Is there a relationship between missing an early diagnosis of neuroborreliosis and later persisting symptoms? There seems to be, based on what Dr. Brian Fallon has stated in the past. This is something that interests me.
In my research on Lyme disease treatment guidelines, I think this recent paper has been mentioned on Lymenet Europe:
Coumou J, van der Poll T, Speelman P, Hovius JW. Tired of Lyme borreliosis. Lyme borreliosis in the Netherlands. Neth J Med. 2011 Mar;69(3):101-11.
Man, these guys know what I'm thinking... I'm tired of Lyme borreliosis, too. And tired from it, as well as the entire stinking enchilada of controversy around the chronic issue.
But I digress... a lot of this paper echoes the IDSA treatment recommendations for Lyme disease, and later on, mentions this:
"In late manifestations of Lyme borreliosis, the same antibiotics are recommended, but with a longer duration of treatment (table 1).
[Ed. - table 1 mentions 30 days of IV ceftriaxone or oral doxycycline, depending on whether or not the patient exhibits pleiocytosis.]
"For selected individuals with aspecific symptoms in combination with positive Lyme serology antibiotic treatment could be considered. Although, to our knowledge, evidence-based guidelines for this are non-existent, treatment could be adjusted based on the duration of symptoms, e.g. short duration of symptoms (< 3 months) could be treated with 10-14 days of doxycycline 100 mg twice a day and longer lasting symptoms with 30 days of doxycycline 100 mg twice a day. In case of persistence of specific Lyme borreliosis symptoms, persisting B. burgdorferi s.l. infection, or re infection, should be considered and additional or prolonged therapy could be indicated."
Okay, so that's about individuals with positive Lyme serology. Positive Lyme serology and subjective measurements. Got that.
Then they mention PLDS patients:
"In stark contrast, patients with PLDS, or individuals with false-positive Lyme serology and aspecific symptoms, such as fatigue, myalgia, headache and joint pain, should not receive antibiotic treatment. However, some of these patients are occasionally unjustly treated for months to years with (multiple) intravenously administered antibiotics, for which no credible scientific evidence exists. Such approaches pose a great risk for serious adverse effects."
And so they're staying that individuals with false-positive Lyme serology and aspecific symptoms should not receive antibiotic treatment.
After rereading these paragraphs a few times, this leaves me with some questions and/or comments:
- How do you determine which patients have aspecific symptoms with positive Lyme serology versus patients with false-positive Lyme serology and aspecific symptoms?
- If evidence-based guidelines for patients with late manifestations for Lyme disease are non-existent, how are you coming up with this recommendation and what IS it based on? If you say opinion, what is that opinion based on?
- Which specific Lyme borreliosis symptoms must persist in order for prolonged therapy to be indicated?
- You're stating right there that the infection can persist. How do you know it persists?
I have a lot of unanswered questions about this, as I'm sure others might after reading this.
At the close of the paper, the authors wrote this:
"Antibiotics are effective in all manifestations of Lyme borreliosis and prognosis is usually excellent. However, a minority of patients experience potentially severe, but aspecific symptoms after previous adequate treatment for Lyme borreliosis. In these individuals, additional antibiotics have no substantial beneficial effects compared with placebo.
A challenge for the future is to develop a test to detect, or rule out, persistent active B. burgdorferi s.l. infection. This could reassure individuals who experience aspecific symptoms after previous recommended therapy for Lyme borreliosis, prevent unnecessary treatment and pave the way for research on the true aetiologies of aspecific symptoms after recommended antibiotic treatment for Lyme borreliosis."
And I agree, a test is needed to detect and rule out persistent active B. burgdorferi infection. However, what are they doing right now to make that determination?
"In case of persistence of specific Lyme borreliosis symptoms, persisting B. burgdorferi s.l. infection, or re-infection, should be considered and additional or prolonged therapy could be indicated."
I just wonder... are we going in circles?
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