Archive for the ‘Lyme’ Category

Lyme Disease Patients Detail Treatment-Denial Conspiracy at Fifth Circuit

https://www.courthousenews.com/lyme-disease-patients-detail-treatment-denial-conspiracy-at-fifth-circuit/

Lyme disease patients detail treatment-denial conspiracy at Fifth Circuit

Lyme disease sufferers say they had trouble finding doctors willing to treat them due to a scheme to deny care by insurers and infectious disease experts.
 / September 7, 2023

Article Excerpts:

(CN) — A group of Lyme disease patients asked the Fifth Circuit on Thursday to revive their lawsuit against a medical society they claim issued bogus guidelines that insurers used to deny them coverage, forcing some to pay hundreds of thousands of dollars for their care.

Lisa Torrey and 27 others sued the Infectious Diseases Society of America, or IDSA, seven health insurance companies and several medical doctors in 2017 in Texarkana, Texas, federal court.

Bringing RICO Act and antitrust claims, the plaintiffs claim several major health insurers decided treating Lyme disease was too expensive, so they paid IDSA-affiliated doctors to establish arbitrary guidelines, first published in 2000, that said the illness could be treated with 28 days of antibiotics.

After reaching confidential settlements with the insurers, the plaintiffs filed a second amended complaint in January 2021, adding fraudulent and negligent misrepresentation claims against the IDSA and its panelists who wrote the guidelines. (See link for article)

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SUMMARY:

  • A U.S. District Judge sided with the IDSA and dismissed the case
  • Although appealed, the IDSA convinced the appellate court to dismiss it as premature since the settlement hadn’t been finalized
  • The plaintiffs filed another appeal and a 3-judge panel of the 5th circuit heard arguments recently
  • The judge is leaning toward dismissing the lawsuit as it is about a scientific issue that needs a forum for debate
  • The challengers’ lawyer made the argument that more than 12 states have passed legislation to protect physicians’ ability to prescribe long-term treatment proving that in reality doctors are bound by IDSA “guidelines,” as well as the fact insurance companies hide behind these “guidelines” which have become mandates allowing them to deny payment for treatment

Category:

Activism, Lyme, Treatment

Novel Treatment For Relapsing Lyme, Babesia, and Bartonella

https://www.mdpi.com/2076-2607/11/9/2301

Comparison of the Efficacy of Longer versus Shorter Pulsed High Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome with Bartonellosis and Associated Coinfections

by 1,2,*, 2 and Phyllis R. Freeman2
Microorganisms 2023, 11(9), 2301; https://doi.org/10.3390/microorganisms11092301
Received: 8 August 2023 / Revised: 27 August 2023 / Accepted: 8 September 2023 / Published: 12 September 2023
(This article belongs to the Special Issue Bartonella and Bartonellosis: New Advances and Further Challenges)

Abstract

Twenty-five patients with relapsing and remitting Borreliosis, Babesiosis, and bartonellosis despite extended anti-infective therapy were prescribed double-dose dapsone combination therapy (DDDCT), followed by one or several courses of High Dose Dapsone Combination Therapy (HDDCT). A retrospective chart review of these 25 patients undergoing DDDCT therapy and HDDCT demonstrated that 100% improved their tick-borne symptoms, and patients completing 6–7 day pulses of HDDCT had superior levels of improvement versus 4-day pulses if Bartonella was present.
At the completion of treatment, 7/23 (30.5%) who completed 8 weeks of DDDCT followed by a 5–7 day pulse of HDDCT remained in remission for 3–9 months, and 3/23 patients (13%) who recently finished treatment were 1 ½ months in full remission.
In conclusion, DDDCT followed by 6–7 day pulses of HDDCT could represent a novel, effective anti-infective strategy in chronic Lyme disease/Post Treatment Lyme Disease Syndrome (PTLDS) and associated co-infections, including Bartonella, especially in individuals who have failed standard antibiotic protocols.
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Category:

Babesia, Bartonella, Lyme, research, Treatment

Lyme Pain

https://danielcameronmd.com/lyme-pain/

LYME PAIN

Lyme pain

Welcome to another selection from my book “An Expert’s Guide on Navigating Lyme disease.” The books highlights the findings of my first 600 Lyme disease Science blogs.  In this episode, I will discuss Lyme pain.

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Reported pain associated with Lyme disease includes headaches, eye pain, neck pain, chest pain, abdominal pain, bladder pain, joint pain, and neuropathy. More recently, central sensitization syndrome (CSS) has been described. Pain medication may not be as effective as when used for other illnesses. Thankfully, pain often improves upon successfully treating Lyme disease.

CENTRAL SENSITIZATION SYNDROME AND LYME DISEASE.

Chronic pain, debilitating fatigue, and heightened sensory disturbances are common in Lyme disease patients. In the article “Post-Treatment Lyme Syndrome and Central Sensitization,” it is suggested that in some cases, such symptoms may be due to central sensitization syndrome (CSS) (Batheja et al., 2013). Central sensitization syndrome (CSS) involves changes in the central nervous system, particularly the brain and spinal cord. This syndrome “is thought to involve hyperactivation of central neurons, leading to various synaptic and neurotransmitter/ neuromodulator changes” (Batheja et al., 2013).

“Notably, in relation to Lyme disease, infections, in general, are known to activate central sensitization in some patients, possibly through the release of inflammatory cytokines,” Batheja points out. Read more.

LYME PRESENTING AS ABDOMINAL PAIN IN A BOY.

At age 8, a boy was hospitalized for severe abdominal pain and underwent extensive testing, but the results were negative. His abdominal pain remitted over the next two months (Savasta et al., 2020).

One year later, the boy was admitted with learning difficulties including attention deficit, difficulty speaking, irritability, and difficulty walking due to an ataxic gait.

He was diagnosed with abdominal neuroradiculopathy. Additional laboratory and radiological findings confirmed the diagnosis of late Lyme disease.

He was treated with six weeks of oral and IV antibiotics. Three months after treatment, the boy’s gait and scholastic performance had improved and entirely resolved after one year. Read more.

A WOMAN WITH A HISTORY OF LYME WITH PAIN REFRACTORY TO TREATMENT.

Lyme disease patients often suffer from ongoing illness following treatment. A study found that 31% of patients remained in significant pain for months after a three-week course of doxycycline to treat an erythema migrans rash (Bechtold et al., 2017).

Researchers describe a 31-year-old woman with Post-Treatment Lyme disease Syndrome (PTLDS) “whose pain was refractory to treatment options such as radiofrequency ablation, vitamin infusion therapy, opioid analgesics, and other pharmacotherapies.” Her pain began gradually, three years prior and a short time after being diagnosed and treated for Lyme disease. “The patient complained of diffuse body pain (6–7/10), fatigue, headache, and brain fog (7–8/10)” (Hanna et al. 2017).

The patient was prescribed off-label Ketamine for pain, reducing her pain by 71%. Read more.

BREAST CANCER PATIENT DEVELOPS LYME DISEASE.

A 61-year-old woman was diagnosed with stage II breast cancer with lymph node metastasis. She underwent a lumpectomy, followed by chemotherapy, radiation, and anti-estrogen treatment, letrozole.

One year later, the woman complained of radicular leg and back pain followed by a foot drop on one foot and right-sided facial palsy in two weeks. Moreover, she was in severe pain despite narcotics.

A spinal tap was performed due to unexplained neurologic findings. Lyme disease tests by blood and spinal fluid were positive.

She was diagnosed with Lyme disease and treated with intravenous ceftriaxone for 14 days. As a result, she became pain-free despite her history of severe pain despite narcotics. Read more.

LYME PRESENTING WITH SEVERE NEUROPATHIC PAIN.

A 36-year-old man suffered from a chronic pain syndrome associated with Post-Treatment Lyme Disease Syndrome (PTLDS) (Karri and Bruel, 2020). The doctors did not offer antibiotic treatment.

The patient described severe neuropathic pain in both feet and categorized the pain at a level 10 out of 10 despite treatment with methadone 5 mg every 4 hours as needed. The doctors assumed that the tick-borne infection had resolved, and elected not to treat it with antibiotics.

Instead, they treated the patient’s symptoms. The pain remained severe despite trials of gabapentin, duloxetine, bupropion, and narcotics. Two surgical procedures were performed, which improved the patient’s pain.

Author’s note: I might have retreated with an antibiotic. Read more.

LYME DISEASE CASE WITH SEVERE PAIN FOR 9 YEARS.

In an article published in Saudi Journal of Anaesthesia, doctors describe the case of a 23-year-old woman who suffered from severe chronic pain for 9 years due to post-treatment Lyme disease syndrome (PTLDS). Her pain intensified and became more difficult to manage after she underwent dental extractions and required hospitalization.

Out of 19 symptoms associated with Post-Treatment Lyme Disease Syndrome (PTLDS), 9 were especially significant and included fatigue, joint pain,  focusing/concentration, muscle pain, memory, finding words, sleep, neck pain, and irritability. The remaining symptoms were paresthesias (tingling sensations), low back pain, headache, photophobia, dizziness, visual clarity, chills, coordination, sweats, fasciculations (muscle twitches), breathing difficulties, urination changes, and nausea (Rebman et al., 2017).

Two participants met the criteria for postural orthostatic tachycardia syndrome (POTS). Results from the physical exam and laboratory testing of our sample of patients with PTLDS did not show a pattern of significant objective abnormalities.” However, “the most notable exception was the higher rate of diminished vibratory sensation on physical exam among participants with PTLDS. Read more.

LYME DISEASE PAIN AFTER DENTAL SURGERY.

Despite an uneventful extraction of four molars, a woman complained of severe widespread pain. Her pain medication list was extensive. The woman’s oral pain was minor, while her main issue was overall body pain (Lim and Kinjo Lim 2018).

Although the physicians used a multimodal pain regimen during surgery, they could not prevent her Lyme disease symptoms from recurring after surgery. Finally, the patient’s pain became so severe that she was transferred to the Intensive Care Unit (ICU). “A multimodal pain regimen was used for two days that include ketamine infusion, acetaminophen, ketorolac, oxycodone, and hydromorphone” (Lim and Kinjo Lim 2018).

Author’s note: It would be reasonable to revisit the woman’s PTLDS clinical history to determine whether she was adequately treated for her infection. Read more.

COMPLEX REGIONAL PAIN SYNDROME (CPRS) FROM LYME.

A review from Raigmore Hospital in the UK discussed autonomic dysfunction due to infectious diseases. “Complex regional pain syndromes [CRPS] and reflex sympathetic dystrophy (RSD) with regional sympathetic hyperactivity have also been reported in some patients with Lyme disease” (Artal 2017). CRPS is characterized by considerable pain (allodynia, hyperalgesia), edema, trophic changes of the skin and muscles, and sudomotor disorders.

Artal discussed a case first described by Sibanc et al. (2002). A 46-year-old man reported increasing pain and swelling in his left foot. The pain eventually caused his leg to become dysfunctional. “Even the slightest contact with the skin of the affected area caused the patient unbearable pain” (Sibanc and Lesnicar, 2002). The man improved after four weeks of intravenous ceftriaxone. Read more.

FATIGUE AND COGNITION FROM CENTRAL SENSITIZATION SYNDROME?

Fatigue and cognitive impairments are prominent features of central sensitization syndrome. Patients with Post-treatment Lyme disease Syndrome or chronic Lyme disease often have persistent insomnia and fatigue. While fatigue can have a central or peripheral origin, “central fatigue often has the significant correlate of cognitive impairment” (Batheja et al., 2013).

Studies of patients with Post-treatment Lyme disease Syndrome “have shown that problems with memory, working memory, processing speed, and verbal fluency are common” (Batheja et al., 2013).

Central sensitization syndrome has been described in several illnesses characterized by fatigue with similar presentations to Lyme disease, including fibromyalgia and chronic fatigue syndrome (Batheja et al., 2013). Read more.

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Category:

Activism, Lyme, Pain Management, Treatment

Borrelia Antibodies Found in Patients With Coronary Heart Disease & Case Report on Lyme Presenting as Complete Heart Block

https://danielcameronmd.com/borrelia-antibodies-found-in-patients-with-coronary-heart-disease/

BORRELIA ANTIBODIES FOUND IN PATIENTS WITH CORONARY HEART DISEASE

borrelia-antibodies-coronary-heart-disease

Borrelia burgdorferi, the causative agent of Lyme disease, can be associated with cardiovascular complications. This is known as Lyme carditis, and occurs when the spirochete bacteria penetrate the heart tissue. The infection can lead to heart block and other complications, as it disrupts the heart’s electrical signals.

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How many patients who underwent surgery for coronary heart disease (CHD) had evidence of a prior infection with Borrelia burgdorferi (the bacterium which causes Lyme disease)?

A study by Pietruszka and colleagues, “Serologic Status of Borrelia burgdorferi sensu lato in Patients with Cardiovascular Changes,” sought to answer that question.¹ The authors examined the level of anti-Borrelia burgdorferi IgG antibodies in the blood serum of patients with advanced coronary heart disease.

The study participants included 70 patients – 22 women and 48 men – between the ages 50-82, who required surgery for coronary artery disease. An ELISA test for Lyme disease was positive in 34% of these patients and ‘borderline’ in 17% of patients.

The study found, “more than a third of the patients had elevated IgG levels against Borrelia as detected by a screening test, indicating previous contact with spirochetes,” the authors wrote.

These individuals were asked whether they had noticed a tick bite during their lifetime and if they ever exhibited typical Lyme disease symptoms.

Borrelia burgdorferi, the causative agent of Lyme disease, can be associated with cardiovascular complications.

More than half (57%) had recalled a tick bite but had not been diagnosed or treated for Lyme disease. The majority (85%) did not notice an erythema migrans rash.

“We found a link between antibody levels and tick bites but not with other risk factors for the development of CHD,” the authors wrote.

“These findings support the idea that, as one of many factors, the contact with spirochetal antigens may indicate a potential positive correlation with the formation of cardiovascular changes,” they added.

“… infectious agents such as Borrelia burgdorferi sensu lato spirochetes, which cause Lyme disease, may also play a role in the development of cardiovascular disease.”

Cardiac complications due to Lyme disease typically occur a few weeks to a few months after infection, the authors point out. Symptoms include loss of consciousness, dizziness, palpitations, chest pain, and shortness of breath.

“The most common symptoms are conduction disorders (which manifest as various degrees of heart block), atrial fibrillation (AFib), and tachycardia,” the authors wrote.

Additionally, an infection with B. burgdorferi may “lead to changes in arteries, and CAD as a result,” the authors point out. Astherosclerosis, an inflammatory condition, is associated with a build-up of plaque in the arteries.

Plaques have been found to include a variety of bacteria. One study concluded “that exposure to infectious pathogens such as spirochetes increases the risk of atherosclerosis in tick-endemic areas.”

References:
  1. Pietruszka K, Reagan F, Stążka J, Kozioł MM. Serologic Status of Borrelia burgdorferi sensu lato in Patients with Cardiovascular Changes. International Journal of Environmental Research and Public Health. 2023; 20(3):2239. https://doi.org/10.3390/ijerph20032239

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https://www.sciencedirect.com/science/article/pii/S2214250923001233?via%3Dihub

Lyme disease presenting as complete heart block in a young man: Case report and review of pathogenesis

https://doi.org/10.1016/j.idcr.2023.e01799Get rights and content
Under a Creative Commons license
open access

Abstract

Lyme carditis is a serious complication of Lyme disease, the most common vector-borne infection in both the United States and Northern Europe. It is a rare manifestation of Lyme disease that primarily affects young adults with a marked 3:1 male-to-female predominance. The presentation of Lyme carditis is heterogenous and often non-specific, although the most common clinical manifestation is AV block, which can be acute in onset and can rapidly progress to complete heart block. We discuss the case of a young adult male with complete heart block as a complication of Lyme infection, presenting with two episodes of syncope without prodromal symptoms months after tick bites. There are several pathogen, host and environmental factors that can play an important role in the epidemiology and pathogenesis of this serious condition that is reversible if treated in a timely manner. It is important for clinicians to be familiar with the presentation and treatment of this infection that is now being observed in a wider geographic distribution so as to avoid serious long-term complications and unnecessary permanent pacemaking implantation.

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**Comment**

The ‘powers that be’ continue to state that these manifestations are ‘rare’ when testing, which has a sordid history, misses over 70% of all cases, leaving a majority of patients undiagnosed and untreated.

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Category:

Heart Issues, Lyme, research, Testing, Ticks

Seroprevalence of Borrelia burgdorferi sensu lato & Anaplasma phagocytophilum Infections in German Horses

https://www.mdpi.com/2076-2615/13/12/1984

Seroprevalence of Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum Infections in German Horses

by 1,*,1, 2, 1, 3, 1 and 3
Received: 15 April 2023 / Revised: 30 May 2023 / Accepted: 10 June 2023 / Published: 14 June 2023

Abstract

There are limited data on Lyme borreliosis (LB), a tick-borne disease caused by the Borrelia burgdorferi sensu lato complex, in horses. Seropositivity is not necessarily associated with clinical disease. Data on seropositivity against Borrelia burgdorferi and Anaplasma phagocytophilum in German horses are sparse. Therefore, serum samples from horses (n = 123) suspected of having Lyme borreliosis and clinically healthy horses (n = 113) from the same stables were tested for specific antibodies against Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum. The samples were screened for antibodies against Borrelia burgdorferi (ELISA and an IgG line immunoblot assay). Furthermore, the samples were examined for antibodies against B. burgdorferi and Anaplasma phagocytophilum with a validated rapid in-house test (SNAP® 4Dx Plus® ELISA).
The clinical signs of suspect horses included lameness (n = 36), poor performance (n = 19), and apathy (n = 12).
Twenty-three percent (n = 26) of suspect horses and 17% (n = 18) of clinically healthy horses were seropositive for having a Borrelia burgdorferi sensu lato infection (p = 0.371), showing that the detection of specific antibodies against B. burgdorferi alone is not sufficient for a diagnosis of equine LB. Anaplasma phagocytophilum seropositivity and seropositivity against both pathogens was 20%/6% in suspect horses and 16%/2% in the clinically healthy population, showing only minor differences (p = 0.108). Unspecific testing for antibodies against B. burgdorferi without clinical suspicion of Lyme borreliosis is not recommended since the clinical relevance of seropositivity against Borrelia burgdorferi sensu lato remains to be elucidated.
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Category:

Anaplasmosis, Lyme, research, Testing