Lyme 2009- 6

Neuro-Lyme Disease: MR Imaging FindingsRajan Agarwal, MD and Gordon Sze, MDRadiology 2009, 10.1148Two very interesting points about this study. One, the large ratio of patients with suspect Lyme disease (392) to the number of patients with actual Lyme disease (66). Two, this report mentioned several other studies of neuro-Lyme and imaging, but not a word about Fallon’s work.

Of 392 patients suspected of having neuro-Lyme disease, 66 patients proved to have the disease on the basis of clinical criteria, serologic results, and response to treatment.

Of the 66 patients with neuro-Lyme disease, 11 showed findings on MR imaging.

Neurologic symptoms may consist of peripheral neuropathies, radiculo-neuropathies, myelopathies, encephalitis, lymphocytic meningitis, pain syndromes, cerebellar signs, cognitive disorders, movement disorders, and cranial nerve palsies. The mechanism of the central nervous system involvement is not clearly understood; the possible pathophysiologic features include direct brain invasion, immunologic mechanisms, or vasculitic processes.

In most of the preceding reports, a substantial percentage of the patients in the studies were middle-aged or elderly. The lesions seen in some patients were nonspecific for neuro-Lyme disease, and other causes, such as small-vessel ischemic disease, were possible. In our retrospective study, we found positive findings in 11 of 66 patients with proven neuro-Lyme disease. Seven patients showed nonspecific foci of T2 prolongation in the cerebral white matter, one patient showed an enhancing lesion with edema, and three patients showed nerve-root or meningeal enhancement. Of the seven patients with nonspecific foci of T2 prolongation, two patients were older than 50 years and one was in her mid-40s. Thus, the white matter lesions may well have been incidental, especially because blinded evaluation of the age-matched controls disclosed similar numbers of patients with nonspecific white matter lesions.

Some important points:

• MR imaging findings of the brain in Lyme disease are rare, even in patients with known Lyme disease who have neurologic manifestations.
• Although Lyme disease has been generally reported to manifest as foci of T2 prolongation in the cerebral white matter, nerve-root or meningeal enhancement is also frequently seen and may be equally common.
• Meningeal and nerve enhancement is comparatively common in Lyme disease, and Lyme disease should be considered in the differential diagnosis in the proper clinical setting.
• Lyme disease should not be considered crucial in the differential diagnosis of foci of T2 prolongation in the cerebral white matter, particularly in middle-aged and elderly patients, except when Lyme disease is clinically suspected.
• This approach will prevent many patients from undergoing further testing for Lyme disease when Lyme disease is not clinically suspected.
• Awareness of nerve-root or meningeal enhancement in Lyme disease will aid in correct diagnosis and thus will affect patient care.

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Labels: Lyme disease

10 July 2009

The Lyme Air War. Part II.

This is interesting: two days of radio broadcasts about Lyme disease and the propaganda film, Under Our Skin. This time it was Connecticut Public Broadcast Network interviewing Kris Newby and Bernard Raxlen from the Lyme Movement, and Yale’s Gene Shapiro as the lone voice of reason. All in all, a good show, briefly marred by the call-in lunacy of Kathleen, a well-known Lyme nutcase and former convict and mental patient.

Newby, the film’s producer, said all the usual Movement things about the alleged inaccuracy of serologic testing for Lyme disease. Isn’t a lie of omission still a lie? I ask because it’s compulsory among Lyme activists to insist that diagnostic tests are no better than 50:50 or that they miss between 75-80% of positives. That’s true…but only in the acute phase of the infection. It takes time to make antibody. If I’m vaccinated for Yellow Fever at 10AM and someone draws blood to look for anti-Yellow Fever virus at 10:30, they’re not going to find anything. They’re not going to find anything the next day either. Or the day after. It takes time to mount an immune response. This is something the activists regularly, indeed religiously, ignore.

The reality is “in patients with later manifestations of the infection, 2‐tier testing ha[s] a sensitivity of 100% and a specificity of 99%. Similarly, the VlsE C6 peptide ELISA ha[s] a sensitivity of 100% but a specificity of 96%” (Clin Infect Dis. 2008 Jul 15;47(2):188-95).

So why do activists compulsively lie about this important fact? I suppose, one, to scare people and two, to avoid having to face the fact that many of them don’t actually have Lyme disease. In the end, lying to oneself or to lying to others amounts to the same thing: it’s a lie.

Talking about chronic Lyme disease, Newby also brought up Willy Burgdorfer, the namesake of B. burgdorferi. She claimed Burgdorfer said Lyme bacteria could lay dormant in people and then re-emerge years later to cause infection. I don’t know if Willy actually said that, but it’s helpful to remember that he’s an 80-year-old retired PhD and his MD is entirely honorary. He doesn’t see or treat patients.

Gene Shapiro, on the other hand, does see and treat patients. So apparently does Bernard Raxlen. But he’s a psychiatrist so why is he playing the role of an infectious disease doc and plugging people into i.v. antibiotics? If someone presented with AV blockage would he implant a pacemaker? Does he debride and resection for gangrene or necrotizing fasciitis too? How would he feel about an oncologist practicing psychiatry? A regular jack-of-all-trades.

Here’s some of the bio that was included on the CPBN website about Raxlin: “After a decade of private practice (1978-1988) pioneering nutritional and integrative psychiatry/ medicine, he became interested in tick-borne disease (Lyme Disease) because of the chronic undiagnosed symptoms of his patients. Dr. Raxlen's practice was situated in the highly Lyme endemic areas of Westchester and Fairfield counties. Over the past 15 years, he has successfully treated over thirty-five hundred cases of Tick- Borne Disease (specializing in neuropsychiatric and neurocognitive complications). Over 90% of his practice is now devoted entirely to Chronic Lyme Disease (CLD) and co-infections.”

Where does he find all those chronic Lyme patients? And what exactly does “successfully treated” mean?

Odd. Nothing at all about his medical license problems in N.Y. or CT. And nothing about the fees he charges for seeing patients. I hate to direct anyone to his website, but here’s the dollar cost of Raxlen’s care.

So listeners got a fair sampling of the Lyme controversy from a biased film producer, a local activist, a call-in nutjob, an expensive psychiatrist with no training in infectious diseases, a Yale professor and infectious disease expert, and finally a call-in from someone who found the Lyme Movement to be too hysterical and the infection to be not too big a deal.

Still, the lies continue. The hysteria continues. The Internet disinformation continues. And “Under Our Skin” is playing in Hartford. Maybe Blumenthal will be out front handing out tickets.

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Labels: Film, Lyme disease, Politics

09 July 2009

Wilson's War of Words

Dan Rodricks, a columnist for the Baltimore Sun, played host to Andy Wilson, the chief propagandist for the Lyme Disease Movement yesterday. You can hear the July 8 interview here.

As news, there wasn’t much that Wilson hasn’t endlessly repeated before. But that’s part of the art of propaganda: lies and disinformation must be regularly repeated. I was interested to hear him say that he tried to avoid talking about Lyme disease (a tick-borne infection) as a “tick centric” illness. Instead, he continued the Movement’s efforts to confuse the public by suggesting the infection was passed from mother to child, and because B. burgdorferi shares the same basic morphology as T. pallidum, sexual transmission “cannot be ruled out.” Right. By that logic, B. burgdorferi also causes gum disease because it looks like T. denticola, and it can be contracted from contaminated water supplies because it looks like Leptospira interrogans. Maybe as an “artist,” he’s just caught up in that old “form follows function” philosophy. Or maybe he just doesn’t know anything about microbiology.

He again accused the IDSA of being Lyme “gate keepers.” There must be some big holes in the fence though. The European Union’s physicians and scientists aren’t under the sway of the IDSA. Neither are the American College of Physicians, the American Academy of Neurology, or the American Academy of Pediatrics.

At one point in the interview, he said, “I probably know more about Lyme disease than a lot of physicians do.” Well, that might be true of some of the quacks he advertises in his film, but when pressed by Mr. Rodricks about whether he would say he knew more than the head of infectious diseases at Johns Hopkins, Wilson confessed, “No, I wouldn’t. I’m a film maker.”

Later, Mr. Rodricks read an email from a caller/listener asking about the motives the IDSA might have for not wanting to treat an infection they could not detect. It’s a key question because the Lyme movement and Wilson believe there’s a conspiracy to deny treatment to people with Lyme disease, and to deny the existence of a Lyme disease epidemic.

Wilson didn’t answer the question until Mr. Rodricks brought it up again a few minutes later. Finally, he made some vague comments about the IDSA being a collection of “academic physicians” who don’t see enough Lyme patients, their reputations being at stake, grant money, and patents for vaccines and test kits.

He and his friends in the Lyme Movement keep saying things like this, but it doesn’t explain motive. How does having an NIH grant to study the stability of linear plasmids in B. burgdorferi motivate a physician to not treat someone for presumptive Lyme disease? How would the presence or absence of a Lyme disease vaccine motivate someone to dismiss as meaningless the number of annual reported cases of Lyme disease? (If you were pushing a vaccine wouldn’t you want to hype the danger and the number of cases? And really, what does the existence of a theoretical vaccine have to do with treatment?) How would having a patent for a possible diagnostic test motivate someone to dismiss chronic Lyme disease as an example of a persisting infectious disease? After all, a patent is just a piece of paper. It may not be an actual commercial product. To make any money it would have to compete with the 70 or so existing tests already approved by the FDA. And in the end, it’s not really the patent that matters, but rather the willingness of commercial diagnostic labs to use the test covered by the patent.

Wilson went on to say there’s a lot of money in vaccines. Actually, there’s not. That’s why there are so few vaccine manufacturers left in the U.S. Too little profit. Too much cost. Too much potential for suits and bad PR. There’s some basic research being done on various immunogens and delivery systems for a Lyme vaccines, but don’t expect to ever again see a commercial product for people. The Lyme Movement saw to that.

In the end, Wilson turns out to be just another anti-science, anti-expert conspiracy theorist. He’s helping to spread pseudoscience. He’s promoting whacky alternative medicine and some of its practitioners. He’s another Oprah or Jenny McCarthy or Andrew Wakefield with a camera.

Mr. Rodricks seems to think so too. Read his summation, “A Polemic on Lyme disease”here.

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Labels: Anti-science, Film, Lyme disease

30 June 2009

What the Germans Know

Dtsch Arztebl Int.

2009 Jan;106(5):72-82.

Lyme disease-current state of knowledge.

Nau R, Christen HJ , Eiffert H.

BACKGROUND: Lyme disease is the most frequent tick-borne infectious disease in Europe. The discovery of the causative pathogen Borrelia burgdorferi in 1982 opened the way for the firm diagnosis of diseases in several clinical disciplines and for causal antibiotic therapy. At the same time, speculation regarding links between Borrelia infection and a variety of nonspecific symptoms and disorders resulted inoverdiagnosis and overtreatment of suspected Lyme disease.

METHOD: The authors conducted a selective review of the literature, including various national and international guidelines.*

RESULTS: The spirochete Borrelia burgdorferi sensu lato is present in approximately 5% to 35% of sheep ticks (Ixodes ricinus) in Germany, depending on the region. In contrast to North America, different genospecies are found in Europe. The most frequent clinical manifestation of Borrelia infection is erythema migrans, followed by neuroborreliosis, arthritis, acrodermatitis chronica atrophicans, and lymphocytosis benigna cutis. Diagnosis is made on the basis of the clinical symptoms, and in stages II and III by detection of Borrelia-specific antibodies. In adults erythema migrans is treated with doxycycline, in children with amoxicillin. The standard treatment of neuroborreliosis is third-generation cephalosporins.

CONCLUSIONS: After appropriate antibiotic therapy, the outcome is favorable. In approximately 95% of cases neuroborreliosis is cured without long-term sequelae. When chronic borreliosis is suspected, other potential causes of the clinical syndrome must be painstakingly excluded.

*No mention of the ‘bootstrapped’ ILADS guidelines here. Just this interesting aside regarding Stricker’s argumentative piece in CID a couple of years ago.

“Nonetheless, prolonged antibiotic treatment is still postulated by some to be beneficial, mainly on the basis of case reports and nonrandomized studies. Such treatment generally lies within the sphere of "alternative medicine".

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Labels: Lyme disease

The Light of Day

Some Connecticut Yankee sense published in the New London Day

Lyme Disease: Legislating Medical Treatment Is Seldom A Successful Approach

By Paul Choiniere

Published on 6/28/2009

Our June 17 editorial urging Gov. M. Jodi Rell not to sign a new law sanctioning the long-term use of antibiotics for the treatment of “chronic Lyme disease” generated an unusually large and critical response.

Perhaps it was the controversial topic, the provocative headline: “The Cure that Does Harm,” or the fact that those suffering from chronic Lyme disease have formed a tight Web-linked network, but for whatever reason the critical comments attached to the editorial and those flooding my e-mail and voice mail kept coming. A week after it ran, the editorial was the second most commented topic found on theday.com.

Last week Rell signed the bill into law.

Few times have politics and medicine clashed as in the case of so-called chronic Lyme. While in the vast majority of cases, prompt antibiotic treatment effectively treats Lyme disease, a small percentage of people report continuing pain - fatigue, sore joints, muscle aches and generalized discomfort.

Many of these sufferers insist that the long-term use of antibiotics eases their suffering. They were enraged when, in 2006, the Infectious Disease Society of America issued its guidelines for treating Lyme disease. The guidelines rejected long-term antibiotic treatment as not only useless, but dangerous.

”In more than 20 years there has not been one scientifically valid study published in the peer-reviewed medical literature that proves that the benefit of long-term antibiotic treatment outweighs the risk.

”Long-term antibiotic therapy for so-called chronic Lyme disease is not only unproven, it may in fact be dangerous. For instance, it may lead to complications related to delivery of the medicine, such as infections of the blood stream as a result of long-term intravenous administration of antibiotics. Also, use of certain antibiotics can lead to a potentially severe and sometimes deadly infection of the bowel caused by a type of bacteria called Clostridium difficile. Further, long-term antibiotic therapy may foster the development of drug-resistant superbugs that are difficult to treat,” states the medical society on its Web site.

Further infuriating chronic Lyme suffers, IDSA concluded there really is no chronic Lyme disease and the benefits of antibiotics may be imagined.

”Although some people may feel better, it doesn't prove that the antibiotic cured or suppressed infection. Sometimes, the belief that a treatment is helping can be enough to make people feel better,” states the IDSA.

Supporters of such treatment call the guidelines' conclusions nonsense. For that perspective, read the adjacent commentary submitted by members of the Lyme Disease Association.

I don't know who is right, I'm not a doctor, but neither are most of the lawmakers in Hartford, nor the governor. This is a matter best settled by the medical community. The state should not be inserting itself into the matter by sanctioning a treatment that remains controversial.

Attorney General Richard Blumenthal also inserted himself into the issue when he launched an investigation two years ago into the IDSA, suggesting the experts who shaped its Lyme disease guidelines had “undisclosed financial interests” in insurance companies, diagnostic testing firms and drug corporations that could have influenced their conclusions. The association flatly denies the allegation.

In May 2008 the IDSA called the attorney general's bluff when it agreed to have its guidelines reviewed by an independent panel. The IDSA and the attorney general agreed that medical ethicist Dr. Howard Brody, author of “Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry,” would screen every potential panelist for potential conflicts of interest.

Dr. Carol J. Baker, an infectious disease specialist and pediatrician with Texas Children's Hospital in Houston, is chairing the nine-member panel. The panel has accepted arguments and documents from those on both sides of the controversy. On July 30 it will conduct a day-long public hearing in Washington. Eighteen experts, representing a wide variety of views, will give presentations.

The conclusions this independent panel reaches should be fascinating, and certainly far more medically informed than those reached by a bunch of politicians in Hartford. It makes no sense that the legislature and governor did not wait to see the review results before acting.

Will the panel's impartial assessment settle the debate about the treatment of “chronic Lyme?”

Probably not.

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Labels: Blumenthal, Lyme disease, Politics

26 June 2009

The Masters

A colleague sent this out the other day:

I just received this tragic news regarding Dr. Ed Masters. Ed was a true pioneer who pursued the path of truth with a fervor that was fueled by his dedication to both his patients and the advancement of medicine and science. He will be truly missed by all who knew him, both personally and professionally.

He certainly was passionate. One thing I won’t miss though are the phone calls from him. It was nearly impossible to get him off the line or get a word in edge-wise. Mail wasn’t much better: big thick packets of typed pages and lots of photos of EM rashes.

He leaves behind an infection named after him though, in fact, the naming was both accidental and intended more as a joke than an accolade. The guilty parties know who they are.

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Labels: Lyme disease, MISC

21 June 2009

Gov. Rell signs Quack Bill

Sunday, June 21, 2009

Ridgefield Press.Com

Governor M. Jodi Rell said Sunday she has signed a bill allowing doctors to prescribe long-term antibiotics in the treatment of persistent Lyme disease – outside of standard guidelines – without fear of sanctions from state health regulators if the patient’s clinical diagnosis of the tick-borne disease and treatment have been documented by a licensed physician.

[Snip]

House Bill 6200, which gained broad bipartisan support in the Legislature, was prompted by an ongoing debate in the medical community. Some health organizations have questioned the existence of chronic Lyme disease and the Infectious Diseases Society of America (IDSA) has cautioned against the long-term use of antibiotics. Some physicians were hesitant to treat patients outside the IDSA guidelines because of potential reprimands from medical boards and insurance companies.

Well, this should encourage a few quacks and charlatans to move to Connecticut. Let’s hope a few of these lawyers follow in hot pursuit.

This isn’t the first time politicians have tried to legislate medical practices and, sadly, it won’t be the last. Still, it was an impressive CYA vote against the evidence of four taxpayer-funded treatment trials for Lyme disease, which found no benefits to long-term antibiotic usage, but plenty of harm. (One of those trials was run by Brian Fallon, a LLMD and celebrity on the Lyme activism circuit.)

Perhaps the only good news about this Lyme disease treatment bill is:

1. It won’t be funded through third-party payments so any long-term antibiotic therapy is going to be out-of-pocket.
2. There aren’t that many emotionally disturbed people demanding i.v. antibiotics and picc lines for imagined infections.
3. There aren’t that many irresponsible or incompetent physicians in the U.S.
4. In Lyme-endemic Ct., local politicians may become victims of their own legislated medicine.

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Labels: Lyme disease, Politics

20 June 2009

Neuroborreliosis

Nervenarzt. 2009 Jun 19.

Kaiser R, Fingerle V.

Neurologische Klinik, Klinikum Pforzheim, Kanzlerstrasse 2-6, 75175, Pforzheim, Deutschland

Neuroborreliosis is easily diagnosed by means of clinical symptoms and laboratory findings. Guiding symptoms are radicular pain and pareses of the extremities and the facial nerve.

There is a great number of further less frequently occurring neurological symptoms, which can be attributed to a borrelial infection only by appropriate investigations of the CSF.

Radiculitis is cured adequately by oral doxycycline while symptoms of the central nervous system are probably better treated intravenously by ceftriaxone, cefotaxime or penicillin G.

Post-Lyme syndrome is a diffuse description of non-specific complaints, which are not the explicit result of a former infection with B. burgdorferi. As further antibiotics do not help and the CSF is unremarkable in most patients, a persistent infection with B. burgdorferi s.l. in all probability can be excluded.

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Labels: Lyme disease

19 June 2009

Sticky Borrelia

Characterization of Borrelia burgdorferi Aggregates

Siddharth Y. Srivastava and Aravinda M. de Silva

VECTOR-BORNE AND ZOONOTIC DISEASES

Volume 9, Number 3, 2009

Some notes on the co-aggregation of Borrelia. Interesting, but it’s hard to know what it means for pathogenesis and disease.

Various investigators have reported that Borrelia make large aggregates and micro colonies within ticks and in culture. In ticks, aggregates were observed during and after the blood meal when the spirochetes grow to high densities in the tick’s gut. In the gut Borrelia formed aggregates that were localized in the intercellular spaces between epithelial cells and within microvillar brush border cells of the gut. Bacterial aggregation is involved in transmission, host colonization, exchange of genetic information, and protection from adverse environmental conditions.

In Yersinia pestis, clumping of bacteria plays an important role in transmission from fleas to animals. Borrelia form aggregates during tick blood feeding, when they also get transmitted from tick vector to mammalian host. During this process, many B. burgdorferi genes required for transmission and host infection are expressed by a pathway regulated by the alternative sigma factors RpoN and RpoS.

As the cell density of the culture increased, the number of aggregates and the average size of each aggregate increased. The earliest aggregates observed consisted of 2–6 spirochetes attached to each. Most of the spirochetes in the aggregates appeared motile.

When the culture reached a density 5X107 bacteria/mL, the average aggregate had greater than 20 bacteria. The center of each aggregate often appeared to have material without a clearly defined shape. Scanning electron microscopy demonstrated that this material was present toward the center of the aggregate and possibly holding the aggregate together. Once the culture reached stationary phase, the aggregates persisted, but the number of aggregates dropped and the average size of each aggregate also decreased.

The environmental conditions (high temperature, low pH, and high cell density) favorable for aggregation were similar to the conditions that increased the expression of B. burgdorferi genes, such as OspC, that are regulated by the RpoN/RpoS sigma factors.

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Labels: Lyme disease

18 June 2009

A 'Cure' That Does Harm

The New London Day An Editorial.

Published on 6/17/2009

Most people diagnosed with Lyme disease are completely cured after less than a couple weeks of antibiotics, but those who complain of lingering symptoms ranging from aches and fatigue to memory loss sometimes are prescribed a lengthier but controversial regimen to treat the tick-borne illness.

State legislation that would in effect allow physicians to administer long-term antibiotics to patients they've diagnosed with chronic Lyme disease was approved by the General Assembly in early June and now awaits Gov. M. Jodi Rell's signature.

While we sympathize with those who put their faith in such treatment, there not only is scant medical research to support its efficacy but there is ample evidence that overuse of antibiotics is a dangerous practice because it makes the drugs less effective against bacterial diseases and infections.

Therefore we urge Gov. Rell to veto or delay signing the measure, and encourage legislators and doctors to come up with a better strategy for dealing with an emotionally charged medical challenge.

In an attempt to reconcile sharp differences in the medical community about Lyme disease treatment, the bill did manage to gain the support of some warring factions. The measure does not actually suggest that long-term antibiotics should be used to treat chronic Lyme disease, but it would protect doctors who prescribed such a regimen from state sanctions. In our view such penalties should remain in place.

Before deciding whether to sign the bill the governor should at least wait until July 30, when the Infectious Disease Society of America holds hearings on the issue. The organization has in the past advised doctors against chronic Lyme disease diagnosis and treatment, suggesting that symptoms may be due in fact to other factors such as an autoimmune disorder. But now, under pressure, it is considering revising its guidelines.

Some of that pressure has come from Connecticut Attorney General Richard Blumenthal, who has challenged the society's findings and negotiated an agreement that calls for an outside arbiter to help draw up new guidelines. Mr. Blumenthal, who supports the state bill, contends that the guidelines unfairly limit doctors and favor insurance companies that restrict coverage for various Lyme disease treatments.

While we agree that doctors should be free to make diagnoses, they should not be authorized to administer unproven treatments that put their patients and the rest of society at risk.

At the same time, in this region that has the ill fortune to be considered the birthplace and epicenter of Lyme disease, we must recognize that many who contracted the affliction believe they suffer long-term consequences. More research is needed to provide them with better diagnoses and more effective treatment of their maladies.

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Labels: Blumenthal, Lyme disease, Politics

12 June 2009

It's a Gender Thing

Well, here's another 'no surprise' story: more women than men claim to have "chronic" Lyme disease. For anyone who has followed the online Lyme groups, seen pictures of Lyme protestors, or met any Lyme activists, your impression of the population as a group of white, middle-aged women is correct. J Womens Health. 2009 Jun;18(6):831-4.

Implications of gender in chronic Lyme disease.

Wormser GP, Shapiro ED.

Division of Infectious Diseases, Department of Medicine, New York Medical College, Munger Pavilion Room 245, Valhalla, NY 10595

BACKGROUND: "Post-Lyme disease syndrome" refers to prolonged subjective symptoms after antibiotic treatment and resolution of an objective manifestation of Borrelia burgdorferi infection (Lyme disease). "Chronic Lyme disease" is a vaguely defined term that has been applied to patients with unexplained prolonged subjective symptoms, whether or not there was or is evidence of B. burgdorferi infection.

OBJECTIVE: To determine if the population of patients with chronic Lyme disease differs from the populations of patients with either Lyme disease or post-Lyme disease syndrome by examining the gender of patients with these diagnoses.

METHODS: Data on gender were compiled in this cross-sectional study based on a systematic review of published studies of antibiotic treatment in United States patients with post-Lyme disease syndrome (n = 184) or chronic Lyme disease (n = 490), and on cases of adults with Lyme disease reported to the Centers for Disease Control and Prevention from 2003 to 2005 (n = 43,282).

RESULTS: Patients with chronic Lyme disease were significantly more likely to be female than were patients diagnosed with either Lyme disease (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.98-2.94, p < 0.0001) or with post-Lyme disease syndrome (OR 2.32, 95% CI 1.62-3.34, p < 0.0001).

CONCLUSIONS: Patients with chronic Lyme disease differ with regard to gender from those with either B. burgdorferi infection or post-Lyme disease syndrome. This finding suggests that illnesses with a female preponderance, such as fibromyalgia, chronic fatigue syndrome, or depression, may be misdiagnosed as chronic Lyme disease.

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Labels: Lyme disease

A Failed Test

Well, this comes as no surprise to anyone familiar with immunology and diagnostics for Lyme disease. I'm sure an angry letter denouncing the study below is already being drafted.

Clin Vaccine Immunol. 2009 Jun 10.

Natural killer cell counts are not different between patients with post-Lyme disease syndrome and controls.

Marques A, Brown MR, Fleisher TA

It has been reported that patients with “chronic Lyme disease” have decreased number of natural killer cells, as defined by the CD57 marker. We performed immunophenotyping in 9 individuals with post-Lyme disease syndrome, 12 who recovered from Lyme disease and 9 healthy volunteers. The number of natural killer cells was not significantly different between the groups.

It has been reported that patients diagnosed with “chronic Lyme disease” have decreased number of natural killer cells, as defined by the CD57 marker, and that the changes in the number of CD57+ cells can be monitored as evidence of response to therapy [Insert Stricker refs here]. CD57 was initially used as a marker for NK cells, but it is not expressed by all NK cells and is also expressed by T cell subpopulations. It is thought that CD57 is a marker of terminally differentiated cells. Currently, the most common approach for identifying NK cells utilizes a combination of CD56 and CD16 surface markers used together with CD3 to exclude T cells expressing NK markers (NK T cells). The CD57 test is being offered in selected clinical laboratories and is being used by some health practitioners [LLMDs] to evaluate and follow patients diagnosed with “chronic Lyme disease”. To further evaluate the utility of NK cell numbers in evaluating and/or monitoring this patient group, we performed immunophenotyping in 9 patients with PLDS, 12 individuals who recovered from Lyme disease and 9 healthy volunteers.

The bracketed notes are mine. Curious about the phrase, "selected clinical laboratories," I searched the Internet for the the words, "CD57 test." One of the first things to pop up was a link to Carol Ryser of Health Centers of America. According to CourtHouse News, she's being sued for diagnosing and treating non-existent Lyme disease.

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Labels: diagnostics, Lyme disease, Stricker

10 June 2009

Addendum to yesterday's, "This is Spinal Tap......"

Turns out I know that "uninvited guest" "pounding on the door."

He's not happy about the ficitious account provided on Newby's blog.

I'm sure he'll have more to say about it.

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Posted by Relative Risk at 14:34 0 comments Links to this post

Labels: Film, Lyme disease, Politics

08 June 2009

Calling All Sero-Positives

Here's another Lyme disease study that not too many patients and advocates are going to feel inclined to participate in. All those people claiming to be chronically, persistently infected by B. burgdorferi might suddenly have those delusions shattered by the clear absence of any antibody to that allegedly raging infection.

Lyme Disease

Attention Lyme Disease Patients

If you have recently been diagnosed or have been experiencing the symptoms of lyme disease in the past two weeks, you may have an opportunity to receive up to $1000 per week for participating in our Plasma Donation Program.

WHAT IS THE PLASMA DONATION PROGRAM?

Participation in Biolynk’s Plasma Donation Program entails nothing more than providing a simple plasma donation at an FDA licensed plasma collection facility. The plasma collection process plasmapheresis is much like giving whole blood. However, donating plasma is a lot easier on the body than a whole blood donation because it typically does not leave you feeling dizzy or weak.

The plasma collected from you is extremely vital in the healthcare industry and helps save the lives of future patients diagnosed with Lyme Disease. However, timing is very critical. The antibodies found in your plasma are at their highest level within the first three weeks of your illness. Therefore, if you or anyone that you know have been diagnosed with or have been experiencing the symptoms of Lyme Disease, please give us a call immediately.

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Posted by Relative Risk at 22:12 0 comments Links to this post

Labels: diagnostics, Lyme disease

07 June 2009

A Cast of Characters

The Infectious Diseases Society of America has selected presenters to speak before its Lyme disease guidelines review panel on July 30. Here’s the list from the Lyme Disease Assoc. incorrecting identifying most of the speakers.

Tina Garcia (patient advocate )

Lorraine Johnson (patient advocate)

Daniel Cameron (physician-scientist)

Phillip Baker (physician-scientist)

Ben Luft (physician-scientist)

Allison Delong (scientist)

Barbara Johnson (physician-scientist)

David Volkman (physician-scientist)

Sam Donta (physician-scientist)

Eugene Shapiro (physician-scientist)

Brian Fallon (physician-scientist)

Sunil Sood (physician-scientist)

Ken Liegner (physician-scientist)

Allen Steere (physician-scientist)

Steven Phillips (physician-scientist)

Art Weinstein (physician-scientist)

Raphael Stricker (physician-scientist)

Gary Wormser (physician-scientist)

Well, this could certainly be entertaining. First off, three people who know nothing about science or medicine (Garcia, Johnson and Delong). Then the LLMD Cameron, whose MPH doesn’t qualify him as a physician-scientist. Baker and Barbara Johnson are not physicians, but they are Lyme experts. Volkman is long retired from NIH. Donta is no scientist. The same with Liegner and Phillips; they’re just two private practice LLMDs.Fallon runs the LDA-created Lyme center at Columbia and spent a lot of federal money trying to 1) find real Lyme patients, and 2) trying to prove chronic Lyme exists and requires long-term antibiotics. He failed in both cases. Rounding out the entertainment is Raphael—do you need a larger penis—Stricker, best known for being fired by UCSF and banned from NIH funding for data manipulation.

Yes, it should be entertaining: some serious infectious disease discussion interspersed with a little emoting and quackery. The only thing missing is popcorn and a few minutes of Blumenthal preening before the webcams.

Posted by Relative Risk at 09:12 0 comments Links to this post

Labels: Cameron, IDSA, Lyme disease

01 June 2009

The Clock is "Ticking"