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Why
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By Tom Grier
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Lyme
disease is a multi system multi organ disease that is caused by a bacterial
spirochete that can penetrate a multitude of tissues. Most people who
are treated get better, but not all of them get well. While antibiotic
therapy often improves Lyme patient's symptoms, in cases of late stage
Lyme disease most patients will have at least one or more lingering symptom.
In post treatment follow-up studies the symptoms most often seen six months
to a year after treatment were:
Short-term memory problems, Fatigue, Joint and Muscle pain, Depression (Asch-Bujak, Haupl-Krause, Natole-Schindeling, MIBDEC patient Survey, Vanderhoof patient survey, )
The question is: What is causing these lingering symptoms? Is it tissue damage? Is it a chemical imbalance? Are continuing symptoms caused by an induced autoimmune response? Is it psychological? Or is it lingering active infection? I think it would be a very dangerous assumption to make an all or nothing hypothesis here and say it is all psychological, or all active infection, but there must be a primary reason why such a significant number of Lyme patients continue to experience lingering symptoms post antibiotic treatment? While I can make an argument for all of these reasons contributing to post-disease sequela, there are five histories of Lyme patients I would like to share that suggest that even long term treatments of high dose antibiotics may not be enough to completely eradicate the Lyme pathogen from human tissues.
Case Histories and patient follow-up studies:
# 1 -Abstract - Ann Med 1999;31:225-232 (Jarmo Oski, M. Marjamaki, et al) Abstract: A total of 165 patients with disseminated Lyme borreliosis (diagnosed in 1990-94, all were seropositive except one seronegative patient who’s E.M. rash cultured positive) were followed after antibiotic treatment, and 32 of them were regarded as having a clinically defined treatment failure. (32 still had significant symptoms of Lyme disease) Of the 165 patients, 136 were tested by polymerase chain reaction (PCR) during the follow-up. PCR was positive from the plasma of 14 patients 0-30 months after discontinuation of the treatment, and 12 of these patients were from the group of 32 that had a clinical relapse of symptoms. In addition, Borrelia burgdorferi was cultured from the blood of three patients during the follow-up. All three patients belonged to the group with relapse, and two of them were also PCR positive. This report focuses on the 13 patients with clinical relapse and culture or PCR positive.
All 13 patients were primarily treated for more than 3 months with intravenous and/or oral antibiotics (11 of them received intravenous ceftriaxone, nine for 2 weeks, one for 3 weeks and one for 7 weeks, followed by oral antibiotics). The treatment caused only temporary relief in the symptoms of the patients. All but one of them had negative PCR results immediately after the first treatment. The patients were retreated again with intravenous ceftriaxone for 4-6 weeks. None of the patients were PCR positive after the retreatment. The response to retreatment was considered good in nine patients. We conclude that the treatment of Lyme borreliosis with appropriate antibiotics for even more than 3 months may not always eradicate the spirochete. By using PCR, it is possible to avoid unnecessary retreatment of patients with 'post-Lyme syndrome' and those with 'serological scars' remaining detectable for months or years after infection.
Commentary: The point and intention of this article was not that relapses of active infection can occur after aggressive antibiotic treatment, but that PCR blood tests are capable of successfully detecting these relapses. I would agree only that PCR when given at the right time can detect some but not all patient relapses and that this paper demonstrates that. This study did not compare PCR to other methods of diagnosis to know how many patients might have been missed by relying on PCR tests alone? In other words it assumed all negative PCR tests were true negatives, but they did not assume all positive PCRs were necessarily from active infection. The criteria was not based on other methods of testing such as biopsy and tissue stain or culture, but rather the absence or presence of symptoms immediately after antibiotic treatment. The problem with using symptoms as your criteria and then using a a few weeks as your follow-up period is illustrated in the Nantucket Island study by Dr. Nancy Shadick M.D. A five year public health study done on Nantucket Island followed 160 + patients post treatment for five years, and found that the longer you waited the higher the relapse rate climbed. At the end of 5.2 years the relapse rate for patients treated for 4 weeks peaked at 57 %.
In this PCR study by Oski et al. all but one of the patients was PCR negative immediately after antibiotic therapy. The others did not become PCR positive until the patient's symptoms made it clear that they had experienced a relapse. Fevers, sweats, and general malaise are usually indicative of infections in the blood. In other words the PCR of blood seems most likely to be positive only when the infection has reseeded back into the bloodstream. So until this happens PCT tests are not likely to detect treatment failures before the infection has become blood-borne a second time. It seems likely that a longer follow up period after treatment could result in even a higher number of relapses. We simply don't know how long does it take a sequestered infection hidden in an immune privileged site to seed back into the blood stream. It is likely that it is highly variable and cannot be predicted from patient to patient. It has been proposed by several researchers that if the binding affinity of Borrelia burgdorferi to the central nervous system tissues is higher than the organism's affinity for the blood stream, then the seeding back into the blood could simply be an accidental consequence of the growing infection elsewhere in the body.
Short-term memory problems, Fatigue, Joint and Muscle pain, Depression (Asch-Bujak, Haupl-Krause, Natole-Schindeling, MIBDEC patient Survey, Vanderhoof patient survey, )
The question is: What is causing these lingering symptoms? Is it tissue damage? Is it a chemical imbalance? Are continuing symptoms caused by an induced autoimmune response? Is it psychological? Or is it lingering active infection? I think it would be a very dangerous assumption to make an all or nothing hypothesis here and say it is all psychological, or all active infection, but there must be a primary reason why such a significant number of Lyme patients continue to experience lingering symptoms post antibiotic treatment? While I can make an argument for all of these reasons contributing to post-disease sequela, there are five histories of Lyme patients I would like to share that suggest that even long term treatments of high dose antibiotics may not be enough to completely eradicate the Lyme pathogen from human tissues.
Case Histories and patient follow-up studies:
# 1 -Abstract - Ann Med 1999;31:225-232 (Jarmo Oski, M. Marjamaki, et al) Abstract: A total of 165 patients with disseminated Lyme borreliosis (diagnosed in 1990-94, all were seropositive except one seronegative patient who’s E.M. rash cultured positive) were followed after antibiotic treatment, and 32 of them were regarded as having a clinically defined treatment failure. (32 still had significant symptoms of Lyme disease) Of the 165 patients, 136 were tested by polymerase chain reaction (PCR) during the follow-up. PCR was positive from the plasma of 14 patients 0-30 months after discontinuation of the treatment, and 12 of these patients were from the group of 32 that had a clinical relapse of symptoms. In addition, Borrelia burgdorferi was cultured from the blood of three patients during the follow-up. All three patients belonged to the group with relapse, and two of them were also PCR positive. This report focuses on the 13 patients with clinical relapse and culture or PCR positive.
All 13 patients were primarily treated for more than 3 months with intravenous and/or oral antibiotics (11 of them received intravenous ceftriaxone, nine for 2 weeks, one for 3 weeks and one for 7 weeks, followed by oral antibiotics). The treatment caused only temporary relief in the symptoms of the patients. All but one of them had negative PCR results immediately after the first treatment. The patients were retreated again with intravenous ceftriaxone for 4-6 weeks. None of the patients were PCR positive after the retreatment. The response to retreatment was considered good in nine patients. We conclude that the treatment of Lyme borreliosis with appropriate antibiotics for even more than 3 months may not always eradicate the spirochete. By using PCR, it is possible to avoid unnecessary retreatment of patients with 'post-Lyme syndrome' and those with 'serological scars' remaining detectable for months or years after infection.
Commentary: The point and intention of this article was not that relapses of active infection can occur after aggressive antibiotic treatment, but that PCR blood tests are capable of successfully detecting these relapses. I would agree only that PCR when given at the right time can detect some but not all patient relapses and that this paper demonstrates that. This study did not compare PCR to other methods of diagnosis to know how many patients might have been missed by relying on PCR tests alone? In other words it assumed all negative PCR tests were true negatives, but they did not assume all positive PCRs were necessarily from active infection. The criteria was not based on other methods of testing such as biopsy and tissue stain or culture, but rather the absence or presence of symptoms immediately after antibiotic treatment. The problem with using symptoms as your criteria and then using a a few weeks as your follow-up period is illustrated in the Nantucket Island study by Dr. Nancy Shadick M.D. A five year public health study done on Nantucket Island followed 160 + patients post treatment for five years, and found that the longer you waited the higher the relapse rate climbed. At the end of 5.2 years the relapse rate for patients treated for 4 weeks peaked at 57 %.
In this PCR study by Oski et al. all but one of the patients was PCR negative immediately after antibiotic therapy. The others did not become PCR positive until the patient's symptoms made it clear that they had experienced a relapse. Fevers, sweats, and general malaise are usually indicative of infections in the blood. In other words the PCR of blood seems most likely to be positive only when the infection has reseeded back into the bloodstream. So until this happens PCT tests are not likely to detect treatment failures before the infection has become blood-borne a second time. It seems likely that a longer follow up period after treatment could result in even a higher number of relapses. We simply don't know how long does it take a sequestered infection hidden in an immune privileged site to seed back into the blood stream. It is likely that it is highly variable and cannot be predicted from patient to patient. It has been proposed by several researchers that if the binding affinity of Borrelia burgdorferi to the central nervous system tissues is higher than the organism's affinity for the blood stream, then the seeding back into the blood could simply be an accidental consequence of the growing infection elsewhere in the body.
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...
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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
to Properly Remove A Tick
Never let tick-borne
infections progress !
Tick-borne diseases can
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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!
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!
Lyme Disease Foundation
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