided into two groups: 'specialists' who are often affiliated with 'large academic institutions', versus 'community- based' providers in 'private (family) practice'. The former group tends to adhere to the guidelines of the CDC and the Infectious Disease Society of America (IDSA) in diagnosing and treating Lyme disease. In contrast, the latter group tends to rely on 'anecdotal reports citing an alarming number of Lyme disease patients who are supposedly co-infected with one or more of the following: Anaplasma, Bartonella or Babesia. Such an unlikely scenario of multiple infections arouses suspicion on the authenticity of these cases and those willing to make such diagnoses'.
Comment (10): We feel that this is a very politically charged statement, featuring two issues that define the Lyme Wars. The first issue concerns the lofty 'academic specialists' who follow the CDC and IDSA guidelines in diagnosing and treating Lyme disease. We have seen that the CDC guidelines give a poor diagnostic yield for Lyme disease, since they were meant for surveillance purposes and not for diagnosis [22,101].
The IDSA guidelines were written by a panel of 12 Lyme disease 'experts', 11 of whom were research scientists with minimal clinical experience in treating Lyme disease. These guidelines have doomed thousands of suffering Lyme disease patients to a lack of therapy based on the opinions of a handful of researchers.
With this knowledge, is it any wonder that 'community-based' providers who deal with the clinical nightmare of Lyme disease have rejected the CDC/IDSA guidelines and formulated their own diagnostic and therapeutic parameters ? [53-55]
Pavia raises the second issue based on this clinical dichotomy, stating that Lyme disease treatment outside the CDC/IDSA guidelines represents a provider-driven policy that impugns the integrity of the provider. The reality is that suffering patients seek out 'Lyme-literate' providers because the 'academic' researchers have abandoned them. These researchers and their followers offer nothing in the way of treatment for the suffering of Lyme disease patients other than pseudopsychiatric semantics [4,22] or meaningless labels such as chronic fatigue syndrome or fibromyalgia, which are often manifestations of chronic, poorly treated Lyme disease [56,57].
Pavia also refers to the alarming number of Lyme disease patients who are supposedly co-infected with other tick-borne organisms. Since this number is now ~ 20% or more of all Lyme disease cases [18,20,29], the alarm should have sounded long ago.
page one - two - three - four - five - six
Comment (7): A serious understatement. B. burgdorferi is an extremely complex organism. The Lyme disease spirochete contains at least 132 functioning genes, in contrast to T. pallidum, the spirochete that causes syphilis, which contains only 22 such genes [41]. Although B. burgdorferi may not be 'resistant' to antibiotics by conventional laboratory methods, we know that the spirochete can enter cells such as fibroblasts, synovial cells, endothelial cells and macrophages [42-47]. In these cells, B. burgdorferi becomes functionally resistant to treatment, partly due to 'camouflage' proteins produced by the organism or adsorbed from the cell and partly due to the altered morphology and replication of the spirochetal cyst form (see above) [34,40,43]. Stricker & Lautin Expert Opin. Investig. Drugs (2003) 12(10) 3
This functional resistance leads to persistent infection despite supposedly adequate treatment for Lyme disease. The immune evasion strategy of B. burgdorferi is reminiscent of mycobacterial infections such as tuberculosis or leprosy [38-40].
Assertion (8): It is unclear whether a concurrent Anaplasma or Babesia infection can influence the outcome of a standard course of treatment for Lyme disease.
Comment (8): Animal models of co-infection with B. burgdorferi and either Babesia microti or Anaplasma phagocytophila (the agent of human granulocytic ehrlichiosis) have demonstrated an altered immune response and clinically worse disease in these animals [48-50]. Similar exacerbation of clinical symptoms and resistance to treatment has been observed in humans [16,51].
Assertion (9): A single dose of doxycycline given within 72 h after a recognisable tick-bite was highly effective in preventing early Lyme disease.
Comment (9): The study that showed the alleged benefit of prophylactic single-dose doxycycline had inadequate follow up to prove the absence of clinical infection following this simple treatment [52]. Furthermore, the authors used development of an EM rash as an end point in the study. Since 41 -65% of Lyme disease patients do not develop an EM rash, the study may have missed more than half the patients who eventually came down with Lyme disease after this theoretically inadequate prophylaxis. The use of single-dose doxycycline also raises concern about antibiotic resistance following this microbiologically unsound therapy.
Assertion (10): Healthcare providers who deal with Lyme disease can be divided into two groups: 'specialists' who are often affiliated with 'large academic institutions', versus 'community- based' providers in 'private (family) practice'. The former group tends to adhere to the guidelines of the CDC and the Infectious Disease Society of America (IDSA) in diagnosing and treating Lyme disease. In contrast, the latter group tends to rely on 'anecdotal reports citing an alarming number of Lyme disease patients who are supposedly co-infected with one or more of the following: Anaplasma, Bartonella or Babesia. Such an unlikely scenario of multiple infections arouses suspicion on the authenticity of these cases and those willing to make such diagnoses'.
Comment (10): We feel that this is a very politically charged statement, featuring two issues that define the Lyme Wars. The first issue concerns the lofty 'academic specialists' who follow the CDC and IDSA guidelines in diagnosing and treating Lyme disease. We have seen that the CDC guidelines give a poor diagnostic yield for Lyme disease, since they were meant for surveillance purposes and not for diagnosis [22,101].
The IDSA guidelines were written by a panel of 12 Lyme disease 'experts', 11 of whom were research scientists with minimal clinical experience in treating Lyme disease. These guidelines have doomed thousands of suffering Lyme disease patients to a lack of therapy based on the opinions of a handful of researchers.
With this knowledge, is it any wonder that 'community-based' providers who deal with the clinical nightmare of Lyme disease have rejected the CDC/IDSA guidelines and formulated their own diagnostic and therapeutic parameters ? [53-55]
Pavia raises the second issue based on this clinical dichotomy, stating that Lyme disease treatment outside the CDC/IDSA guidelines represents a provider-driven policy that impugns the integrity of the provider. The reality is that suffering patients seek out 'Lyme-literate' providers because the 'academic' researchers have abandoned them. These researchers and their followers offer nothing in the way of treatment for the suffering of Lyme disease patients other than pseudopsychiatric semantics [4,22] or meaningless labels such as chronic fatigue syndrome or fibromyalgia, which are often manifestations of chronic, poorly treated Lyme disease [56,57].
Pavia also refers to the alarming number of Lyme disease patients who are supposedly co-infected with other tick-borne organisms. Since this number is now ~ 20% or more of all Lyme disease cases [18,20,29], the alarm should have sounded long ago.
page one - two - three - four - five - six
Ticks carry more than just
Lyme disease! Including:
0 -Ehrlichia;
o -Bartonella;
0 -Babesia;
o -Q- Fever;
0 -Tularemia;
o -Tick-borne Encephalitis;
0 -Mycoplasma;
o -Relapsing Fever;
0 -Rocky Mountain Spotted Fever and others.
Never WAIT and SEE about a tick bite, please! Quickly and properly treated infections are less likely to progress to later stage or chronic disease.
Sometimes tick bites are
mistaken for spider bites!
Some diseases may be spread by animal bites or scratches and from mosquitoes, fleas or lice.
There is still so much to learn about Lyme disease and related infections.
Sometimes Lyme disease and related infectious diseases are undiagnosed for years, even decades!
Watch closely for symptoms after tick bites. Some never see a tick or a bulls-eye rash.
Don't ignore tick-borne disease symptoms!
If you feel sick, ask a doctor!
SYMPTOMS may include:
0 -Tick bites;
o -Fever; Flu symptoms;
0 -All kinds of Rashes;
o -Muscle; Joint; Neck Pain;
0 -Body Aches; Weakness
o -Light /Sound Sensitivity;
0 -Bells Palsy; Nerve pain;
o -Insomnia; Poor memory
0 -Headaches; Numbness;
o -Mood disorders; Confusion;
0 -Extreme Fatigue; Exhaustion
Never let tick-borne diseases progress!
Lyme and associated diseases are often MISTAKEN FOR OTHER ILLNESSES, Including:
0 -Chronic Fatigue;
o -Fibromyalgia;
0 -Hypochondria;
o -Multiple Sclerosis;
0 -Lupus;
o -Rheumatoid Arthritis;
0 -Lou Gehrig's disease (ALS);
o -Alzheimer's and
0 -Parkinson's disease
******************
Don't be fooled about ticks and their diseases.
******************
Directly affecting humankind, worldwide:
W H A T H A P P E N E D
when the U.S. Senate addressed the Centers for Disease Control regarding Lyme disease?
Consult a good doctor!
Visit ILADS, LDF, LymeNet or LDA to find a specialist in your location.
Protect your children and your family.
Learn about ticks and their many diseases.
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TICK
BYTES:
- TICKS KNOW NO BOUNDARIES -
Tick-borne diseases are spreading rapidly in many countries across the world -not only in Scandinavia, UK, Hungary, Scotland, USA, France, Germany, China, and Australia.
- ONE BIG PROBLEM WITH TESTS -
There is NO 100% accurate Lyme disease test currently available to detect infection or cure. more...
- WHERE TICKS LIVE -
Ticks can be found in and around leaf litter; grass; logs; animal fur; bird feeders; and deer, mice, squirrel, and other small animal habitats.
- HOW TO REMOVE TICKS -
There is only one right way. Promptly and properly remove ticks to avoid infection. Here's how...
- TICKS KNOW NO BOUNDARIES -
Tick-borne diseases are spreading rapidly in many countries across the world -not only in Scandinavia, UK, Hungary, Scotland, USA, France, Germany, China, and Australia.
- ONE BIG PROBLEM WITH TESTS -
There is NO 100% accurate Lyme disease test currently available to detect infection or cure. more...
- WHERE TICKS LIVE -
Ticks can be found in and around leaf litter; grass; logs; animal fur; bird feeders; and deer, mice, squirrel, and other small animal habitats.
- HOW TO REMOVE TICKS -
There is only one right way. Promptly and properly remove ticks to avoid infection. Here's how...
How
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Never let tick-borne
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Lyme disease and Syphilis are both caused by a type of bacteria called a spirochete.
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Ticks travel on mice!
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Never let tick-borne
infections progress !
Tick-borne diseases can
affect any body part,
organ, and any system
of the body.
Lyme disease and Syphilis are both caused by a type of bacteria called a spirochete.
Tick-borne diseases can KILL!
Ticks travel on mice!
ALWAYS Get Ticks Tested!
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