Lyme Disease Workshop

Conference

  • Location: San Diego, California
  • Date: April 21-22, 2010
  • Presenters: Andy Schlafly, Esq., Raphael Stricker, MD, Steven Harris, MD, Joseph Burrascano,Jr.,MD, Joseph Brewer, MD, Ron Strauss, Ann Corson, MD, Wayne Anderson, ND, Nick Harris, PhD and Jyotsna Shah, PhD.
  • Attendee: Joanne Quinn, PhD, RMA

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Photo by James Gathany, 2007 / Image ID#:9875, Public Health Image Library, Centers for Disease Control and Prevention

This photograph depicts the pathognomonic erythematous rash in the pattern of a "bull's-eye," which manifested at the site of a tick bite on this Maryland woman's posterior right upper arm. She subsequently contracted Lyme disease.

Lyme disease is a condition that is typically spread by ticks. However, new evidence is supporting theories that Lyme can also be sexually transmitted and spread by mosquitoes. There are many problems confronting Lyme disease physicians seeking to help their patients. The threats to freedom in medicine posed by insurance companies, medical boards and peer review were covered in detail with examples.

Lyme disease is a controversial illness, and the optimal approach to the diagnosis and treatment of disease caused by the spirochete, Borrelia burgdorferi, remains undefined. The presentations reviewed the epidemiology, clinical features and pathophysiology of Lyme disease. The controversy surrounding chronic Lyme disease was discussed and the diagnostic criteria and therapeutic options for patients with tick-borne illness were examined. The influence of tick-borne co-infections on the evolution of Lyme disease was reviewed.

Ticks harboring the Borrelia spirochete have spread to most of the US. Mice, shrews, chipmunks, squirrels, birds, skunks, deer, opossums, raccoons are all reservoirs for the infection. The deer population in 1900 was 500,000 and in 2000 there were 35-40 million. Ticks also travel on birds (migratory birds) so they can travel great distances.

The nymph tick, which is active November to April, is the most infectious. These are very small bugs. Adult ticks are active May to November. Only about half of the people infected recall getting a tick bite. Only 35-60 % get the typical bulls eye rash called EM. Only 20-30% get joint swelling.

Borrelia has 1500 gene sequences, 132 functioning genes with 21 plasmids and stealth pathology to evade the immune system response. All making it extremely complex compared to other pathogens. Plasmids are a rapid response allowing the spirochete the ability to adapt to changing conditions. Four genotypes of the opsC casute are typically found in harboring ticks on the east coast. On the west coast there is a totally different genetic makeup of the spirochete. Testing looks at genetics so it makes testing difficult and essential that the right genotypes are looked at.

Stealth pathology allows the Lyme bacteria to evade the immune response. Tick saliva components suppress the immune response, causes anticoagulation, complements inhibition and cytokine induction. Phase and antigenic variation including gene switching, mutation, variable antigen expression, dormant with auto-induction and fibronectin binding, all allow changes so the bacteria can hide from the immune system.

Physical seclusion is another survival mechanism. Spirochetes, when threatened by the presence of antibiotics can go into the cell and remain there for over 8 weeks. They can also be in a dormant state with cyst formation. Spirochetes can also go to extracellular sites including joints, eyes, and the central nervous system and can cloak themselves in the plasma.

An additional survival mechanism involves secreted factors; proteins that are secreted by the bacteria allowing the spirochetes to penetrate into cells causing damage to joints where they can multiply.

This is a nasty bug that causes a lot of problems. It exists as a spirochete and when under attack spirochetes unite together and surround themselves with a membrane in the form of a cyst. Cysts are very hard to get rid of. Biofilms also protect the spirochete from being recognized by the immune system. There are genetic factors that help the biofilm be formed. Scientists are looking at genetic manipulation to affect the ability of the Lyme bacteria to create the biofilm.

The state health departments say that a case can only be reported if there is laboratory evidence. Most commercial testing is inaccurate for Lyme. Studies show that half of the people tested are false negative. Thus the numbers are most likely under reported.

There are many co-infections transmitted by the tick that can exacerbate Lyme disease. These include Babesia, Ehrlichia and Bartonella, to mention a few. Most are subclinical and chronic complicating the picture. More ticks are infected with Bartonella than borrelia (Lyme).

Much Lyme is not diagnosed. There is research that links Lyme to Alzheimer's disease. Borrelia was found in the ganglia in the brain of Alzheimer's patients.

In conclusion Lyme disease and co-infections are spreading. Borrelia burgdorferi is difficult to eradicate. Lyme testing is not as sensitive as we are told. Lyme treatment failure is more common than we think. Prolonged antibiotic therapy appears to be useful and appropriate in persistent Lyme disease.

IDSA Infectious Diseases Society of America and ILADS International Lyme and Associated Diseases Society are two active organizations addressing Lyme disease.

Co-Infections with Lyme disease

There are several co-infections that can occur along with Borrelia burgdorferi (Lyme). Babesia, Bartonella and Erlichia are three.

Babesia

Babesia has a 1-4 week incubation. It is common in human blood supply and can be transmitted through transfusion. However, it is not always pathogenic. It is typically found in human blood, brain tissue and bone marrow. When it presents with borrelia it makes the disease more virulent. Babesia responds unconventionally to treatment but hard to predict when exacerbated. It has a 2-6 weeks regeneration cycle. Babesia flares are different than Lyme flares.

Symptoms include headaches, night sweats (soaking the sheets), fevers, dry cough, easy bruising, tinnitus (ringing ears), intense rage, profound despair, chills , flushing, profound sleep disturbance, dsyphagia, psychosis, neurological illnesses, thirst, fatigue, rheumatoid arthritis, severe nausea, malaise, anemia, thrombocytopenia, abdominal pain, cherry angiomas, temperature of above 99 and below 103, Babinski reflex, hypothenar atrophy, papulovasicular rash, Ecchymosis, Petechiae, splenomegaly, increased fundal pressure, proptosis, severe nuchal tension, myoclonus, rooting reflexes, murmurs from tricuspid regurgitation, S3+ on auscultation, expanded apex on percussion, restrictive lung disease, rhonchi, crepitations, onychomycosis of the Hallux, decreased bowel sounds, rheumatoid nodules and abdominal tenderness.

Lab testing used is the FISH which tags the RNA for Babesia.

Treatment of Babesia involves the use of antibiotics for 4-10 months. Herbals and naturopathic treatments are also integrated into the treatment. It is best to consult a practitioner who is experienced with treating Lyme disease and the co-infections as a treatment that is too weak will drive the bacteria into the tissue and make it especially hard to eradicate in the future.

Bartonella

Another co-infection is Bartonella, sometimes compared to cat scratch disease. However, the presentation in chronic Bartonella is much different.

Typical symptoms are brain fog, higher fever, headaches like ice pick headaches, photophobia, tachycardia, bowel problems, swollen glands all over, Obsessive Compulsive Disorder, profound anxiety, endocarditis, retinitis, peripheral neuropathy, rapid relapse when off of antibiotics, immediate illness following tick bite, psychiatric problems, no response to previous antibiotic therapy, plantar pain, costal margin pain, rapid mood shifts and development of these symptoms during Babesia treatment. Additional symptoms include purple non-blanching abdominal striae, hyperesthesia burning nerve pain, abdominal tenderness, subcutaneous nodules, anxiety, swollen joints and lymph nodes, fever, photophobia and general lymphadenopathy.

Lab tests include IgM and IgG testing but cannot always be counted on. PCR testing is also hit or miss. Fry Labs blood smear may show more results for Mycoplasma. There is a FISH test that is pending and should be available soon.

Treatment includes the use of antibiotics and other drugs as well as many herbal remedies. Herbals include Boneset, Houttuynia , Pao d'Arco, Arnica, Rizol My, oil of artemisia, clove, cumin, walnut marjoram, cat's claw, sarsaparilla, burdock, blessed thistle, mullein and Oregon grape.

Usually practitioners will treat for Babesia first and then Bartonella. Sometimes the patient will be treated for Lyme first. It will vary depending on the patient. When a patient is really sick, it is important to first resuscitate them, balance the hormones, rehydrate, supplement with vitamins, eliminate bad habits and improve sleep (no stimulants or alcohol).

Basically the patient must be cleaned up in order to be able to clear the toxins and spirochetes. Then the practitioner can start with more specific treatment. Supportive therapy also includes the use of probiotics, antifungal regimen, nutritional support- multivitamin, B, CoQ10 400 mg day, magnesium (used with care as oral magnesium can negate some antibiotic therapies). Exercise and rehab program for Lyme patients is essential. Without it they will not get better. Exercise intolerant patient needs the right program.

Ehrlichia

Ehrlichia is a third possible co-infections having two types, monocytes and granulocytes. HME (monocytic) is mostly spread by the Lonestar tick.

With acute ehrlichiosis mimics a bad flu with fever, myalgia, headache, malaise, nausea, vomiting, diarrhea, arthralgia, rash and confusion. In lab tests most findings are normal with the following exceptions: Thrombocytopenia occurs in 71% of the cases, increased AST/ALT occurs in 83% of the case and leucopenia in 62% of the cases. In testing the practitioner looks for an IgG response.

Antibiotic treatment is usually used. Chronic Ehrlichia can last for a long time. Relapses post-treatment can occur. Also there doesn't seem to be protection from previous infections and people do get the disease again when re-infected.

XMRV

XMRV is a new human retrovirus which is a Xenotropic murine leukemia related virus. There is a possibility that this can also be a co-infection with Lyme disease. Information about XMRV is just coming to light and is associated with fibromyalgia, MS, autism and other neurological diseases. It has been found in saliva, blood transfusion .