Exp Ther Med. 2015 Jan;9(1):39-42. Epub 2014 Nov 3.

Antistress and antioxidant effects of virgin coconut oil in vivo.

"Furthermore, mice treated with VCO were found to exhibit higher levels of brainantioxidants, lower levels of brain 5-hydroxytryptamine and reduced weight of the adrenal glands. Consequently, the serum cholesterol, triglyceride, glucose and corticosterone levels were also lower in VCO-treated mice. These results suggest the potential value of VCO as an antistress functional oil."

Full abstract here- http://www.ncbi.nlm.nih.gov/pubmed/25452773

ISB LAUNCHES 3-YEAR WILKE LYME DISEASE PROJECT WITH $2.13M FUNDING

Study Utilizes Systems Approaches to Develop Diagnostics and Deeper Understanding of Chronic Lyme

PRESS RELEASE, SEATTLE, March 26, 2015 – Institute for Systems Biology (ISB) has received $2.13 million in transformational gifts from Jeff and Liesl Wilke; Jeff and MacKenzie Bezos; and the Bay Area Lyme Foundation to tackle chronic Lyme disease, a highly complex and often misdiagnosed disease that can be debilitating for those who do not respond to a standard course of antibiotics.

Read the whole story: 

http://isbmolecularme.com/isb-launches-3-year-wilke-lyme-disease-project-with-2-13m-funding-2/

Note that that one of the funders is one of founders of Google. on the downside, note who is in the research committee....“Clinical experts included:

 

Allen Steere, MD  Harvard Medical School

Gary Wormser,MD  New York Medical College

Brian Fallon, MD,MPH Med  Columbia University Medical Center

Ralph Budd, MD The University of Vermont College of Medicine”

Perhaps the IDSA is beginning to think twice about the possibility of persistence

Drug Combinations against Borrelia burgdorferi Persisters In Vitro: 

Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline

Jie Feng, Paul G. Auwaerter, Ying Zhang

PLOS One 10(3):e0117207. Published: March 25, 2015.

http://doi.org/10.1371/journal.pone.0117207

Abstract

Although most Lyme disease patients can be cured with antibiotics doxycycline or amoxicillin using 2-4 week treatment durations, some patients suffer from persistent arthritis or post-treatment Lyme disease syndrome. Why these phenomena occur is unclear, but possibilities include host responses, antigenic debris, or B. burgdorferi organisms remaining despite antibiotic therapy. 

In vitro, B. burgdorferi developed increasing antibiotic tolerance as morphology changed from typical spirochetal form in log phase growth to variant round body and microcolony forms in stationary phase. B. burgdorferi appeared to have higher persister frequencies thanE. coli as a control as measured by SYBR Green I/propidium iodide (PI) viability stain and microscope counting. 

To more effectively eradicate the different persister forms tolerant to doxycycline or amoxicillin, drug combinations were studied using previously identified drugs from an FDA-approved drug library with high activity against such persisters. Using a SYBR Green/PI viability assay, daptomycin-containing drug combinations were the most effective. Of studied drugs, daptomycin was the common element in the most active regimens when combined with doxycycline plus either beta-lactams (cefoperazone or carbenicillin) or an energy inhibitor (clofazimine). Daptomycin plus doxycycline and cefoperazone eradicated the most resistant microcolony form of B. burgdorferi persisters and did not yield viable spirochetes upon subculturing, suggesting durable killing that was not achieved by any other two or three drug combinations. 

These findings may have implications for improved treatment of Lyme disease, if persistent organisms or detritus are responsible for symptoms that do not resolve with conventional therapy. Further studies are needed to validate whether such combination antimicrobial approaches are useful in animal models and human infection.

http://doi.org/10.1371/journal.pone.0117207

Free, full text (pdf file, 403 KB):
http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0117207&representation=PDF
or http://tinyurl.com/nrwbclo

 

 

Lyme Patient Advocates Meet with IDSA President, Discuss Concerns About Guidelines Review Process

For Immediate Release

Lyme Patient Advocates Meet with IDSA President, Discuss Concerns About Guidelines Review Process

ARLINGTON, VA, Tuesday, March 24—Representatives from The Mayday Project Lyme patient advocacy group met with Infectious Diseases Society of America (IDSA) President, Dr. Stephen Calderwood, on Friday, March 20, to discuss concerns about the IDSA's guidelines for diagnosis and treatment of Lyme disease.

The 90-minute meeting took place via teleconference and was attended by Mayday Project co-founders Josh Cutler and Allison Caruana, along with lead researcher Saby Molina. According to Cutler, this was the first time the IDSA leadership has met with a Lyme patient advocacy group.

The meeting was the culmination of a series of multi-day, boots-on-the-ground protests backed by an aggressive publicity campaign that generated favorable coverage from a wide range of media outlets, including Medscape Medical News, Fox News, and Infectious Disease: Special Edition. In addition to media coverage, Mayday's press releases generated more than 500,000 headline impressions and were shared on Facebook pages with more than 50 million collective likes.

The campaign began with a two-day protest May 22–23, 2014, at IDSA headquarters in Arlington, VA. A follow-up candlelight vigil and protest were held at IDSA's IDWeek medical conference in Philadelphia, October 8–12, 2014. Mayday members purchased passes and attended the conference to learn more about IDSA members' viewpoints and provide them with references to relevant science about chronic Lyme disease.

During IDWeek, Mayday released an open letter to IDSA members calling on them to intervene on the behalf of patients to help rectify the guidelines in the interest of improving patient care. The letter called on the IDSA leadership to work with a sense of urgency to develop a national action plan to stem the rapidly spreading epidemic of Lyme disease and related tick-borne illnesses.

Following IDWeek, the Mayday Project established a dialog with then President-elect Calderwood and began a cordial, yet frank and persistent, correspondence focused on correcting deficiencies with the current guidelines, and more recently on addressing concerns with IDSA's project plan to update the guidelines that was announced on March 9. The plan includes a 30-day period for public comments.

Prior to the March 20 meeting, the Mayday Project conferred with leaders within the Lyme Community for suggestions on concerns, requests, and questions to be presented to Dr. Calderwood that best represented the interests of Lyme patients and the physicians who treat them.

Following the meeting, Cutler posted on the Mayday Project's Facebook page that Dr. Calderwood was receptive to Mayday's concerns and agreed that much is still unknown about Lyme disease, that current testing methods are unreliable, and that better diagnostic tools are needed. According to Cutler, Dr. Calderwood agrees that Lyme disease is underreported and represents a large-scale, national epidemic that needs much more research and attention.

Mayday expressed strong concerns about the inclusion of panelists with significant conflicts of interests, especially with those who also coauthored the 2006 guidelines. The Lyme Disease Association report, Conflicts of Interest in Lyme Disease: Laboratory Testing, Vaccination and Treatment Guidelines, documents the most serious conflicts of interests among past and current members of IDSA's review panels.

During the meeting, Cutler asked Dr. Calderwood to write a letter to Congress requesting more Federal funding for research.

Lack of research money is a major impediment to containing the epidemic of Lyme disease and resolving the debate over the prevalence of persistent infection following the antibiotic treatment recommended by the current IDSA guidelines. This is often referred to as Chronic Lyme disease.

In FY2014 NIH funding for Lyme was just $23 million—barely 1 percent of the $1.9 billion in NIH funding for emerging infectious diseases. By comparison, Federal funding for HIV/AIDS during the same period was $2.9 billion, despite the incidence of Lyme being magnitudes greater at up to 1 million new cases per year, compared to approximately 50,000 new cases of HIV/AIDS. 

Dr. Calderwood agreed that more research money was needed but did not commit to writing a letter to Congress. 

Mayday also requested that Dr. Calderwood push for additions to the review panel that would better represent the interests of Lyme patients, including representatives from patient support groups, physicians in private practice who specialize in treating tick-borne illnesses, psychiatrists who treat patients with Lyme disease, and at least one patient with a persistent infection.

Cutler gave the following account of Mayday's attempts to address concerns regarding the lack of balance and conflicts of interests within the Guidelines Review Panel: 

Dr. Calderwood asked that Mayday direct its requests to the public forum IDSA created for comments on the project plan for updating the guidelines. He essentially declared we must wait for the review of the public comments to be completed to see if there will be any changes to the panel for revising the guidelines. We informed Dr. Calderwood that based on the outcome of the meeting we would continue with our plans for the protest at IDSA's headquarters on April 30 and May 1.

The day after the meeting, the Mayday Project received encouraging correspondence from Dr. Calderwood.

Mayday co-founder Allison Caruana wrote in a subsequent Facebook post that, based on the meeting and his follow-up correspondence, Dr. Calderwood seemed truly open to "discussing and working on solutions to the community's greatest concerns."

In addition, according to Caruana, Dr. Calderwood requested suggestions from patients about the types of questions they would like to see addressed in the revised guidelines. 

Examples include the impact of Jarisch-Herxheimer reactions, the benefits of detoxification, the advantages of integrative medicine, and the effectiveness of alternative treatments. 

In the same post, Caruana reported:

We are focusing our attention to working with the IDSA to advance improvement of patient rights, and to make changes to the panel that will be reviewing the guidelines. Our strategy is to continue developing a working relationship with the IDSA that addresses the community's concerns.

We ask for your continued effort to maintain a positive outlook and focus on the achievements already made. It is important to us that we look at how far we have come and not how far we still have to go. One step, regardless of how small right now, is a step in the right direction. Remember, a journey of a thousand miles starts with the first step. We are beyond our first step, but our journey is still a long one. So patience and optimism will be the hallmarks of our approach to dealing with these discussions. Mayday encouraged patients who submit comments about the project plan to include a request to add a patient to the review panel who represents the Lyme community, along with at least one independent doctor who specializes in treating patients with Lyme disease.

The Mayday Project encourages those who submit comments to organize and spell-check them in a word processor before submitting them via IDSA's on-line survey form, because the form must be filled out in one sitting. All comments should include the page and line numbers the comment applies to.

People who have already submitted comments do not have an option to revise them, but these and all other patients are encouraged to forward comments to the Mayday Project so they can be compiled and sent directly to IDSA's leadership.

Cutler and Caruana expressed optimism about IDSA's willingness to continue the dialogue, while clearly stating Mayday's intent to continue to organize protests until the guidelines are updated to promote the quality of care patients deserve.

About the Mayday Project
The Mayday Project was formed by a group of volunteers who have been touched by Lyme disease. Mayday advocates for more accurate tests, better guidelines, improved access to treatment, increased education for physicians, and more funding for research. For more information visit www.themaydayproject.org. 

Contact:
Michelle McDonald
(703) 340-0413
michelle@mcdonaldoz.com

References:

The Infectious Diseases Society of America Lyme Guidelines: a Cautionary Tale About the Development of Clinical Practice Guidelines
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901226

Findings of Richard Blumenthal's Anti-Trust Investigation of IDSA
http://www.ct.gov/ag/cwp/view.asp?a=2795&q=414284

Lyme Activists Target IDSA's IDWeek Conference
http://www.webwire.com/ViewPressRel.asp?aId=190933

Lyme Patients Infiltrate IDWeek Medical Conference, Call on IDSA Members for Help
http://www.webwire.com/ViewPressRel.asp?aId=191763

The Mayday Project Responds to Dr. Paul Auwaerter's Defense of IDSA Guidelines for Lyme Disease http://www.webwire.com/ViewPressRel.asp?aId=192558

URGENT CRITICAL do this NOW.. IDSA Deadline Very Soon

Dear fellow Lyme patient and Lyme patient advocates,

The IDSA is preparing to hand down their new guidelines for Lyme disease. As you are probably aware, we have extremely well founded concerns that the IDSA does not consider all the scientific evidence and all the patients' claims in their review and revision of their previous guidelines. (a requirement by the Institute Of Medicine (IOM) is that guidelines be reviewed, updated and revised every five years to reflect new evidence)

The New York State Coalition on Lyme and Tick-borne Diseases has worked very hard to craft a letter which is attached that you can send to your United States Senator and Congressman/woman in your state if you agree with the views taken in our letter. We feel that it is urgent that everyone be on board in this effort to insure that the IDSA consider all relevant information for their "2015 Guidelines for Lyme and Tick-borne Diseases."

The time element is crucial, since the deadline for comments is April 9th. Please do this immediately if possible.

To find your legislators go to:https://www.opencongress.org/people/zipcodelookup  and enter your zip code.
--------------------------------------------------------------------------------

The following is a sample letter we ask if you will send to your Senator and Congressman/woman and please attach the pdf document which is attached below as well.

Thank you for helping with this critical issue that will affect every single Lyme and Tickborne disease patient in the USA and beyond

Jill Auerbach

Hudson Valley Lyme Disease Association, Chairperson
NYS Coalition on Lyme and Tick-borne Disease, Member
"What's the problem? Well it's the ticks of course!"

 

 --------------------------------------------------------------------------------Dear Senator /Congressman:
The New York State Coalition on Lyme and Tick-borne Diseases, representing hundreds of thousands of Lyme disease patients, requests your immediate attention to an urgent matter that has serious implications to the health and wellness of the American public.

We seek your intervention to ensure that the new treatment guidelines for Lyme disease, currently in the process of being drafted by the Infectious Diseases Society of America (IDSA), will result in a set of guidelines that reflects a complete, fair, transparent, and trustworthy process in accordance with the Institute of "Standards for Developing Trustworthy Clinical Practice Guidelines," free of conflicts of interest, and with inclusion of the entire body of scientific evidence. We ask for your attention to this matter because historically the IDSA treatment guidelines have been the endorsed by the NIH and the CDC. Since 2002, IDSA guidelines have been limited and restrictive, resulting in the failure of patients to be informed about their treatment options and the use of such guidelines by insurance companies to deny essential medical care to patients with persistent Lyme disease symptoms, which, in many cases, leads to long term suffering and disability. To ensure the safety and well-being of your constituents, we ask you to please intervene..

We request that you:

1) Send a letter to the IDSA reminding them that their review should be unbiased and representative of all available science (sample letter attached, IDSA Directors are listed APPENDIX E)

2) Send a copy of your letter to the CDC, so they will be aware that biased guidelines might initiate further inquiry.

Background and resource information is attached for your review.

Your immediate attention to this issue would be appreciated s the IDSA comment period closes on April 9, 2015.

Sincerely,
Fill In your name and affiliation here

Tick borne diseases | Entomological Society of America (ESA)

Background on Federal and Congressional Efforts Related to Tick and Vector-Borne Diseases 

http://www.entsoc.org/PDF/2015/Tick-Vector-Background.pdf

Parkinson's disease vaccine??

View this email as a webpage | Add no-reply@michaeljfox-email.org to your address book | Contact Us Vaccine Approaches Continue Showing Promise in Clinical Testing Last week biotechnology company Prothena announced positive safety results in a Phase I study of its Parkinson's vaccine. By introducing an antibody (the body's natural disease fighters), Prothena's vaccine could potentially slow or stop disease progression. This announcement is the second of its kind in recent months. In July, MJFF-grantee AFFiRiS also shared positive safety results of its own vaccine approach to treating Parkinson's.   Read More > From iPhone to Genome: How Patient Data Is Changing Parkinson's Research Join us for our Third Thursdays Webinar series. Hear expert discussion, and ask your questions. April 16, 2015, at 12 p.m. ET PPMI Expands Genetic Cohort The Parkinson's Progression Markers Initiative (PPMI) is expanding to study individuals who have a mutation of the GBA gene. A GBA mutation is more common among certain populations, specifically those of Ashkenazi (Eastern European) Jewish descent.  Read More > Why I Run: Tour de Fox Endurance Athlete Opens Up about Inspiration  This spring, Sam Fox (no relation to Michael) will embark on Tour de Fox: a 14,000-mile hiking and biking journey across the United States. Sam is inspired by his mom, Lucy, who hasn't let her Parkinson's disease curb her love of the outdoors. Read More > New Technologies Propel Parkinson's Research Forward This month, MJFF joined Apple Computer and Sage Bionetworks in announcing new technologies that hold the potential to streamline and advance patient data collection. Read More >

Lyme disease: A case report of a 17-year old male with fatal Lyme carditis

E. Yoon, E. Vail, G. Kleinman, P.A. Lento,S. Li, G. Wang, R. Limberger, J.T. Fallon

Cardiovascular Pathology, Published Online: March 21, 2015
http://dx.doi.org/10.1016/j.carpath.2015.03.003

Abstract

Lyme disease is a systemic infection commonly found in the northeastern, mid-Atlantic and north-central regions of the United States. Of the many systemic manifestations of Lyme disease, cardiac involvement is uncommon and rarely causes mortality. We describe a case of a 17-year-old adolescent who died unexpectedly after a 2-week viral-like syndrome. 

Postmortem examination was remarkable for diffuse pancarditis characterized by extensive infiltrates of lymphocytes and focal interstitial fibrosis. In the cardiac tissue, Borrelia burgdorferi was identified via special stains, immunohistochemistry and PCR. The findings support Borrelia burgdorferi as the causative agent for his fulminant carditis and that the patient suffered fatal Lyme carditis. 

Usually, Lyme carditis is associated with conduction disturbances and is a treatable condition. Nevertheless, few cases of mortality have been reported in the literature. Here, we report a rare example of fatal Lyme carditis in an unsuspected patient.

http://dx.doi.org/10.1016/j.carpath.2015.03.003

Int J Med Sci 2013; 10(7):915-931. doi:10.7150/ijms.6273

Research Paper

Lyme Borreliosis in Human Patients in Florida and Georgia, USA

Kerry L. Clark^1, , Brian Leydet^1,2, Shirley Hartman³

http://www.medsci.org/v10p0915.htm

Abstract

The aim of this study was to determine the cause of illness in several human patients residing in Florida and Georgia, USA, with suspected Lyme disease based upon EM-like skin lesions and/or symptoms consistent with early localized or late disseminated Lyme borreliosis. Using polymerase chain reaction (PCR) assays developed specifically for Lyme group Borrelia spp., followed by DNA sequencing for confirmation, we identified Borrelia burgdorferi sensu lato DNA in samples of blood and skin and also in lone star ticks (Amblyomma americanum) removed from several patients who either live in or were exposed to ticks in Florida or Georgia. This is the first report to present combined PCR and DNA sequence evidence of infection with Lyme Borrelia spp. in human patients in the southern U.S., and to demonstrate that several B. burgdorferi sensu lato species may be associated with Lyme disease-like signs and symptoms in southern states. Based on the findings of this study, we suggest that human Lyme borreliosis occurs in Florida and Georgia, and that some cases of Lyme-like illness referred to as southern tick associated rash illness (STARI) in the southern U.S. may be attributable to previously undetected B. burgdorferi sensu lato infections.

http://www.medsci.org/v10p0915.htm

Stanford researchers unravel secrets of shape-shifting bacteria

Here's a good video on how bacteria shape shift when you blast them with antibiotics.

http://news.stanford.edu/news/2015/march/lform-shape-shift-031615.html

New Problem with Lyme in RI, again!

This is an important issue especially for Lyme patients in Rhode Island. However, legal precedents set in one state will not necessarily affect legislation around patients' rights in other states. Therefore, I have decided to repost this request on my blog. This originally came into me through a physicians' listserv that I participate in. The issue and the request by the author are self-explanatory, as you'll see below. 

-Bob

From:

Elaine Mullen Cassinelli RNBS.  Independent researcher.  

Hi All,

Rhode Island Lyme patients and all those who believe in a patient's freedom to obtain treatment need your help!!  Several weeks ago, we were elated  to learn that Dr. Michael Fine, the prior head of the Rhode Island Department of Health, who was director during the trumped-up investigation of Dr. James Gloor, a Lyme literate doctor, was stepping down.  However the new nominee for the position, chosen by Governor Gina Raimondo, is Dr.Nicole Alexander, the Infectious Disease Doctor who was responsible for sending out emails to dozens of physicians literally trolling for complaints against Dr. Gloor, in a way that was clearly contradictory to Rhode Island law!  Dr Alexander was working at Brown University, as well as acting as a consultant for the Department of Health, at the time she sent this email out, in clear violation of the rules of confidentiality of the board of medical licensure. She is not only not Lyme literate, she is hostile to the treatment of Lyme.

I am asking anyone who cares about these issues to PLEASE write a quick email to both Governor Raimondo and the Rhode Island senators who will be voting to approve or reject her nominee. If anyone would like to see the email that Dr. Alexander wrote, I would be happy to provide that. I am very much afraid that getting treatment for Lyme disease in Rhode Island is about to get harder unless we oppose this nomination. I will also let everyone know when the nomination hearing will be if anyone wants to attend or even to testify.  THANK YOU!!

Governor Gina Raimondo Office of the Governor 82 Smith Street Providence, RI 02903 email:brad.inman@governor.ri.gov.  Phone: (401) 222-2080 Fax: (401) 222-8096

New test for early detection of Lyme infection

This seems promising as a means of testing potentially-infected patients shortly after a suspected tick bite. 

-Bob

Clin Infect Dis. 2015 Mar 11. pii: civ185. [Epub ahead of print]

Development of a metabolic biosignature for detection of early Lyme disease.

Molins CR1, Ashton LV2, Wormser GP3, Hess AM4, Delorey MJ1, Mahapatra S2, Schriefer ME1, Belisle JT5.

http://cid.oxfordjournals.org/content/early/2015/03/11/cid.civ185.abstract

 

Early Lyme disease patients often present to the clinic prior to developing a detectable antibody response to Borrelia burgdorferi, the etiologic agent. Thus, existing two-tier serology-based assays yield low sensitivities (29-40%) for early infection. The lack of an accurate laboratory test for early Lyme disease contributes to misconceptions about diagnosis and treatment, and underscores the need for new diagnostic approaches.

 

METHODS:

Retrospective serum samples from patients with early Lyme disease, other diseases, and healthy controls were analyzed for small molecule metabolites by liquid chromatography-mass spectrometry (LC-MS). A metabolomics data workflow was applied to select a biosignature for classifying early Lyme disease and non-Lyme disease patients. A statistical model of the biosignature was trained using the patients' LC-MS data, and subsequently applied as an experimental diagnostic tool with LC-MS data from additional patient sera. The accuracy of this method was compared with standard two-tier serology.

 

RESULTS:

Metabolic biosignature development selected 95 molecular features that distinguished early Lyme disease patients from healthy controls. Statistical modeling reduced the biosignature to 44 molecular features, and correctly classified early Lyme disease patients and healthy controls with a sensitivity of 88% (84-95%), and a specificity of 95% (90-100%). Importantly, the metabolic biosignature correctly classified 77-95% of the of serology negative Lyme disease patients.

 

CONCLUSION:

The data provide proof-of-concept that metabolic profiling for early Lyme disease can achieve significantly greater (p<0.0001) diagnostic sensitivity than current two-tier serology, while retaining high specificity.

 

PMID: 25761869

New Lyme bacteria test, very fast results....

This study looks promising. A new, real-time (no waiting for weeks for a Bb culture test) test for Lyme bacteria (Borrelia miyamotoi, which is only one of many Borrelia species, but good enough for a proof-of-concept) seems to have been developed in Austria. Read on....

-Bob

Ticks Tick Borne Dis. 2015 Feb 23. pii: S1877-959X(15)00028-X. doi:
10.1016/j.ttbdis.2015.02.002. [Epub ahead of print]

A newly established real-time PCR for detection of Borrelia miyamotoi in Ixodes ricinus ticks.

Reiter M1, Schötta AM2, Müller A2, Stockinger H2, Stanek G2.

Author information

   1Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria. Electronic address: michael.a.reiter@meduniwien.ac.at.
   2Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.

Abstract

A total of 350 ticks collected in Austria were analyzed for the presence of DNA sequences of B. miyamotoi. Three ticks gave positive results in a B. miyamotoi-specific nested PCR. Results were confirmed by sequencing the amplified glpQ gene from the positive samples.
Moreover we developed a real-time PCR which unambiguously detected B. miyamotoi in all positive samples. Further genotyping of the samples found 100% identity of the 16S-23S intergenic spacer region with Swedish B. miyamotoi sequences.
This is the first detection of the relapsing fever spirochete Borrelia miyamotoi in hard ticks in Austria. The results consolidate the picture of a European-wide distribution of B. miyamotoi and again underscore the need for clinical awareness to clarify possible involvement of this species in human disease.

Copyright © 2015 Elsevier GmbH. All rights reserved.
KEYWORDS:

Borrelia; Ixodes; Miyamotoi; PCR; Tick

PMID:
   25736476
   [PubMed - as supplied by publisher]

Medscape Medical News

(C) Medscape Medical News, (c) Annals Emerg Med

Lyme CNS Infection Mimics Stroke in Teenager

Janis C. Kelly

March 06, 2015

http://www.medscape.com/viewarticle/841010

The chameleon qualities of Lyme neuroborreliosis gained another layer with a case report of a teenager with sudden onset of what appeared to be ischemic stroke but turned out to be Borrelia burgdorferi infection. The correct diagnosis was made just in time to avoid the administration of thrombolytic therapy to the teenager.

Arseny A. Sokolov, MD, from the Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois, Lausanne , Switzerland , and colleagues reported in an article published online February 25 in the Annals of Emergency Medicine that the 16-year-old girl presented the morning after a disco party with acute onset of severe headache and confusion. By the time she was evaluated at an urgent care center, she had right-sided face and arm weakness and language deficits. She was transferred by helicopter to a medical center for possible thrombolysis.

"Everything about her symptoms indicated stroke: speech deficits, poor comprehension and right-sided face and arm weakness, so we considered treating her with clot-busting drugs. But a 16 year-old having a stroke, while not unheard of, would be quite rare so we looked at other possibilities and found Lyme," Dr Sokolov said in a news release.

By 3 hours after symptom onset, the hemiparesis had resolved, but the patient still displayed agitation, confusion, and aggressiveness. She had reduced ability to speak but no meningismus. Motor and sensory deficits had resolved, and the patient had normal reflexes and other neurological examinations.

"The language deficits with reduced speech production and comprehension but preserved repetition were compatible with transcortical sensory aphasia," the authors write. "Although right-sided face and arm weakness could not be confirmed, both language and motor symptoms pointed to focal left parietotemporal affection, with ischemic stroke and nonconvulsive status epilepticus to be excluded first. Although thrombolytic treatment in pediatric stroke is an evolving area, the patient would have been within the European 4.5-hour window in which thrombolysis has been effective in adults."

Drug intoxication and psychogenic origin were ruled out because the patient had been directly observed for at least 16 hours before hospital admission.

In view of the possible indication for thrombolysis, Dr Sokolov's team conducted contrast-enhanced brain computed tomography with arterial and venous angiographies, which showed no signs of brain lesion, hemorrhagic stroke, vasculitis, or cerebral venous sinus thrombosis but did reveal diffuse brain hyperperfusion with patchy perfusion in the left temporoparietal junction. Given the imaging results, the clinicians concluded that thrombolysis was not indicated. They ruled out nonconvulsive status epilepticus by electroencephalography and drug or other toxicity by extensive toxicologic screening.

"The imaging findings for the first time demonstrate acute brain dysfunction that appears to be directly related to neuroborreliosis," coauthor Renaud Du Pasquier, MD, neurology chairman at the Centre Hospitalier Universitaire Vaudois in Lausanne , said in the news release. "It may point out future perspectives for research on the underlying mechanisms."

The next step in the diagnosis was lumbar puncture. Cerebrospinal fluid (CSF) analysis showed elevated leucocyte levels with 45% neutrophils, elevated protein, and elevated lactate, along with reduced CSF glucose. The researchers concluded that despite the relatively low leucocyte counts and unremarkable Gram stain, the patient might have bacterial meningitis.

The patient was quickly treated with an intravenous regimen of ceftriaxone, amoxicillin/clavulanate, and acyclovir and began to improve almost immediately.

Within 24 hours, symptoms had resolved, apart from circumstantial amnesia. Blood immunoassays for B burgdorferi immunoglobulin G, immunoglobulin M, and C6 Lyme immunoglobulin were positive. Intrathecal production of immunoglobulin G was observed using isoelectrofocalization, and highly significant levels of B burgdorferi  immunoglobulin M and immunoglobulin G were identified in CSF and serum, yielding an intrathecal antibody index of 7.1 (vs normal <1.5). The CXCL13 chemokine in CSF was nearly double normal levels.

Despite the absence of a history of tick bite, the researchers concluded the patient had acute neuroborreliosis. They continued ceftriaxone alone for 4 weeks, by which time the patient had achieved "excellent clinical evolution."

The authors emphasize that this report "highlights the importance of lumbar puncture and early empiric antimicrobial treatment" to avoid complications such as chronic Lyme encephalopathy with cognitive deficits. They also suggest that CXCL13 might be a particularly useful early marker of Lyme neuroborreliosis before positive tests for intrathecal antibodies because CXCL13 is secreted afterBorrelia invasion of the central nervous system and attracts B lymphocytes.

The authors have disclosed no relevant financial relationships.

Annals Emerg Med. Published online February 25, 2015. Full text

1 comment

Tim Rhudy| Other Healthcare Provider16 hours ago

Lyme is a great imitator and a great detonator. When the ridiculous bad testing is finally acknowledged and the medical culture shifts towards greater recognition (when the old guard dies off if Max Planck is correct), we will be seeing a lot more of these stories.

Apple Introduces ResearchKit, Giving Medical Researchers New Tools

Date: March 9, 2015 3:07:41 PM PDT

Subject: Apple Introduces ResearchKit, Giving Medical Researchers New Tools

Source: Apple Hot News

Apple today announced ResearchKit, an open-source software framework designed for medical and health research that can help doctors and scientists gather data more frequently and more accurately from participants using iPhone apps. World-class research institutions have already developed apps with ResearchKit for studies on asthma, breast cancer, cardiovascular disease, diabetes, and Parkinson's disease. "iOS apps already help millions of customers track and improve their health. With hundreds of millions of iPhones in use around the world, we saw an opportunity for Apple to have an even greater impact by empowering people to participate in and contribute to medical research," said Jeff Williams, Apple's senior vice president of Operations. "ResearchKit gives the scientific community access to a diverse, global population and more ways to collect data than ever before."

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Harvard team success with stem cells for Parkinson's disease

Harvard Stem Cell Institute (HSCI) researchers at University-affiliated McLean Hospital have taken what they describe as an important step toward using the implantation of stem cell-generated neurons as a treatment for Parkinson's disease.

Ole Isacson and colleagues reported that dopamine-producing neurons derived from the skin cells of primates survived for more than two years after implantation into one of the animals, and markedly reduced its Parkinson's symptoms. The primate did not require immunosuppression, the scientists reported in the journal Cell Stem Cell.

Read the full story here:

http://news.harvard.edu/gazette/story/2015/03/possible-progress-against-parkinsons/

Dr R. Stricker (LLMD) comment on recent Lyme article on Pub Med

A recent article (Jan 5, 2015) on Lyme bacteria persistence after antibiotic treatment went up Pub Med. Noted LLMD and researcher Dr Raphael Stricker responded to the article with a letter you can read below. If you want to see the study he is referring to, explore the two links below. This article (report) is viewable without having a PubMed account. Anyone may view it.  -Bob

Full text of the article:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311275/

Dr Stricker's comment:   http://www.ncbi.nlm.nih.gov/pubmed/25705394

 

·        Repeat or persistent Lyme disease: persistence, recrudescence or reinfection with Borrelia Burgdorferi?

Shapiro ED.F1000Prime Rep. 2015.1 comment

Raphael Stricker2015 Mar 03 8:40 p.m. (30 minutes ago)

In this one-sided opinion piece about Lyme disease, Eugene Shapiro once again finds "no evidence that viable B. burgdorferi persist in humans after conventional treatment with antimicrobials". Shapiro is a well known member of the shrinking "Lyme Denialist" cabal that views Lyme disease as a trivial illness that is "hard to catch and easy to cure", apparently ignoring the latest CDC figures showing more than 300,000 new cases per year in the USA. The fact that Lyme disease has become a major epidemic that is six times more common than HIV/AIDS in this country fails to impress Shapiro, who adheres to the dogma that persistent infection with B. burgdorferi, the Lyme spirochete, does not exist following short-course antibiotic therapy despite extensive evidence to the contrary (Stricker & Johnson, Infect Drug Resist 4: 1-9, 2011; Cameron et al, Expert Rev. Anti Infect. Ther. 12:1103-1135, 2014).

Significant controversy over Lyme disease exists for three main reasons: (1) lack of accurate and/or universally accepted testing for the disease, (2) disagreement about symptoms associated with persistent infection in chronic Lyme disease, and (3) misinterpretation and misrepresentation of underpowered Lyme antibiotic treatment trials. While many studies describe the constellation of musculoskeletal, neurocognitive and/or cardiac symptoms associated with chronic Lyme disease, Shapiro views these as "medically unexplained symptoms" not necessarily related to persistent B. burgdorferi infection. Without a universally accepted "gold standard" test, the controversy over persistent infection and optimal therapy continues to smoulder while thousands of patients continue to suffer due to the dogma espoused by Shapiro (Johnson et al. PeerJ 2:e322, 2014).

A major problem faced by Shapiro is that he is trying to prove a negative. Thus if there is any evidence that persistent infection with B. burgdorferi does exist following short-course antibiotic therapy, his opinion is obviously wrong. To address this problem, Shapiro narrows his evidence to two recent Lyme disease articles, ignoring numerous studies in animals and humans that support persistent infection or leave the issue unsettled (Cairns & Godwin, Int J Epidemiol 34: 1340-1345, 2005; Berndtson, Int J Gen Med 6: 291-306, 2013; Stricker & Johnson, PLoS Pathog 10: e1003796, 2014). Shapiro dismisses this contrary evidence as "speculative", but his narrow selection of two "convincing" studies is insufficient to support his biased conclusion.

The first study examined a group of 17 patients with recurrent erythema migrans (EM) rashes who were promptly treated for their initial episode of Lyme disease and then developed one or more EM rashes at a later date. Culture of the rashes revealed different strains of B. burgdorferi in the subsequent episodes, and Shapiro points to this as evidence for new infection rather than relapse in these patients. However as pointed out in a letter addressing the article, this is a poor model for chronic Lyme disease due to persistent infection because all patients were promptly treated for their initial illness, lived in endemic areas and most likely were reinfected with a different strain of the spirochete from a subsequent tickbite. This is a very different situation from a patient who may have been infected and never treated for months to years and develops the constellation of musculoskeletal, neurocognitive and/or cardiac symptoms that are characteristic of persistent infection with the Lyme spirochete (Donta, N Engl J Med 368:1063-1064, 2013). Thus the model for persistent infection in this study is flawed.

The second study was a xenodiagnosis safety study of 36 patients (26 Lyme patients in different stages of disease and 10 controls) who allowed ticks to feed on them, and the ticks were then examined for B. burgdorferi transmission. Shapiro states that "no viable B. burgdorferi were cultured from ticks fed on any of these patients". This conclusion is flawed for two reasons: First, 30-50% of ticks were lost during the study, rendering the transmission results uninterpretable. Second, one patient with post-treatment Lyme disease syndrome (PTLDS) was found to have a positive culture from one tick, as stated in the Results: "One nymph was found to be positive by PCR of the nymph lysate culture, but direct PCR of the nymph lysate and microscopic evaluation of the culture were negative....The original positive OspA PCR of the tick culture was confirmed by PCRs for other B. burgdorferi genes.... The DNA extracted from this culture sample was then tested by IA/PCR/ESI-MS, which was positive for 7 of the 8 assay primer pairs" (emphasis added). Thus this patient had culture-confirmed evidence of persistent infection with the Lyme spirochete in PTLDS. Shapiro generously states that this finding is "provocative" when in fact it provides definitive evidence that he is wrong.

In summary, this one-sided opinion piece will only add to the confusion and misinformation surrounding Lyme disease. With better testing and novel treatments, a solution to this tickborne disease will someday be found. Shapiro's muddled article fails to contribute to this solution.