Thursday, October 17, 2013

Better diagnostic tools would aid Lyme disease fight

Poughkeepsie Journal opinion piece June 28, 2013 Online extra: 

"Better diagnostic tools would aid Lyme disease fight"

By Nevena Zubcevik, a resident physician at Harvard Medical School/Partners Healthcare and a member of the advisory board at the Neuromuscular Infections Fund.

Excerpt from the article: ...According to a recent study by Steere et al, we are able to identify only 11 percent of infected individuals who present with erythema migrans in the first six weeks of infection utilizing the current two tiered test. If the C6 enzyme-linked immunosorbent assay is utilized, the success rate raises to 19 percent. That is, 81 percent of the cases of acute illness could be missed [2, table 1].

We must educate the physicians about the above fact. It is crucial physicians are acutely aware of the fact we miss most cases of infection in the initial phase. This should also be followed by a recommendation that a person with a tick bite or without a tick bite and with any physiologic symptom of this infection in an endemic area should be aggressively treated without awaiting positive testing or new symptoms. The risk of neurological, cardiac and musculoskeletal injury is too high to wait. ...We have to devise better antibiotic regimens which will treat late-previously untreated Borrelia infection and the possible co-infections. In vitro studies show three types of the spirochetal existence - extracellular, intracellular and cystic form, as well as bio-film presence [5, 6]. These factors might play a significant role in antibiotic effectiveness. In vivo study on Rhesus monkeys supports the persistence of the spirochetal organism in late Borreliosis after the individuals were treated with long courses of both Ceftriaxone and Doxycycline [7]. Studies in mice reveal infectious spirochete activity in spite of lengthy antibiotic treatments [9]. Persistence and latency of Treponema as in syphilis, the sister spirochete, should be a good example of what we can expect from Borrelia [5]. We do not know whether the organism is capable of dormancy, as is the Treponema. If it is, then we could suspect that in situations of depressed immune system as in pregnancy, post-surgery or other high-stress events, the patient's infection could relapse. We do not have adequate tests to identify whether this exists, but if it does, we need to be aware to provide adequate antimicrobial treatment for our patients.  


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