Lyme Articles 2008/09

2008 & 2009 Lyme Articles

09 April 2009

Don't Disturb the Sleeping Microbes

Cartilage Transplants: New Hope for Damaged Knees

By Robert Mitchum, Tribune Reporter

The Chicago Tribune

April 8, 2009

[snip]

The meniscus and articular cartilage serve as the cushion between the femur and the tibia at the knee. When either type of cartilage is worn down--through injury, corrective surgery or general wear and tear--painful arthritis can result.

In a cartilage transplant, a plug of the tissue is removed from a person who recently has died, similar to the process of organ donation. That plug then can be surgically inserted into the joint of a person with reduced cartilage, where it can form new cartilage that attaches itself to surrounding bones.

...alternative methods are being studied by Cole and at other centers. One procedure, already in limited use, takes cartilage from another part of the patient's own body; the cartilage then is stimulated to grow new cartilage cells in a laboratory before being implanted in the injured joint in a second surgery.

This little story about knee injuries reminded me of an obscure paper from Austria (below). The authors describe an apparently dormant, 15-year-old borrelia infection made active (again?) by the mechanical trauma of surgery and chondrocyte transplantation.

Arthritis Rheum. 2004 Jan;50(1):259-64.

Emergence of lyme arthritis after autologous chondrocyte transplantation.

Marlovits S, Khanakah G, Striessnig G, VÈcsei V, Stanek G.

University of Vienna, Vienna, Austria.

We report herein the first known incidence of the emergence of borrelial arthritis following autologous chondrocyte transplantation for repair of a cartilage defect. The patient had no recent manifestation of Lyme borreliosis, but 15 years earlier had had an expanding erythematous lesion after a tick bite. The current infection resulted in massive joint swelling, elevated body temperature, dissemination of the graft, and transplant failure. Results of routine bacteriologic studies were negative. A diagnosis of Lyme arthritis was first considered following the detection of Borrelia-specific serum antibodies. Additional evidence was provided when borrelial DNA sequences were detected in the synovial fluid through polymerase chain reaction. The diagnosis was confirmed by culture of Borrelia burgdorferi from the synovial fluid. The possibility of a dormant borrelial infection should be considered in patients who undergo repair of cartilage defects with autologous chondrocyte transplantation. We recommend that synovial fluid and joint tissue be screened for the presence of viable Borrelia before transplantation of an autologous graft.

Posted by Relative Risk at 16:08 0 comments Links to this post

Labels: Lyme disease

08 April 2009

Cases of Lyme Disease Soar in Region

Lyme Neuroborreliosis: Manifestations of a rapidly emerging zoonosis. An excellent review in the April 3, 2009 issue of theAm. J. Neuroradiol. by P. Hildenbrand and others.

Posted by Relative Risk at 15:39 0 comments Links to this post

Labels: Lyme disease

02 April 2009

How many times does this have to be said?

Arthritis Rheum. 2009 Mar 30;60(4):1179-1186.

HLA type and immune response to Borrelia burgdorferi outer surface protein a in people in whom arthritis developed after Lyme disease vaccination.

Ball R, Shadomy SV, Meyer A, Huber BT, Leffell MS, Zachary A, Belotto M, Hilton E, Bryant-Genevier M, Schriefer ME, Miller FW, Braun MM.

Center for Biologics Evaluation and Research, FDA, Rockville, Maryland.

OBJECTIVE: To investigate whether persons with treatment-resistant Lyme arthritis-associated HLA alleles might develop arthritis as a result of an autoimmune reaction triggered by Borrelia burgdorferi outer surface protein A (OspA), the Lyme disease vaccine antigen.

METHODS: Persons in whom inflammatory arthritis had developed after Lyme disease vaccine (cases) were compared with 3 control groups: 1) inflammatory arthritis but not Lyme disease vaccine (arthritis controls), 2) Lyme disease vaccine but not inflammatory arthritis (vaccine controls), and 3) neither Lyme disease vaccine nor inflammatory arthritis (normal controls). HLA-DRB1 allele typing, Western blotting for Lyme antigen, and T cell reactivity testing were performed.

RESULTS: Twenty-seven cases were matched with 162 controls (54 in each control group). Odds ratios (ORs) for the presence of 1 or 2 treatment-resistant Lyme arthritis alleles were 0.8 (95% confidence interval [95% CI] 0.3-2.1), 1.6 (95% CI 0.5-4.4), and 1.75 (95% CI 0.6-5.3) in cases versus arthritis controls, vaccine controls, and normal controls, respectively. There were no significant differences in the frequency of DRB1 alleles. T cell response to OspA was similar between cases and vaccine controls, as measured using the stimulation index (OR 1.6 [95% CI 0.5-5.1]) or change in uptake of tritiated thymidine (counts per minute) (OR 0.7 [95% CI 0.2-2.3]), but cases were less likely to have IgG antibodies to OspA (OR 0.3 [95% CI 0.1-0.8]). Cases were sampled closer to the time of vaccination (median 3.59 years versus 5.48 years), and fewer cases had received 3 doses of vaccine (37% versus 93%).

CONCLUSION: Treatment-resistant Lyme arthritis alleles were not found more commonly in persons who developed arthritis after Lyme disease vaccination, and immune responses to OspA were not significantly more common in arthritis cases. These results suggest that Lyme disease vaccine is not a major factor in the development of arthritis in these cases.

See the FDA/VAERS data on Lymerix from January 31, 2001.

Posted by Relative Risk at 11:59 0 comments Links to this post

Labels: Lyme disease, vaccines

31 March 2009

Poking at the IDSA Guidelines

Well, at least some of the comments coming into the IDSA regarding the guidelines review are from credible and rational sources.

David Volkman, Ph.D., M.D., Emeritus Professor of Medicine and Pediatrics, SUNY, Stony Brook, NY, fired off a referenced, 10-page letter about the guidelines and the authors of those guidelines.

He makes some good points.

I wouldn’t presume to argue with him about the immunology of natural infections or the proper treatment of human patients, but I think his reliance on the clinical outcomes of 17 patients from 1988, and the white-footed mouse as a model of human infection are serious weaknesses.

He writes that there is “…both animal and human evidence of persistent borreliosis following inadequately treated LD….” The critical word in that sentence is “inadequately.” I don’t think anyone would argue that “inadequate” treatment of any infection would not encourage persistent or chronic infection.

Commenting further about those 17 patients, he writes, “…all lacked detectable antibodies against borrelia. Although early antibiotic treatment abrogated antibody responses, it did not eradicate infection. When retreated, most of these chronic patients markedly improved within a month of completing a course of intravenous ceftriaxone, consistent with their problems being due to persistent, ongoing occult infection; although borrelia was not isolated in most cases….”

The issue of abrogated antibody responses and seronegative Lyme is interesting, but not exclusive to Lyme disease. Stopping any infection with effective antimicrobials should also truncate an immune response to that infection. I suppose the absence of antibody in an infection (i.e., seronegativity) only becomes an issue when one is relying on serology for a diagnosis.

Volkman also suggests that, “IDSA committee members deny the possibility of persistent seronegative Lyme disease.” I think all they deny is that pumping expensive antibiotics into symptomatic people on an open-ended schedule is somehow beneficial.

Volkman’s answer to the serology dilemma seems to be PCR. Maybe. I’m not sure. It’s sensitive and specific: just like a good diagnostic should be. But what does it tell you about infection, disease, and immunity? I’m sure if someone subjected me to enough PCR they could possibly find M. tuberculosis, MRSA, N. meningitidis, S. pyogenes, and measles. I don’t have TB, a staph or strep infection, meningitis or the measles. I might have DNA to these bugs, but there’s a big difference between being “colonized” and being “infected.” Should I be treated anyway just because a PCR assay says I have bug X?

As for the lowly white-footed mouse, I don’t think it’s a very credible model of natural infection in humans. Mice don’t show much morbidity and seem to clear their borrelial infections. I guess they’ve had a few million generations to evolve and adapt to ticks and B. burgdorferi since its arrival from Europe some 15,000 years ago.

Regarding financial conflicts and conflicts of interest, I wish Volkman had spent some time pointing out those kinds of conflicts among Lyme advocacy organizations, A.G. Blumenthal, Lyme specialty labs, and the many cash-and-carry private practice physicianswho make a nice living off of the ignorant, the gullible, and the desperate. Fortunately, some of them are now in jail.

Just today, one of these online Lyme patients complained about how much his Lyme Literate MD was costing him. He wrote, “My first visit was $450 for 1 1/2 hours. The lab testing was approximately $1600.” (Two weeks ago, I had a complete physical, hematology and blood chemistry, EKG, PPD, chest film, and a colonoscopy. Out-of-pocket cost was zero. But then I have good insurance and I don’t see quacks.)

So Volkman could have spent a few paragraphs talking about these for-profit LLMDs; their ties to i.v. infusion companies and diagnostic labs with “unusual” Lyme tests; their patient trolling at Lyme advocacy meetings; their memberships on Lyme advisory boards; their partnerships in Lyme clinics; their hawking of nutritional supplements and quack treatments; and, of course, their lack of published evidence and peer-review to back up their practices and claims.

Last year, Volkman wrote, “Although the use of repeated courses of antibiotics for aputative borrelia infection is unsupported and may cause serious morbidity, persons with evidence of previously inadequately treated Lyme disease may be seronegative and may benefit from adequate antibiotic therapy.” (My emphasis.)

Well, yes, I don’t thing anyone would disagree. But he’s describing a minority of patients. The majority of patients get bit, get sick, test seropositive, and respond to antibiotics.

NEJM. 2008;358(4):428-431.

To the Editor: The article by Feder et al. on the proper therapy of chronic Lyme disease addresses a very timely concern. Unfortunately, the authors' statement that there are no "scientific data" that support persistent B. burgdorferi infection in the face of negative serologic test results is erroneous. In 1988, we reported on 17 patients who had all had erythema migrans, received inadequate antibiotic therapy, had vigorous T-cell blastogenesis to borrelia antigens, and were seronegative on the basis of enzyme-linked immunoassay.1,2 The majority of these patients had improvement after definitive antibiotic therapy. Seronegative infection was confirmed by other laboratories using polymerase-chain-reaction (PCR) assays to document the presence of microbes in seronegative patients.3,4 Abrogation of a humoral response by removal of the bulk of microbial antigens has been seen in other settings, including infection with Treponema pallidum. Although the use of repeated courses of antibiotics for a putative borrelia infection is unsupported and may cause serious morbidity,5 persons with evidence of previously inadequately treated Lyme disease may be seronegative and may benefit from adequate antibiotic therapy. Fortunately, erythema migrans is now more readily recognized, and occult Lyme disease is rarer. In the absence of antibiotic treatment, most persons become seropositive.

David J. Volkman, M.D., Ph.D.

State University of New York at Stony Brook

Posted by Relative Risk at 22:45 0 comments Links to this post

Labels: IDSA, Lyme disease

30 March 2009

Lyme sufferers sought for new study

Block Island Times

03/28/09 -

Bryant University and Providence Psychology Services seek chronic Lyme disease sufferers 18 and older to participate in a study that will gauge the effectiveness of cognitive behavioral psychotherapy (CBT) in reducing distress and improving quality of life.

The study, called Project PILS (for Psychotherapy Intervention for Lyme Sufferers), offers 10 sessions of CBT to Lyme disease sufferers. The study is led by Joseph Trunzo, Ph.D., associate professor of applied psychology at Bryant University and a licensed clinical psychologist with a background in research and treatment of the psychological impact of chronic illness.

“Lyme disease is a complicated, confusing, and distressing illness, and one of the most rapidly growing infectious diseases in the country,” Dr. Trunzo said in a statement. “Although effective medical interventions are available, there are no formalized … validated treatments for the psychological difficulties that can be caused by, or are related to, Lyme. Our goal is to examine whether CBT — which has been highly effective in helping people cope with depression, anxiety, and other symptoms of chronic illness — is appropriate treatment for chronic Lyme sufferers.”

For more information about the study or to inquire about becoming a study participant, contact Dr. Trunzo at 273-3322, ext. 2, or visit the project’s website, www.providencepsychology.com/lyme-disease.html.

This could be a useful follow-up to Hassett's recent paper on psychiatric co-morbidity in "chronic" Lyme patients. Abstract below.

Arthritis Rheum. 2008 Dec 15;59(12):1742-9.

Role of psychiatric comorbidity in chronic Lyme disease.

Hassett AL, Radvanski DC, Buyske S, Savage SV, Gara M, Escobar JI, Sigal LH.

OBJECTIVE: To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD).

METHODS: We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses. Axis II personality disorders, functional status, and traits like negative and positive affect and pain catastrophizing were also evaluated. A physician blind to psychiatric assessment results performed a medical evaluation. Two groups of CLD patients (those with post-Lyme disease syndrome and those with medically unexplained symptoms attributed to Lyme disease but without Borrelia burgdorferi infection) were compared with 2 groups of patients without CLD (patients recovered from Lyme disease and those with an identifiable medical condition explaining symptoms attributed to Lyme disease).

RESULTS: After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients (P = 0.02, odds ratio 2.64, 95% confidence interval 1.30-5.35), but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain.

CONCLUSION: Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in Lyme disease referral centers, and were related to poor functional outcomes.

Posted by Relative Risk at 22:16 0 comments Links to this post

Labels: Internet, Lyme disease, Psych

27 March 2009

Ct. Dems show they can ignore science just as well as Bush

From the News-Times in Ct.

Here's a legislative act that shows even Democrats can ignore peer-reviewed science and evidence-based medicine when they're out scrounging for votes and campaign funds. I guess it could be called the "Quack Protection Act" or maybe the "Imaginary Infections Act of Connecticut." Moreover, I can't help but think that the skeletal hand of Blumenthalwill be found in this piece of farcical legislation.

The Legislature' s Public Health Committee unanimously passed

a bill about tick-borne Lyme disease Thursday that could rock the health

care industry if it becomes law.

"This is a huge message," state Rep. Kim Fawcett, D-Fairfield, the

bill's sponsor, said after the panel approved the proposal without

debate.

The proposal would validate the treatment of chronic Lyme disease in

Connecticut. It clarifies to physicians, despite an opinion from the

Infectious Disease Society of America that chronic Lyme disease does not

exist, that they do have the right to diagnose and prescribe long-term

antibiotics for the illness without fear of reprisal by the state.

"The thing that's important to us is we send a clear message, 'It's OK

to go outside the Infectious Disease Society of America guidelines,' "

said Fawcett, who is not a member of the health panel.

Discovered in the mid-1970s in Connecticut, Lyme disease is transmitted

to humans by the bite of infected blacklegged ticks.

Symptoms include fever, headache, fatigue and a rash. If untreated,

infection can spread to joints, the heart and the nervous system.

The commonly accepted treatment is up to 28 days of antibiotics. But

some patients are convinced they suffer from chronic Lyme disease and

need longer courses of antibiotic treatment.

But the Infectious Diseases Society, which in 2006 developed updated

treatment guidelines for doctors, dismisses chronic Lyme disease as a

myth.

"There are no convincing published scientific data that support the

existence of chronic Lyme disease," Anne Gershon, president of the

Virginia-based society, wrote lawmakers in February.

She wrote that the concept of chronic Lyme disease has been promoted by

"a small group of physicians" but the dangers of long-term antibiotic

therapy are well-documented and should not be encouraged by legislation

like the bill passed by the committee Thursday.

State Rep. Jason Bartlett, D-Bethel, another bill sponsor who sits on

the Public Health Committee, told colleagues Thursday the legislation

would address the dueling "standards for practice" that have arisen over

chronic Lyme disease.

"Because of these two disagreements the (Connecticut) Department of

Public Health, we feel, has been biased towards the 28 days of

antibiotics, " Bartlett said.

He said the result is a "chill effect" on physicians who might otherwise

be willing to diagnose and treat chronic Lyme disease.

Following a public hearing on the bill in early February, William

Gerrish, a spokesman for the health department, said there is no state

policy against long-term antibiotic treatment of Lyme disease.

Gerrish said state health officials are concerned the bill as written

would strip the department of its ability to review complaints and

violations, particularly in cases where the care being provided to a

patient deviates from current, evidence-based practice.

No doctors offered testimony in February that they felt persecuted by

the state health department for treating chronic Lyme disease.

But at the time, Matthew Katz, vice president of the Connecticut State

Medical Society, confirmed there are concerns among physicians over the

state's recent actions against Dr. Charles Ray Jones, a New Haven

pediatrician renowned for treating chronic Lyme disease.

In December 2007, the state Medical Examining Board, responding to an

investigation by the Department of Public Health, fined Jones $10,000

and put him on probation for two years for diagnosing children with Lyme

disease and treating them with antibiotics before examining them.

Jones is appealing the decision.

Katz said news coverage focused on the doctor's reputation as a last

resort for those complaining of chronic Lyme disease.

"What appeared in the paper and on the news -- Lyme disease mistreatment

-- it raised a lot of concerns," Katz said at the time.

Fawcett's bill states that as of July 1, 2009, the Medical Examining

Board may not discipline a licensed physician "solely for" prescribing,

administering and dispensing long-term antibiotic therapy to a patient

clinically diagnosed with Lyme disease as documented in their medical

records.

The State Medical Society backs the concept of the bill, but is not

taking a position on the existence of chronic Lyme disease.

Gerrish said the Department of Public Health is still hoping to work

with the health committee to "preserve our ability to conduct a thorough

investigation to protect the public."

"That bill is perfect in our eyes," Fawcett said.

But Health Committee co-chairwoman state Rep. Betsy Ritter, D-Quaker

Hill, told her colleagues before Thursday's vote the legislation may

change before going to the full General Assembly.

"There will be at least a bit more work going on with this bill

before we're finished," Ritter said.

For the sake of science, medicine, public health, and common sense, let's hope so.

Posted by Relative Risk at 21:35 0 comments Links to this post

Labels: Lyme disease, Politics

Talking to the Deaf and Dumb

This is from the Norwich Bulletin in Ct.

Connecticut is a state endemic for Lyme disease, Lyme activists, Lyme quacks, and foolish local politicians willing to take up the banner of "chronic" Lyme disease on behalf of their deluded, but voting, constituents. It's a state with a near perfect mixture of bad medicine and bad politics.

Guest column: Data show long-term treatment of Lyme disease ineffective

Posted Mar 27, 2009 @ 11:05 PM

Ashford, Conn. —

With tick season fast approaching, the Infectious Diseases Society of America, the nation’s largest medical society of infectious disease doctors and researchers with more than 8,600 members, wants to help people understand Lyme disease.

Lyme disease is the most common vector-borne disease in the United States, and Connecticut leads the nation in reported cases. The disease is transmitted by the bite of a deer tick that is infected with a bacterium, Borrelia burgdorferi. If an infected tick is not removed from the skin within a day or so, a person may develop Lyme disease.

Most commonly identified by a circular, red “bull’s-eye” rash, the infection can spread to affect the joints, heart and nervous system if left untreated. Extensive research shows a short course of antibiotics is highly effective, and the vast majority of people recover in a couple of weeks with no lingering effects.

Unfortunately, Lyme disease has been drawn into the center of controversy by a small group of physicians and patient advocacy groups who attribute a wide range of symptoms to what they call “chronic” Lyme disease. The self-described “Lyme-literate” community claims that months or even years of high-dose antibiotics, often delivered intravenously, are required to rid the body of infection.

However, scientific evidence to date does not support long-term antibiotic treatment for Lyme disease.

In our 2006 treatment guidelines, IDSA experts combed through the medical literature — and even examined evidence provided by “Lyme-literate” physicians — and did not find convincing evidence that this treatment works better than placebo.

In fact, long-term antibiotic treatment for Lyme disease is not only expensive and ineffective, but can be extremely harmful to a patient’s health. Such treatment can cause infections and reactions to the drugs, and also can foster the development of life-threatening drug-resistant superbugs.

Science is constantly evolving, and if convincing evidence emerges that long-term antibiotics do more good than harm, we would gladly support it. Right now, however, we cannot endorse this protocol.

We encourage patients who receive a “chronic” Lyme disease diagnosis to get a second opinion from a physician with experience treating a wide range of diseases and conditions. It is essential for patients to receive the correct diagnosis so they begin the right treatment for their ailments — and avoid treatments that cause unnecessary harm to their bodies.

In the meantime, there are simple measures to prevent Lyme disease, including avoiding tick-infested areas, wearing protective, light-colored clothing when outdoors, and applying tick and insect repellent to your exposed skin and clothing.

Anne Gershon is president of the Infectious Diseases Society of America, headquartered in Arlington, Va., and with members across the country. You can learn more about the organization at www.idsociety.org

Posted by Relative Risk at 12:24 0 comments Links to this post

Labels: Internet, Lyme disease, Politics

16 March 2009

More nonsense about chronic Lyme

See the recent posting at "Science-Based Medicine."

This particular piece, posted on a popular blog, is a horrible piece of medical writing, but a perfect example of what can go wrong when a reporter doesn’t understand science. The diagnosis and treatment of disease is supposed to be based on science, not on wish-fulfillment. It’s difficult to have unexplained symptoms, but giving them a false label and subjecting oneself to fake treatments helps no one except the person receiving the check.

More at.....

Posted by Relative Risk at 10:59 0 comments Links to this post

Labels: Lyme disease

10 March 2009

A Failed Defense

The Lyme Disease Defense

by David Whelan

Another church shooting; another arrest. But this one comes with a twist of Lyme. According to news reports, the suspect who's charged with shooting a pastor during Sunday morning services in Illinois last weekend suffered from Lyme disease.

Read more at Forbes.Com.

Posted by Relative Risk at 13:51 0 comments Links to this post

Labels: Lyme disease

09 March 2009

White Coat Underground asks: Does Lyme disease make you shoot people?

Does Lyme disease make you shoot people?

Category: Medicine

Posted on: March 9, 2009 1:30 PM, by PalMD

A pastor in Illinois was shot and killed over the weekend. A similar tragedy happened in my community many years ago. Religious leaders are very public figures and have an emotional connection with members of their communities, so I suppose it's not so strange that they should be targets. Many of the cases I have read about over the years involved a mentally ill assailant, as it appears the Illinois case did. Mental illness doesn't usually lead to violence, but one can certainly imagine how a particularly disturbing delusion could lead someone to violence. The American mental health system is abominable, and there is very little help for people with severe mental illness, so they often end up living untreated in the community. Read more.

Posted by Relative Risk at 11:49 0 comments Links to this post

Labels: Lyme disease, Psych

15 December 2008

Blumenthal's Undeclared Bias

Lyme Disease and the Politics of Public AdvocacyThe recent summary of negotiations between the Infectious Diseases Society of America and the Attorney General of Connecticut Richard Blumenthal suggested that the motivation for the Attorney General's actions was provided by Lyme disease advocates [1]. Groups such as the New Jersey Lyme Disease Association and Connecticut's Time for Lyme have acknowledged their involvement [2], but Blumenthal's long record of legal and political activism on behalf of patients with Lyme disease suggests a significant degree of self-motivation.Read the full correspondence in Clinical Infectious Diseases.

Posted by Relative Risk at 12:13 0 comments Links to this post

Labels: Blumenthal, Lyme disease, Politics

24 November 2008

ScienceInsider: Lyme disease

Lyme Disease: Taking Shots at Shots

Congress is wading into the murky question of whether people with Lyme disease should get long-term antibiotics or whether the drugs harm more than help. That issue, which has been a never-ending source of friction among biomedical researchers between researchers and patient-advocates, will get congressional hearings next year.

More here.....

Posted by Relative Risk at 09:53 0 comments Links to this post

Labels: diagnostics, Lyme disease, Politics

30 June 2008

ScienceDaily: Lyme is Euro-Trash

Lyme Disease Bacterium Came From Europe Before Ice Age

Researchers at the University of Bath have discovered that a bacterium that causes Lyme disease originated in Europe, rather than in North America as previously thought. More at.....

Posted by Relative Risk at 14:55 0 comments Links to this post

Labels: Lyme disease