Thursday, December 11, 2014

Update on persistent symptoms associated with Lyme disease. - PubMed - NCBI

If you like reading medical studies or abstracts (much easier to read the abstracts, IMHO, but you can miss the nuances in the detailed publication if you do), here's an interesting/annoying one supposedly proving that Lyme bacteria do not persist in the human body after basic treatment with oral antibiotics. Of course, this topic is THE pivotal argument going on between the IDSA and ILADS docs and researchers. There are other areas of contention, yes, but this argument determines health insurance company policy, standards of care that affect virtually anyone diagnosed with Lyme, and especially chronic Lyme. A study such as this can truly have life-or-death consequences for those of us living with chronic Lyme disease. 

-Bob Cowart

Curr Opin Pediatr. 2014 Dec 7. [Epub ahead of print]
Update on persistent symptoms associated with Lyme disease.
Oliveira CR, Shapiro ED.

Curr Opin Pediatr. 2014 Dec 7. [Epub ahead of print]

Update on persistent symptoms associated with Lyme disease.

Oliveira CR1, Shapiro ED.

Author information


Lyme disease, caused by Borrelia burgdorferi, is the most common 
vector-borne illness in the United States. The pathogenesis, ecology, 
and epidemiology of Lyme disease have been well described, and 
antimicrobial treatment is very effective. There has been controversy 
about whether infection can persist and cause chronic symptoms despite 
treatment with antimicrobials. This review summarizes recent studies 
that have addressed this issue.


The pathogenesis of persistent nonspecific symptoms in patients who were 
treated for Lyme disease is poorly understood, and the validity of 
results of attempts to demonstrate persistent infection with B. 
burgdorferi has not been established. One study attempted to use 
xenodiagnosis to detect B. burgdorferi in patients who have been treated 
for Lyme disease. Another study assessed whether repeated episodes of 
erythema migrans were due to the same or different strains of B. 
burgdorferi. A possible cause of persistent arthritis in some treated 
patients is slow clearance of nonviable organisms that may lead to 
prolonged inflammation. The results of all of these studies continue to 
provide evidence that viable B. burgdorferi do not persist in patients 
who receive conventional antimicrobial treatment for Lyme disease.


Patients with persistent symptoms possibly associated with Lyme disease 
often provide a challenge for clinicians. Recent studies have provided 
additional evidence that viable B. burgdorferi do not persist after 
conventional treatment with antimicrobials, indicating that ongoing 
symptoms in patients who received conventional treatment for Lyme 
disease should not be attributed to persistent active infection.


     [PubMed - as supplied by publisher]

Response to the study, by Carl Tuttle,  US-based Lyme activist, challenging the accuracy of the study:

Dec 11, 2014
LWW Business Offices 
250 Waterloo Road
United Kingdom
Attn: Richard B. Johnston, Jr., MD Editor-in-Chief,      
Current Opinion in Pediatrics
Current Opinion in Pediatrics
Dear Dr Johnston,
In reference to the Shapiro article, "Update on persistent symptoms associated with Lyme disease" I would like to point out that the CDC criteria for positive serologic results require five out of ten IgG bands on the Western blot. In contrast, a single band criterion in China is sufficient to diagnose Lyme disease.(1)
The CDC's positive case definition for Lyme disease (five out of ten bands) was created for surveillance/reporting purposes only but is routinely responsible for misdiagnosis. A recent paper published in the International Journal of Molecular Sciences (2) identified the misdiagnosis of a sixteen year old (Patient #3who was hospitalized for pure psychiatric illnesses at a psychiatric hospital for seven weeks. The boy's Western blot identified only four out of five positive bands so the so-called "Lyme expert" mislabeled the teenager as a psychiatric patient and the boy was hospitalized without proper treatment of the infectious agents.
The correct diagnosis was made through the use of DNA sequencing positive for B. burgdorferi identifying the infectious agents in the patient's blood. I would like to point out that this patient failed a previous treatment following the recommended one-size-fits-all IDSA treatment guideline for Lyme disease; identifying persistent infection.
Shapiro's so-called expert opinion ("antimicrobial treatment is very effective") does not hold true in this case. I would like to call attention to Shapiro's additional misleading Lyme disease comments previously archived on the Internet:
Per the U.S. Food and Drug Administration website there appears to be four pages of patient complaints regarding faulty/misleading Lyme disease antibody testing and subsequent misdiagnosis.(3)
Current misleading serology is frequently responsible for delayed diagnosis and often used to deny insurance reimbursement. Yale University Schools of Medicine and of Public Health prefers to turn a blind eye to these facts as Shapiro has had a career long bias against persistent infection. Any lab test outside of serology threatens that bias.
Respectfully submitted,
Carl Tuttle                                                       
Hudson, NH
Attachment: Dr David J. Volkman's letter to Dr. Thomas Frieden, Director of the CDC.
[1] A Study of the Technique of Western Blot for Diagnosis of Lyme Disease caused by Borrelia afzelii in China
[2] DNA Sequencing Diagnosis of Off-Season Spirochetemia with Low Bacterial Density in Borrelia burgdorferi and Borrelia miyamotoi Infections
[Please be advised that there is an error in the paper; CORRECTION: "negative IgM and positive IgG for 4 bands" NOT 6 as verified by Dr Lantsman]
[3] MAUDE - Manufacturer and User Facility Device Experience

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