Archive for the ‘Lyme’ Category

Lyme Disease: The Silent Pandemic

https://www.drtaniadempsey.com/post/lyme-disease-the-silent-pandemic

Dr. Tania Dempsey

Lyme Disease: The Silent Pandemic

Updated: Jul 21, 2020

Lyme disease is the other pandemic that has been ignored. Tick season and an increase in Lyme disease cases in the next few months will be difficult to discern from COVID-19. Plus, many hospitals have reported running out of doxycycline during COVID-19, which is the number one medication that is used for lyme disease… All of this will skyrocket cases of lyme and make it even harder to treat and diagnose.

· Lyme Disease is a silent pandemic

· Estimates suggest that over 1 million people suffer from chronic Lyme disease

While the county races to find a cure for COVID-19 in record time, lyme disease treatment and testing lag behind in comparison.

We are living through what many would consider our first real pandemic in our lifetime. However, I would argue that we have been in the midst of a global epidemic of Lyme disease for over twenty years.

Lyme disease has been underreported and misunderstood since the first case was diagnosed in 1975 in Old Lyme, CT. While we watch the rapid scientific discoveries come to light regarding COVID-19, I become more aware of the paucity of new data for Lyme disease.

In a matter of months, we have seen a rapid response to the development of tests for COVID-19 PCR and antibodies (with room for improvement), but in the 39 years since the bacteria that causes Lyme disease (Borrelia burgdorferi) was identified, we are still incredibly behind in diagnostic testing, as well as treatment strategies and prevention.

While we are engaged in the battle with one infectious disease, we have the opportunity to reflect on other infectious diseases, specifically Lyme disease and co-infections, such as Babesia, Bartonella and other tick-borne infections. Tick-borne infections are on the rise and increasing exponentially with some research indicating that there are approximately 300,000 new cases of Lyme disease each year.

This increase in cases is due to a number of factors. The tick population, as a whole, has exploded as a result of global temperature increases, which in the last few years has led to shorter winters that allow adult ticks to continue to thrive. In addition, ticks have expanded their range as their hosts, the white-footed mouse and deer infiltrate into more heavily populated areas.

Every year, as the number of ticks increase, so do the number of diseases that each tick can carry. Research from July to October 2019 in upstate New York showed that 32% of the ticks carried at least one infection, primarily Lyme disease. This number was higher than expected. 3% of the ticks also carried multiple diseases or co-infections.

Each tick-borne infection carries their own risks. Some are deadly, like Powassan, some present acutely but are easily treated if found early, such as Ehrlichiosis, and others vary dramatically in their presentation and ease of treatment. The reality is that with Lyme disease, many patients that are infected are diagnosed and treated early, can make a full recovery.

However, about 10 to 20% of patients may have persistent symptoms that become chronic. There is very little data about chronic lyme disease and many believe that these patients have PTLDS (post-treatment Lyme disease syndrome), which implies that the patient’s symptoms are due to something other than continued infection. Similarly, COVID-19 seems to cause persistent or relapsing symptoms in some patients long after the initial infection.

Understanding our immune system’s response to one infection might, in fact, benefit our understanding of others.

People are justifiably fearful about getting infected with COVID-19. It’s a new virus. We don’t know that much about it, but it seems that every day we slowly gain insight into how this virus works. What is most astonishing is the tremendous variability in presentations that patients with COVID-19 have. No two patients are alike.

We are seeing some patients with mild respiratory symptoms and others with severe symptoms requiring intubation. We are seeing patients present with large blood clots, like pulmonary embolisms or strokes. We are seeing patients with other vascular symptoms, such as “COVID toes.” Some patients have gastrointestinal symptoms. Fever was initially thought to be a hallmark feature of the viral infection, but the data shows that less than 50% of patients with COVID-19 develop a fever at presentation.

The medical field is starting to understand the importance of keeping an open mind and that “no two patients are alike.” This approach sounds incredibly familiar to those of us who treat patients with Lyme disease, but unfortunately, it has not necessarily been embraced by the medical establishment until now.

Lyme disease is similarly inconsistent.

Lyme can present early with classic symptoms of a bull’s eye rash, fever, headache and muscle aches but less than 50% of patients present in this manner and even when there is a rash it often doesn’t resemble a bull’s eye. Many patients don’t even remember getting bitten by a tick, so Lyme disease can go undetected during the early stages until it infects major organs. It can damage the heart, the nervous system, joints, and many other parts of the body.

Lyme is a multisystemic disease with great variability that is not often recognized by doctors which, unfortunately, leaves many patients without an accurate diagnosis and without proper treatment. COVID-19 also causes multisystemic inflammation, but this phenomenon has been well accepted by medical professionals.

You don’t see COVID-19 patients being stigmatized as Lyme patients often are. Lyme disease can cause debilitating symptoms such as fatigue, headaches, joint pain, and brain fog, and yet on the outside these patients can look completely normal. This leads those around them, including their doctors to doubt the severity of their illness. They may be labeled as “crazy.” We often refer to diseases like Lyme as invisible illnesses, because they are invisible on the outside but devastating to the patient on the inside.

This is the spring when the trees are blooming, the grass is growing, and the ticks are out in droves, raising the concern for the potential of a significant rise in Lyme disease cases. This year might, in fact, be worse than previous years due to the relatively warm winter, which allowed ticks to continue thriving. I believe SARS-COV-2 might play an even larger role in the potential increased incidence of Lyme disease. While we remain isolated at home and practice social distancing, the beautiful weather will send more people outdoors. Some will stay in their backyard and others will venture out onto hiking trails. Some have new puppies or dogs that need to be exercised outdoors and others will embrace growing their own food and gardening.

What precautions are people taking before going outside? I know many will don masks in case they run into other people. I think some people will remember to put on sunscreen or wear a hat to prevent a sunburn.

How many people will remember to protect themselves from insect and tick bites with insect repellant?

How many will remember to do tick checks when they come indoors?

I fear that our shift towards COVID-19 prevention may shift the focus away from Lyme disease prevention. This could lead to an escalation in tick bites and new infections.

There is real danger from getting bitten by a tick. There is, no doubt, real danger from getting infected with SARS-COV-2, too. Both pose serious risks and both present challenges to treatment. For months preceding the pandemic, we had been seeing an increasing number of drug shortages. Certainly, since the pandemic, this situation is worse. As soon as a drug is found to have activity against COVID-19, people begin to stock-pile and the supply dwindles quickly.

Unfortunately, some of these drugs that are in limited supply are used as first and second-line treatment against Lyme and co-infections, such as doxycycline and hydroxychloroquine. Lyme disease that is not adequately treated can leave long lasting, chronic sequelae that may be irreversible. This is not acceptable. Why? Because it is not acceptable to watch people suffer and potentially die from infections that are treatable just because the medications are not available due to manufacturing issues and stockpiling.

Lastly, as we start to see a rise in Lyme disease, not only will we have great difficulty with treatment, but I suspect diagnosis may be delayed due to the overlap in symptoms with COVID-19 in the early stages. I urge everyone to be on alert. Check yourself, your children and your pets for ticks. Use appropriate insect repellants but also use caution avoiding heavily wooded areas, areas with high grass and shrubs, leaf piles and wood piles, and other high-risk areas. Alert your doctor if you get a tick bite or develop fever, achiness, headache or other non-specific symptoms. Of course, it could be COVID-19, but it could also be something else.

THE SOLUTION:

We cannot ignore other potentially dangerous conditions and we must not assume that everything is COVID-19. I strongly urge doctors to keep Lyme disease and other tick-borne infections on their differential diagnosis list. While our country, our scientists and our medical professionals work towards control of the COVID-19 pandemic, let us not forget the silent pandemic of Lyme disease.

Lyme disease is found in every state in the U.S. and every continent in the world, except for Antarctica. The incidence and prevalence of the infection increases each year. Based on the assumption that at least 20% of patients experience treatment failure, we currently have over 1 million people in the U.S. with chronic Lyme disease and this does not include many who are undiagnosed, yet suffer the debilitating consequences.

Despite these growing numbers, naysayers still believe that Lyme is very easily treated and not a significant public health problem. That couldn’t be further from the truth. There are very loud voices championing Lyme disease research and education and yet their voices are muffled by those that don’t recognize that we are dealing with a global health issue that is expanding its reach every year.

Once we gain control over the immediate COVID-19 pandemic, I truly hope we use what we have learned and apply the same sense of medical urgency to Lyme disease and other tick-borne infections.

The destruction of Covid-19 is visible. The destruction and multisystemic effects of lyme disease is not. Just because you cannot see the destruction, does not mean it is not there. It is time we treat invisible illness with as much urgency as we treat visible illness in this country.

The economic impact of the effects of chronic lyme disease.

Lyme disease costs approximately $1.3 billion each year in direct medical costs in the United States, but this is likely a gross underestimate that doesn’t consider the full economic and societal costs. Some have proposed the cost to be closer to the $50- to $100-billion-dollar range. The numbers are even more staggering when we look at individual patients and what the cost is to them, not just financially but also in quality of life.

On average, Lyme patients might see 10-30 or more doctors before being properly diagnosed. Some of the costs might initially be covered by their insurance but as time goes on and their condition worsens, patients often need to do more extensive testing and see doctors outside their insurance plan, who have a specific interest and passion in treating complex, chronically ill patients. Lyme disease is a complex, multisystemic illness that is difficult to detect due to the lack of sensitive test and the way it evades the immune system, wreaking havoc before it’s discovered. The current medical model does not allow doctors to spend enough time with patients, which leads to misdiagnoses and even false labeling, that is not easily reversed.

Because the symptoms are so diverse and involve so many different parts of the body, including the nervous system and the brain, doctors have a hard time piecing the symptoms together.

Unfortunately, these patients are at risk for being labeled with a functional psychiatric disorder like anxiety, depression or OCD, and are often sent for psychiatric evaluation, which further delays them from receiving proper treatment for Lyme disease. We know that Lyme can cause neuropsychiatric illnesses, but this needs to be recognized as a consequence of the Lyme and treated as such.

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**Comment**

This article was written before the good news of successful COVID treatments.  HCQ, zinc, azithromycin, and Ivermectin have all shown fantastic results, along with numerous natural treatments.  Doctors have been writing about their clinical success using these treatments for months and months but now have clinical studies supporting their success.

The ‘powers that be’ continue to malign, deny, and censor this important information.
The reason for this censorship is quite simple.  Vaccines are not needed if treatments exist.

The Biology of Lyme Disease, An Expert’s Perspective With Alan MacDonald

http://

The Biology of Lyme Disease, An Experts Perspective With Alan MacDonald

Dr. Alan MacDonald, a retired M.D. and board certified in Anatomic Pathology and Clinical Pathology. This revealing interview from May 2013 covers many of the controversies associated with Lyme disease:
 
Part 1Chronic lyme disease
– Alzheimer’s and Lyme disease: microscopy and culturing brain tissue
– How Borrelia changes and survives within the human host
– The many strains and variations in Borrelia, how this relates to flawed testing
 
Part 2Brains and eyes as infection sanctuary sites
-Cloaking of spirochetes in complementary proteins
-Borrelia lifeforms: biofilms, communities, persisters, liposomes
-Syphilis spirochetes and similararities
-Spirochetes similar in biofunction as sperm
-Anatomy of a tick assault
-Six ways of evading the human immune system
-The CDC and Borrelia biofilms
-Atomic force microscopy: confirms Borrelia biofilms
-101 strains of Borrelia, 150 global genotypes
-Babesiosis types
-Why strain variation makes testing inaccurate
 
Part 3Biofilm communities
-Herxheimer reactions
-Failed therapy vs. Doctor failure
-Better terms for Lyme disease
-How Lyme was named and actual discoverer
-Four points of the Steere compass Multiple co-infections
-Complexity and adaptability of borrelia DNA
-Importance of CME for competency Globalization of Lyme disease
-Treatment options Biofilm infections and endocarditis
 
Our specific library of current intelligence on biofilms: http://www.biofilmcommunity.org/
 
Our documentary on biofilms, Why Am I Still Sick, now available in French, Spanish, Simplified and Traditional Chinese: http://www.whyamistillsick.com/
 
See all our free HD videos on health topics: https://www.youtube.com/user/ADRSuppo…
 
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For more:
 
  • https://madisonarealymesupportgroup.com/2019/02/22/why-mainstream-lyme-msids-research-remains-in-the-dark-ages/  This link contains Dr. Burrascano’s crucial video on “The History of Lyme Disease,” where he united with Dr. MacDonald for drug studies and more.  They found:
    • patients can test negative but still be infected (seronegative Lyme).
    • They also cultured EM biopsies for antibiotic sensitivity studies to determine the most effective antibiotics.
    • They also did drug level studies and found CDC/IDSA recommendations don’t work for many as they don’t give detectable blood levels of antibiotics (which means the antibiotics aren’t effective).  Some people need higher doses and treatment is not a “one size fits all.”  This is important because the CDC/IDSA guidelines are setting patients up for severe chronic Lyme as these surviving pathogens mutate into something that will become treatment resistant.

Laane states:

The website of the scientific journal that published our article was so severely hacked that it stayed offline for three years. Once it came back up, our article had dissapeared.

The hacking of the Journal ‘Biological and Biomedical Reports’ seems to be done with a person knowing more than my closest enemies. And was someone with access to a quite advanced compilator system. Why this was done might well have been political or personal prestige.

Who is More likely to Fail Lyme Disease Treatment?

https://danielcameronmd.com/fail-lyme-disease-treatment/

WHO IS MORE LIKELY TO FAIL LYME DISEASE TREATMENT?

lyme disease treatment

In a recent article entitled “Risk Factors and Outcomes of Treatment Delays in Lyme Disease: A Population-Based Retrospective Cohort Study,” Hirsch and colleagues described which Lyme disease patients were more likely to fail treatment.¹

Investigators reviewed questionnaires from 778 Lyme disease patients treated at the Geisinger Clinic, a health system in Pennsylvania. The authors determined the length of time a patient was ill before seeking medical attention, and the length of time between seeking care for Lyme disease and receiving lyme treatment.

They found that the amount of time between a patient’s initial symptom onset to treatment ranged from 0 days to 15 years.

• Nearly 3 out of 4 patients were treated within 1 month of symptom onset;
• More than 1 in 4 patients were treated more than 1 month after the onset of symptoms;
• 9% were not treated for at least 6 months after symptoms started.

Symptoms misdiagnosed

Some of the Lyme disease patients mistakenly attributed their symptoms to another condition including, the flu or virus, bug bite, allergy, skin problem, muscle or joint strain/injury, arthritis or bursitis, dehydration, overexertion, stress, and old age.

A self-reported diagnosis of chronic fatigue also increased the odds of delay. “Considering the similarity in some symptoms in the two conditions, health care providers may not have initially recognized the onset of Lyme disease symptoms as a new condition, resulting in delayed treatment,” the authors explain.

Some of the Lyme disease patients were diagnosed with other illnesses including, flu or other viral conditions, skin rashes, allergic reactions, shingles, muscle or joint injury, cellulitis or other skin conditions and insect bites.

Socioeconomic status affects treatment

Socioeconomic barriers impacted treatment. “Uninsured individuals in our study were more likely to delay contacting a medical professional for their symptoms than were individuals with private insurance.”

The delayed treatment was more likely to occur when patients were consulting with a primary care doctor versus visiting an urgent care center or emergency room.

Individuals with delayed treatment were more likely to suffer from Post-Treatment Lyme Disease Syndrome (PTLDS). PTLDS patients suffer from pain, impaired cognitive function, fatigue and poor function. The authors stressed the need to reduce the risk of treatment delays to prevent PTLDS.

Editor’s perspective:

Several of the factors associated with treatment failure are amenable to prevention. I remain opposed to the term “PTLDS” until we have a reliable test to exclude a persistent infection.

References:
  1. Hirsch AG, Poulsen MN, Nordberg C, et al. Risk Factors and Outcomes of Treatment Delays in Lyme Disease: A Population-Based Retrospective Cohort Study. Front Med (Lausanne). 2020;7:560018. doi:10.3389/fmed.2020.560018

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For more:

Causes of Treatment Delays in 16 Lyme Disease Patients

https://danielcameronmd.com/causes-treatment-delays-lyme-disease/

CAUSES OF TREATMENT DELAYS 16 LYME DISEASE PATIENTS

The longer time between onset of symptoms and treatment of Lyme disease has been associated with poor outcomes. [1] Unfortunately, delays in treatment are often reported. So, what are the causes for such delays?

I have identified several factors that might have contributed to treatment delays in 15 Lyme disease patients. All 15 subjects failed their initial antibiotic treatment. In many cases, their illness could have been mitigated had diagnosis and treatment occurred in the early stages of the disease.

These 15 patients were part of a case series which included 100 Lyme disease patients who were treated at a single private medical practice. The study was described in the Journal Evaluation Clinical Practice. [2] All patients in the series met the CDC’s two-tier criteria with at least 5 out of 10 IgG positive Western blot bands.

Treatment delays for Lyme disease

Case 1

35-year-old man presented with an erythema migrans rash. One week later, he had a blood test, which was negative. He was never re-tested. The man was not treated for Lyme disease for 8 years.
Failure to treat an erythema migrans rash despite a negative test

Case 2

16-year-old girl was diagnosed with Epstein Barr and a streptococcal infection. Her tonsils were subsequently removed. She was not treated for Lyme disease for 8 years.
Failure to consider Lyme disease

Case 3

57-year-old woman had a tick bite followed by a swollen right knee. She was diagnosed with a meniscus tear. She was not treated for Lyme disease for 6 years.
Failure to consider Lyme disease

Case 4

16-year-old girl was diagnosed with Bell’s palsy. She subsequently did poorly in school. She was not treated for Lyme disease for 6 years.
Failure to consider Lyme disease; failure to associate Lyme disease as a cause of poor school performance

Case 5

31-year-old man had a 6” x 6” rash. He was not treated for Lyme disease for 4 years.
Failure to recognize an erythema migrans rash

Case 6

35-year-old man with typical symptoms. He was told he did not have Lyme disease by two doctors. He was not treated for Lyme disease for 3 years.
Failure to seek a second opinion from a doctor experienced in treating chronic manifestations of Lyme disease

Case 7

42-year-old woman with Bell’s palsy. She was told she did not have Lyme disease based upon results from a spinal tap. She was not treated for Lyme disease for 3 years.
Relied on negative spinal tap results to dismiss Lyme disease; failure to consider Lyme disease even with Bell’s palsy manifestation

Case 8

22-year-old man with sinusitis followed by two sinus operations. He was not treated for Lyme disease for 17 months.
Failure to consider sinusitis as a symptom of Lyme disease

15 Lyme disease patients experience delays in diagnosis and treatment. Study reviews each case and possible causes behind the delays. CLICK TO TWEETCase 9

75-year-old man with aches and pains and walking difficulties. He was told the symptoms were related to a previous heart attack and stroke. He was not treated for Lyme disease for 15 months.
Failure to consider Lyme disease

Case 10

50-year-old man with a rotator cuff and meniscus tear. He was not treated for Lyme disease for 8 months.
Failure to consider Lyme disease

Case 11

36-year-old woman with an ill-defined rash with a positive Lyme disease test. She was told it was not Lyme disease by her doctor. She was not treated for Lyme disease for 6 months.
Failure to recognize an erythema migrans rash; failure to seek a second opinion from a doctor experienced in treating chronic manifestations of Lyme disease

Case 12

75-year-old man with edema. He was treated initially with diuretics followed by steroids for “water on knee.” He was not treated for Lyme disease for 4 months.
Failure to associate “water on knee” as a symptom of Lyme disease

Case 13

18-year-old woman with a 4” x 4” rash followed by pericarditis. She was treated with steroids instead of antibiotics. She was not treated for Lyme disease for 3 months.
Failure to recognize an erythema migrans rash

Case 14

37-year-old man with disseminated Lyme disease rashes and asthmatic bronchitis. He was treated with steroids instead of antibiotics. He was not treated for Lyme disease for 2 months.
Failure to recognize an erythema migrans rash

Case 15

20-year-old woman was treated three times for cellulitis. She was not treated for Lyme disease for 2 months.
Failure to recognize an erythema migrans rash

Editor’s Note: These 15 patients did well with retreatment or treatment of a co-infection. It would have been easier to treat in a timely manner. Timely treatment would also avoid needless suffering.

There are multiple factors associated with treatment delays. These cases are reflective of only one practice and may not be generalizable to the broader population. Other factors may have contributed to these treatment delays.

Lyme disease patients should not have to suffer for months to years before being treated. More researcher on the causes behind treatment delays is required.

References:
  1. Hirsch AG, Poulsen MN, Nordberg C, et al. Risk Factors and Outcomes of Treatment Delays in Lyme Disease: A Population-Based Retrospective Cohort Study. Front Med (Lausanne). 2020;7:560018. doi:10.3389/fmed.2020.560018
  2. Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract. Jun 2007;13(3):470-2. doi:10.1111/j.1365-2753.2006.00734.x

Tuttle’s Response to HHS Request for Information: “Any Published Evidence Identifying Persistent Infection After Extensive Antibiotic Treatment Has Been Completely Ignored”

https://www.change.org/p/the-us-senate-calling-for-a-congressional-investigation-of-the-cdc-idsa-and-aldf/u/29172177?

HHS Request for Information

JUN 7, 2021 — 

Please see below my submission to HHS Request for Information: (Deadline June 11th)

How to submit a comment:  https://www.federalregister.gov/documents/2021/04/27/2021-08167/request-for-information-rfi-developing-the-national-public-health-strategy-for-the-prevention-and

June 6, 2021

Developing the National Public Health Strategy for the Prevention and Control of Vector-Borne Diseases in Humans

It was once believed that rifampin was curative in treating Brucellosis but when symptoms returned doxycycline was added to the mix and when that too failed a third antibiotic, streptomycin was added to the current treatment regimen. [1] [2]

In 1985 the worldwide incidence of leprosy was 6,000,000. In 2018, it was 208,619. The only thing that changed was the addition of rifampin to dapsone in the treatment of the disease. Rifampin was added to dapsone because the M leprae were becoming resistant and it was a new antibiotic at that time.

Treatments for multidrug-resistant tuberculosis have been introduced (bedaquiline and delamanid) with more in the pipeline. [3]

A new treatment for recurrent Clostridium difficile was recently studied (bezlotoxumab) for reducing the risk of a repeat infection. [4]

In contrast, oral amoxicillin or doxycycline remains the treatment of choice for treating Lyme disease for over thirty years regardless if debilitating symptoms return. Since 1977 Dr. Allen Steere knew that these antibiotics were not effective for all patients [5] but there has been no change in treatment or research to find more effective ways to eradicate the infection in all stages of disease.

To my knowledge, a “Federal Working Group” was never established for brucellosis, leprosy, tuberculosis or C. difficile but then again there was no rush to create a vaccine as there was with Lyme disease. It would appear that a chronic relapsing seronegative disease did not fit the vaccine model.

All patients in the 2018 Middelveen et al pilot study were culture positive for infection (genital secretions, skin and blood) even after multiple years on antibiotics so there was no relief from current antimicrobials. Some of these patients had taken as many as eleven different types of antibiotics. [6]

Here’s what researchers at Johns Hopkins and Northeastern are saying: [7]

“Under experimental stress conditions such as starvation or antibiotic exposure, Borrelia burgdorferi can develop round body forms, which are a type of persister bacteria that appear resistant in vitro to customary first-line antibiotics for Lyme disease.”

Dr. Brian Fallon of Columbia University recently published his findings of autopsy specimens from a patient previously treated for Lyme disease. Persistent infection with the Lyme disease spirochete was identified in the brain of the Lyme patient who died with a diagnosis of Lewy body dementia. [8]

Any published evidence identifying persistent infection after extensive antibiotic treatment has been completely ignored. Please see my letter to the editor of the BMJ published June 2020 for examples. [9] The research to find a cure for this antibiotic resistant/tolerant superbug has been denied for decades as the co-chair of the Tick-Borne Disease Working Group, Dr David Walker calls persistent infection after extensive antibiotic treatment a “religious belief” [10] This partnership to deny chronic Lyme disease has left hundreds of thousands if not millions around the globe in a debilitated state.

For three decades now patient testimony all across America (and around the globe) has been describing a disease that is destroying lives, ending careers while leaving its victim in financial ruin.

Priority # 1 for Lyme disease:

Establish a Manhattan Project to Find a Cure for this antibiotic resistant/tolerant superbug and elevate Lyme to Highest Alert at the CDC while recognizing the disabling stage of Lyme disease.

Respectfully submitted,

Carl Tuttle
Hudson, NH

Member of Governor Chris Sununu’s Lyme Disease Study Commission
http://www.gencourt.state.nh.us/statstudcomm/details.aspx?id=1515&rbl=1&txtbillnumber=hb490

Cc: All members of the New Hampshire Lyme Disease Study Commission

References: 

[1] Chronic Brucellosis and Persistence of Brucella melitensis DNA
https://www.ncbi.nlm.nih.gov/pubmed/?term=Chronic+Brucellosis+and+Persistence+of+Brucella+melitensis+DNA

[2] Administration of a triple versus a standard double antimicrobial regimen for human brucellosis more efficiently eliminates bacterial DNA load.
https://www.ncbi.nlm.nih.gov/pubmed/25246401

[3] Global Introduction of New Multidrug-Resistant Tuberculosis Drugs—Balancing Regulation with Urgent Patient Needs
https://wwwnc.cdc.gov/eid/article/22/3/15-1228_article

[4] New C.diff treatment reduces recurrent infections by 40%
https://www.sciencedaily.com/releases/2017/01/170126081724.htm

[5] Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. 1977
https://pubmed.ncbi.nlm.nih.gov/836338/

Excerpt:

“The best treatment for this illness is not clear. Some physicians have reported that penicillin or tetracycline results in disappearance of the skin lesion (41,42), but others find antibiotics ineffective. Four of the patients with expanding skin lesions received penicillin but still developed arthritis.” 

[6] Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease
http://www.mdpi.com/2227-9032/6/2/33

[7] A Drug Combination Screen Identifies Drugs Active against Amoxicillin-Induced Round Bodies of In Vitro Borrelia burgdorferi Persisters from an FDA Drug Library
https://pubmed.ncbi.nlm.nih.gov/27242757/

[8] Detecting Borrelia Spirochetes: A Case Study With Validation Among Autopsy Specimens
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141553/

[9] Lyme borreliosis: diagnosis and management
https://www.bmj.com/content/369/bmj.m1041/rr-1

[10] Public comment: Does that sound like a religious belief, Dr. Walker?
https://www.lymedisease.org/tuttle-comment-tbdwg-nov17/

Request for Information (RFI): Developing the National Public Health Strategy for the Prevention and Control of Vector-Borne Diseases in Humans
The development of a national strategy on vector-borne diseases including tickborne diseases was…