Topic: Recently in the New England Journal of Medicine
Vermont_Lymie
Frequent Contributor (1K+ posts)
Member # 9780
posted
Are the editors at NEJM beginning to learn about lyme disease?
Or beginning to atone for past omissions and IDSA-stupidity?
I was excited to see them use the word "chronic" and "lyme" in the same sentence. Although, not together, it was enough to catch my eye! The IDSA-types would probably explain it away as "post-lyme" syndrome.
Would these IDSA guys ever say "post-syphilis" syndrome?
Anyway, from the 1/1/09 NEJM Resident E-bulletin:
Clinical Pearls
Chronic Meningitis
The causes of chronic meningitis include infectious (e.g., herpes simplex virus, varicella-zoster virus, cytomegalovirus, Mycobacterium tuberculosis, syphilis, Lyme neuroboreliosis, brucella species, acanthamoeba species, actinomyces, aspergillus, nocardia, cryptococcus, toxoplasma, and Epstein-Barr virus) and noninfectious causes (e.g., connective tissue, inflammatory, and malignant diseases such as systemic lupus erythematous, Beh�et's disease, and sarcoidosis).
***
It seems to indicate that chronic meningitis is caused by a chronic infection.......
Maybe this is not significant, but I do believe times are changing. With Pam's great book, Under Our Skin, AG Blumenthal's investigation, and last but not least, the large amount of scientific data on chronic infections...
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Vermont_Lymie
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Member # 9780
posted
OK, did a little more web research on this.
No, sadly, it does not mean that the NEJM is wising up about lyme disease, as chronic meningitis just means that the symptoms last one month or more.
Still, I hope they do wise-up soon for everyone's sake!
From the Merck manual:
Chronic meningitis is a slowly developing inflammation of the subarachnoid space (located within the layers of tissues covering the brain and spinal cord) that lasts a month or longer.
People may have a fever, a stiff neck, a headache, double vision, or difficulty walking, or they may become confused.
Imaging of the head and a spinal tap are required for diagnosis.
Treatment depends on the cause.
The subarachnoid space is located between the middle layer (arachnoid mater) and the thin inner layer (pia mater) of the tissues that cover the brain and spinal cord (meninges--see Biology of the Nervous System: Viewing the Brain).
Chronic meningitis resembles acute bacterial meningitis, but the causes are different and the infection and inflammation develop more slowly, over weeks and months rather than hours and days.
If symptoms have been present for a month or more, meningitis is described as chronic.
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TerryK
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Member # 8552
posted
In my opinion, this unfortunately doesn't have anything to do with our definition of chronic lyme which is persistent infection after what they consider to be adequate treatment.
NEJM seems to be aligned with the IDSA and their claim that one month of IV abx would completly clear an old, previously untreated lyme infection.
Maybe someday they will allow for the possibility of the truth.
Terry
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Vermont_Lymie
Frequent Contributor (1K+ posts)
Member # 9780
posted
Terry,
Thanks, I totally agree. I got momentarily excited to see the word 'chronic' and lyme in the same sentence from these folks!
But nothing has changed there, as yet.
Thanks for your clarity, as always.
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