Archive for the ‘Lyme’ Category

Lyme & TBD: Where Are We, 2021?

https://lymediseaseassociation.org/blogs/lda-guest-blogs/kenneth-liegner-md-lyme-tbd-where-we-are-2021/

Kenneth Liegner, MD – Lyme & TBD: Where Are We, 2021?

May Awareness LDA Guest Blogger

Dr. Kenneth Liegner, MD

Dr. Kenneth Liegner is a Board Certified Internist with additional training in Pathology and Critical Care Medicine, practicing in Pawling, New York. He has been actively involved in diagnosis and treatment of Lyme disease and related disorders since 1988. He has published articles on Lyme disease in peer-reviewed scientific journals and has presented poster abstracts and talks at national and international conferences on Lyme disease and other tick borne diseases. He has cared for many persons seriously ill with chronic and neurologic Lyme disease. His work has focused on the serious morbidity and (occasional) mortality that can eventuate from this aspect of the illness. He has emphasized the urgent need for widespread clinical availability of improved methods of diagnostic testing and for development of improved methods of treatment for Lyme disease in all its stages. He holds the first United States patent issued proposing application of acaricide to deer for area-wide control of deer-tick populations as a means of reducing the incidence of Lyme disease. He has authored In the Crucible of Chronic Lyme Disease – Collected Writings & Associated Materials, a documentational history of the struggle to characterize the nature of Lyme disease in the late 20th and early 21st centuries, published November 2015 (www.inthecrucibleofchroniclymedisease.com).

He served two terms on the Board of Directors of The International Lyme and Associated Diseases Society (www.ilads.org), is on the Scientific Advisory Board of the Lyme Disease Association (www.lymediseaseassociation.org), and is a member of the American Medical Association (www.ama-assn.org), the Westchester County Medical Society (www,wcms.org), the Medical Society of the State of New York (www.mssny.org) and The American Association of Physicians and Surgeons (www.aapsonline.org). He is on the staff of Northern Westchester Hospital Center in Mount Kisco, New York (Northwell Health System) and the Sharon Hospital in Sharon, Connecticut (Nuvance Health System).

He was the first physician to apply disulfiram in the treatment of Lyme disease and published his experience with his first three patients in the peer-reviewed journal Antibiotics, May 2019 (https://www.mdpi.com/2079-6382/8/2/72) and reported his first 3 years’ experience with the drug in December 2020 (Antibiotics 2020, 9(12), 868; https://doi.org/10.3390/antibiotics9120868)  He was co-author on a landmark pathologic study of tissues from a person with chronic Lyme disease (https://www.mdpi.com/2079-6382/8/4/183) and co-author of the ILADS evidence-based definition of chronic Lyme disease (https://www.mdpi.com/2079-6382/8/4/269).

Lyme & Tick- & Vector-Borne Disease: Where Are We, May 2021?

The COVID-19 Pandemic has overwhelmed the U.S. of A. and the world and has temporarily overshadowed another ‘shadow on the Land’* – the global pandemic of Lyme disease.

As city denizens flee for more rural areas in efforts to minimize the risks of acquiring COVID-19, they may be less mindful of the risks ticks pose. Deer tick bites often go unnoticed, yet they can transmit the agent of Lyme disease and a range of other infectious diseases:  non-Lyme borrelioses (e.g. tick-borne relapsing fever due to the spirochete Borrelia miyamotoi), Powassan virus, anaplasmosis (a Rocky Mountain Spotted Fever-like illness) and babesiosis. Bartonellosis may also occur in persons with Lyme disease (whether tick- or flea-transmitted or due to a cat scratch), complicating the clinical picture.  Onset of Lyme disease can be insidious and tests not always reliable so there can be delays in diagnosis which allow borrelial infections to become deeply entrenched and more difficult to treat.

The HHS Tick-borne Diseases Working Group with very significant input by patients, advocates and some treating clinicians has developed important perspectives to the problems posed by tick-borne infections and is serving to ‘move things forward’.

Although there has been some increased Federal funding for Lyme and other tick-borne diseases recently, as well as influx of funds from charitable foundations and private donors, the total commitment to solving these complex problems had been inadequate: consistent funding for H.I.V./A.I.D.S. greater than $1 billon/year for decades has enabled real progress in diagnosis and therapy.  An infection that was basically a death sentence is now eminently manageable with oral anti-viral agents. Affected individuals can enjoy a good quality of life with a life-span approximating those not infected.  Annual funding for Lyme disease by comparison, has been paltry.

Sadly, despite decades of advocacy we still lack a clinically available, well-validated and reproducible direct detection test for Lyme disease that can measure ‘borrelial load’ (analogous to measures of ‘viral load’ so very useful in the management of H.I.V./A.I.D.S.).

Likewise, attention to the development of improved therapeutics has been grossly inadequate at the Federal level, progress stymied by the damaging dogma: chronic Lyme disease does not exist.

In the past decade and largely due to funding from private foundations and patient advocacy groups, innovative forays in to repurposing of FDA-approved agents already in the United States Pharmacopeia and novel combinations of pharmaceutical as well has herbal-derived principles in vitro have identified promising new approaches which are beginning to be explored clinically, mostly by individual practitioners.

This ought to be vastly expanded and undertaken as systematic and formal clinical trials against ‘comparator’ agents such as ‘standard’ recommended antibiotherapies.  Such trials are costly, however, would lead to more ‘robust’ data that are more than merely ‘anecdotal’.   This merits funding with Federal dollars.  Academic medical centers are well-equipped and well-accustomed to running such randomized controlled trials.  However, such trials could also be undertaken ‘in the community’ through clinicians actually caring for patients with chronic tick-borne illnesses.

I have likened practitioners caring for patients with the ‘big 3’ B’s of tick and vector-borne diseases (Borreliosis, Babesiosis and Bartonellosis) to playing 3 simultaneous games of chess in 3 dimensions against 3 opposing Grandmasters.  It is a great challenge for practitioners.  It is not boring!  But when one successfully enables patients to improve their quality of life and sometimes (with shared decision-making, luck, skill and patient & practitioner perseverance) to make a full or substantial recovery, well, it is very gratifying.

Lots of work remains to be done!  Let us all resolve to do that work!  Let’s cooperate!  Let’s get busy!

*the title of United States Public Health Service Surgeon General (1936-1948) Thomas Parran’s influential book concerning syphilis

Kenneth B. Liegner, M.D.
Pawling, New York
April 29, 2021

___________________

For more:

5 Reasons Why You Should Care About Lyme Disease

https://www.globallymealliance.org/blog/5-reasons-you-should-care-about-lyme-disease

“The fact is, everyone should care about Lyme disease. Here are five reasons why.”

May is Lyme Disease Awareness Month. Some people may think, “Oh, I already know about Lyme disease. You only have it if you see a bull’s eye rash.” Or, “I don’t need to worry about Lyme disease, because I don’t live in New England.” These are myths about Lyme disease that are all too commonly heard. The fact is, everyone should care about Lyme disease.

Here are five reasons why:

  1. If you spend time outdoors, you are at risk.

Lyme disease used to be known for its prevalence in New England, as well as the fact that it is carried by deer. Both of those things are still true, but what people don’t always realize is that infected blacklegged ticks that carry Lyme disease are found across the country and world. Some ticks carry other diseases that are endemic to certain areas of the country, such as Heartland virus and Southern Tick-Associated Rash Illness (STARI). Moreover, in addition to deer, ticks also feed on other mammalian hosts such as mice, chipmunks, and birds. They don’t just live in the woods, either. They like to hide in tall grasses, leaf piles and on brush. Anyone who spends time outdoors is at risk for Lyme and other tick-borne diseases, and should take important precautions.

  1. Your children and pets are at high-risk for Lyme disease.

Do you have kids who like to play outside? Do you have pets who run through the woods? They are both at high-risk for contracting Lyme disease—and, your pets can bring ticks into your home, which can then infect you and your family. Children ages 3-14 are at the highest risk for Lyme disease, since they love to roll in the grass, explore in the woods, etc. Complications for both children and pets can be severe if Lyme is not detected and treated immediately. Like adults, children can develop cognitive issues, mood changes, sleep disturbances, and prolonged fatigue that can significantly impact their ability to focus in, or even attend, school. Here are specific prevention measures you can take for your kids and for your pets.

  1. If not treated early, Lyme disease can become seriously debilitating.

Most cases of Lyme disease that are treated immediately can be cleared up with a course of antibiotics, but some 10-20% of patients go on to experience persistent symptoms. And that’s for patients who are lucky enough to see a bull’s eye rash or whose doctor quickly recognizes their clinical symptoms. About 50% of people never see a bull’s eye rash, or any rash at all. Others present nebulous symptoms such as fatigue, or take months to develop other symptoms such as joint and muscle aches, fevers, and neurological impairments, which are often misdiagnosed; Lyme is considered “The Great Imitator” because its symptoms can mirror those of other conditions such as Multiple Sclerosis (MS) and Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS).

  1. Diagnosis and treatment can be complicated.

Lyme disease testing is notoriously faulty, since it only can detect antibodies against Borrelia burgdorferi (the pathogen that causes Lyme disease), not the bacteria itself. Many patients either get misdiagnosed, as described above, or not diagnosed at all. Their Lyme disease then progresses to later, more complex and systemic stages. It then becomes more difficult to treat. Treatment can also be complicated by co-infections that require different treatment—some doctors don’t know to test for co-infections in addition to Lyme disease—as well as an individual’s immune response. Each person’s case of tick-borne illness is different, and requires an individually tailored protocol.

  1. Ticks DON’T ONLY carry Lyme disease.

As mentioned above, ticks can carry other illnesses, commonly referred to as co-infections. Some of these include babesiosis, anaplasmosis, ehrlichiosis, and possible bartonella. Some require different treatment than Lyme disease (for example, babesiosis is a parasite that is treated with anti-malarial medication). They also can be more difficult to get rid of, even when caught early. If you have Lyme disease and have not been tested for co-infections, you may only be fighting half the battle.

According to the Centers for Disease Control and Prevention (CDC), approximately 476,000 people are diagnosed and treated for Lyme disease every year. That’s more than breast cancer and HIV combined. Lyme and other tick-borne diseases are a serious health threat. The more people are aware of Lyme, the greater chance they’ll have of taking good preventative measures and/or getting accurately and efficiently diagnosed.

Writer

Jennifer Crystal

Opinions expressed by contributors are their own. Jennifer Crystal is a writer and educator in Boston. Her work has appeared in local and national publications including Harvard Health Publishing and The Boston Globe. As a GLA columnist for over six years, her work on GLA.org has received mention in publications such as The New Yorker, weatherchannel.com, CQ Researcher, and ProHealth.com. Jennifer is a patient advocate who has dealt with chronic illness, including Lyme and other tick-borne infections. Her memoir about her medical journey is forthcoming. Contact her via email below.

Email: lymewarriorjennifercrystal@gmail.com

_______________________

**Comment**

Here’s some more reasons why you should care:   https://madisonarealymesupportgroup.com/2020/09/25/why-should-we-care-about-lyme-disease-a-colorful-tale-of-government-conflicts-of-interest-probable-bioweaponization-and-pathogen-complexity/  The information within this article is imperative to understand why patients are not believed, diagnosed, or treated within mainstream medicine unless they are lucky enough to have a bull’s eye rash and a tick dangling off their arm.  (Even then, people are sent home packing and told to “wait and see.”)

Biofilm

https://www.medicalnewstoday.com/articles/319858.php

Strength in numbers: How biofilms outfox antibiotics

Bacteria are vital for survival, but when they form communities, they can wreak serious havoc and pose a threat to our health.

When bacteria flock together and form a community, this is called a biofilm. Found all over the planet — from desert rocks to the surfaces of buildings — biofilms are an integral part of nature.

Biofilms are tricky beasts because they have a tendency to become resistant to all manner of efforts employed to eradicate them. This spells bad news for anyone with conditions such as cystic fibrosisperiodontitis, or chronic wounds as medical implants and catheters are hotspots for biofilm formation.

But why are biofilms so persistent, and what are doctors and scientists doing to outsmart these clever microbial communities?

What are biofilms?

“Biofilms are one of the most widely distributed and successful modes of life on Earth,” says Prof. Hans-Curt Flemming — director of the Institute for Interface Biotechnology at the University of Duisburg-Essen in Germany — in a 2016 article published in Nature Reviews Microbiology.

(See link for article)

_____________________

For more:

Lyme Disease Protein Tricks Immune System, Ignites Arthritis

https://danielcameronmd.com/lyme-disease-protein-ignites-arthritis/

LYME DISEASE PROTEIN TRICKS IMMUNE SYSTEM, IGNITES ARTHRITIS

man with lyme disease and arthritis rubbing his knee
Researchers from Virginia Tech believe they have discovered another piece of the Lyme disease puzzle – How does the Borrelia burgdorferi bacterium cause inflammation and Lyme arthritis?

Lyme disease patients often struggle with ongoing symptoms including arthritis. Findings from this latest study are a “testament to how unique this bacterium is — and how we need to keep working to understand more about what is going on behind the scenes in order to develop future diagnostics and treatments,” states Mari Davis, lead author on the paper.

In earlier studies, Brandon Jutras, a Virginia Tech biochemist, discovered that as the “Lyme-causing bacteria Borrelia burgdorferi multiplies, it sheds a cellular component called peptidoglycan that elicits a unique inflammatory response in the body.”¹

Peptidoglycan, he reported, contributes to inflammation and Lyme arthritis.

Peptidoglycan  is an essential component of bacterial cell walls. It was still present in Lyme disease patients weeks to months after the initial infection, inciting inflammation and arthritis, Jutras reported.

NapA protein tricks immune system

But most recently, scientists at the Jutras lab (lead by Brandon Jutras) identified a type of peptidoglycan-associated protein, called Neutrophil Attracting Protein A (NapA) in Borrelia burgdorferi bacterium.

“Using microfluidics, we demonstrate that NapA acts as a molecular beacon—exacerbating the pathogenic properties of B. burgdorferi [peptidoglycan].”²

NapA is an “immunomodulatory molecule that is able to recruit immune cells, called neutrophils, toward the inflammatory peptidoglycan,” the author explains.

“NapA is another piece to an ever-evolving puzzle; it seems to play a basic role in everyday bacterial life by helping the overall protective properties of peptidoglycan,” explains Jutras, “but it moonlights as a devious protein capable of tricking our immune system.”

NapA has two devious sides

“Early in infection, when bacteria are dying and releasing NapA and peptidoglycan, it acts as a decoy to attract immune cells, which allows the viable bacteria to escape and cause disease,” Jutras explains.

“In later stages of disease, it may act to attract immune cells to peptidoglycan, a molecule capable of causing inflammation and arthritis.”

Authors’ Conclusion

The combination of peptidoglycan and NapA could serve as a novel target for prevention and diagnostics developments.

“One thing that we know for sure is that this finding furthers our understanding of how peptidoglycan can drive Lyme arthritis patient symptomology.”

References:
  1. Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis
    Brandon L. Jutras, Robert B. Lochhead, Zachary A. Kloos, Jacob Biboy, Klemen Strle, Carmen J. Booth, Sander K. Govers, Joe Gray, Peter Schumann, Waldemar Vollmer, Linda K. Bockenstedt, Allen C. Steere, Christine Jacobs-Wagner Proceedings of the National Academy of Sciences Jul 2019, 116 (27) 13498-13507; DOI: 10.1073/pnas.1904170116
  2. Marisela M. Davis, Aaron M. Brock, Tanner G. DeHart, Brittany P. Boribong, Katherine Lee, Mecaila E. McClune, Yunjie Chang, Nicholas Cramer, Jun Liu, Caroline N. Jones, Brandon L. Jutras. The peptidoglycan-associated protein NapA plays an important role in the envelope integrity and in the pathogenesis of the lyme disease spirochete. PLOS Pathogens, 2021; 17 (5): e1009546 DOI: 10.1371/journal.ppat.1009546

______________________

For more:

Ryan Sutter Reveals He Has Lyme Disease Worsened by Mold: ‘My Immune System Was Weakened’

https://people.com/health/ryan-sutter-reveals-he-has-lyme-disease-worsened-by-mold/

The former Bachelorette winner, who has been struggling with an mystery sickness for the last year, said he also tested positive for COVID-19 and Epstein-Barr virus
By Julie Mazziotta
May 25, 2021 12:27 PM
Ryan Sutter Says He’s ‘Doing Ok’ amid Lyme Disease Diagnosis: ‘Finding Value in My Own Suffering’

The former Bachelorette winner, 46, has Lyme disease that was triggered by high levels of mold in his body, he shared on his wife Trista Sutter’s podcast, Better Etc., on Tuesday. Ryan explained that after going through a litany of testing and blood work over the last year, doctors determined that his body is susceptible to taking in mold toxins, which he is frequently exposed to as a firefighter.  (See link for article)

___________________

**Comment**

Many Lyme/MSIDS patients also suffer from mold, but who really knows which came first?

For more:

For more articles on Sutter’s diagnosis of Lyme disease: https://people.com/health/ryan-sutter-says-hes-doing-ok-amid-lyme-disease-diagnosis-finding-value-in-suffering/