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01/04/2010 04:41 AM

A MUST READ FOR NEW MEMBERS

toothfairy55
toothfairy55  
Posts: 3856
Senior Member

I have found that our new members are continually asking us about these areas. I will try to address them in this post.

As quoted by Dr. Burrascano

WHAT IS LYME DISEASE

“"Lyme Disease" is not simply an infection with Borrelia burgdorferi, but a complex illness potentially consisting of multiple tick-derived co-infections.

In later stages, it also includes collateral conditions that result from being ill with multiple pathogens, each of which can have profound impact on the person's overall health.

Together, damage to virtually all bodily systems can result. In addition, it is possible to see latent infections reactivate, especially viruses of the Herpes type.”

“Lyme is diagnosed clinically, as no currently available test, no matter the source or type, is definitive in ruling in or ruling out infection with these pathogens, or whether these infections are responsible for the patient's symptoms.

The entire clinical picture must be taken into account, including a search for concurrent conditions and alternate diagnoses, and other reasons for some of the presenting complaints.

Often, much of the diagnostic process in late, disseminated Lyme involves ruling out other illnesses and defining the extent of damage that might require separate evaluation and treatment.

”Consideration should be given to tick exposure, rashes (even atypical ones), evolution of typical symptoms in a previously asymptomatic individual, and results of tests for tick borne pathogens.

Another very important factor is response to treatment- presence or absence of Jarisch Herxheimer-like reactions, the classic four week cycle of waxing and waning of symptoms, and improvement with therapy.”

“The evaluation of a Lyme patient must begin with testing for all currently known tick borne pathogens. Serological studies for Borrelia, Babesia and Ehrlichia should be combined where appropriate with direct antigen assays.

Antigen detection tests (antigen capture and PCR) are especially helpful in evaluating the seronegative patient and those still ill or relapsing after therapy. Unfortunately, over a dozen protozoans other than Babesia microti can be found in ticks, “

“So as in Borrelia, clinical assessment is the primary diagnostic tool. In Ehrlichiosis, test for both the monocytic and granulocytic forms.

Many presently uncharacterized Ehrlichia-like organisms can be found in ticks and may not be picked up by currently available assays, so in this illness too, serologies are only an adjunct in making the diagnosis.

Babesia are parasites, and I suggest that if a coinfection is found involving this organism, treat this first, so that subsequent therapy for Borrelia and Ehrlichia will be more effective.”

THREE DIFFERENT FORMS OF Bb

“B. burgdorferi exists in at least three different forms: bacterial (the well known, cell wall-containing spirochete), spheroplast or l-form, and the newly discovered cystic form.

The importance is that only the spirochete form can be killed by beta lactam antibiotics. Spheroplasts seem to be susceptible to tetracyclines and erythromycins, yet the cyst so far has been proven to be susceptible only to metronidzole.”

“There is evidence that B. burgdorferi can remain viable within cells, such as macrophages, lymphocytes, endothelial cells, neurons, and fibroblasts.

Bb has been shown to evade the effects of antibiotics in vitro by sequestering in these intracellular niches.

In addition, Bb can coat itself with host cell membranes, and it secretes a glycoprotein that can encapsulate the organism (an "S-layer"Wink. Because this glycoprotein binds host IgM, it is possible that host protein as well as cell membrane hide Borrelial antigens.

In theory at least, these coatings interfere with immune recognition, thus affecting the clearing of Bb, and also cause seronegativity.”

CYST FORM

“When present in a hostile environment, such as growth medium lacking some nutrients, or spinal fluid, or serum with certain antibiotics added, Bb will change into a cyst form.

This cyst seems to be able to remain dormant, but when placed into an environment more favorable to its growth, the cyst can open, and an intact spirochete emerges.”

“The conventional antibiotics used for Lyme, such as the penicillins, cephalosporins, etc do not kill the cystic form of Bb. Furthermore, the cyst lacks the usual surface antigens found on the spirochete (these are the markers detected by ELISAs and western blots).

This may be another reason for the chronically sick Lyme patient remaining seronegative.”

”There are multiple strains of Borrelia burgdorferi and they vary in their antigen profile and antibiotic susceptibilities. In addition, L-forms and cystic forms exist which do not contain cell walls, and thus cell wall antibiotics will not affect them.

Apparently, Bb can shift among the three forms during the course of the infection and cause the varying serologic responses seen over time, including seronegativity.

Because of this, it may be necessary to change antibiotic or even prescribe a combination of agents.”

USE OF STEROIDS

“More evidence has accumulated indicating the severe detrimental effects of immunosuppressants including steroids in the patient with active B. burgdorferi infection.

Never give steroids to any patient who may even remotely be suffering from Lyme, or serious, permanent damage may result, especially if given for anything greater than a short course.”

WESTERN BLOT MADE EASY

“Western blots are reported by showing which bands are reactive.

41KD bands appear the earliest but can cross-react with other spirochetes.

The 18KD, 23-25KD (Osp C), 31KD (Osp A), 34KD (Osp Cool, 37KD, 39KD, 83KD and the 93KD bands are the most specific but appear later or may not appear at all.

You need to see at least the 41KD and one of the specific bands.

55KD, 60KD, 66KD, and 73KD are nonspecific and nondiagnostic.”

PCR AND SPINAL TAPS

“Antigen detection tests including PCR are now available, and although they are very specific, sensitivity remains poor, possibly less than 30%. This is because Bb causes a deep tissue infection and is only transiently found in body humors.

Therefore, multiple specimens must be collected to increase yield; a negative result does not rule out infection, but a positive one is significant.

The patient must be antibiotic free for at least six weeks before testing to obtain the highest yield. Antigen capture can be done on urine, CSF, and synovial fluid.

PCR can be done on blood (buffy coat is best), urine, CSF, any other body fluid including breast milk, and on tissue biopsy specimens.

I strongly urge you to biopsy all unexplained skin lesions/rashes and perform PCR and careful histology. You will need to alert the pathologist to look for spirochetes.

Spinal taps are not routinely recommended, as a negative tap does not rule out Lyme. Antibodies to Bb

can be detected in the CSF in just 20% of patients with late disease. Therefore, spinal taps are only performed on patients with pronounced neurological manifestations, if they are seronegative, or are still significantly symptomatic after completion of treatment. When done, the goal is to rule out other conditions, and to determine if Bb antigens are present.

It is especially important to look for elevated protein and mononuclear cells, which would dictate the need for more aggressive therapy, as well as the opening pressure, which can be elevated and add to headaches, especially in children.”

TREATMENT LEGNTH

“As the spirochete has a very long generation time (12 to 24 hours in vitro and possibly much longer in living systems) and may have periods of dormancy, during which time antibiotics will not kill the organism, treatment has to be continued for a long period of time to eradicate all the active symptoms and prevent a relapse, especially in late infections.

If treatment is discontinued before all symptoms of active infection have cleared, the patient will remain ill and possibly relapse further.

In general, early-disseminated LB is treated for four to six weeks, and late LB usually requires a minimum of four to six months of continuous treatment. A

ll patients respond differently and therapy must be individualized.

It is not uncommon for a patient who has been ill for many years to require open ended treatment regimens; indeed, some patients will require ongoing maintenance therapy to remain well.”

ANTIBIOTICS AND DOSAGES

ORAL THERAPY: Always check blood levels when using agents marked with an *, and adjust dose to achieve a peak level in the mid- teens and a trough greater than five. Because of this, the doses listed below may have to be raised. Consider Doxycycline first due to concern for Ehrlichia.

TREATMENT INFORMATION

”There is no universally effective antibiotic for treating LB. The choice of medication used and the dosage prescribed will vary for different people based on multiple factors.

These include duration and severity of illness, presence of co infections, immune deficiencies, prior significant steroid use while infected, age, weight, gastrointestinal function, blood levels achieved, and patient tolerance.

Doses found to be effective clinically are often higher than those recommended in older texts.

This is due to deep tissue penetration by Bb, it's presence in the CNS including the eye, within tendons, and because very few of the many strains of this organism now known to exist have been studied for antibiotic susceptibility. “

Amoxicillin- Adults: 1g q8h plus probenecid 500mg q8h; doses up to 6 grams daily are often needed

Pregnancy: 1g q6h and adjust.

Children: 50 mg/kg/day divided into q8h doses.

Doxycycline-

Adults: 100 mg qid with food; doses of up to 600 mg daily are often needed, as doxycycline is only effective at high blood levels. Not for children or in pregnancy. If levels are too low at tolerated doses, give parenterally.

Cefuroxime axetil-

Oral alternative that may be effective in amoxicillin and doxycycline failures. Useful in EM rashes co-infected with common skin pathogens.

Adults and pregnancy: 1g q12h and adjust.

Children: 125 to 500 mg q12h based on weight.

Tetracycline-

Adults only, and not in pregnancy. 500 mg tid to qid

Erythromycin-

Poor response and not recommended.

Azithromycin-

Adults: 500 to 1200 mg/d.

Adolescents: 250 to 500 mg/d

add hydroxychloroquine, 200-400 mg/d, or amantadine 100-200 mg/d

Cannot be used in pregnancy or in younger children.

Clarithromycin-

Adults: 250 to 500 mg q6h plus hydroxychloroquine, 200-400 mg/d, or amantadine 100-200 mg/d.

Cannot be used in pregnancy or in younger children.

Augmentin-

Cannot exceed three tablets daily due to the clavulanate, thus is given with amoxicillin.

Chloramphenicol-Not recommended as not proven and potentially toxic.

Metronidazole (see later section):

500 to 1500 mg daily in divided doses. Adults only.

IN CONCLUSION

“The physician cannot rely on a laboratory test or clinical finding at the time of the bite to definitely rule in or rule out Lyme Disease infection, so must use clinical judgment as to whether to use antibiotic prophylaxis. Testing the tick itself for the presence of the spirochete, even with PCR technology, is not reliable enough to guide your decision to treat, as false positives and false negatives occur.

An established infection by B. burgdorferi can have serious, long-standing or permanent, and painful medical consequences, and be expensive to treat.

Since the likelihood of harm arising from prophylactically applied spirochetal antibiotics is low, and since treatment is inexpensive and painless, it follows that the risk benefit ratio favors tick bite prophylaxis.

It is the Medical Advisory Committee's recommendation that antibiotic prophylactic treatment for tick bite in many circumstances is not only justified but warranted.

The ultimate decision for treatment on tick bite should be determined jointly between the physician and patient.”

FOR THE FULL ARTICLE GO TO

http://www2.lymenet.org/domino/file.nsf/UID/guidelines

BROKE up the longer paragraphs. bettyg, leader

Post edited by: Bettyg, at: 10/24/2011 03:53 AM

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01/04/2010 03:33 PM
Bettyg
 
Posts: 32202
VIP Member
I'm an Advocate

carol,

i look forward to reading this, but may i suggest being more specific in subject line:

example What is lyme disease by Dr. Burrascano.

so may folks use...must read; so non-specific; just food for thought ok. Smile thanks for listening carol. hugs to you for your efforts for summarizing what you found.


03/20/2010 12:18 PM
Bettyg
 
Posts: 32202
VIP Member
I'm an Advocate

FREQUENTLY ASKED QUESTIONS POSTED BY TOOTHFAIRY; please read Smile thanks betty
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