Patients with chronic symptoms but no objective criteria for infection are receiving long-term antibiotic therapy.
Lyme disease, caused by Borrelia burgdorferi in North America and other Borrelia species in Europe, is the most common tick-borne infection in the Northern hemisphere and is a significant public health problem.
Whereas early Lyme disease, late Lyme disease, and post-Lyme disease symptoms/syndrome are recognized conditions, the term "chronic Lyme disease" has recently been popularized by a small number of practitioners.
Chronic, nonspecific symptoms (e.g., fatigue, headache, dizziness) are attributed to persistent or incurable B. burgdorferi infection, and patients are subsequently treated with long-term parenteral antibiotics.
The Ad Hoc International Lyme Disease Group has written an editorial summarizing the controversy surrounding the diagnosis and treatment of chronic Lyme disease.
Objective manifestations of Lyme disease include erythema migrans (the most common presentation of early Lyme disease), certain neurologic and cardiac manifestations, and pauciarticular arthritis (the most common presentation of late Lyme disease).
These symptoms respond well to conventional antibiotic therapy. Symptoms of post-Lyme disease include fatigue, musculoskeletal pain, and difficulties with concentration or short-term memory following resolution of objective manifestations of infection.
These symptoms are usually mild, typically resolve within months, and antibiotic therapy is not indicated; when the difficulties persist longer than 6 months, the condition is termed post-Lyme disease syndrome.
Laboratory testing (usually acute- and convalescent-phase serologies; less commonly, PCR or culture) is a key component of Lyme disease diagnosis; in most cases, the testing allows clinicians to confirm evidence of current or past B. burgdorferi infection.
By contrast, chronic Lyme disease is the term assigned to patients reporting chronic symptoms without objective clinical, laboratory, or epidemiologic criteria for infection.
They receive chronic parenteral antibiotic therapy for periods of many months to years, despite the absence of any scientific evidence to support this practice.
The authors divide patients receiving a diagnosis of chronic Lyme disease into four categories:
Those with symptoms of unknown cause and no evidence of B. burgdorferi infection
Those with an identifiable illness other than Lyme disease unrelated to B. burgdorferi infection (e.g., multiple sclerosis)
Those with symptoms of unknown cause and antibodies against B. burgdorferi but no history of objective clinical findings consistent with Lyme disease
Those with resolution of objective manifestations of Lyme disease after antibiotic therapy who have symptoms of unknown cause (some have post-Lyme disease symptoms or syndrome)
Chronic antibiotic therapy for chronic Lyme disease has resulted in life-threatening anaphylaxis, cholecystectomy after biliary complications from ceftriaxone administration, a fatality due to candidemia from intravenous catheter infection, and other serious adverse events related to intravenous catheters.
Comment: The authors systematically refute the pseudoscience behind the diagnosis and treatment of so-called chronic Lyme disease in this well-referenced editorial.
The writing and the tables summarizing the manifestations of B. burgdorferi infection and the laboratory diagnosis of Lyme disease are lucent and practical.
-- Mary Wu Chang, MD
Published in Journal Watch Dermatology October 3, 2007
Citation(s): Feder HM et al. A critical appraisal of "chronic lyme disease." N Engl J Med 2007 Oct 4; 357:1422.
AliG
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posted
I'd like to tell Mary to go get bit!
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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Ann-OH
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This dermatologist is so clueless, she probably diagnoses all EM rashes as urticaria, ringworm, or spider bites.
Geesh. What a dope. She obviously has never taken care of someone who truly has chronic lyme because many of us DO have OBJECTIVE and specific findings.
Heh, She cits "A fatality due to candidemia" .
I wonder why she didn't cite all the Lyme fatalities from CHRONIC LYME DISEASE??????
Well referenced article my ***
Posts: 339 | From nowhere | Registered: May 2007
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CaliforniaLyme
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posted
Yup, that's how I'd describe it!!!
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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Ann-OH
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posted
And how many who relapse or are reinfected are told that it can't be Lyme disease and/or that they have "Post Lyme Syndrome?"
Isn't it amazing that the publication of the article in the New England Journal of Medicine just happened to coincide with the Infectious Disease Society's conference in San Diego??
Arrggghhhh! Ann
[quote] About 95 percent of patients recover completely and quickly with two to three weeks of antibiotic treatment. Left untreated, the infection usually goes away within a month. However, untreated patients can relapse and/or develop late complications that affect the joints, heart, or nervous system, according to background information in a new release about the study.[end quote]
Lyme Disease Relapse Often a New Infection Thursday, October 4, 2007; 12:00 AM
THURSDAY, Oct. 4 (HealthDay News) -- Many people who believe they're suffering a relapse of Lyme disease may actually have been bitten by another tick and have a second, completely new infection, a new study suggests.
"It is striking how often re-infection appears to occur," lead author Dr. Robert B. Nadelman, professor of medicine at New York Medical College, said in a prepared statement.
"Our findings support clinical evidence that a surprising number of patients experience more than one episode of Lyme disease and that recurrent infections are unrelated to the original infection."
Lyme disease, which affects about 20,000 Americans a year, is caused by Borrelia burgdorferi, a bacterium that's transmitted to humans by deer ticks.
About 95 percent of patients recover completely and quickly with two to three weeks of antibiotic treatment.
Left untreated, the infection usually goes away within a month.
However, untreated patients can relapse and/or develop late complications that affect the joints, heart, or nervous system, according to background information in a new release about the study.
Many patients who are diagnosed and successfully treated for Lyme disease develop the infection again, likely because they live in areas where deer ticks are common, the researchers said.
They analyzed B. burgdorferi genotypes from skin biopsies of 272 people diagnosed with Lyme diseases between 1991 and 2005. The team found that some of the patients had suffered separate Lyme disease-causing tick bites.
The findings "underscore the importance of preventing exposure to ticks, by covering exposed skin, using tick repellants, and performing self-examination for ticks on a regular basis during the tick season," Nadelman said.
The findings were to be reported Thursday at the annual meeting of the Infectious Diseases Society of America, in San Diego.
More information
The American Medical Association has more about Lyme disease.
SOURCE: Infectious Diseases Society of America, news release, Oct. 4, 2007
posted
Looks like we are in for a blitz! Several states are hoping to get legislation passed protecting doctors who treat long-term from disciplinry action by medical boards; and mandating insurance companies to pay for long term treatment.
Wish these guys would take a break. On the other hand, all these articles must raise a bit of suspicion in the medical community.
May they all get tick bites and go on to suffer in h** like the rest of ua!
-------------------- nan Posts: 2135 | From Tick Country | Registered: Oct 2000
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posted
Maybe we should just keep going back to the doctors and saying we got bit again... They'll be like "Can't you be more careful and stop getting bit by ticks .... " And I'll just tell them that I have memory loss from "post-lyme syndrome" and keep forgeting to check myself...
I am really starting to not like this situation...
It took me 13 years to find out what was wrong with me. It is bad enough that all of us suffer so long due to the poor testing that is recommended, but to then not be able to get adequate treatment is ridiculous....
Posts: 48 | From New Jersey | Registered: Aug 2007
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dmc
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posted
someone postedthis on the Hsrtford Courant article
Funny from the same school denouncing chronic. Yale University;
Borrelia burgdorferi changes antigens based on host immune response.
08 December 2004 Biotech Week
-- The Lyme disease spirochete, Borrelia burgdorferi, causes persistent mammalian infection despite the development of vigorous immune responses against the pathogen.
To examine spirochetal phenotypes that dominate in the hostile immune environment, the mRNA transcripts of four prototypic surface lipoproteins, decorin-binding protein A (DbpA), outer surface protein C (OspC), BBF01, and VlsE, were analyzed by quantitative reverse transcription-PCR under various immune conditions.
We demonstrate that B. burgdorferi changes its surface antigenic expression in response to immune attack," investigators in the United States report.
TD "dbpA expression was unchanged while the spirochetes decreased ospC expression by 446 times and increased BBF01 and vlsE expression up to 20 and 32 times, respectively,
under the influence of immune pressure generated in immunocompetent mice during infection," stated Fang Ting Liang and collaborators at Yale University, Centocor, Inc., and the Centers for Disease Control and Prevention.
"This change in antigenic expression could be induced by passively immunizing infected severe combined immunodeficiency mice with specific Borrelia antisera or
OspC antibody and appears to allow B. burgdorferi to resist immune attack." Liang and associates published their study in Infection and Immunity
(Borrelia burgdorferi changes its surface antigenic expression in response to host immune responses.
Infec Immunity, 2004;72(10):5759-5767).
This article was prepared by Biotech Week editors from staff and other reports.
Posts: 2675 | From ct, usa | Registered: Jan 2004
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dmc
Frequent Contributor (1K+ posts)
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posted
and from another poster:
STUDY SUPPORTS CHRONIC LYME from the Yale University Am J Pathol. 2004 Sep;165(3):977-85 Protective Niche for Borrelia burgdorferi to Evade Humoral Immunity Fang Ting Liang*, Eric L. Brown, Tian Wang*, Renato V. Iozzo and Erol Fikrig*
From the Department of Internal Medicine,* Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut;
the Center for Extracellular Matrix Biology, Texas A&M University
System Health Science Center, Albert B. Alkek Institute of Biosciences and Technology, Houston, Texas; and
the Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
The Lyme disease spirochete, Borrelia burgdorferi, is an extracellular microbe that causes persistent infection despite the development of strong immune responses against the bacterium.
B. burgdorferi expresses several ligand-binding lipoproteins, including the decorin-binding proteins (Dbps) A and B,
which may mediate attachment to decorin, a major component of the host extracellular matrix during murine infection.
We show that B. burgdorferi was better protected in the joints and skin, two tissues with a higher decorin expression, than in the urinary bladder and heart, two tissues with a lower decorin expression, during chronic infection of wild-type mice.
Targeted disruption of decorin alone completely abolished the protective niche in chronically infected decorin-deficient mice but did not affect the spirochete burden during early infection.
The nature of protection appeared to be specific because the spirochetes with higher outer surface protein C expression were not protected while the protective niche seemed to favor the spirochetes with a higher dbpA expression during chronic infection.
These data suggest that spirochetal DbpA may interact with host decorin during infection and such interactions could be a mechanism that B. burgdorferi uses to evade humoral immunity and establish chronic infection .
Posts: 2675 | From ct, usa | Registered: Jan 2004
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bettyg
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up
ann, thank you for breakig this up for us all.
having hard time typing with extended wrist slint;.
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Dave6002
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I would say these guys are the allies of B. burgdorferi and the coinfection pathogens of chronic Lyme disease.
Because they deny microbe pathogens as causative agents of Lyme disease by saying:
1. There is no Lyme here or there, Lyme only exists in northern east states.
The fact: Lyme exists in every states.
2. If you have Lyme disease,you should have developed "bull's eye" rash.
The fact: only a small fraction of Lyme patients have "bull's eye" rash.
3. Two weeks of conventional antibiotics will cure Lyme disease.
The fact: there is no effective abx available so far. The abx used for Lyme are only suppressive. That's why long term and high dose of abx are usually needed for treating Lyme disease.
4. It's post Lyme disease if you still have symptoms; the Lyme pathogens have been eradicated by two weeks of abx.
The fact: the body has tremendous ability of self-healing, once the pathogens have been removed, the body will heal by itself.
5. It's all in your head; you have psychological problems.
The fact:
To be continued
Posts: 1078 | From Fairland | Registered: Apr 2006
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