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Author Topic: Complications of 'chronic Lyme disease' reported  (Read 865 times)

Omegafant

  • Boltbender
  • Jr. Member
  • *
  • Posts: 846
Complications of 'chronic Lyme disease' reported
« on: December 16, 2017, 05:56:44 PM »

[*quote*]
Consumer Health Digest #17-25
June 25, 2017

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D
http://www.quackwatch.org/10Bio/bio.html
, with help from William M. London, Ed.D., M.P.H
http://www.calstatela.edu/faculty/william-m-london
. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making. Its primary focus is on health, but occasionally it includes non-health scams and practical tips.

###
Complications of “chronic Lyme disease" reported

Cases have reported in which treatment for "chronic Lyme disease" resulted in the development of septic shock, osteomyelitis, Clostridium difficile colitis, or paraspinal abscess.
[Marzec NS and others.
Serious bacterial infections acquired during treatment of patients given a diagnosis of chronic Lyme disease — United States
https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6623a3.pdf
 MMWR 66:607-609, 2017]

"Chronic Lyme disease" is not a valid diagnostic entity. Lyme disease infections are usually cured by 2 to 4 weeks of antibiotic treatment. However, a small network of physicians and their patients have been barraging the public with claims that thousands of people being maimed, killed, and bankrupted each year by chronic Lyme disease. They incorrectly assert that Lyme is a deadly, chronic disease that requires long-term antibiotic therapy even though clinical trial evidence shows no advantage over placebo treatment.

[Melia TM, Auwaerter PG.
Time for a different approach to Lyme disease and long-term symptoms
http://www.nejm.org/doi/pdf/10.1056/NEJMe1502350
 New England Journal of Medicine 374:1277-1278, 2016]

###
Anti-vaccination statements of Canadian naturopaths criticized

Canadian researchers who examined the Web sites of 330 naturopaths who practice in the provinces of Alberta and Manitoba have reported that 40 included vaccine hesitancy discourse and 26 offered vaccine or flu shot alternatives.
[Caulfield T and others. Injecting doubt: responding to the naturopathic anti-vaccination rhetoric
https://academic.oup.com/jlb/article/doi/10.1093/jlb/lsx017/3871793/Injecting-doubt-responding-to-the-naturopathic
Journal of Law and the Biosciences, June 20, 2017]
The researchers concluded:
<i>"It is essential that we combat these dangerous misrepresentations. Various legal and policy approaches could be taken to address this issue. The Competition Bureau and Health Canada could modify advertising standards to prohibit all clearly unsubstantiated treatment and performance claims online, and the latter could even act to prevent entirely the sale of demonstrably ineffective natural health products like homeopathic vaccines. After all, these products need not be intrinsically harmful to ultimately cause harm. Provincial regulation has helped to legitimize naturopaths, making their claims more persuasive. It would be wise to roll back the scope of naturopath self-regulation, and to establish third-party oversight and management of disciplinary bodies. If naturopaths were truly an evidence-based profession and held to a science-informed standard, one would expect the relevant regulatory bodies to take action on the misleading advertising. Naturopaths genuinely interested in the science of health care would logically also be open and welcoming to such changes. The scope of offerings available for naturopaths to advertise would certainly be diminished, and these changes would likely entail a ban on naturopaths providing any advice or service relating to vaccination, other than a referral to an appropriate, science-informed, healthcare provider. As a result, we could expect an improvement in the accuracy of representations made to Canadians trying to make difficult health care decisions. Misrepresentations relating to vaccination can be matters of life and death. As such, it is essential to employ the various legal tools that could be used to help address this dangerous social trend."</i>

###

Anti-vax myths lampooned

Comedian John Oliver has debunked the common myths and fears that influence some parents to delay or avoid vaccinating their children. The June 26 "Last Week Tonight" TV episode can be viewed on YouTube
https://www.youtube.com/watch?v=7VG_s2PCH_c

###

Quack device exhibit announced

Loma Linda University has opened its Quack 'o' Rama
http://myllu.llu.edu/blogs/hrcnews/2017/05/01/quack-o-rama-on-display-now-at-the-heritage-research-center/
of devices collected by the late professor, William T. Jarvis, Ph.D. The exhibit can be viewed free of charge during regular hours in the university's Del E. Webb Memorial Library until September 29, 2017.

###

Other issues of the Digest are accessible through
http://www.ncahf.org/digest17/index.html
To help prevent the newsletter from being filtered out as spam, please add
bounces-chd@lists.quackwatch.org
to your address book or other "whitelist." To unsubscribe, log into your chd account or send a blank message to
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This must be sent from the address you used to subscribe. To subscribe from a new address, send a blank message to
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=================================

Stephen Barrett, M.D.
Consumer Advocate
287 Fearrington Post
Pittsboro, NC 27312

Telephone: (919) 533-6009

http://www.quackwatch.org (health fraud and quackery)
[*/quote*]


I dare say that  Stephen Barrett, M.D is not the egghead he thinks he is. This statement by Barrett

"Chronic Lyme disease" is not a valid diagnostic entity. Lyme disease infections are usually cured by 2 to 4 weeks of antibiotic treatment. However, a small network of physicians and their patients have been barraging the public with claims that thousands of people being maimed, killed, and bankrupted each year by chronic Lyme disease. They incorrectly assert that Lyme is a deadly, chronic disease that requires long-term antibiotic therapy even though clinical trial evidence shows no advantage over placebo treatment.

for years was unlikely to be true. But he did not accept this.

Considering LYME DISEASE please read this brand-new study published in December 2017:

"Study finds Lyme bacteria can survive antibiotic treatment months after infection"
http://www.transgallaxys.com/~kanzlerzwo/index.php?topic=9412.0

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Omegafant

  • Boltbender
  • Jr. Member
  • *
  • Posts: 846
Re: Complications of 'chronic Lyme disease' reported
« Reply #1 on: December 16, 2017, 06:25:46 PM »

This text is a comment about a study. I consider it dead wrong. This is why I post it here.

http://www.nejm.org/doi/pdf/10.1056/NEJMe1502350

[*quote*]
Editorials
The new england journal of medicine
n engl j med  374;13  nejm.org
March 31, 2016

1277

Time for a Different Approach to Lyme Disease and Long-Term Symptoms
Michael T. Melia, M.D., and Paul G. Auwaerter, M.D.

The condition of most patients with Lyme disease  improves  after  initial  antibiotic  therapy;  however, 10 to 20% of treated patients may have lingering symptoms of fatigue, musculoskeletal pains,  disrupted  sleep,  and  lack  of  customary  mental functions. The plausible idea that additional antimicrobial therapy for potentially persistent bacterial infection would foster improvement  has  been  a  touchstone  of  hope  in  the  40  years since discovery of the disease in the mid-1970s.  Patients  with  long-standing  symptoms  and  well-documented,  previously  treated  Lyme  disease have been the focus of a number of randomized,  placebo-controlled  studies  in  North  America that assessed whether additional antibiotic  therapy  offers  a  reduction  in  symptoms. 1

Because  molecular  or  culture  methods  did  not  find  evidence  of  persistent  infection  in  the  enrolled patients, it was perhaps not surprising that additional  antimicrobial  therapy  yielded  neither  clinically  significant  nor  durable  reductions  in  symptoms as compared with placebo. Despite these findings, proponents of longer-term antibiotic therapy prescribe them for people  living  with  stubborn  symptoms  —  whether  the symptoms are called the post-treatment Lyme disease syndrome or the more nebulous chronic Lyme  disease  that  is  often  not  associated  with 
customary, objective measures of Borrelia burgdorferi infection. 2

Weaker evidence, including findings from observational studies that suggest an improvement driven by antibiotic treatment, are commonly  cited  as a rationale for longer-term  therapy, though  such conclusions  should  be  moderated to take into account the placebo response of 36% that was observed in the randomized, controlled trials. 3

In this issue of the Journal, Berende and colleagues report the results of the Persistent Lyme Empiric Antibiotic Study Europe (PLEASE) trial, which  again  investigated  whether  longer-term  antibiotic therapy provides relief for subjective symptoms  (lasting  an  average  of  more  than  2  years)  attributed  to  Lyme  disease. 4

The  trial  design  is  interesting  in  several  respects.  First,  the trial involved a European population, and the species of B. burgdorferi sensu lato that circulate in Europe, including B. afzelii and B. garinii, differ from those that circulate in North America. The infections  associated  with  these  species  can  manifest  differently  than  do  infections  from  North  American  species,  such  as  with  a  longer  initial  duration  of  illness. 5

Second,  only  96  of  280 participants (34%) had objective evidence of Lyme  disease  such  as  the  characteristic  rash,  erythema  migrans.  This  means  that  nearly  two  thirds of their study population had nonspecific symptoms that were attributed to Lyme disease solely  on  the  basis  of  positive  IgM  or  IgG  (or  both) immunoblot assays for B. burgdorferi. Such laboratory  findings  do  not  necessarily  imply  causation and could represent either false positive  results  or  remote  infection,  since  antibody  titers can remain elevated for decades. 6,7

Finally, all patients in the three study groups that were included in this trial received intravenous ceftriaxone  for  2  weeks  before  the  12-week  randomized phase, which means that there was no true placebo  component;  the  two  active  oral  study  regimens  (doxycycline  and  clarithromycin  with hydroxychloroquine) that were used in the 12-week randomized phase are both known to produce antiinflammatory  effects  in  addition  to  their  antimicrobial properties.


1278

The takeaway from this well-performed study is  that  12  weeks  of  therapy  with  either  doxycycline or clarithromycin plus hydroxychloroquine yielded  no  additional  benefit  over  placebo  with  respect to serial mental and physical health-related quality-of-life measures that spanned the duration of  the study through 38 weeks  after  the  active study drugs or placebo were discontinued.

Although  some  may  attribute  the  improvement  seen  in  all  three  study  groups  to  the  initial  2 weeks of ceftriaxone received by everyone, this improvement might be explained by the 11% of patients who had not received any previous antibiotic therapy before study entry.

Critics may rightly say that this trial does not truly capture with certainty the consequences of bona  fide  Lyme  disease.  However,  studies  with  more stringent inclusion criteria have already been conducted,  and  the  approach  used  by  Berende  and  colleagues  probably  reflects  the  common  practice  in  ambulatory  care  settings,  in  which  patient  presentations  of  fatigue  or  nonspecific  pain prompt serologic checks for Lyme disease, despite evidence suggesting that these tests will not identify a probable cause or result in a treatment benefit. 8

Because antibiotics that target infection generally return a benefit before 12 weeks, arguments for a favorable delayed-onset outcome with  even  longer  courses  are  weak.  Moreover,  although  the  side  effects  were  mostly  minor,  68.6% of the patients reported at least one adverse reaction that was thought to be drug related, which should lessen the temptation among physicians to prescribe longer courses of antibiotics just in case they might help.

Where does this leave patients who are living with symptoms possibly related to Lyme disease, and  where  does  this  lead  their  clinicians?  The report by Berende et al. is an important contribution  and  contains  a  simple  message,  regardless of the diagnosis given to those enrolled in the trial. Patients with subjective, vexing symptoms attributed to Lyme disease should not anticipate  that  even  longer  courses  of  antibiotics  will  produce  relief,  a  finding  that  is  in  concert  with results from previous trials. These patients may,  however,  take  small  comfort  in  a  recent  study  of  longer-term  outcomes  after  culture-confirmed Lyme disease that showed that mental and physical health scores had returned to baseline  scores  similar  to  those  of  the  age-adjusted U.S. population. 9

Though prolonged antibiotic therapy is not the answer,  we  do  not  know  what  is  truly  helpful.  Our  personal  approach  is  centered  on  making  thorough  assessments  for  alternative  diagnoses  such  as  sleep  disorders  and  providing  recommendations borrowed from practices in general medicine.  Such  a  patchwork  approach  should  make it clear that chronic health problems such as fatigue and pain that afflict millions of people worldwide urgently require answers with respect to the causal mechanisms and better approaches  for  a  quicker  recovery,  regardless  of  whether the problems were triggered by B.  burgdorferi or by some other process. One example of an innovative investigation is the recent finding of  differential gene expression suggesting postinfectious cytokine or metabolic changes after Lyme disease, as compared with other acute infections. 10

Future research efforts should continue to explore such different strategies that may lead to proven options for helping our patients.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
From  the  Sherrilyn  and  Ken  Fisher  Center  for  Environmental  Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore.

1.
Klempner MS, Baker PJ, Shapiro ED, et al. Treatment trials for post-Lyme disease symptoms revisited. Am J Med 2013; 126:665-9.

2.
Feder HM Jr, Johnson BJB, O’Connell S, et al. A critical appraisal of “chronic Lyme disease.” N Engl J Med 2007; 357:1422-30.

3.
Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 345: 85-92.

4.
Berende A, ter Hofstede HJM, Vos FJ, et al. Randomized trial of longer-term therapy for symptoms attributed to Lyme disease. N Engl J Med 2016;
374:1209-20.

5.
Strle F, Nadelman RB, Cimperman J, et al. Comparison of culture-confirmed erythema migrans caused by Borrelia burgdorferi sensu stricto in New York State and by Borrelia afzelii in Slovenia. Ann Intern Med 1999; 130: 32-6.

6.
Seriburi V, Ndukwe N, Chang Z, Cox ME, Wormser GP. High frequency of false positive IgM immunoblots for Borrelia burgdorferi in clinical practice. Clin Microbiol Infect 2012; 18: 1236-40.

7.
Kalish  RA,  McHugh  G,  Granquist  J,  Shea  B,  Ruthazer  R,  Steere AC. Persistence of immunoglobulin M or immunoglobulin G antibody responses to Borrelia burgdorferi 10-20 years after active Lyme disease. Clin Infect Dis 2001; 33: 780-5.

8.
Markowicz  M,  Kivaranovic  D,  Stanek  G.  Testing  patients  with  non-specific  symptoms  for  antibodies  against  Borrelia  burgdorferi sensu lato does not provide useful clinical information about their aetiology. Clin Microbiol Infect 2015; 21: 1098-103.

9.
Wormser GP, Weitzner E, McKenna D, et al. Long-term assessment of health-related quality of life in patients with culture-confirmed early Lyme disease. Clin Infect Dis 2015; 61:  244-7.

10.
Bouquet J, Soloski MJ, Swei A, et al. Longitudinal transcriptome  analysis  reveals  a  sustained  differential  gene  expression  signature in patients treated for acute Lyme disease. MBio 2016; 7(1): e00100-16.

DOI: 10.1056/NEJMe1502350
The New England Journal of Medicine

For personal use only. No other uses without permission.
 Copyright © 2016 Massachusetts Medical Society. All rights reserved.
[*/quote*]


[*quote*]
Second,  only  96  of  280 participants (34%) had objective evidence of Lyme  disease  such  as  the  characteristic  rash,  erythema  migrans.  This  means  that  nearly  two  thirds of their study population had nonspecific symptoms that were attributed to Lyme disease solely  on  the  basis  of  positive  IgM  or  IgG  (or  both) immunoblot assays for B. burgdorferi. Such laboratory  findings  do  not  necessarily  imply  causation and could represent either false positive  results  or  remote  infection,  since  antibody  titers can remain elevated for decades. 6,7
[*/quote*]

This is nonsense, because an erythema migrans only occurs in a fraction of the cases of infection!

[*quote*]
Finally, all patients in the three study groups that were included in this trial received intravenous ceftriaxone  for  2  weeks  before  the  12-week  randomized phase, which means that there was no true placebo component;  the  two active oral  study  regimens  (doxycycline  and  clarithromycin  with hydroxychloroquine) that were used in the 12-week randomized phase are both known to produce antiinflammatory  effects  in  addition  to  their  antimicrobial properties. [/b]
[*/quote*]

This indeed is a bad spot.


[*quote*]
although  the  side  effects  were  mostly  minor,  68.6% of the patients reported at least one adverse reaction that was thought to be drug related, which should lessen the temptation among physicians to prescribe longer courses of antibiotics just in case they might help.
[*/quote*]

"thought to be drug related"! And what is real!?


[*quote*]
Though prolonged antibiotic therapy is not the answer,  we  do  not  know  what  is  truly  helpful.  Our  personal  approach  is  centered  on  making  thorough  assessments  for  alternative  diagnoses  such  as  sleep  disorders  and  providing  recommendations borrowed from practices in general medicine.  Such  a  patchwork  approach  should  make it clear that chronic health problems such as fatigue and pain that afflict millions of people worldwide urgently require answers with respect to the causal mechanisms and better approaches  for  a  quicker  recovery,  regardless  of  whether the problems were triggered by B.  burgdorferi or by some other process.
[*/quote*]

This is the crucial part of the whole approach. Melia and Auwaerter do write  "urgently require answers with respect to the causal mechanisms and better approaches  for  a  quicker  recovery,  regardless  of  whether the problems were triggered by B.  burgdorferi or by some other process."

But the second part is: "and better approaches  for  a  quicker  recovery", leaving a universe of opportunities for charlatans to claim to better the health conditions. Exactly this is the entrance for the frauds from homeopaths to psychic healers.

The key to all medicine is: solid diagnosing. But the huge entrance for charlatans does not exclude any putting the patients into the "psych" bin. But that is where they end up, sooner or later.



Considering LYME DISEASE please read this brand-new study published in December 2017:

"Study finds Lyme bacteria can survive antibiotic treatment months after infection"
http://www.transgallaxys.com/~kanzlerzwo/index.php?topic=9412.0
« Last Edit: December 16, 2017, 06:41:58 PM by Omegafant »
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