Archive for the ‘research’ Category

Psychiatric Diagnosis Cannot be Given Solely Based Upon the Absence of Physical, Laboratory, or Pathological Findings

https://danielcameronmd.com/lyme-disease-symptoms-not-excessive/

LYME DISEASE PATIENT SYMPTOMS ARE NOT “EXCESSIVE”

Lyme disease is a complex, multisystem illness, which may be misdiagnosed as having a psychological cause, writes Bransfield in his article “Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty.”¹

“Historically, there has been a bias in which poorly understood illnesses are often considered to have a psychiatric origin until the pathophysiology is better understood and explained on some other basis.”

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Clinicians face great challenges in diagnosing disorders that involve symptoms seen in both general medicine and psychiatry, writes Bransfield. All too often, these patients are labeled as having “excessive” symptoms and given outdated diagnoses (i.e. psychosomatic disorder).

“There is often difficulty differentiating between psychosomatic, somatopsychic, multisystem illness, and different degrees of medical uncertainty,” writes Robert Bransfield, MD, a psychiatrist and professor at Rutgers Robert Wood Johnson Medical School.

The term “excessive” is used in the diagnosis of somatic symptom disorder and is, in fact, listed in the DSM-5 criterion.

“Excessive thoughts, feelings, or behavior related to somatic symptoms, which have been present for at least six months is a criterion for somatic symptom disorder in DSM-5,” Bransfield points out.

Some individuals with Lyme disease could be misdiagnosed with this disorder. Testing is often negative, symptoms may wax and wane, and psychiatric manifestations may accompany physical pains, causing both mental and bodily distress for the patient.

But as Bransfield points out,

“A psychiatric diagnosis cannot be given solely based upon the absence of physical, laboratory, or pathological findings.”

In fact, “Many ‘all in your head’ conditions may be related to the microbiome and the immune system,” he argues.

For instance, Lyme disease is caused by a bacterial infection.

“Some patients with Lyme disease are viewed as having an excessive concern for their symptoms,” writes Bransfield.

Actually, the Infectious Diseases Society of America’s (IDSA) Lyme disease guidelines “dismissed the chronic complaints from Lyme disease as being the ‘aches and pains of daily living.’”

Meanwhile, patients with complex, poorly understood illnesses, such as Lyme disease, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and chronic pain syndrome may be diagnosed with bodily distress disorder or bodily distress syndrome. These diagnoses, writes Bransfield, have not been scientifically validated.

“In the definition of bodily distress syndrome, there is a group of conditions that have little in common other than being distressing to deal with by some physicians,” he writes.

According to Bransfield, bodily distress disorder involves “bodily symptoms that the individual finds distressing and to which excessive attention is directed … and is not alleviated by appropriate clinical examination or investigations and appropriate reassurance.”

Bodily distress disorder symptoms are persistent, last at least several months and involve multiple bodily symptoms that may vary over time, he explains. Sometimes, there is only one symptom, usually pain or fatigue.

“If a previously healthy and active person acquires a debilitating, multisystem condition, with multiple complaints including paralyzing fatigue and pain that adversely impact multiple areas of functioning,” writes Bransfield, “and the evaluating physician has an inadequate knowledge of the illness, takes an inadequate history, performs an inadequate exam, and does not understand the seriousness of symptoms, or fails to use adequate clinical judgment, how can the patient’s response to the physician’s “reassurance” be considered excessive?”

Related Articles:

Complex multisystemic illnesses lead to psychiatric diagnosis

Dismissing chronic Lyme disease for somatic symptom disorder

Lyme disease conversations with Dr. Robert Bransfield

References:
  1. Bransfield RC, Friedman KJ, Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty. Healthcare 2019, 7(4), 114.

Category:

Lyme, Psychological Aspects, research

Many Lyme Disease Cases Go Unreported. A New Model Could Help Change That.

https://blogs.ei.columbia.edu/2020/03/06/lyme-disease-new-model/

Many Lyme Disease Cases Go Unreported. A New Model Could Help Change That.

tick on a blade of grass

The Centers for Disease Control and Prevention receives reports of about 30,000 cases of Lyme disease each year. The real number, according to the agency, is closer to 300,000.

Underreporting affects the ability of public health authorities to assess risk, allocate resources and devise prevention strategies. It also makes early detection very difficult, hampering efforts to treat the condition quickly and effectively.

A new report, published March 3 in the Journal of the American Medical Association, describes a data model developed by researchers from Columbia University and RTI International, a nonprofit research institute, that helps identify areas of the United States where Lyme disease cases may go unreported.

“We believe our analysis can help predict the trajectory of where Lyme disease will spread,” said Maria Pilar Fernandez, a post-doctoral researcher at Columbia and lead author of the study. “Identifying high-risk areas can lead to surveillance in counties and areas where infections are likely to emerge. It also allows authorities to alert physicians and the public, which can lead to early treatment, when it is most effective.”

To develop their model, the researchers analyzed publicly available data, tracking the geographic spread of Lyme disease over nearly two decades. They studied an estimated 500,000 cases of the illness reported to CDC from different counties across the United States between 2000 and 2017.

“We were able to show that about 162 U.S. counties may already have Lyme disease, but they have not yet been reported to the CDC,” said Maria Diuk-Wasser, associate professor in the Department of Ecology, Evolution and Environmental Biology at Columbia and a co-author on the study.

The CDC collects Lyme disease data from state and local health departments, which base the number of cases on notifications from clinicians, hospitals and laboratories. Lyme disease is difficult to diagnose, and accurate case assessment depends on many variables, the researchers said, from provider awareness and testing methods to reporting practices, state budgets and personnel.

Although Lyme disease has been diagnosed in almost every state, most cases reported to the CDC are in the Northeast and upper Midwest. If diagnosed early—a rash commonly appears around the site of the tick bite—the condition can be effectively treated with antibiotics. Longer term infections can produce more serious symptoms, including joint stiffness, brain inflammation and nerve pain.

Models have been created in the past to identify high-risk areas in a few states or regions in the United States, but the new one expands the geographic scope to all areas in the U.S. where the disease is most likely to occur.

“In the future, the model can be expanded,” Fernandez said. “We hope to continue to keep track of the spread and inform authorities about areas where Lyme disease is likely to emerge.”

This research was supported by the US Centers for Disease Control and Prevention and by an Interdisciplinary Predoctoral Fellowship from the Earth Institute, Columbia University.

This story was originally published by Columbia News. 

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**Comment**

A rash DOES NOT COMMONLY APPEAR.  Depending upon who’s counting the numbers range from 25-80%.  It’s highly variable.  And, the “condition” is not effectively treated with antibiotics.  This narrative needs to be corrected as it continues to be used as if it’s gospel truth.  Antibiotic failure has been reported from the beginning.  The longer you follow the patient, the higher the failure rate.  https://madisonarealymesupportgroup.com/2019/02/22/why-mainstream-lyme-msids-research-remains-in-the-dark-ages/

Unfortunately, it’s an apples and oranges story.  The CDC wants us to believe that antibiotics clear the EM rash, therefore patients are “cured,” when there is absolutely no proof that clearance of the rash equates to clearing a systemic infection.  It’s also important to remember that the rash (if there even is one) will eventually clear on its own without any drugs. 

 

Category:

Activism, Lyme, research

Grace Period For Ticks – Nope

https://www.lymedisease.org/lyme-sci-tick-attachment-time/

LYME SCI: There’s no grace period for tick bites. Let’s quit implying that there is.

No Safe Tick attachment time

I delivered these comments to the federal Tick-Borne Disease Working Group on March 4.

My name is Lonnie Marcum. I am a Physical Therapist and health and science writer for the non-profit LymeDisease.org. I’m also a member of the Tick Biology, Ecology and Control Subcommittee.

One of the biggest problems we face today is misinformation—Lyme and tick-borne diseases are no exception.

One piece of misinformation I’d like to talk about today is tick attachment time.

Currently, the CDC’s website states: “In most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted.”

False message

Unfortunately, this sends the false message that there is NO risk if any tick is removed within 36 to 48 hours of attachment.

This simply IS NOT TRUE!

In fact, there is ample evidence showing the risk for transmission with adult ticks begins at 24 hours in mice. But there are no studies showing the minimum attachment time for transmission of Lyme to humans—especially from nymphal ticks.

One European study documented six cases of culture-confirmed Lyme disease where tick attachment was less than six hours, and another nine cases where transmission occurred in under 24 hours.

While Lyme disease may be the most prevalent tick-borne infection, it is not the only pathogen carried by blacklegged ticks. Anaplasma, Babesia, Borreila mayonii, Borrelia miyamotoi, Ehrlichia and Powassan virus are all transmitted by the same tick that transmits Lyme. And that last one—Powassan—can be transmitted within 15 minutes.

In addition, there are at least nine other tick species in the US known to transmit pathogens to humans, many of them within 24 hours.  Furthermore, many pathogens in the Rickettsia family, like Rocky Mountain spotted fever, can be deadly if not treated within the first few days.

Members of the public, as well as many healthcare professionals, are not skilled at identifying ticks or knowing how long they have been attached. Add to that the studies showing most people with Lyme never even saw the tick.

Why give the public a false sense of security?

A better message would be to simply inform the public that the chance of disease from infected ticks increases the longer they are attached and feeding. Why not just tell people to keep the tick and send it for testing if they come down with symptoms?

There really is no such thing as a 36 to 48 hour grace period. Let’s stop promoting this misinformation.

Please see my written comments for full references. Thank you.

LymeSci is written by Lonnie Marcum, a Licensed Physical Therapist and mother of a daughter with Lyme. Follow her on Twitter: @LonnieRhea  Email her at: lmarcum@lymedisease.org .

References:

Bernard W. Berger, Dermatologic Manifestations of Lyme Disease, Reviews of Infectious Diseases, Volume 11, Issue Supplement_6, September-October 1989, Pages S1475–S1481, https://doi.org/10.1093/clinids/11.Supplement_6.S1475

CDC | Transmission of Lyme disease | https://www.cdc.gov/lyme/transmission/index.html

Cook M. J. (2014). Lyme borreliosis: a review of data on transmission time after tick attachment. International journal of general medicine, 8, 1–8. https://doi.org/10.2147/IJGM.S73791 

Eisen, L. (2018). Pathogen transmission in relation to duration of attachment by Ixodes scapularis ticks. Ticks and Tick-borne Diseases 9, 535-542. doi: 10.1016/j.ttbdis.2018.01.002

Peavey, CA; Lane, RS (1995) Transmission of Borrelia burgdorferi by Ixodes pacificus nymphs and reservoir competence of deer mice (Peromyscus maniculatus) infected by tick-bite. J Parasitol.  Apr;81(2):175-8. PMID: 7707191

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**Comment**

I’ve been saying this for years.  I’m glad someone is bluntly stating it to the TBDWG.  If there’s one thing I’m certain of – it’s that ticks do not understand the definition of grace.

Eventually the bill on all of this will come due.

For more:  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/ A little girl couldn’t walk or talk within 4-6 hours of tick bite.

https://madisonarealymesupportgroup.com/2019/04/26/three-strains-of-borrelia-other-pathogens-found-in-salivary-glands-of-ixodes-ticks-suggesting-quicker-transmission-time/

https://madisonarealymesupportgroup.com/2019/11/14/study-shows-ticks-can-transmit-rickettsia-immediately/

https://madisonarealymesupportgroup.com/2017/06/28/powassan-can-kill/

 

Category:

Activism, Lyme, research, Transmission

The Long-Term Persistence of Borrelia burgdorferi Antigens & DNA in the Tissues of Lyme Disease Patient

https://www.mdpi.com/2079-6382/8/4/183

The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease

by Eva Sapi 1,*, Rumanah S. Kasliwala 1, Hebo Ismail 1, Jason P. Torres 1, Michael Oldakowski 1, Sarah Markland 1, Gauri Gaur 1, Anthony Melillo 1, Klaus Eisendle 2, Kenneth B. Liegner 3,4,5, Jenny Libien 6 and James E. Goldman 7
*Author to whom correspondence should be addressed.
Antibiotics 2019, 8(4), 183; https://doi.org/10.3390/antibiotics8040183
Received: 22 August 2019 / Revised: 6 October 2019 / Accepted: 9 October 2019 / Published: 11 October 2019
(This article belongs to the Special Issue Antibiotics Resistance of Borrelia)

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Abstract

Whether Borrelia burgdorferi, the causative agent of Lyme disease, can persist for long periods in the human body has been a controversial question. The objective of this study was to see if we could find B. burgdorferi in a Lyme disease patient after a long clinical course and after long-term antibiotic treatment. Therefore, we investigated the potential presence of B. burgdorferi antigens and DNA in human autopsy tissues from a well-documented serum-, PCR-, and culture-positive Lyme disease patient, a 53-year-old female from northern Westchester County in the lower Hudson Valley Region of New York State, who had received extensive antibiotic treatments during extensive antibiotic treatments over the course of her 16-year-long illness. We also asked what form the organism might take, with special interest in the recently found antibiotic-resistant aggregate form, biofilm. We also examined the host tissues for the presence of inflammatory markers such as CD3+ T lymphocytes. Autopsy tissue sections of the brain, heart, kidney, and liver were analyzed by histological and immunohistochemical methods (IHC), confocal microscopy, fluorescent in situ hybridization (FISH), polymerase chain reaction (PCR), and whole-genome sequencing (WGS)/metagenomics.
We found significant pathological changes, including borrelial spirochetal clusters, in all of the organs using IHC combined with confocal microscopy.
The aggregates contained a well-established biofilm marker, alginate, on their surfaces, suggesting they are true biofilm.
We found:
  • B. burgdorferi DNA by FISH, polymerase chain reaction (PCR), and an independent verification by WGS/metagenomics, which resulted in the
  • detection of B. burgdorferi sensu stricto specific DNA sequences
  • IHC analyses showed significant numbers of infiltrating CD3+ T lymphocytes present next to B. burgdorferi biofilms
In summary, we provide several lines of evidence that suggest that B. burgdorferi can persist in the human body, not only in the spirochetal but also in the antibiotic-resistant biofilm form, even after long-term antibiotic treatment. The presence of infiltrating lymphocytes in the vicinity of B. burgdorferi biofilms suggests that the organism in biofilm form might trigger chronic inflammation. View Full-Text
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**Comment**
When will there be enough evidence for mainstream medicine?

Category:

Lyme, research

Study Shows Lyme Patients Treated With Immune Suppressants Have Frequent Comorbidities, Late Stage Symptoms, & Treatment Failure

https://danielcameronmd.com/is-suppressing-immune-system-harmful-to-lyme-patients/

IS SUPPRESSING IMMUNE SYSTEM HARMFUL TO LYME PATIENTS?

Lyme disease, treatment

There have only been a few published reports detailing the outcome of treatment on Lyme disease patients who are immunocompromised. Now, a study by Maraspin and colleagues¹ evaluates the impact of tumour necrosis factor-alpha (TNF-α) inhibitors, medications that suppress the immune system, on Lyme disease patients.

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The authors compared 16 individuals receiving TNF-α inhibitors with 32 healthy controls. The individuals had confirmed Lyme disease with an erythema migrans rash manifestation. The patients received immune-suppressing medications, which included adalimumab, infliximab, etanercept, golimumab. These were often combined with other immunosuppressant drugs for rheumatic (13 patients) or inflammatory bowel (3 patients) disease.

Investigators found that, when compared to controls, patients receiving immunosuppressants had:

  1. frequent comorbidities other than immune-mediated diseases (62.5% vs. 25%)
  2. symptoms/signs of disseminated Lyme borreliosis (18.8% vs. 0%)
  3. treatment failure (25% vs. 0%.)

In fact, 4 out of 16 (25%) Lyme disease patients treated with immunosuppression therapy failed treatment. Three of these four patients required retreatment. One of them was quite ill.

“The immunocompromised patients were also more likely to fail treatment than patients who were not immunocompromised,” writes Maraspin.

The fourth patient, a 44-year-old man, remained well until his 6-month follow-up visit. But, “7 months after beginning antibiotic treatment he developed severe arthralgia, fatigue and back pain,” writes Maraspin in the Journal of Clinical Medicine.

A specialist was consulted but could not confirm whether the man had a relapse of rheumatoid arthritis. He remained ill for the next 5 months. And tests revealed his IgG antibody to VlsE borrelial antigens rose from 542.1 to 1462.0 AU/mL.

His symptoms improved following re-treatment with the antibiotic, ceftriaxone.
The authors recommended regular follow-up visits to carefully monitor immunocompromised Lyme patients.
Related Articles:

Persistent Lyme infection or inflammatory immune response?

Can Lyme trigger an autoimmune disease?

Lyme disease mimics autoimmune disorder in elderly woman

References:
  1. Bransfield RC, Friedman KJ, Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty. Healthcare 2019, 7(4), 114.

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**Comment**

I would argue that ALL Lyme/MSIDS patients are immune suppressed even if they are not taking immune suppressing drugs, which means the outcome would be similar.  This issue desperately needs to be addressed as mainstream medicine and research continues to approach this as a singular pathogen illness when recent research shows 65% of TBD patients produce immune responses to various microbes:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

Here’s a study shows patients with EM who were receiving rituximab (an immune suppressant) for underlying disease show more borrelia isolated in the blood and that their cases are more often disseminated than in immunocompetent patients : https://madisonarealymesupportgroup.com/2019/08/06/em-course-outcome-in-patients-treated-with-rituximab/

And here we see ticks have immunosuppressive proteins in their saliva:  https://madisonarealymesupportgroup.com/2019/08/14/what-tick-saliva-does-to-the-human-body/

The exact cocktail of a tick’s saliva proteins changes every few hours, Ribeiro says. The thousands of proteins in its saliva are highly redundant in function, and the tick cycles through them as a way of circumventing a host’s immune system. Immune systems take time to recognize and react to a foreign tick protein, and this strategy simply doesn’t give a host’s cells a chance to do that. Suppose, Ribeiro says, “Monday a tick starts feeding on you and injecting the saliva in you.” By Friday, when your body can mount a proper immune response against those first proteins, “the tick has already changed the repertoire.”

https://madisonarealymesupportgroup.com/2019/12/15/immunosuppressive-proteins-found-in-tick-saliva-in-every-life-stage/

Taken together, these results suggest that Ip-sL1 and Ip-sL2 confer immunosuppressive functions and appear to be involved in the transmission of pathogens by suppressing host immune responses, such as cytokine production and dendritic cell maturation.

In other words, there are immunosuppressants within tick saliva that makes it easier for transmission to occur.

It only follows that giving patients immunsuppressants (or those patients infected with numerous pathogens) will function similarly in the body – allowing for pathogen proliferation which will be demonstrated by more severe disease.

Category:

Lyme, research, Treatment