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Lyme disease: Treatment wars

MagazineApril 2009 (Vol. 20 Issue 1)Lyme disease: Treatment wars

There are two main factions in the Lyme disease (LD) treatment wars: the

There are two main factions in the Lyme disease (LD) treatment wars: theIDSA (Infectious Diseases Society of America) vs the ILADS (InternationalLyme and Associated Diseases Society).

The IDSA claims that LD is primarily a short-term disease for which a short course of antibiotics is usually all that is necessary. The ILADS disagrees. Its members say that LD is a chronic, potentially recurring disease, and may need many months or even years of treatment with a cocktail of antibiotics.

A French review of the evidence showed that antibiotics are effective in90 per cent of cases (Med Mal Infect, 2007; April 3; Epub ahead of print), lending support to the IDSA position.

However, two studies by Dr Mark Klempner and his colleagues at Tufts University in Boston, MA, have shown that even intensive antibiotic therapy for 90 days may not work in cases where LD symptoms persist despite treatment (N Engl J Med, 2001; 345: 85-92), lending support to the ILADS. "Profound fatigue, myalgias, arthralgias, dysaesthesia, and mood and memory disturbances still persist after standard courses of antibiotic treatment for LD," he says. ILADS practitioners, therefore, usually take a more holistic approach, combining antibiotics with botanical remedies, nutritional supplements, diet, detoxification and homeopathy.

A vaccine called Lymerix was marketed in 1998, but withdrawn four years later. GlaxoSmithKline, the manufacturers, blamed poor sales and the needfor frequent boosters. Patients cited the high pricetag and side-effects, including severe arthritis and even LD itself, problems which resulted in a class-action lawsuit.

The main reason why Lyme disease is so difficult to treat may be because the causal bacteria are so wily. Borrelia has been called "one of the most complex bacteria known to man" (Chemotherapy, 2006; 52: 53-9). A further confounding factor is that Borrelia burgdorferi is rarely the only invader. Most LD patients are also found to be infected with multiple tick-borne pathogens, such as protozoans and other parasites.

The diagnosis problem

Diagnosis is a major problem area due to the wiliness of the Borrelia bacterium.

The main diagnostic tests (ELISA, EIA and IFA) look for antibodies to Borrelia-they measure the body's immune response to the bacteria. However, one of the difficulties is that, because Borrelia can hide in the body, the immune system can't always detect it and make antibodies. This means that there's a danger of false-negative results. In fact, one study showed the ELISA test to be wrong as much as half of the time (J Clin Microbiol, 1997; 35: 537-43).

Lyme disease practitioners often use a back-up test called the Western Blot, which detects the DNA of Borrelia itself. However, this, too, is not fool-proof, as the DNA may not show up for weeks after the infection, if at all.

Although new lab tests, such as IVIAT and QRIBb, are claimed to be more accurate, there is still no totally reliable laboratory diagnostic test. The absence of a definitive diagnosis simply serves to fuel the controversy as to what LD really is, and how best to treat it.

One high-tech tool is a SPECT (single photon emission computed tomography) brainscan. Its high resolution images can reveal characteristic abnormalities in the brains of LD victims, in particular 'cerebral vasculitis', believed to be the underlying cause of many Lyme disease symptoms.

What to do

PREVENTING TICK ATTACK

- When walking in the country, always tuck your trouser bottoms in and button-up your shirt

- Avoid deer areas that are wooded, or covered by tall shrubs and grass

- Use insect repellents containing natural ingredients such as geranium, palmerosa, lavender, eucalyptus and peppermint oils. Avoid DEET, malathion and permethrin as they are potentially neurotoxic to humans as well as to ticks (J Toxicol Environ Health A, 2004; 67: 331-56).

Alternative treatments

Many physicians have created their own treatment regimes for chronic Lyme disease. The following are the core therapies of some of the best known.

- Samento, from cat's claw vine; cumanda, from an Amazonian tree bark; and burbur (from Desmodium molliculum, a Peruvian herb (Dr Lee Cowden, Texas, US; Dr Andrew Wright, Manchester, UK)

- Burbur, parsley, lymph drainage, diet detox (Jean Reist, Pennsylvania, US)

- Intensive antibiotic therapy plus magnesium (300 mg/day), vitamin B-complex (50 mg/day), Co-Q10 (250 mg/day), omega-3s (4g/day), Ginkgo, acidophilus (two per meal) (Dr Joseph Burrascano, New York)

- Sea salt (3 g), vitamin C (3 g), both taken four times a day (Dr Dietrich Klinghardt, Washington).

Note: Dosages are usually individualized for each patient

Lyme hotspots

In Britain, Lyme disease (LD) is not an officially notifiable disease but, according to Health Protection Agency estimates, there are at least 2000 cases each year. The number of LD cases is rising each year in almost all countries.

US: 25,000 a year

(mostly along the Northeasterm seaboard)

Germany: 20,000

Austria: 14,000

France: 10,000

Sweden: 7000


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