In the United States, laboratories frequently offer multiple different assays for testing of cerebrospinal fluid (CSF) samples to provide laboratory support for the diagnosis of central nervous system Lyme disease (CNSLD). Often included among these diagnostic tests are the same enzyme immunoassays and immunoblots that are routinely used to detect the presence of antibodies to Borrelia burgdorferi in serum. However, performing these assays on CSF alone may yield positive results simply from passive diffusion of serum antibodies into the CSF. In addition, such tests are only United States Food and Drug Administration-cleared and well-validated for testing serum, not CSF. When performed using CSF, positive results from these assays do not establish the presence of intrathecal antibody production to B. burgdorferi and therefore should not be offered. The preferred test to detect intrathecal production of antibodies to B. burgdorferi is the antibody index assay, which corrects for passive diffusion of serum antibodies into CSF and requires testing of paired serum and CSF collected at approximately the same time. However, this assay also has limitations and should only be used to establish a diagnosis of CNSLD in conjunction with patient exposure history, clinical presentation and other laboratory findings.
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**Comment**
ALL testing for tick-borne infections is abysmal.Diagnosis should still be clinical, which is why medical practitioners MUST become educated on this beast.
Also, the past is riddled with thousands who have not made the “antibody” cut and have been essentially left to die. Trust me when I say there are far more false negatives than positives!
Please read the entire article as zinger after zinger is exposed as to the corruption involved, but Liegner requested an autopsy on Vicki and the pathologist not only refused, he refused to even let an outside pathologist use the facilities to perform it.
The reason? Wait for it…..
……danger of infection to himself and his staff.
I thought Lyme disease was benign and similar to the common cold – easily cured with 21 days of doxy?
By now you know that Liegner wasn’t about to let the ball drop and found a way to get Vicki to the Chief of Neuropathology at Columbia Presbyterian where her autopsy results are now available to all. Without this critical step, propelled by Liegner, the pathologist at Hudson Valley Hospital would have successfully prevented medical knowledge of chronic and neurologic Lyme disease as well as the cause of her hypotension, a missed diagnosis of myocardial infarction.
Then there’s this little gem proving seronegativity with active infection occurs:
aDepartment of Medicine, bDepartment of Neurology, and cDivision of Infectious Diseases, Albert Einstein College of Medicine, and dDepartment of Neurology, State University of New York at Stony Brook, New York, NY., USA
Eur Neurol 1995; 35:113–117 (DOI:10.1159/000117104)
Abstract
We report an unusual patient with evidence of Borrelia burgdorferi infection who experienced repeated neurologic relapses despite aggressive antibiotic therapy. Each course of therapy was associated with a Jarisch-Herxheimer-like reaction. Although the patient never had detectable free antibodies to B. burgdorferi in serum or spinal fluid, the CSF was positive on multiple occasions for complexed anti-B. burgdorferi antibodies, B. burgdorferi nucleic acids and free antigen.
A project to track ticks in Indiana hosted student scientists at Purdue University last week. The students have been involved in the statewide collection of ticks to better understand what diseases they carry.
Purdue University entomology professor Catherine Hill leads the project. She says a better understanding of what else is inside a tick influences diagnosis and treatment.
“We always think about one tick bite, one pathogen, one disease and that’s not really the case,” says Hill.
The Tick INsider project was created because so many Hoosiers reported difficulty getting an accurate right diagnosis.
“What we’re beginning to understand is that ticks are filled with lots of different bacteria and probably some parasites and protozoa and viruses,” says Hill.
These factors are influenced by what animal the tick feeds on.
The students visited the Purdue labs to learn about how the analysis works.
Hill says students are drawn to this opportunity because of the intersection of environment, entomology and health. Another class of student scientists will be recruited next year.
Nine different diseases have been identified in ticks in Indiana including Rocky Mountain spotted fever and Lyme disease.
One thing is for sure, the idea of numerous pathogens working symbiotically is not even on The Cabal’s radar. No research exists.No treatments are offered – just a “one-size fit’s all” 21 days of doxy to “cure” you of this complex monster, which if you ponder that for just 1 solitary second would be a joke if it wasn’t so deadly.
Importance: Controversies about the choice of antibiotic agent and treatment modality exist in the management of erythema migrans in early cutaneous Lyme borreliosis (LB).
Objective: To conduct a network meta-analysis (NMA) of all randomized clinical trials on various antibiotic agents and treatment modalities in early cutaneous LB.
Data Sources: Electronic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were conducted from inception until July 2017. The reference lists of the included studies were hand searched, authors were contacted, and ongoing trials were searched at ClinicalTrials.gov.
Study Selection: One reviewer screened the titles and abstracts of the 9975 reports identified by the electronic searches. Full-text copies of 161 potentially relevant articles were obtained, and 2 reviewers independently assessed those articles for inclusion. Adults with a physician-confirmed early localized skin infection who were treated with antibiotics of any dose or duration were included.
Data Extraction and Synthesis: Two reviewers independently extracted data on study, patient, and intervention characteristics. Network meta-analyses on treatment effects and adverse outcomes were calculated with a frequentist approach using the R package netmeta. The Grading of Recommendations Assessment, Development and Evaluation guidance for NMA was used to assess the certainty of evidence.
Main Outcomes and Measures: Treatment effects for response to treatment (resolution of symptoms) and treatment-related adverse events.
Results: Overall, 19 studies (2532 patients) were included. The mean patient age ranged between 37 and 56 years, and the percentage of female patients ranged from 36% to 60%. The antibiotics investigated were doxycycline, cefuroxime axetil, ceftriaxone, amoxicillin, azithromycin, penicillin V, and minocycline. Pooled effect sizes from NMAs did not suggest any significant differences in treatment response by antibiotic agent (eg, amoxicillin vs doxycycline odds ratio, 1.26; 95% CI, 0.41-3.87), dose, or duration (eg, doxycycline, 200 mg/d for 3 weeks, vs doxycycline, 200 mg/d for 2 weeks, odds ratio, 1.28; 95% CI, 0.49-3.34). Treatment failures were rare at both 2 months (4%; 95% CI, 2%-5%) and 12 months (2%, 95% CI, 1%-3%) after treatment initiation. There were also no differences in the effect sizes among antibiotic agents and treatment modalities for treatment-related adverse outcomes, which were generally mild to moderate.
Certainty of evidence was categorized as low and very low mostly because of imprecision, indirectness, and study limitations (high risk of bias) of the included studies.
Conclusions and Relevance: This NMA suggests that neither the antibiotic agent nor treatment modality contributed to comparative effectiveness or drug-related adverse outcomes. This finding is relevant for physicians treating patients with LB and for patient decision making.
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**Comment**
This meta-analysis demonstrates that early detection and treatment for LD is IMPERATIVE.
Misses up to 60% of acute cases(Rosenfeld , Wang, Schwartz, Wormser, 2005)
Can not differentiate between active infection and previous exposure
Does not detect other Borrelia species including B. miyamotoi, which causes Lyme-like symptoms
Requires subjective interpretation of results, leading to significant variability across and even within laboratories
So there’s a problem Houston even getting through the initial gate. Many, many people are not even making the criteria to be diagnosed in the first place.
Then, the “management of erythema migrans in early cutaneous Lyme borreliosis (LB),” is a poor marker of effective treatment, particularly since many never remember a tick bite or see the bullseye rash. https://www.bayarealyme.org/blog/lyme-disease-bullseye-rash/ This informative article shows pictures of varying rashes as well as the fact while the CDC states 70% may exhibit the erythema migrans, it can vary by region. A 2010 study showed that in the state of Maine only 43% of Lyme patients exhibited this particular type of rash.
So….far less than half in Maine had this rash at all…..
This is a great example of garbage in, garbage out. This article shows us very little due to its parameters. This, right here, has been the trouble from the get-go. The Cabal has set parameters that just aren’t accurate.
And, everyone under the sun recognizes acute cases are fairly straight forward. We don’t need MORE research showing this. What we need is research on the thousands if not millions of us who struggle with chronic/persistent symptoms.
Oh, and then there’s this gem:
Certainty of evidence was categorized as low and very low mostly because of imprecision, indirectness, and study limitations (high risk of bias) of the included studies.
Background: Lyme disease accounts for >90% of all vector-borne disease cases in the United States and affect ~300,000 persons annually in North America. Though traditional tetracycline antibiotic therapy is generally prescribed for Lyme disease, still 10%-20% of patients treated with current antibiotic therapy still show lingering symptoms.
Methods: In order to identify new drugs, we have evaluated four cephalosporins as a therapeutic alternative to commonly used antibiotics for the treatment of Lyme disease by using microdilution techniques like minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). We have determined the MIC and MBC of four drugs for three Borrelia burgdorferi s.s strains namely CA8, JLB31 and NP40. The binding studies were performed using in silico analysis.
Results: The MIC order of the four drugs tested is cefoxitin (1.25 µM/mL) > cefamandole (2.5 µM/mL), > cefuroxime (5 µM/mL) > cefapirin (10 µM/mL). Among the drugs that are tested in this study using in vivo C3H/HeN mouse model, cefoxitin effectively kills B. burgdorferi. The in silico analysis revealed that all four cephalosporins studied binds effectively to B. burgdorferi proteins, SecA subunit penicillin-binding protein (PBP) and Outer surface protein E (OspE).
Conclusion: Based on the data obtained, cefoxitin has shown high efficacy killing B. burgdorferi at concentration of 1.25 µM/mL. In addition to it, cefoxitin cleared B. burgdorferi infection in C3H/HeN mice model at 20 mg/kg.
“I think I’m losing this battle,” the 58-year-old man told his wife one Saturday night nearly a year ago.
While she was at the theater — they’d bought the tickets months earlier — he had to crawl up the stairs on his hands and knees to get to bed. Terrible bone-shaking chills racked him, despite the thick layer of blankets. The chills were followed by sudden blasts of internal heat and drenching sweats that made him kick off the covers — only to haul them back up as the cycle repeated itself.
“I need to go to the E.R.,” he told his wife. He’d been there three times already. They’d give him intravenous fluids and send him home with the diagnosis of a viral syndrome. He would start to feel better soon, he was told. But he didn’t.
Too Sick to Work
This all began nine days before. That first day he called in sick to his job as a physical therapist. He felt feverish and achy,as if he had the flu. He decided to drink plenty of fluids, take it easy and go back to work the next day. But the next day he felt even worse. That’s when the fever and chills really kicked in. He was alternating between acetaminophen and ibuprofen, but the fever never let up. He’d started sleeping in the guest room because his sweat was soaking the sheets, and his chills shook the bed, waking his wife.
After three days of this, he made his first visit to the Yale New Haven Hospital emergency room. He was already taking antibiotics. Several weekends earlier, he developed a red, swollen elbow and went to an urgent-care center, where he was started on one antibiotic for a presumed infection. He took it for 10 days, but his elbow was still killing him. He went back to urgent care, where he was started on a broader-spectrum drug, which he had nearly finished. Now his elbow was fine. It was the rest of his body that ached as if he had the flu.
But at the hospital, his flu swab was negative. So was his chest X-ray. It was probably just a virus, he was told. He should take it easy until it passed. And come back if he got any worse.
High Fever
The next day his fever spiked above 105. He went again to the E.R. It was a mob scene — crowded with people who, like him, appeared to have the flu. It would be hours before he could be seen, he was told, because they already knew he didn’t have it. Discouraged, he went home to bed. He went back the next morning after a nurse called to say the E.R. was more manageable.
He might not have the flu, he thought, but he was sure he had something. But the E.R. doctor didn’t know what. He didn’t have chest pain or shortness of breath. No cough, no headache, no rash, no abdominal pain, no urinary symptoms. He felt weak but no longer achy. His heart was beating hard and fast, but otherwise his exam was fine. His white count was low — which was a little strange. White blood cells are expected to increase with an acute infection. Still, a virus can cause white counts to drop. His platelets — the tiny blood fragments that form clots — were also low. That can also be seen in viral infections, but it was less common.
No Help From His Internist
The E.R. staff sent the abnormal blood results to the patient’s primary-care provider and told the patient to follow up with him. He’d been trying get in to see him for days, but the doctor’s schedule was full. When he called again, he was told that the soonest he could be seen was the following week.
The patient asked the doctor to order blood tests to look for an infection in his blood. And could they also test him for tick-borne infections? This was Connecticut, after all. He dragged himself to the lab and then waited for his doctor to call with the results. The call never came. In his mind, he fired his doctor. He’d been sick for over a week, and the doctor’s office couldn’t arrange an appointment, and they couldn’t even call him with the lab results for the test he had to ask for in the first place.
Back to the Hospital
That Sunday morning after the man’s wife had been to the theater, he went once more to the emergency room. It was brought to the attention of the physician assistant on duty that the man had been there several times before and had lab abnormalities. She ordered a bunch of blood tests — looking for everything from H.I.V. to mono. She ordered another chest X-ray and started him on broad-spectrum antibiotics, as well as doxycycline, an antibiotic often used for tick-borne infections. He was given Tylenol for his fever and admitted to the hospital. As he was preparing to leave the emergency department, a new flu test came back positive. He was pretty sure he didn’t have it; he’d never heard of a flu being this bad for this long. But if he could stay in the hospital, where someone could monitor him, he was happy to take Tamiflu.
The lab called again the next day to say that the test had been read incorrectly; he did not have the flu. By then other results started to come in. It wasn’t an infection in his elbow. He didn’t have H.I.V.; he didn’t have mono or Lyme; he didn’t have any of the other respiratory viruses that, along with the worse influenza outbreak in years, had filled up so much of the hospital.
CreditIllustration by Andreas Samuelsson
Getting Better
Yet after a couple of days, the patient began to feel better. His fever came down. The shaking chills disappeared. His white count and platelets edged up. It was clear he was recovering, but from what? More blood tests were ordered, and an infectious-disease specialist consulted.
Gabriel Vilchez, the infectious-disease specialist in training, reviewed the chart and examined the patient. He thought that the patient most likely had a tick-borne infection. The hospital had sent off blood to test for the usual suspects in the Northeast: Lyme, babesiosis, ehrlichiosis and anaplasmosis. Except for the Lyme test, which was negative, none of the results had come back yet. Vilchez considered that given the patient’s symptoms — and his response to the doxycycline — it would turn out that he’d have one of them.
And yet, the results for tick-borne infections were negative. Vilchez thought about other tick-borne diseases that are not on the usual panel. The most likely was Rocky Mountain spotted fever (R.M.S.F.).The name is a misnomer: R.M.S.F. is much more common in the Smoky Mountains than the Rocky Mountains, and the spotted-fever part, the rash, is not seen in all cases. It’s unusual to acquire the infection in Connecticut but not unheard-of. Vilchez sent off blood to be tested for R.M.S.F. The following day, the patient felt well enough to go home. A couple of days later, he got a call. He had Rocky Mountain spotted fever.
A Diagnostic Delay
Why did the diagnosis take so long? The patient had an unusual infection. But perhaps the bigger issue was that he was one of many patients in the emergency room with flulike symptoms in the midst of a flu epidemic. Under those circumstances, the question for the staff simply becomes: Does he have the flu? When the answer is no, doctors tend to move on to the next very sick patient in line. It’s hard to get back to the question of what the nonflu patient does have.
For the patient, recovery has been tough. Though the antibiotic helped with the acute symptoms, it took months before he had the stamina to resume his usual patient load at work. He feels that the illness brought him as close to dying as he had ever been. Indeed, Rocky Mountain spotted fever is one of the most dangerous of all the tick-borne infections, with a mortality rate as high as 5 percent even with current antibiotics.
One thing he was certain about, however: He needed a new primary-care doctor. And he got one.
Lisa Sanders, M.D., is a contributing writer for the magazine and the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.” If you have a solved case to share with Dr. Sanders, write her at Lisa.Sandersmd@gmail.com.
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**Comment**
This is playing out all over the world. He was one of the lucky ones to finally get an accurate diagnosis.
It is interesting; however, that they are quick to state he doesn’t have the other tick-borne infectionswhen the testing for all of them misses over half of all cases. Once they gave him doxy, they should have retested him. This is called a “provocation test” and is used by many LLMD’s (Lyme literate doctors) as they’ve learned this often finally shows an active infection(s) due to the ability of the body to NOW see the pathogens in the blood stream allowing antibodies to be made and picked up by the tests.
RMSF is a nasty beast on it’s own; however, this man should be monitored over time. If symptoms come back or new ones show up, TBI’s should be suspected.
It’s also a mind boggler how in Connecticut of all places, TBI’s wouldn’t be the FIRST thing medical practitioners think of. It’s literally ground zero.
It’s also been found to be spread by the common brown dog tick:
https://madisonarealymesupportgroup.com/2018/08/16/new-tick-causes-epidemic-of-rmsf/ It’s usually spread by the American dog tick and the closely related Rocky Mountain wood tick. But in recent years the bacterial infection has also been spread by the brown dog tick — a completely different species…The researchers were investigating an epidemic of the infection that broke out in the border town of Mexicali starting in 2008. It’s already sickened at least 4,000 people, according to Mexican government estimates. Several hundred have died, and at least four people have died in the U.S. after crossing the border, according to this report and others.
“I was absolutely startled,” Foley said in an interview.
The people who had been sickened in Mexicali had a heavy load of the infectious agent in their blood — something that had not been seen in past outbreaks. The epidemic is worrisome because the brown dog tick is more likely to bite people and it adapts easily to living in a house, as opposed to living on wild animals, the researchers said.
“The Rocky Mountain spotted fever epidemic in Mexicali has not been contained and may be spreading to other parts of Baja California and into the United States,” the team wrote.
And now it’s possible that for some reason, the infection the brown dog tick transmits is more virulent, Foley said.
https://madisonarealymesupportgroup.com/2017/10/21/mom-got-rocky-mountain-spotted-fever-while-picking-pumpkins/ “When you go to these pumpkin patches and petting zoos and all those fun fall activities, wear pants, long socks and shoes!” “Make sure you check for tics! This was me 2 years ago after being bit by a tick and contracting Rocky Mountain spotted fever at a pumpkin patch,” she continued. “I couldn’t walk, my whole body was in pain, my hair fell out, and I almost died.”
My journey was similar with the same issue in both my elbow and knee in the middle of January in Wisconsin. I was told, and I promise I didn’t make this up, that I had “Washer Woman’s Knee,” and “Barstool elbow.”
I kid you not.
Now, first, I use a mop and rarely get on my knees. Second, I assure you, I’m not sitting at the bar and have NO reason to have a red, swollen, excruciatingly painful elbow.
Please remember, Lyme is the rock star we all know by name. There are many, many other players involved and people are often coinfected. Mainstream medicine has yet to accept and deal with this very real fact.
