Friday, October 11, 2013

13 24 Hours Of Attachment Is An Estimate - Not a Safety Blanket

By now you may have heard the news that the CDC announced that there are over 300,000 estimated cases of Lyme disease in the United States each year.

For many people, this estimate came as a shock, but it really shouldn't be - the CDC itself has stated in the past that reported cases are a fraction of actual case numbers - especially in highly endemic areas - and researchers have also stated a case count of 30,000 was an underestimate.

Many Lyme disease patients and advocacy groups felt vindicated by the announcement, as it confirmed their position that the number of people contracting Lyme disease was always much larger than official numbers which were originally reported. The below chart, for example, was created by Open Eye Pictures, which produced the controversial film on Lyme disease, Under Our Skin:

Lyme Disease in the US as of 2009 - 0ver 461,000 estimated cases
Click to zoom in for a closer look.

Open Eye Pictures created this chart back in 2011, based on data directly from the CDC but without direct access to the insurance study, patient survey, and other information the CDC used recently to adjust their new estimate to 300,000 annual cases of Lyme disease. As one can see, their estimate managed to come pretty close to the CDC's - if not potentially higher.

With this announcement, news outlets, park rangers, and medical experts began warning the public once again to take proper precautions to prevent tick bites and to do body checks for ticks after being outdoors.

Some are also informing people that if they don't spot a tick right away, not to worry - if a tick is removed properly within 24 hours, it is highly unlikely to transmit any tickborne disease.

While there is truth in that statement, unfortunately it isn't exactly accurate and doesn't cover all kinds of ticks and any tickborne infections they might be carrying.

This chart shows only a small fraction of tickborne infections currently known to be pathogenic to people along with their transmission times (and in some cases, typical attachment times):

Sample of Well-known and Newly Emerging Tickborne Diseases in North America and Europe and Their Estimated Transmission Times

Tickborne Infection
Pathogen
Tick Species
Location
Estimated Transmission Time
Upon Attachment
Lyme disease BorreliosisBorrelia burgdorferi sensu strictuIxodes scapularis,
Ixodes pacificus
North America36-48 hrs;
24 hours or more;
potentially less 
Borrelia burgdorferi Ixodes ricinusEuropeLess than 24 hours
Borrelia afzeliiIxodes ricinusEuropeLess than 24 hours
Borrelia gariniiIxodes ricinusEuropeLess than 24 hours
Tickborne
Relapsing Fever
Borrelia miyamotoiIxodes scapularis, Ixodes pacificusNorth Americaunknown
Ixodes ricinusEuropeunknown
Borrelia turicataeOrnithodoros turciataNorth America30 seconds with a total tick attachment time 15-90 minutes
Borrelia hermsiiOrnithodoros hermsiiNorth America30 seconds with a total tick attachment time 15-90 minutes 
Human Monocytic EhrlichiosisEhrlichia chaffeensisAmblyomma americanum, Ixodes pacificus,
possibly Dermacentor variabilis 
North America12 to 24 hours 
Human Ewingii EhrlichiosisEhrlichia ewingiiAmblyomma americanumNorth Americasuspected 12 to 24 hours
Anaplasmosis
(formerly HGE)
Anaplasma phagocytophilum (formerly Ehrlichia phagocytophilum)Ixodes scapularis, Ixodes pacificus, Dermacentor variabilisNorth America12 to 24 hours
BabesiosisBabesia duncaniIxodes pacificusNorth America24 to 36 hours
Babesia divergensIxodes ricinusEurope24 to 36 hours
Babesia microtiIxodes scapularisNorth America24 to 36 hours
Rocky Mountain Spotted FeverRickettsia rickettsiiDermacentor andersoni, Dermacentor variabilisNorth America4 to 6 hours
Q FeverCoxiella burnetiiDermacentor
andersoni (rare*)
North Americaunknown - suspected fast as highly infectious
Ixodes ricinus, others  (rare*)Europeunknown - suspected fast as highly infectious
Powassan Virus or Powassan EncephalitisLineage 1 or 2 FlavivirusIxodes cookei, Ixodes scapularisNorth America~15 minutes
Heartland VirusGroup V PhlebovirusAmblyomma americanumNorth Americaunknown
Tickborne Encephalitis (TBE)Flaviviridae FlavivirusIxodes ricinusEuropeWithin minutes

* Q fever is usually transmitted to people by exposure to contaminated raw dairy products, inhalation of aerosol fluids from pregnant animals, blood transfusions, and in utero. Tickborne infection with Q fever can happen - either through a tick bite or exposure to tick fecal matter - but along with cases of sexual transmission,  this is rare compared to other methods.

There Are Unknowns In Tickborne Disease Transmission Times

Note that in the above chart, some items are marked unknown. This is because - as far as could be determined, no lab animal model transmission studies for that specific organism have been completed.

Incubation research may have been conducted - and this can inform us how long it takes before animals show signs and symptoms of being infected - but it does not inform us how long a tick must be attached before an infection can occur.

For example, the chart above contains information on Borrelia miyamotoi as one causative agent of relapsing fever, but transmission time from a hard-bodied Ixodid tick is currently unknown.

Until recently, it was thought relapsing fever spirochetes only colonize soft-bodied ticks and persist in their salivary glands, where they can transmit infection to blood quickly. But does the same situation apply to all hard-bodied ticks Borrelia miyamotoi colonizes? Is it the organism, or the tick's physiology, or both which determines how quickly Borrelia miyamotoi can be transmitted on average?

Heartland Virus is another example where transmission time is unknown. Heartland Virus is so new, very little is known about it.

Transmission Time Varies Based On Pathogen And Tick Species

Some pathogens are transmitted from a tick to its host in a few minutes - not hours - and so the 24 hour guideline does not apply to them. Relapsing fever organisms and tickborne viruses often fall into this category.

Some pathogens are transmitted more rapidly from one tick than they are from another. In Europe, there is evidence Lyme disease spirochetes are transmitted to their host more rapidly due to Ixodes ricinus' physiology. So if you live in Europe or visit there and get bitten by Ixodes ricinus, if the tick was attached for under 24 hours you are more likely to contract Lyme disease than if you were bitten by an Ixodes tick in North America.

Note, too, that transmission times can be periodically revised based on new data - and if anything, the trend has been demonstrating infection transmission could take place in less time than originally determined.

Overview Of Risk Factors In Tickborne Disease Transmission

What your risk is for contracting particular tickborne infections can vary, depending on:

  • The geographic location you were in when you were bitten; 
  • The type of tick which has bitten you;
  • How recently the tick may have fed on another host;
  • How many infectious organisms it has in its salivary glands;
  • Whether or not the tick is carrying other pathogens;
  • How long the tick has been attached; 
  • How the tick has been removed.

Those are risk factors involving the tick. But there are also host factors as well. Different hosts - including humans - have different immune systems and responses to specific tickborne strains of pathogens, and this, too, can determine the outcome of how or even if an infection will occur.

The Bottom Line

So what does the 24 hour guideline mean? It means many tickborne infections are less likely to infect you if a tick has been removed within 24 hours, but it isn't an ironclad guarantee that you won't contract an infection.

The best thing to do, of course, is to prevent ticks from getting on you in the first place. Prevention is key. No ticks means no tick bites, and not having to worry about what kind of tick has bitten you and what disease it might be carrying.

Wear permethrin coated clothes and use DEET spray on exposed skin. Wear pants tucked into socks and long-sleeved shirts and stick to the middle of the trail when hiking.

The second best thing to do is to do a regular tick check outdoors with a friend and not wait until you come home. Brush off any loose ticks, and carefully remove ticks with tweezers or narrow forceps as soon as you find them. Clean the tick bite area and place antibiotic lotion on it, then save the tick(s) you find in a well-sealed container for identification and testing at a tick testing lab.

There is no 100% guarantee that even with early tick removal, you will avoid contracting a tickborne infection. But your odds of getting infected are greatly reduced the sooner you properly remove a tick.


References

Lyme disease. Centers for Disease Control. http://www.cdc.gov/lyme/transmission/index.html Downloaded September 28, 2013.
Lyme disease. Centers for Disease Control. http://www.cdc.gov/features/lymedisease/ Downloaded September 28, 2013.
Piesman J, Mather TN, Sinsky RJ, et al. Duration of tick attachment and Borrelia burgdorferi transmission. J Clin Microbiol. 1987;25:557–8.
Joseph Piesman, Andrias Hojgaard, Protective value of prophylactic antibiotic treatment of tick bite for Lyme disease prevention: An animal model, Ticks and Tick-borne Diseases, Volume 3, Issue 3, June 2012, Pages 193-196.
Kahl O, Janetzki-Mittmann C, Gray JS, Jonas R, Stein J, et al. Risk of infection with Borrelia burgdorferi sensu lato for a host in relation to the duration of nymphal Ixodes ricinus feeding and the method of tick removal. Zentralbl Bakteriol 1998; 287: 41–52.
Leuba-Garcia S, Kramer MD, Wallich R, Gern L. Characterization of Borrelia burgdorferi isolated from different organs of Ixodes ricinus ticks collected in nature. Zbl Bakt 1994; 280: 468–475.
Crippa M, Rais O, Gern L Investigations on the mode and dynamics of transmission and infectivity of Borrelia burgdorferi sensu stricto and Borrelia afzelii in Ixodes ricinus ticks. Vector Borne Zoonotic Dis 2002; 2: 3–9.
Hofhuis A, Herremans T, Notermans DW, Sprong H, Fonville M, et al.  A Prospective Study among Patients Presenting at the General Practitioner with a Tick Bite or Erythema Migrans in the Netherlands. PLoS ONE 2013; 8(5): e64361.
Franc Strle, Jeffrey A. Nelson, Eva Ruzic-Sabljic, Joze Cimperman, Vera Maraspin, Stanka Lotric-Furlan, Yu Cheng, Maria M. Picken, Gordon M. Trenholme, and Roger N. Picken. European Lyme Borreliosis: 231 Culture-Confirmed Cases Involving Patients with Erythema Migrans. Clin Infect Dis. 1996; 23 (1): 61-65.
Davis GE. The endemic relapsing fevers. In: Hull TG, editor. Diseases transmitted from animals to man. Springfield (IL): Charles C Thomas; 1955. pp. 552–565.
Dworkin MS, Schwan TG, Anderson DE, Jr, Borchardt SM. Tick-borne relapsing fever. Infect. Dis. Clin. North Am. 2008; 22:449–468, viii.
Wisconsin Ticks and Tick-borne Diseases, Department of Entomology, University of Wisconsin-Madison http://labs.russell.wisc.edu/wisconsin-ticks/anaplasmosis/ Downloaded September 28, 2013.
Kramer V L, Randolph M P, Hui L T, Irwin W E, Gutierrez A G, Vugia D J. Detection of the agents of human ehrlichioses in ixodid ticks from California. Am J Trop Med Hyg. 1999; 60:62–65.
Piesman J., Hicks T. C., Sinsky R. J., Obiri G. Simultaneous transmission of Borrelia burgdorferi and Babesia microti by individual nymphal Ixodes dammini ticks. J. Clin. Microbiol. 1987; 25:2012–2013.
Piesman J., Spielman A. Human babesiosis on Nantucket Island: prevalence of Babesia microti in ticks. Am. J. Trop. Med. Hyg. 1980; 29:742–746.
Colville, J. L., and D. L. Berryhill. Rocky Mountain Spotted Fever, Handbook of Zoonoses, Mosby, Saint Louis, 2007, Pages 150-154.
Ebel GD, Kramer LD. Short report: duration of tick attachment required for transmission of Powassan virus by deer ticks. AmJTrop Med Hyg. 2004; 6:268–271.
Tickborne Encephalitis Centers for Disease Control & Prevention, 2009.
Lindquist L, et al. Tick-borne encephalitis. Lancet. 2008; 371(9627):1861-71.



13 comments:

  1. Excellent summary regarding transmission times for various tick-borne infections. I would like your permission to put your table: "Sample of Well-known and Newly Emerging Tickborne Diseases in North America and Europe
    and Their Estimated Transmission Times" in our next Newsletter." Of course, we would include a link to your entire article. Thanks. www.tic-nc.org, info@tic-nc.org. Marcia E Herman-Giddens

    ReplyDelete
  2. Marcia,

    Yes, please feel free to use the above table in your newsletter, with my permission provided you give Camp Other blog at campother.blogspot.com credit and use the attached list of references.

    My post has a Creative Commons 3.0 license on it, which means you can reuse and republish my material in it provided you give me credit and proper attribution. =)

    Thanks for asking - I appreciate knowing that my research is useful for others.

    CO

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  3. According to me precaution is better than the cure. Hope everyone is aware with these precaution. Thank for your useful post.

    Regards,
    Health And Safety Consultant Peterborough

    ReplyDelete
  4. In Germany the extrapolation of a careful incidence study of LD in a rural community (1992) yielded far more than 100.000 new B.b infections per years for the whole country, at a time when offical "experts" estimated 3000, later 30.000 per year.
    Meanwhile numbers of 230.000 - and even close to a million - per year are circulated. (The German population is about 1/4 of the US population.)

    From the same 1992 source it is known that LB always is CHRONIC (as is the case with syphilis) - spontaneous healing is a myth / a lie. The infection may cause little signs or symptoms over years, even decades (probably on the basis of a competent immune system), but with (severe) stress, other infections (like influenza, HIV...)... the disease may cause trouble again. This is similar to a "resting" Tbc infection, nothing new to those with some infectiology knowledge.

    So we can multiply the incidence per year with the average age of the population to arrive at a VERY ROUGH estimate for the PREVALENCE of chronic LB, which yields ca. 10 millions for Germany, with a population of about 80 millions!

    Of course not all will develop a severe chronic case like yours. But if "only" 1 million is severely handicapped that's an enormous problem!
    So it's urgent to find a way to deal with millions of LB patients "around the world" which is "manageable".

    I was aware of this for 2 decades by now. High dose long time ABs (even combinations) as propagated by ?LDMDs and pressure groups is NO solution! That's why I am so frustrated that "nobody" seems to take notice of my simple and cheap pulse- / interval dosing scheme with doxycyline (first line AB for LD, including NB).

    An MS patient from the USA told me that she got 60x 100mg doses of doxy for just 10$. Depending on weight of patient and "pulse interval" my scheme would cost 15...20 $ per person, or 15..20 million $$ per million patients per year. That's "nothing".

    Since such simple approaches obviously are ignored by both sides (my own experience over more than 10 years by now) my hope is sort of a grass roots movement to test if the pulse - interval - scheme with doxy might solve MUCH of the problem (the controversy), certainly not all of it.
    chen-men

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  5. Chen-men,

    Hi and welcome to Camp Other blog. Thanks for commenting. Some thoughts in response to your comment:

    "Meanwhile numbers of 230.000 - and even close to a million - per year are circulated. (The German population is about 1/4 of the US population.)" [...] "So we can multiply the incidence per year with the average age of the population to arrive at a VERY ROUGH estimate for the PREVALENCE of chronic LB, which yields ca. 10 millions for Germany, with a population of about 80 millions!"

    Do you know how this incidence has been calculated? What data sources have been applied to determine these estimates? e.g. health insurance, doctor reports, etc.?

    Would be interested in hearing this. I'm aware of a report of roughly 1 million Lyme Borreliosis cases in Germany that Berghoff made recently - but have not heard of anyone making the projected estimate you are making for chronic Lyme Borreliosis.

    How do you come up with 80 million cases of chronic LB in Germany? I know here in the US, I could make an estimate that 45000 - 60000 people a year have chronic Lyme disease (post treatment Lyme disease) based on the CDC stating 10-20% of 300000 patients contract Lyme disease a year - but I can't be certain that is a reliable estimate because the original 10-20% was based on only 30000 cases.

    That base percentage may have changed. I have no way of knowing for certain. And in fact, I'm going to be revisiting that 10-20% estimate. Where did it come from originally?

    I suspect that Germany's environment is going to produce a higher number of Lyme Borreliosis cases because many highly populated areas are on the border of small stands of forest and woodlands next to fields. These optimal tick environments are closer to people than they may be in other areas where there is more urbanization or extended suburbanization alongside industrial parks instead of fields and forest.

    Bavaria is particularly awful for Lyme Borreliosis. High number of infected ticks. Increased opportunities for exposure - people live much closer to environments ticks love. And no surprise: Increased number of Lyme Borreliosis cases we do know about.

    "Of course not all will develop a severe chronic case like yours. But if "only" 1 million is severely handicapped that's an enormous problem!
    So it's urgent to find a way to deal with millions of LB patients "around the world" which is "manageable".


    Whatever the actual number of cases, this is a big problem and a growing problem. Chronic illness is a big problem for anyone suffering with it. We need much better prevention and early diagnosis for tickborne disease - and also more effective treatment for late and chronic infection.

    "I was aware of this for 2 decades by now. High dose long time ABs (even combinations) as propagated by ?LDMDs and pressure groups is NO solution! That's why I am so frustrated that "nobody" seems to take notice of my simple and cheap pulse- / interval dosing scheme with doxycyline (first line AB for LD, including NB)."

    I think that pulsed antibiotics should be studied more closely. That and combination therapies - and not just antibiotic combinations, but antibiotics alongside immune modulating therapies which are targeted. ( Refer to VGV-L)

    "Since such simple approaches obviously are ignored by both sides (my own experience over more than 10 years by now) my hope is sort of a grass roots movement to test if the pulse - interval - scheme with doxy might solve MUCH of the problem (the controversy), certainly not all of it."

    What do you suggest for organizing and funding this sort of study? A kickstarter, microryza, or some other online crowdfunding site for research? Who do you think would be willing to conduct such a study, and would you try for animal studies first?

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  6. Hello CO,
    because I took time to write I tried to post many comments under different headings, ?most of which seem to have disappeared after hitting the "Publish" button, I lost my ?overvies. Now I used Google to find your (first / only?) reply, some 4 days after it was posted.

    At first a correction: 80 million is the population of Germany (roughly 1/4 of the US population). Dieter Hassler et al. in 1992 reported an incidence of ca. 0.4% per year (from memory) for the rural community of Muenzesheim (near Heidelberg) of ca. 3000, where he is the GP. According to his observations over many years the B.b infection ALWAYS is chronic. Therefore without cures (by ABs) you would arrive at a prevalence of about 50 x 0.4% = ca. 20% at age 50, which is close to 20-25% at age 50...60 years, which can be taken from a graph in that paper. (All from my memory - I don't have the paper at hand; but my memory has improved a lot with my interval dosing scheme over more than a dozen years...)

    He found 207 "seropositives" among more than 1200 tested, and 11 more with a clinical diagnosis of LB, but "seronegative": so his over-all average was ca. 18% (all ages).
    If that would apply to the whole German population of 80 mio we would arrive at a prevalence not far from 15 mio. But the real number will be lower for at least two reasons:
    --- Northern (and propably eastern) parts of Germany have a lower incidence, as far as I am aware (so the average for the whole country will be lower).
    --- Of course quite a few of those infected (without NB = neuroborreliosis) will be cured, many of them unintentionally in the course of AB therapy for another indication.
    (Migraine often seems to be caused by LB: it has been reported that migraine disappeared or was much improved after eradication therapy for chronic H.pylori infection. I became aware of a similar case in a collegue who got AB therapy for pneumonia. That's indirect evidence - and simply ignored! How high could the cure rate for headaches be? When my LB became symptomatic under severe stress in the early 90s I got headaches for the first time in my life, not counting sinusitis one or two times in early years. Those headaches have disappered completely for maybe 10 years by now, after a few years of "experimentation" with a number of different ABs.)

    That's the basis for my VERY ROUGH estimation of 10 mio chronically infected with B.b for the whole of Germany. Most of them may have "minor" symptoms like headaches (i.e. migraine), some arthalgias, maybe cardiac arrythmias (one of my few signs: several 100 ventricular extrasystoles per hour from 1991 onward, NOT cured by costly i.v. ceftriaxone in 1993 or 1995, but by cheap doxy early in 1996, after 5 years) and a number of other "unspecific complaints", psychiatric symptoms "ignored" by Hassler...

    Hassler after 20 years of GP work and research presented findings on SPIEGEL online:
    http://www.spiegel.de/wissenschaft/mensch/lyme-borreliose-die-ewige-krankheit-a-558170.html
    Of course it's in German; if you have someone to translate, I might add a few comments. (I.e. on Hassler's low ?opinion on doxycycline: I'm convinced that doxy definitely is BETTER than ceftriaxone and cefotaxime, which Hassler promotes, obviously in close association with the producer of cefotaxime, Hoechst ---> Aventis... They sponsored his decade long research...)
    (To be continued in another comment - I hope I do not reach the 4000 something limit of ?keystrokes with this first part...)

    ReplyDelete
  7. (Second part of 3:)
    You are right with your thoughts on tick abundance and infection risk (i.e. in Germany). What's "needed" is:
    --- suitable vegetation (meadows, scrubs, brush, forest borders..),
    --- relatively high humidity (else ticks will die from desiccation),
    --- mammals small and large. (Even lizards here can carry lots of ticks, but I do not know if B.b is passed from one tick to others this way.)

    Neurologists and psychiatrists in Germany practically ignore LB. So there is NO CHANCE for a clinical study. Own experience with a psychiatry professor:

    From medical literature it can be learned that neuroborreliosis = NB is a very important cause of depression (major ... bipolar...).Years ago, after a lecture I tried to discuss this with the professor - and he really got angry: psychiatry had "LOST" the whole spectrum of psychiatric sequelae of syphilis to neurology -- it may not be that another large ?chunk of psychiatric diseases should be lost!
    Such "professors" profess that they mind their business (i.e. enough psych. patients to "make a living" / have a career perspective..), not public health or the suffering of patients and family members / friends!

    The division into psychiatry and neurology is a catastrophe! It began more than 100 years ago and was strongly opposed by famous "nerve doctors", e.g. Prof. Karl Bonhoeffer. But "divide and impera" succeeded. Now neurologists can (and do) declare difficult / unwanted patients as "psycho-somatic", "somatoform" and send them to psychiatry docs and psychologists...
    And ALL of them (together with "big pharma" etc.) oppose clarification of the "root causes" of neuropsychiatric diseases, from headaches and "endogenous" (etc.) depression, panic disorder over MS, ALS, Parkinson's to the dementias, schizophrenia...

    From the view of professional groups the early cure or control of these "bread & butter" neuropsychiatric diseases would be an awful "catastrophe", be it in Europe, America or elsewhere. With some "insider" knowledge of these mechanisms (including the very successfull lobbying of politicians / governments etc., including the large public health institutions) I have no hope for any support for a "pulsing scheme study" with cheap doxy from the "disease industry" including public institutions, as I call it. Not for years with the present ignorant attitude.

    A "grass routes" approach would begin with the spread of the idea via discussion boards, ?"words of mouth" (self help groups) etc. Once a few hundred persons have tested it personally (and find it effective / helpful) a more organized ?propagation / promotion of the concept could be started. I'm a scientist, not a PR professional: others would have to work out a strategy, the best moves.

    Presently I try to figure out an argument to advocate the "pulsing" approach.
    Health needs a ?competent immune defence. It seems to be true that the immune system needs lots of "stimulus" (i.e. hygiene possibly has major drawbacks: more allergies etc.).

    In chronic LD the immune defence should be in control, no LLMDs with "tons" of ABs! How can the immune system be TRAINED to fight down B.b? High dose long term antibiotics are ?contraproductive! If you are a runnner for example you have to TRAIN your muscles, not drive your car all the time or take a taxi, a bus or train (= ABs)!
    That training should be "continuous", without pausing over months.

    (Well: the limit of 4096 forces me to divide my comment one more time...)

    ReplyDelete
  8. A coach will help: that could be the pulses of doxy once a month (as I have done for more than a decade by now) or maybe every other week in cases of high stress / a somehow depressed immune system. (Individuals certainly are different in that respect.)

    The "pulse" will kill - or possibly only strongly impair - "active" spirochetes, which then are cleared by the immune defence: this is the training that is NEEDED to keep chronic infections (i.e. LD, NB) and the signs and symptoms (suffering) continuously under control.

    That could be a third "camp": neither ignorance / denial of causal therapy on the one side (Steere, Wormser etc.) nor "massive strikes" with ABs by "LLMD"s, but recognition of the immune defence of each patient as the central ressource, which has to be trained, strengthened, not ?overridden by massive AB "therapy", "over-kill".
    chen-men "

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  9. Animal studies? No.
    Take animal studies in MS, which almost certainly is a special / severe (demyelinating) form of NB / neuroborreliosis: Over decades researchers did not
    --- find a really good / close animal model of MS,
    --- are ignorant about the root cause of MS, and
    --- have NOT found a reliably effective and tolerable (risk/benefit...) therapy, which - ignorant of the cause - is hard to achieve!

    Prof. Gabriel Steiner in a 1922 review showed that the hypothetical infection causing MS obviously is transmitted by ticks (MS patient histories / epidemiology). About a decade later he had documented spirochetes - morphologically borreliae - in MS lesions in the brains of deceased patients.

    As soon as antibiotics became available he knew what to do: test them for effectiveness in MS! (See his final monograph "Die multiple Sklerose", Springer Verlag 1962, three years before he died.) Unfortunately suitable lipophilic ABs like doxycycline became available too late to be tested by him. His work was ignored, "forgotten"... (One study was begun in Germany: if I had more time I might look for results - but that is VERY difficult after half a century, and they, too, tested penicillin and / or tetracycline, as far as I remember, which both do not penetrate the (intact) blood-brain barrier.)

    Meanwhile, after almost half a century of extremely broad experience with doxy, it is the first line AB for NB in Sweden (see also G.Stanek, Vienna, LB ?"guidelines" for Austria: doxy for all forms of LD, except for children).

    Doxy is the premium AB with respect to tolerability, as far as I know. It has been shown to be effetive in the prevention of leptospirosis (taken once per WEEK, if I remember correctly) as well as prevention of LD with a single 200mg dose within ?3 days after a tick bite, which could not have been predicted from textbook knowledge on doxy.
    It's quite easy to test for new indications etc. with a drug with such good tolerability and safety profile as doxy.

    The "pulse" dosing scheme has been demonstrated by Hassler & Preac-Mursic with cefotaxime i.v. more than a decade ago (seems to have been adopted for an LB therapy guideline from Eastern Europe (or Russia?) you presented?).
    So there is some knowledge on "interval dosing" available.

    Anybody willing to test (oral!) doxy for NB i.e. can start with continuous dosage for a few weeks as is done in Sweden, then continue with a pulse scheme, i.e. start with an interval of 1 week, then 2 weeks... - there is total flexibility.
    There are suggestions to take oral doxy after an i.v. AB course: that might be a starting point also.
    (To be continued in a second part.)

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  10. (Second part of 3.)
    When I started to "experiment" with doxy pulses in the second half of the 90s I first imitated the Preac-Mursic-(Hassler)1week interval, but with 2 days doxy with an initial "loading dose" to allow the doxy to reach close to equilibrium in the CNS, which of course takes some time: 300-100-100-100-100-100 mg with 8 hour spacing (+/- 1-2 h) ---> 800 mg/2d. The concentrations in blood / tissue, including the CNS, will fall off within 2-3 days, so with 1week cycles there remains little interval for the immune defence to get some "training" without doxy. Therefore 2 weeks seems (more) reasonable to me.

    Because a person of my weight then would need ca. 200 x 100 mg per year, which a doc has to prescribe, at times it could be difficult to obtain that much - unless you have a doc fully cooperating.
    A larger pulse interval means less doxy required (and less doxy reaching the sewage...), therefore I increased the interval further and had the impression that 4 weeks work with me.

    So I would suggest for participants in sort of an informal "pilot study" of a doxy interval dosing scheme (which should run over more than a year, better 2 years or more) to increase or choose the interval according to their "feeling" of effect, patience required. (We have to trust into the ability of a patient to find out for him- or herself - just as you do in any measures in a moderately severe cold, for example!)

    Over time the experience of many individuals could be used to devise some sort of advice / suggestion - sort of an informal guideline? - for others.
    If and when some ?consensus has been reached an LD "institution" might ask a professional research team or institution (e.g. the MRC / Med. Reseach Council in GB? A WHO body, i.e. WHO Europe?) to organzie a formal study.

    I will not try to do this: there's an awful lot of work / "pushing" to be done to get ahead with the clarification of the "root causes" of MS, Parkinson's, dementias, strokes, depressions, panic disorders... - and a lot more.

    I will gladly help with what I know about the effects of doxy in chronic NB.
    (Two persons started with an interval scheme this year, but without a diagnosis of LD or NB - just on the probability that a chronic CNS infection with B.b or some other microorganism(s) susceptible to doxy might be the "root cause" of their chronic, more or less progressive health problems.
    In conditions with a highly variable course it will take time to arrive at a cautious judgement of effect. It was a big problem for G.Steiner in his early AB therapy studies in MS patients in Detroit that the MS course is so extremely variable.
    (To be continued in a final part.)

    ReplyDelete
  11. So it's important to collect any information that might be of help. An example:
    An MS patient - when confronted with the possibility that MS might be controlled by mino- or doxycycline - remembered to have taken minocycline for a mild form of acne over a period of 11 years, but interrupted by two periods without, a pregnancy with some time after delivery and another pregnancy or something else. As long as she was on minocycline (at low dose!) she was free of MS symptoms (bouts), which only happened when off the drug.
    (This also demonstrates that a still more or less hypothetical infection causing MS is chronic, "suppressed" by low dose minocycline, but "reappearing" without the AB, several times "on" and "off" over 11 years.)

    NB also is quite variable ("The new great imitator"...): we have to collect experiences in humans, victims, not infect animals!
    (I never had a dog: dog owners might know if there is anything like NB in dogs - and of course could try a pulse scheme in them too. Why not? They have to get the doxy from a veterinarian, so they can and should discuss details with the animal health specialist. - In passing: tetracyclines have been added to animal feed in many countries over decades: it appears that those animals were more healthy - possibly because the AB prevented LB in them? ---> No LD, no NB!? No "depression", no "mad cows"? Is there NB in cows, for example? I don't know, but wouldn't be surprised...)
    chen-men

    ReplyDelete
  12. To Anonymous (November 9) who appears to be Chen-Men who has been posting comments on multiple posts on this blog:

    Before I respond to any more of your comments, I'd like to respond to this statement first:

    " I took time to write I tried to post many comments under different headings, ?most of which seem to have disappeared after hitting the "Publish" button, I lost my ?overvies. Now I used Google to find your (first / only?) reply, some 4 days after it was posted."

    Actually, I responded to several of your comments on both November 5 and November 6. I published both your comments and my responses to them.

    I am sorry I cannot respond to every comment each day they are submitted - particularly if they are long and require detailed responses.

    Much as I have written a lot of content for this blog and answered many comments in the past, I am chronically ill and have to pace myself in responding.
    So if you do not see a response within 24 hours, it is either because I need to rest, need more time to respond in detail, and/or something going on in real life prevents me from responding right away.

    In any case I try to respond as soon as I can. On a few occasions I didn't respond to some comments on this blog because either I had no opinion on them or they made a point in and of themselves or they were part of a dialog between other readers of this blog and I waited for them to continue their discussion.

    My responses to your comments from November 5:
    24 hrs post: My comment above.
    The Friday Four: Here.
    Tick Spit: Here.

    My responses to your comments from November 6:
    Tired of Lyme: Here. And here. (2 part comment)
    Lyme Excitotoxin: Here.
    Antibodies Linked: Here.Here.And here. (3 part comment)
    Researchers on Persistence: Here.

    That is a fair amount for me to respond to over 2 days. I recommend reviewing my responses at the above links and seeing if I have addressed some of your questions and comments.

    CO

    ReplyDelete
  13. Anonymous Nov. 9/ suspected Chen Men,

    In the future, if you want to continue a general discussion about Lyme disease, please post comments to the same article.

    If you have a specific comment to make about content in a specific article, then post a comment on that article.

    This makes tracking comments easier for me and easier for you.

    CO

    ReplyDelete

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