Archive for the ‘research’ Category

Forty Years of Evidence on the Efficacy & Safety of Oral & Injectable Antibiotics for Treating Lyme Disease in Adults & Children: A Network Meta-Analysis

https://journals.asm.org/doi/10.1128/Spectrum.00761-21

Forty Years of Evidence on the Efficacy and Safety of Oral and Injectable Antibiotics for Treating Lyme Disease of Adults and Children: A Network Meta-Analysis

ABSTRACT
Lyme disease (LD) is a heavy public health burden. The most common manifestations of LD include erythema migrans (EM), Lyme neuroborreliosis (LNB), and Lyme arthritis (LA). The efficacy and safety of antibiotics for treating LD is still controversial. Thus, we performed a network meta-analysis (NMA) to obtain more data and tried to solve this problem. We searched studies in the databases of Embase and PubMed from the date of their establishments until 22 April 2021. Odds ratios (ORs) were used to assess dichotomous outcomes. A total of 31 randomized controlled trials (RCTs) involving 2,748 patients and 11 antibiotics were included.
  • Oral amoxicillin (1.5 g/day)
  • oral azithromycin (0.5 g/day)
  • injectable ceftriaxone
  • injectable cefotaxime were effective for treating LD (range of ORs, 1.02 to 1,610.43)
  • Cefuroxime and penicillin were safe for treating LD (range of ORs, 0.027 to 0.98)
  • Amoxicillin was effective for treating EM (range of ORs, 1.18 to 25.66)
  • Based on the results, we thought oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating LD
  • Cefuroxime and penicillin were safe for treating LD.
  • Amoxicillin was effective for treating EM.
  • We did not observe evidence proving the advantage of doxycycline in efficacy and safety for treating LD, LA, LNB, and EM of children or adults.
  • We did not have sufficient data to prove the significant difference of efficacy for treating LA and LNB in adults and LD in children, the significant difference of safety of oral drugs for treating LD, and the significant difference of safety of drugs for treating EM.

On Disulfiram for Lyme? Good News: It May Also Protect Against Severe COVID Study Says

https://insight.jci.org/articles/view/157342

Disulfiram inhibits neutrophil extracellular trap formation protecting rodents from acute lung injury and SARS-CoV-2 infection

Published February 8, 2022 –

 

Abstract

Severe acute lung injury has few treatment options and a high mortality rate. Upon injury, neutrophils infiltrate the lungs and form neutrophil extracellular traps (NETs), damaging the lungs and driving an exacerbated immune response. Unfortunately, no drug preventing NET formation has completed clinical development. Here, we report that disulfiram —an FDA-approved drug for alcohol use disorder— dramatically reduced NETs, increased survival, improved blood oxygenation, and reduced lung edema in a transfusion-related acute lung injury (TRALI) mouse model. We then tested whether disulfiram could confer protection in the context of SARS-CoV-2 infection, as NETs are elevated in patients with severe COVID-19. In SARS-CoV-2-infected golden hamsters, disulfiram reduced NETs and perivascular fibrosis in the lungs, and downregulated innate immune and complement/coagulation pathways, suggesting that it could be beneficial for COVID-19 patients.

In conclusion, an existing FDA-approved drug can block NET formation and improve disease course in two rodent models of lung injury for which treatment options are limited.

Disulfiram has previously been associated in observational studies with lowering the risk of infection from SARS-CoV-2, and one study of the drug in human patients with moderate COVID-19 was completed in 2021, but results haven’t yet been posted. A separate trial testing the drug against COVID-19 in humans has not yet been completed.

For more:

Other drugs approved for different uses have shown some success against COVID-19, including ivermectin, hydroxychloroquine, and fluvoxamine, though U.S. health officials primarily recommend ones such as paxlovid that are specifically approved.

Lumbar Puncture Helpful for Diagnosing Lyme Neuroborreliosis?

https://danielcameronmd.com/lumbar-puncture-helpful-for-diagnosing-lyme-neuroborreliosis/

Lumbar puncture helpful for diagnosing Lyme neuroborreliosis?

patient getting lumbar puncture to diagnose lyme neuroborreliosis

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing a case which examines the diagnostic value of a lumbar puncture in Lyme neuroborreliosis.

The case was first described by Portales-Castillo and colleagues in the journal Cureus in a paper entitled “To Lumbar Puncture or Not to Lumbar Puncture.” The authors presented a case of “early disseminated Lyme neuroborreliosis with manifestations of facial palsy and painful radiculoneuritis as determined by clinical and serological criteria.”¹

A 61-year-old woman was admitted to the hospital with an inability to close her left eye and an odd sensation on part of her face. She presented with erythematous raised circled rash and swelling on the base of the index finger of her right hand.

She thought she might have been bitten by a spider two days prior and was therefore treated with cephalexin for a presumed cellulitis.

Three weeks later, she started to develop posterior dull neck pain, along with bilateral arm pain and arm weakness. Her symptoms progressed to the point where she could no longer comb her hair.

CLICK BELOW TO WATCH VIDEO DISCUSSION OF THE CASE

“The pain later became associated with progressive arm weakness, which continued to progress over the following three weeks up to the point where she could not comb her hair,” the authors wrote.

The woman then developed Bell’s palsy. A Lyme disease IgM Western blot test was positive, consistent with acute Lyme disease.

“Our case aimed to highlight the controversy on the diagnostic utility of cerebrospinal fluid (CSF) analysis in certain presentations of [Lyme neuroborreliosis].”

A spinal tap was recommended but not performed. “She politely declined as she wondered if the treatment decision would be altered by the results of an invasive procedure,” wrote the authors.

Instead, she was treated empirically for Lyme disease.

“After discussion with the neurology and infectious disease consultants, the diagnosis of early disseminated Lyme neuroborreliosis manifesting as painful radiculoneuritis, motor weakness, and facial nerve palsy (so-called Bannwarth syndrome) was considered a strong possibility based on her clinical presentation and serologic criteria,” wrote the authors.

The woman’s Bell’s palsy and pain resolved after 4 weeks of treatment with doxycycline, prednisone (60 mg for 5 days) and eye drops. In addition, there was marked improvement in her weakness.

At her two-week follow-up appointment, the woman reported having a “complete resolution of her facial weakness and pain along with marked improvement in her weakness, which did not recur after successful course completion,” the authors wrote.

Spinal tap controversy

“[Lyme neuroborreliosis] remains a challenging diagnosis and often warrants spinal fluid analysis, particularly in the context of acute meningitis,” wrote the authors. “However, the ultimate decision to obtain a lumbar puncture (LP) in such patients with facial palsy and peripheral neurological symptoms remains controversial.”

Guidelines are divided over whether to take an individualized approach for spinal fluid analysis or relying on spinal fluid analysis for the diagnosis.

Cerebral spinal fluid (CSF) tests are not reliable, given that the increase in the number of white cells in the CSF (called pleocytosis) can be raised from other illnesses.

A finding of an elevated B. burgdorferi antibody in the spinal fluid has been helpful. However, the ration of CSF: serum antibodies should be 1.3 or higher. In other words, the CSF antibodies must be 30% higher than the serum antibodies. In some cases, the CSF B. burgdorferi polymerase chain reaction (PCR) may be positive.

The sensitivity of the spinal tests can be low. Only 1 in 27 patients with neurologic Lyme disease had a pleocytosis and that was only 7 cells. One other patient with neurologic Lyme had CSF antibodies but the ratio was only 1. Other studies have shown higher sensitivities. Other CSF tests have been examined including the CXCL13 chemokine biomarker in CSF.

“To Lumbar Puncture or Not to Lumbar Puncture”

A spinal tap may be important to rule out alternative diagnoses. “The need for an LP in suspected cases of LNB remains a clinical decision that needs to be tailored to the specific clinical situation, favored when diagnostic uncertainty is present, and potentially spared when the clinical suspicion for LNB is high,” wrote the authors.

The following questions are addressed in this Podcast episode:

1. What is neurologic Lyme disease?
2. What were the neurologic findings for this patient?
3. What is Bannwarth syndrome?
4. What is a spinal tap?
5. Why is a spinal tap useful and what is the accuracy?
6. What are the findings in a spinal tap of someone with neurologic Lyme disease?
7. What are problems with reliability of the test?
8. Do you discuss “To Lumbar Puncture or Not to Lumbar Puncture” with your patients?

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Portales-Castillo C A, Said M (September 14, 2021) To Lumbar Puncture or Not to Lumbar Puncture: A Case of Lyme Neuroborreliosis. Cureus 13(9): e17970. doi:10.7759/cureus.17970

Babesia & Lyme: Missed Diagnosis Can Have “Dire Consequences”

https://danielcameronmd.com/co-infections-babesiosis-lyme-disease-dire-consequences/

Co-infections Babesiosis and Lyme disease, missed diagnosis can have “dire consequences”

Woman being examined for co-infections with Babesiosis and Lyme disease

In a recently published article, “A Case of Tick Bite Induced Babesiosis With Lyme Disease,” Bhesania and colleagues [1] describe a 72-year-old woman with atypical symptoms, who was found to have co-infections with Lyme disease and Babesiosis.

 

The woman had a three-week history of a fever (maximum temperature, 104 F], chills, nausea, and productive cough of yellow sputum.

Six weeks prior to her onset of symptoms, the woman had been vacationing in Connecticut, an area endemic for Lyme disease. She reported having 2 tick bites during the previous year.

Her examination and tests were normal, except for pancytopenia and manual peripheral blood smear showed Babesia microti in her red blood cells. Initially, 1.7% red blood cells were infected with Babesia microti.

“The unique feature of our case was the atypical presentation with no rash and no joint pain, but the patient had only constitutional symptoms like weakness and occasional fever…”

“The patient was started on azithromycin, atovaquone for Babesiosis, and doxycycline to treat Lyme disease with initial suspicion of co-infection and a plan to deescalate once the Lyme disease was ruled out,” the authors state.

She was discharged home with the combination of the three oral treatments.

Dire consequences with delayed treatment

“Cases with severe hemolytic anemia, disseminated intravascular coagulation, respiratory failure, renal failure erythrocyte apheresis should be considered,” they suggest.

And, “Clinicians should consider co-infection when suspecting tick-borne disease which can lead to fatal consequences if not addressed promptly.”

“If there is delayed initiation of therapy in these kinds of patients, there may be dire consequences that may require aggressive therapy.”

The authors cited another case report to highlight the importance of a timely diagnosis.

A 67-year-old woman was treated for Lyme disease. But her fever, rash, and myalgias persisted despite a 21-day course of amoxicillin. The patient was also found to have pancytopenia and evidence of Babesia. Once she began treatment for Babesia, her symptoms improved.

References:
  1. Bhesania S, Arora KS, Tokarski M, et al. A Case of Tick Bite Induced Babesiosis With Lyme Disease. Cureus. Aug 2021;13(8):e17401. doi:10.7759/cureus.17401

For more:

Spanish Study Shows Vaxxed Spread COVID at Same Rate as Unvaccinated

https://thevaccinereaction.org/2022/02/spains-first-study-on-omicron-finds-vaccinated-people-spread-covid-at-same-rate-as-unvaccinated/

Spain’s First Study on Omicron Finds Vaccinated People Spread COVID at Same Rate as Unvaccinated

Spain’s First Study on Omicron Finds Vaccinated People Spread COVID at Same Rate as Unvaccinated

Several governments in Spain scrapped COVID passports following the study’s release.

The first Spanish study on how the Omicron variant of COVID-19 infects, incubates, and transmits was recently concluded by the Public Health Observatory of Cantabria.

The findings, which have not yet been peer reviewed, show that the highly infectious variant accounted for nearly half of the infections recorded during the whole pandemic. One reason Omicron has proven so transmissible, researchers discovered, is that the window for transmission is earlier than previous variants.

“Half of the infections occurred before the onset of symptoms,” researchers said.

The early stage transmission, scientists noted, complicates some mitigation efforts.

“This would imply that the effectiveness of measures such as screening, rapid testing or isolation would decrease significantly in the absence of preventive measures such as distance, limiting mass gatherings or social gatherings,” researchers said.

Perhaps the most consequential finding in the research, however, is that vaccines did not appear to reduce the spread of the virus.

“Vaccinated cases seem to have the same transmission capacity as unvaccinated people,” researchers concluded, according to EITB Radio Televisión Pública Vasca (the Basque Autonomous Community’s public broadcast service).

This is a departure from the Delta variant, researchers said, where transmission differences were found in vaccinated households and workplaces.

The study was based on 622 Omicron cases (and their 1,420 contacts) detected in Cantabria, a region on Spain’s north coast, in December 2021.

Scrapping Vaccine Passports

The findings out of Spain are just the latest example of why COVID-19 continues to spread despite human ingenuity and the widespread efforts of central planners to tame the virus.

Unlike previous pandemics, governments around the world took sweeping actions to restrict basic freedoms out of fear of the deadly pathogen. Businesses were closed, speech restricted, free assembly denied, and bodily autonomy was violated.

Despite these efforts the virus, now in its third year, continues to rage, and in many parts of the world governments have been slow to rescind harmful policies despite their ineffectiveness.

To its credit, parts of Spain have proven much more responsive than other parts of the world.

Two week ago, public health officials in Catalonia, an autonomous province in northeast Spain, and several other provinces, announced they were scrapping vaccine passports in light of this new evidence.

A committee of scientists told Catalonia’s regional government that because of the nature of Omicron, “a large part of the population is once again susceptible to getting infected whether or not they are vaccinated or have already had the illness.”

“The effectiveness of the compulsory use of the Covid certificate is reduced as an extra level of security,” scientists added.

The requirement to show a COVID passport had been in place since November in Catalonia, the second most-populous community in Spain, with some 7.7 million people. Smaller regions in Spain, such as Cantabria and Asturias, also have reportedly announced they will no longer require COVID passports for people to enter bars, restaurants, and other public spaces.

European media point out that Spain has suffered from widespread Omicron outbreaks even though the country boasts one of the higher vaccination rates in the world.

“Despite high levels of vaccination in Spain where 90.7 percent of people over the age of 12 are fully immunised,” The Local reports, “coronavirus cases exploded in Spain over the Christmas holidays, giving it one of Europe’s highest incidence rates.

The decision to scrap the vaccine passport follows widespread protests in Spain against vaccine passports and mask mandates.

The Pre-Eminence of His Own Plan

While the effectiveness of vaccines in slowing the spread is questionable, there is still an abundance of evidence suggesting that vaccines can significantly reduce the likelihood of falling seriously ill from COVID-19.

Dr. Jay Bhattacharya, a professor of medicine who studies epidemiology at Stanford University, credits his own speedy recovery from COVID to the vaccines and has praised them as “a wonderful achievement.”

But Bhattacharya has said vaccines are primarily a matter of personal health, not public health, since the benefits of vaccination lay primarily with the individual, and has argued that efforts to mandate vaccination erode confidence in public health.

“Opposition to discriminatory vaccine mandates is not the same as opposition to vaccines,” Bhattacharya said last year. “On the contrary, support for vaccine mandates is an anti-vax position because it breeds distrust and resentment toward public health.”

The new research out of Spain, combined with recent data from the CDC that show natural immunity confers more protection from some COVID variants than vaccines, reveals the folly of these coercive policies.

Vaccine passports are inherently unjust because free people require free movement, but they become both unjust and ridiculous when they fail to reduce the transmission of the virus or account for natural immunity.

Provinces in Spain that are rescinding their vaccine passport policies in light of this new evidence deserve some credit, because this does not come naturally to state planners.

In his work Socialism: An Economic and Sociological Analysis, the economist Ludwig von Mises noted how difficult it is for bureaucrats to relinquish control over their own plans.

“What those calling themselves planners advocate is not the substitution of planned action for letting things go. It is the substitution of the planner’s own plan for the plans of his fellow-men,” Mises wrote. “The planner is a potential dictator who wants to deprive all other people of the power to plan and act according to their own plans. He aims at one thing only: the exclusive absolute pre-eminence of his own plan.”

For those wondering why many countries continue to use coercive policies even in light of this new evidence, the words of Mises offer a beam of understanding.

Fortunately, many countries around the world—including the United Kingdom, Denmark, and the Czech Republic—are beginning to see the error and injustice of these coercive measures.


This article was reprinted with the author’s permission. It was originally published by the Foundation for Economic Education. Jonathan Miltimore is the Managing Editor of FEE.org. His writing/reporting has been the subject of articles in TIME magazine, The Wall Street Journal, CNN, Forbes, Fox News, and the Star Tribune.

Note: This commentary provides referenced information and perspective on a topic related to vaccine science, policy, law or ethics being discussed in public forums and by U.S. lawmakers.  The websites of the U.S. Department of Health and Human Services (DHHS) provide information and perspective of federal agencies responsible for vaccine research, development, regulation and policymaking.