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| Lyme Disease is commonly misspelled or called
Lime Disease, Limes Disease, Lyme's Disease, Lymes Disease
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No Warranties or Representations
Lyme Disease symptoms vary from person to person. (lymes disease lyme's disease lime disease limes disease)
The data and information presented in this web site are presented in good faith and believed to be accurate regarding Lyme disease (commonly misspelled lymes disease lyme's disease lime disease limes disease) and other related diseases. Any and all liability for the content or any omissions including any inaccuracies, errors, or misstatements in such data or information is expressly disclaimed. The web site is compiled for the sole purpose of informing community members of resources and information pertaining to Lyme Borreliosis Disease and its coinfections. Lyme disease symptoms may vary from person to person.
The Canadian Lyme Disease Foundation, Directors and members are not liable for any direct or indirect damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action arising out of or in connection with the use or performance of information available from this website.
Consult a qualified Lyme ( Borreliosis ) Disease literate doctor for medical advice if Lyme Disease is suspect to discuss your Lyme Disease Symptoms.
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Letter to the Editor: International Journal of Epidemiology
(see article referred to below this letter)
Post Lyme Disease Syndrome, Chronic infection in `post-Lyme borreliosis syndrome'
From STEVEN E PHILLIPS, JOSEPH J BURRASCANO, NICK S HARRIS, LORRAINE
JOHNSON,
PATRICIA V SMITH and RAPHAEL B STRICKER*
Cairns and Godwin provide strong evidence that patients with
Lyme borreliosis may have persistent fatigue, musculoskeletal
pain, and neurocognitive difficulties despite `adequate' antibiotic
therapy.1 The authors state that `ongoing infection has not been
excluded' in these patients with `post-Lyme borreliosis syndrome'.
Based on the evidence, we postulate that ongoing
infection is the most likely explanation for chronic Lyme disease
symptoms.26
Recent molecular, biochemical, and immunological studies of
Borrelia burgdorferi, the causative agent of Lyme borreliosis, have
demonstrated the complexity and elusiveness of this tick-borne
spirochete.3,6,7
The Lyme spirochete possesses functional properties
that are found in other agents of chronic infection, such as
Mycobacteria, Brucella, and Treponema species.7 Thus it is highly
likely that B. burgdorferi would evade both the human immune
response and perfunctory antibiotic therapy to produce chronic
infection in certain patients, especially those who initially go
untreated owing to lack of recognition of the tick-borne disease
or those who are coinfected with other tick-borne agents such as
Babesia, Anaplasma, Ehrlichia, and Bartonella species.3,6 In fact,
the medical literature contains numerous examples of persistent
human infection with B. burgdorferi.3,6
What is the evidence for `post-Lyme borreliosis syndrome',
defined as the persistence of symptoms in the absence of chronic
infection with B. burgdorferi?
Cairns and Godwin cite a study that
found negative PCR testing in blood samples from 1800 patients
with chronic Lyme disease. This study has been criticized for the
lack of sensitivity of its non-nested PCR testing because it is
highly unlikely that not a single patient in this Lyme disease
cohort would have a positive PCR test.3,5,6
Moreover, it is widely
recognized that when minimal numbers of organisms are present
in the blood, a negative blood PCR test does not exclude the
presence of infection because rigorous tissue sampling may yield
positive results.8,9
For example, a necropsy study in dogs using
PCR analysis of 25 tissue samples per dog demonstrated persistent
infection after treatment.9 Thus the argument that negative
blood PCR testing excludes persistent infection is erroneous.
Cairns and Godwin also cite the hypothesis that infection with
B. burgdorferi may trigger some autoreactive inflammatory
processes leading to persistent symptomatology. Despite the
attractiveness of this hypothesis, there is no convincing evidence
to support it, and attempts to identify a candidate autoantigen
have consistently failed.3,6,10
The studies that have shown
persistent inflammation in animal models of chronic Lyme
disease have not excluded ongoing infection, and persistent
infection with B. burgdorferi has been demonstrated in mice, dogs,
and chimps with experimental Lyme disease.3,6 Thus we are left
with the strong assumption that chronic Lyme disease is caused
by chronic infection with the Lyme spirochete.
As long as the medical community perceives chronic Lyme
disease as an untreatable process that will somehow disappear
with faith and prayer, patients with the debilitating symptoms of
this disease will continue to suffer.
Conversely, if the persistent
symptoms described so elegantly by Cairns and Godwin are
recognized as markers of chronic infection, then treatment of
patients with chronic Lyme disease will become a logical
approach, and the suffering of patients with chronic Lyme
disease symptoms will be alleviated.
References
1
Cairns V, Godwin J. Post-Lyme borreliosis syndrome: a meta-analysis
of reported symptoms. Int J Epidemiol 2005; doi:10.1093/ije/dyi129.
2
Lautin A, McNeil EL, Liegner KB, Stricker RB, Sigal LH. Lyme disease
controversy: Use and misuse of language. Ann Intern Med
2002;137:77577.
3
Stricker RB, Lautin A, Burrascano JJ. Lyme disease: point/
counterpoint. Expert Rev Anti Infect Ther 2005;3:15565.
4
Harvey WT, Salvato P. `Lyme disease': ancient engine of an
unrecognized borreliosis pandemic? Med Hypotheses 2003;60:74259.
5
The ILADS Working Group. Evidence-based guidelines for the
management of Lyme disease. Expert Rev Anti Infect Ther 2004;2
(Suppl 1):S113.
6
Johnson L, Stricker RB. Treatment of Lyme disease: A medicolegal
assessment. Expert Rev Anti Infect Ther 2004;2:53357.
7
Embers ME, Ramamoorthy R, Philipp MT. Survival strategies of
Borrelia burgdorferi, the etiologic agent of Lyme disease. Microbes
Infect
2004;6:31218.
8
Bradley JF, Johnson RC, Goodman JL. The persistence of spirochetal
nucleic acids in active Lyme arthritis. Ann Intern Med 1994;120:487
89.
9
Straubinger, RK. PCR-based quantification of Borrelia burgdorferi
organisms in canine tissues over a 500-Day postinfection period. J
Clin Microbiol 2000;38:219199.
10
Stricker RB, McNeil EL. Duration of antibiotic therapy for Lyme
disease. Ann Intern Med 2004;140:W6.
doi:10.1093/ije/dyi240
International Lyme and Associated Diseases Society, PO Box 341461,
Bethesda, MD 20827-1461, USA.
Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms
Victoria Cairns, Consultant Statistician, Am Rothlauf 9, 61476 Kronberg, Germany and Jon Godwin, Clinical Trial Service Unit, University of Oxford, RDB, Roosevelt Drive, Oxford OX3 7LF, UK
Corresponding author. E-mail: cairns@t-online.de
Background: This meta-analysis compares the prevalence of fatigue, musculoskeletal pain, and neurocognitive difficulties in patients who have had Lyme borreliosis LB and control subjects without LB.
Methods: Titles and abstracts in PubMed were reviewed for studies with data on the symptoms listed above that compared patients who had had LB with controls from the general population. Five studies with 504 patients and 530 controls were included in the meta-analysis.
Results: The prevalence of symptoms was significantly higher in the LB patients, with P-values between <0.00001 and 0.007 for 8 of the 10 symptoms in the three categories listed above. The higher prevalence of certain neurocognitive symptoms but not others, in the same pattern as reported in the literature, is further confirmation of this syndrome. The pattern of symptoms appears to be different from that seen in fibromyalgia, depression, and chronic fatigue syndrome.
Conclusions This meta-analysis provides strong evidence that some patients with LB have fatigue, musculoskeletal pain, and neurocognitive difficulties that may last for years despite antibiotic treatment.
IJE Advance Access originally published online on July 22, 2005
International Journal of Epidemiology 2005 34-6:1340-1345; doi:10.1093/ije/dyi129
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