Latest Treatments for Lyme Disease

Lyme Strategies

This latest updated text, in digital eBook form and available for immediate download, has been expanded nearly eightfold over the original guide of 2004 in terms of the exact, step-by-step lue-print and essential information designed to maximize this protocol. Just some of the valuable information contained in this 193-page guide includes: How to do the protocol, including the exact, specific method or procedure that is critical to its success. Schedule chart, measurements guide, tips and recommendations. The basic elements of the protocol are actually five, not just salt and vitamin C what these are and why Understanding what a Jarisch-Herxheimer reaction (or Herx) is. Particular djunct items found to be extremely helpful and particular items for special issues. A Technical Section detailing why the protocol works (posited mechanisms), including scientific citations and and studies. The right salt versus wrong salt and why. the low-salt, no-salt myth and scientific truth. the historical, medicinal use of natural salt. Did you know salt was used to treat syphilis, caused by Lyme's bacterial cousin, in the 1800s? Why Vitamin C and what does it do? The protocol and specific body considerations (heart, adrenals, etc.) Key Characteristics of the Lyme bacterium (Borrelia burgdorferi), including nearly 20 extraordinary mechanisms and features it uses to elude the immune and proliferate in the body

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Borrelia that Cause Relapsing Fevers

Borrelia Giemsa Stain

The genus Borrelia belongs to the family Spir-ochaetaceae. The body louseborne epidemic form of relapsing fever is caused by the species B. recurrentis. The endemic form, transmitted by various tick species, can be caused by any of a number of species (at least 15), the most important being B. duttonii and B. hermsii. Morphology and culture. Borreliae are highly motile spirochetes with three to eight windings, 0.3-0.6 im wide, and 8-18 im in length. They propel themselves forward by rotating about their lengthwise axis. They can be rendered visible with Giemsa stain (Fig. 4.24). It is possible to observe live bor-reliae using dark field or phase contrast microscopy. Borrelia (Relapsing Fever, Lyme Disease) 325 Borrelia duttonii- Borreliae can be cultured using special nutrient mediums, although it must be added that negative results are not reliable. Following an incubation period of five to eight days, the disease manifests with fever that lasts three to...

Reactive or postinfectious arthritis

Borrelia burgdorferi infection during the primary, early stage of Lyme disease can lead to a migratory polyarthralgias associated with low-grade fever and symptoms typical of viral infection. Late Lyme disease assumes a more oligoarthritic pattern that waxes and wanes. The diagnosis is supported by the clinical presentation, the presence of an erythema chronicum migrans rash, and serologic testing.

Preface and Introduction

The summer of 2006 marked the 30th anniversary of the outbreak of Legionnaires' disease, an acute pneumonia that occurred among veterans who had gathered in Philadelphia, Pennsylvania, in 1976 to celebrate the bicentennial of the founding of the United States. Ironically, the nation and world were braced for an epidemic of swine influenza, which never materialized and no one expected the emergence of a new bacterial pathogen, since most in the medical field sincerely believed that all the pathogens of humans were now known. This new bacterial agent of Legionnaires' disease, Legionella pneumophila (named in memory of the deceased veterans) was a harbinger of diseases to come (emerging pathogens) that has included HIV AIDS, SARS, Lyme disease, hamburger disease, and many others. The further discovery that L. pneumophila was ubiquitous to aquatic environments worldwide and resided as an intracellular parasite of amoeba and protozoa provided a link between natural environments and human...

Childhood Rheumatic Diseases

Etiology and pathogenesis The rheumatic diseases of childhood represent a diverse group. Their etiologies are varied and their pathogenesis unclear. Lyme disease and acute rheumatic fever result from exposure to known infectious agents, but the majority of childhood rheumatic diseases result from the combination of genetic predisposition, autoimmunity, and unknown environmental factors.

Acute articular inflammation

An acutely inflamed joint must be considered septic until proved otherwise. Staphylococci, streptococci, and Haemophilus influenzae are frequent causes of septic arthritis in childhood. Lyme disease is a frequent infectious arthritis in areas where Ixodes ticks are endemic. Septic arthritis typically presents with a single inflamed joint accompanied by fever and an elevated ESR. It is less common but not impossible for other infectious agents to involve multiple joints. Not infrequently, Lyme disease may involve several joints simultaneously. b. Reactive arthritis may accompany or follow bacterial, viral, or fungal infection. Toxic synovitis is the most common reactive arthritis in childhood. The typical child with toxic synovitis is 3 to 5 years of age. Classically, they have been well except, perhaps, for symptoms of an upper respiratory infection the prior evening. The following morning, the child awakens unable to walk, with a decreased range of motion in one hip....

Role of IL10Producing Regulatory T Cells in the Persistence of Infection

Recently, antigen-specific IL-10-producing Tr cells have been detected in a number of infectious diseases. Pathogen-specific CD4+ T cell clones producing both IL-10 and IFN-y have been detected in broncho-alveolar lavages from patients infected with M. tuberculosis.79 These T cell clones produced IL-10 and IFN-y in an antigen-dependent as well as an antigen-independent manner. High frequencies of antigen-specific T cells producing both IL-10 and IFN-y have also been detected in T cell lines derived from patients infected with Borrelia burgdorferi, (Lyme disease),80,81 P. falciparum,8Pneumocystiscarinii,83 HCV,84 Leishmania,85,86 HIV,87 and other retroviral infections.86,88 In addition, both of these cytokines have been detected in the lesions and plasma of patients with Leishmaniasis, suggesting the involvement of IL-10 in clinical persistence and disease reactivation.68 These observations suggest that IL-10 and IFN-y producing cells enriched at the site of infection or lesions may...

Clinical presentation

Certain pyarthroses are accompanied by dermatologic manifestations along with articular involvement. This presentation is most commonly recognized with Neisseria gonorrhoeae and Haemophilus influenzae. Gonococcal arthritis often is associated with prodromal or concomitant tenosynovitis and erythematous papular, vesiculopustular, or petechial skin rashes characteristic of the disseminated stage of gonococcemia. H. influenzae pyarthrosis can be associated with tenosynovitis and erysipeloid, pustular, or petechial rashes. Similar presentations have been described for bacterial arthritis associated with Neisseria meningitidis and Streptobacillus moniliformis (rat bite fever). The pathognomonic appearance of erythema chronicum migrans can be essential for the diagnosis of early Borrelia burgdorferi arthritis (Lyme disease), which is discussed in Ch pt L41. Exanthems are important features in the presentation of viral arthritis associated with rubella and...

Epidemiology and Classification of Uveitis

Infectious causes of uveitis include viruses, bacteria, protozoa, parasites and rickettsiae. Typical organisms involve Toxoplasma gondii, Histoplasma capsulatum, Toxocara canis, cytomegalovirus, Borrelia burgdorferi, and Mycobacterium tuberculosis, for example. Most recently, a presumed viral etiology (i.e. rubella) for a form of AU, namely Fuchs heterochromic cyclitis, has been reported 13 . There is a lingering suspicion that many cases of AU are the result of infection with a pathogen that has not been recognized or is difficult to identify.

Falsenegative results of immunofluorescence assay or enzymelinked immunosorbent assay may be caused by the following

Lyme disease patients with negative IFA or ELISA serologies may occasionally be positive for cerebrospinal fluid antibodies or, as mentioned above, demonstrate a T-cell proliferation response to Bb. H. False-positive results of immunofluorescence assay or enzyme-linked immunosorbent assay are common. They may be caused by the following 3. Prior, possibly asymptomatic Bb infection. If another type of illness occurs in these patients, it may be wrongly attributed to Lyme disease. This is exemplified by a report of four patients who were initially thought to have Lyme disease but were shown to have endocarditis. This highlights the care with which a diagnosis of Lyme disease must be made.

Stability of Community Variables

Diversity may dampen the spread of insects or pathogens that could threaten some species, hence disrupting community structure. For example, the diversity of pines and hardwoods in the southern United States reduces spread of southern pine beetle populations (Schowalter and Turchin 1993). Ostfeld and Keesing (2000) found that the number of human cases of Lyme disease, caused by the tick-vectored spirochete, Borrelia burgdorferi, declined with species richness of small mammals and lizards but increased with species richness of ground-dwelling birds (Fig. 10.10). These data indicated that disease epidemiology may depend on the diversity of reservoir hosts, but disease incidence generally should decline with increasing dilution of reservoir hosts by nonhosts.

Spatial Temporal Dynamics in Nonlocal Epidemiological Models

Spatial heterogeneities can be included by adding an immigration term where infective individuals enter the system at a constant rate. De Mottoni et al. (1979) and Busenberg and Travis (1983) considered a population in an open bounded region and assumed that the susceptible, infective, and removed individuals can migrate inside the region according to the rules of group migration. The existence of traveling waves in epidemic models described by reaction-diffusion systems has been extensively studied by many researchers, for example, Thieme (1980), Kallen et al. (1985), Murray et al. (1986) and Murray and Seward (1992) studied the spatial spread of rabies in fox Abramson et al. (2003) considered traveling waves of infection in the Hantavirus epidemics Cruickshank et al. (1999), Djebali (2001), Hosono and Ilyas (1995) investigated the traveling waves in general SI epidemic models Caraco et al. (2002) studied the spatial velocity of the epidemic of lyme disease Greenfell et al. (2001)...

Subacute Or Chronic Meningitis

Of the treatable conditions, crytococcosis and syphilis can be easily diagnosed on the basis of serology and antigen detection. Lyme disease (Borrelia burgdorferi) with nervous system involvement usually presents as a chronic meningitis and should be suspected if a combination of facial nerve palsy (often bilateral) and aseptic meningitis is present. Later in the course of the disease it may cause an encephalomyelitis, although several patterns of peripheral neuropathies, radiculopathy, and myositis have also been described. The characteristic skin lesion erythema chronicum migrans is often accompanied by secondary annular skin lesions. Other symptoms may include myalgias, arthral-gias, dysesthesias, or abdominal pain. The causative spirochete, Borrelia burgdorferi, is transmitted by the bite of an infected Ixodes tick. Infection can spread hematogenously to, heart, nervous system, joints, and other organs (reviewed in ref. 5). For diagnosis of Lyme disease, positive or equivocal...

Recommended approach to seropositive patients

This is the most difficult group to evaluate. In general, most patients with Lyme disease will have objective evidence of the disease on history, physical examination, and laboratory testing. The pitfalls of treating ELISA-positive patients with nonspecific symptoms but without Western blot confirmation of Lyme disease should be appreciated. E. Treatment of confirmed Lyme disease. The treatment protocols currently recommended are summarized in Ta.b.l 4.1-2 1. Early localized (stage 1). Antibiotic treatment of EM is felt to shorten the course of the rash and decrease the chance of disease progression. Bb is sensitive, in animal studies and in vitro, to tetracycline, ampicillin, ceftriaxone, imipenem, and erythromycin. The advantages of doxycycline over tetracycline are better gastrointestinal absorption and central nervous system penetration and twice-daily dosing. However, neither should be used in pregnant women or in children. It is important to be aware...

Dendritic Cells In Other Nonhiv Infections

Chlamydia trachomatis is a common cause of sexually transmitted diseases and a leading cause of preventable blindness worldwide (57). Host defense against chlamydial infection is mediated by both cellular and humoral immune responses (58). Ex vivo DCs pulsed with killed or live chlamydiae and reinfused into mice have been reported to induce strong protective immunity to vaginal infection (59,60). Similar protective effects have been observed for Borrelia bergdorfei, lymphocytic choriomenin-gitis, Toxoplasma, Leishmania major, and equine herpesvirus.

The increasing impact of law and regulation on medical practice

Increasingly, legal standards of care of have replaced medical standards. In some cases this may be relatively explicit, such as indications for Cesarean section based more on the probability of liability than medical judgment. Frequently, however, the replacement of medical judgment by courtroom standards is more subtle. Examples are as varied as the high rate of false-positive readings on mammography and the high incidence of antibiotic prescription to prevent even the remotest possibility of Lyme disease (17).

Anthropogenic regulators

Decreasing natural biodiversity (usually brought about through anthropogenic disturbance) has been hypothesized to result in increasing risk for various diseases in human populations. This concept has been frequently cited in the popular press, and there has been some treatment of the hypothesis in the scientific literature 19 . Nevertheless, such treatments have remained largely theoretical, because few data are available for testing hypotheses. Using Lyme disease as a model system, Ostfeld and others 33, 34, 38 developed a general theoretical model for vector-borne diseases (the dilution effect hypothesis). The basic theory is that vertebrate communities with high species diversity will contain a greater proportion of incompetent reservoir hosts that deflect feeding vectors away from the most competent reservoirs, thereby reducing both infection prevalence in the vector and human disease risk 33 .

Immunotherapy Of Specific Bacterial Infections

Limited, anecdotal, studies in various other settings have suggested some therapeutic and prophylactic benefit of standard IVIG preparations. These include sepsis following cardiac surgery in high-risk patients (33), patients with cerebrospinal fluid shunt infections (34), and patients with multiple myeloma (35). No effect was found in preventing infections in pediatric head trauma patients (36). One report suggested that early treatment with IVIG prevented polyneuropathy following multiple organ failure and Gramnegative sepsis (37). Another report suggested that IVIG facilitated the recovery of lymphocytic meningoradiculitis associated with Lyme disease (38). Experimentally, the use of human IVIG protected rabbits from diarrhea and death associated with E. coli shiga-like toxin (39).

Relapsing fevers

Includes recurrent fever Excludes Lyme disease ( A69.2 ) A68.0 Louse-borne relapsing fever Relapsing fever due to Borrelia recurrentis A68.1 Tick-borne relapsing fever Relapsing fever due to any Borrelia species other than Borrelia recurrentis A69.2 Lyme disease Erythema chronicum migrans due to Borrelia burgdorferi A69.8 Other specified spirochaetal infections A69.9 Spirochaetal infection, unspecified

Acute monarthritis

One may be deceived, however, in a partially treated patient on oral antibiotics or in an immunosuppressed patient by the mild appearance of the joint. A prudent approach includes careful examination for associated infectious foci and clues (e.g., cutaneous pustules with neisserial infection), prompt joint aspiration, synovial fluid culture and Gram's stain, and empiric antibiotics (depending on age and epidemiology). A viral process is typically polyarticular (except transient synovitis of the hip in childhood, which is thought to be viral or postviral in origin). Lyme arthritis, caused by a Borrelia spirochete, can present acutely as recurring knee monarthritis, but more often it presents early in the course of the disease as migratory polyarthralgias (see Chapter41).

Infectious arthritis

Lyme disease rarely presents in an RA-like fashion. Early Lyme disease may present with arthralgias and myalgias in the setting of the erythema chronicum migrans rash and history of tick bite. Late (tertiary) Lyme presents with a waxing and waning monarticular synovitis or oligoarthritis (four or fewer joints) that often involves the knees.

NKT Cells

The role of NKT in host defense against various infections including virus, parasites, and bacteria has also been reported. For example, studies on NKT with a-GalCer inhibited hepatitis B viral replication in HBV transgenic mice while CD1 gene-knockout mice (lack of NKT) showed substantial impairment in antiviral response to encephalomyocarditis virus infection and herpes simplex type 1 virus infections. Moreover, a-GalCer treatment significantly enhanced protective antimalarial immunity and reduced bacterial burden and tissue injury in Mycobacte-rium tuberculosis mouse models. Furthermore, CD1 gene-knockout mice have been found to be less resistant to Borrelia burgdorferi infection and fail to eradicate Pseudomonas aeruginosa infection.

Arthritis

In one study, 55 patients with untreated EM were followed. Eleven patients had EM as the only manifestation of Lyme disease, with no joint involvement at all. Ten patients had EM with arthralgias, 28 had EM with intermittent arthritis, and only 6 had EM with chronic arthritis. The most common pattern was an asymmetric oligoarthritis or monarthritis of large joints. Most patients had knee involvement at some point in their illness. Characteristically, the knees became very swollen (sometimes massively). They appeared warm but not hot. Pain was moderate but not severe. In three patients, Baker's cysts developed with early rupture. Arthritis of the ankle, wrist, and occasionally elbow and hand has also been seen. Temporomandibular joint involvement is also frequent. It is rare for more than five joints to be involved. Although it is unusual for small joints to be involved, a rheumatoid arthritis-like picture has been reported. Nodules are unusual but have been...

Eukarya

Archaea High Pressure Lovers

Spirochetes are Gram-negative, motile, chemoheterotrophic bacteria characterized by unique structures called axial filaments, which are modified flagella running through the periplasm (see Figure 27.4a). The cell body is a long cylinder coiled into a spiral (Figure 27.12). The axial filaments begin at either end of the cell and overlap in the middle, and there are typical basal bodies where they are attached to the cell wall. The basal bodies rotate, as they do in other prokaryotic flagella. Many spirochetes live in humans as parasites a few are pathogens, including those that cause syphilis and Lyme disease. Others live free in mud or water.

Ixodes ricinus

Phlebotomus Papatasi

Vector of the causative agents of Lyme borreliosis and tickborne encephalitis Ixodes ricinus, (common sheep tick, castor bean tick) is the most frequent hard tick species in central Europe. The medical significance of this species is due to its role as vector of the causative agents of Lyme borreliosis, tickborne encephalitis (European tickborne encephalitis, early summer meningoencephalitis, ESME), and other pathogens. Ticks that have attached to the skin should be mechanically removed as soon as possible to reduce the risk of infection. The great epidemiological significance of I. ricinus in central Europe is predominantly due to its function as vector of the causative agents of Lyme bor-reliosis (Borrelia spp., p. 324f.) and the European tickborne encephalitis (TBE) (virus of TBE, p. 443f.). In northern and eastern Europe the TBE virus is transmitted by Ixodes persulcatus Ixodes scapularis (syn. I. dammini) is the vector of Borrelia burgdorferi in the USA. After staying in a tick...

Stringent Response

There is considerable evidence that (p)ppGpp acts as a global regulator to modulate a variety of bacterial cellular and physiological processes. Furthermore, numerous intracellular and extracellular pathogens appear to exploit the stringent response pathway to activate virulence genes and persist in the hostile environment of their host these include Mycobacterium tuberculosis, Listeria monocytogenes, Pseudomonas aeruginosa, Streptococcus pyogenes, Staphylococcus aureus, Borrelia burgdorferi, and Salmonella typhimurium (Godfrey et al. 2002 Magnusson et al. 2005). By monitoring environmental conditions and invoking the stringent response, pathogens can elicit swift changes in gene expression to adapt to the metabolic stresses encountered in their host, thereby promoting self-preservation.

Liquid Ingestion

A number of carnivores also are adapted to consume a liquid diet. As ghoulish as it might sound, ingesting blood is the most common mechanism of feeding for these animals. Mosquitoes, for example, are equipped with a syringelike mouthpart called a proboscis. Although the male sips nectar, the female mosquito uses her proboscis to pierce skin and suck blood. As with most bloodsucking animals, mosquitoes secrete an anticoagulant that prevents blood from clotting (and also makes people itch). Some flies use a similar mode of feeding, but the common housefly generally laps up food and sugary solutions. Leeches are also well adapted for bloodsucking They have a suction-cup-like mouth that clings tenaciously to a host while their jaws make a Y-shaped cut in the skin. Further, leeches have a muscular pharynx (throat) that literally pumps blood from their host. Ticks, which are related to spiders and scorpions, have tiny heads that are designed to burrow into the skin of their host and suck...

Vasculitis

This multisystem inflammatory disorder is caused by the spirochete Borrelia burgdorferi, which is transmitted by the bite of an Ixodes tick. Erythema migrans, present in up to 75 of patients, is a rapidly expanding annular erythematous lesion that begins at the site of the tick bite. The central portion may remain erythematous, clear, or rarely become necrotic. The rash appears within days to 4 weeks after the tick bite. Patients at this stage will often have fever, fatigue, headache, and arthralgias. A secondary rash consisting of multiple annular lesions resembling those of secondary syphilis may follow. The nervous system, heart, eyes, and joints can become involved weeks to years later. Borrelia has also been implicated in some cases of acrodermatitits chronica atrophicans, morphea, and progressive facial hemiatrophy of Parry-Romberg.