Tri J. Burrascano on maailmalla yksi tunnetuimmista borrelioosilääkäreistä. Hän ja muutama muu lääkäri ja tutkija luennoi juuri borrelioosin diagnostiikasta ja hoidosta "Hope to heal Lyme" -konferenssissa . Seuraavassa tekstissä on osa Scott Forsgrenin raporttia konferenssin yhdestä luennosta. Kokonaisuudessaan luennot voi lukea hänen kotisivuiltaan www.BetterHealthGuy.com. Sivuilla on sen lisäksi paljon tietoa borrelioosista, hänen omasta sairaudestaan, sekä erilaisista hoitovaihtoehdoista. Forsgren on hoitanut itseään lukuisilla erilaisilla koululääketieteen ja vaihtoehtoisilla hoitomenetelmillä.
Ote Burrascanon luennosta:
Bakteerilla on 3 eri muotoa: Spirokeettamuoto jota hoidetaan penisilliineillä, kefalosporiineilla jne; L-muoto jolla ei ole soluseinämää hoidetaan tetrasykliineillä ja erytromysiinillä sekä kystamuoto jota on vaikea tuhota - sen hoidossa käytetään metronidatsolia, tinidatsolia ja mahdollisesti Rifampinia.
Varhaisvaiheessa hoitotulokset ovat usein hyvät, mutta noin vuoden kuluttua infektiosta elimistön immuunipuolustus näyttää luhistuvan. Tästä syystä ei tule odottaa positiivisia vasta-ainetuloksia vaan aloittaa hoito välittömästi. Testitulokset tulevat positiivisiksi vasta useiden viikkojen kuluttua infektiosta ja silloin tauti on selvästi vaikeampi hoitaa. Lisäksi monet ihmiset eivät koskaan saa positiivista vasta-ainetulosta. Hoitoaika 4 -6 viikkoa. Tätä lyhyemmät hoidot eivät välttämättä tuo hyvää lopputulosta. Edetessään tauti vaikuttaa useisiin eri elimiin ja sitä on huomattavasti vaikeampi hoitaa. Hoitoaika on yleensä useita kuukausia. Kroonisessa vaiheessa (yli vuosi infektion alkamisesta) immuunipuolustuksen toiminta on selvästi heikentynyt. Tässä vaiheessa borrelioositestit ovat mm. siitä syystä erittäin epäluotettavia. Hoidon tulee olla agressiivinen ja kestää pitkään.
Vain n. 17 % ihmisistä muistaa nähneensä punkinpureman itsessään, n. 36 %:lle muodostuu ihomuutos ja vain noin puolet saavat positiivisen vasta-ainetuloksen (Elisa ja/tai immunoblottaus; Western Blot). Testit eivät siis tunnista noin puolta borrelioositapauksista. Vääriä positiivisia tuloksia on sen sijaan vain noin 5 - 10 %. Burrascano ehdottaa sen sijaan CD57 -testin suorittamista 3 - 6 kk:n välein. Arvon ollessa alle 20 tauti on vaikea, kun arvo nousee yli 120:een paraneminen on todennäköinen ja taudin uusiutuminen ei ole enää todennäköistä.
Hope to Heal Lyme 2007
Dr. Joseph J. Burrascano - Lyme Disease Diagnosis and Treatment
Dr. Burrascano started with a broad definition of Lyme disease. He described it as "the illness that results from the bite of an infected deer tick". Personally, I felt this definition was both broad and restrictive. I see it as broad given that it clearly suggests that there is much more than Borrelia burgdorferi that impacts us when we have chronic Lyme disease. It is restrictive however in that it is my opinion that means of transmission are much more broad that the bite of a deer tick.
Stages of Illness
Three stages of illness were discussed. Dr. B. noted that something happens to the body after about one year of illness and the immune system breaks down. He suggested the following three categories:
? Stage I ? Early Lyme ? the time before or when symptoms appear. At this stage, the disease can be entirely cured in many cases with appropriate early intervention. It is a mistake to wait for positive blood tests to start treating. By the time the tests turn positive several weeks after being infected, the disease is much more difficult to treat. On top of that, many people will never get a "positive" test result. It is important to be the most aggressive at this stage since this is the stage that may actually be curable. 4-6 weeks of antibiotics generally recommended. Shorter courses result in higher number of failures. Even at this stage, Lyme has spread to many areas of the body including the CNS.
? Stage II - Disseminated ? many body systems are involved and the disease becomes more difficult to treat. May be present even if tests are negative. Dr. B. suggested looking for symptoms that move from place to place and vary over time. Treatment at this stage is generally several months or longer.
? Stage III ? Chronic Lyme disease ? this is defined as one or more years of infection resulting in the breakdown of the immune system. Dr. B. pointed out that this is the stage where serologic (blood) tests are the LEAST reliable given that most of them are looking for immune response to the antigen (infections) and most people in this stage do not have what it takes to mount any such response. At this stage, the treatment has to be aggressive and of long duration.
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Only 17% of people recall a tick bite and only 36% of people develop a characteristic rash. Just over half (50-70%) of people will have a positive ELISA or Western Blot. Dr. B. does not even use the ELISA test. (Personal note: If a doctor suggested running the ELISA as a screening test for Lyme, I would turn and run for the door.)
Lyme has a 4 week regeneration cycle. If you have symptoms, you must be treated at least one month, if not longer, beyond the end of symptoms.
Tests miss 30-50% of cases of Lyme. The ELISA is false positive 5-10% of the time. CSF (spinal tap) is positive only 9% of the time and PCR generally positive 30% of the time or less and this requires being done many times. The Lyme urine antigen capture test has similar positivity rates to the PCR. None of these are good tests.
In terms of symptoms, onset is often gradual starting with fatigue, stiff neck, aches and pains, and headaches. May observe joint pain or arthritic symptoms. The nerves and brain later become involved.
CD57 ? lower counts are often observed in people that have been ill longer than one year. The test can reflect the severity of illness. It may be a helpful screening test. It is a good predictor of relapse at cessation of treatment. The following ranges are suggested:
20-60 most common in chronic Lyme disease
> 60 Lyme activity minimal
> 120 Relapse not likely when treatment ends
Dr. B. suggested that testing CD57 about every 3-6 months is appropriate. He noted that if often jumps towards the end of treatment and that it is not a linear improvement in all cases.
(Personal Note: I have found this test to be very useful and it has tracked well with my recovery. I did not do the test at my sickest as I was unaware of it at that time. However, after several months of treatment, my CD57 was 65. It later went to 84. Later to about 130 and most recently to ~160. My personal desire is to see it over 200 before stopping treatment but based on Dr. B?s comments, ~160 suggests that stopping antibiotics may soon become a reality!).
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Dr. B. discussed a point system that he devised that can be helpful in determining whether or not someone has Lyme disease. The point system is discussed in his published protocol which is available here.
He pointed out what should be common knowledge by now but sadly is not in the minds of many doctors ? that is that Lyme is a CLINICAL diagnosis. The best tests available only help to support a diagnosis. All tests can be negative and Lyme may still be present.
For disseminated Lyme, treatment should be continued for at least six weeks beyond resolution of symptoms. Combination therapy is often required. Sicker patients often require 6-12 weeks of IV followed by oral or injectable antibiotics.
Chronic Lyme is much more complex. It is often the stage that is the most difficult to diagnose. The range of presentation of illness is large; from subclinical to debilitating. The infection is very difficult to treat at this stage and may not be curable.
Why are chronic Lyme patients more ill? There are often higher spirochete loads observed as either a result of having been infected longer or as a result of multiple exposures. Borrelia finds compartments in the body where immune surveillance is limited and essentially evades our immune system. Our immune systems become suppressed and numerous other co-infections take up residence.
Many other conditions are often observed in people with chronic Lyme disease. These include:
? Encephalitis ? can be observed on scans such as PET and SPECT. Areas of decreased blood flow are present. The scans are not diagnostic but can support that disease is not psychosomatic. Scans can be done over time to show progress.
? Neurotoxins ? Borrelia produces neurotoxins. These cause further dysfunction in our nervous systems and increase cytokines which increase inflammation. Neurotoxins can impact hormone receptors. Testing for neurotoxins is done using the VCS (Personal note: I wrote about this test in the Public Health Alert. A link is available on the "My Articles" page on my site.) Cytokine levels can be measured. Tests for insulin resistance are useful. Treatment is with "bile acid sequestrants" such as
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cholestyramine. (Personal note: I wrote about the Biotoxin Pathway in a recent edition of the Public Health Alert. That article is also available here). Hormones find binding sites. These binding sites / receptors are often blocked by toxins. Hormone levels in the blood may look adequate but if the receptors are blocked by neurotoxins, problems result.
? Heavy metals ? presence increases symptoms especially neurological. Weakens immune system and results in more severe illness. Metals prevent recovery. Should always be suspected in patients with increased neurological symptoms are patients that are slow to respond to treatments. (Personal note: I think heavy metals are a much more significant issue than most people recognize. Treatment protocols that do not address the presence of metals are often ineffective.) Heavy metals poison our immune system and damage our nervous systems. Over 90% of people that do not respond to treatment have a heavy metal issue.
? Hormonal issues ? lack of energy and stamina, loss of libido, exercise intolerance, weight gain, hypersensitive to surroundings/environment
? Neurally mediated hypotension ? dehydration, adrenal/pituitary insufficiency. Profound fatigue and often need to lie down. Diagnosed with tilt table test and hormone evaluation.
Approach to Treatment
Must achieve therapeutic levels in the blood. It is critical to measure peak and trough levels. Peak levels should be measured about 1 hour after having taken antibiotics and trough levels 1 hour before next dose.
It is important for the antibiotics chosen to be effective for both extracellular and intraceullar infection. This is why it is important to consider combination therapies. Borrelia can survive in both inside and outside of the cells. They must further work on both bodily fluids and in tissues as Borrelia lives in both.
Types of Antibiotics
? Cell-wall agents ? must sustain high levels for 72 hours to be effective.
? Doxycycline and macrolides such as Biaxin and Zithromax ? Need a spike in blood levels. Taking at one time during the day is better than taking throughout the day. IV is better here to obtain a spike.
? Metronidazole requires sustained level for at least 2 weeks.
Forms of Borrelia
? Spirochete ? has a cell wall. Penicillins, cephalosporins, Primaxin, Vancomycin
? L-Forms ? has no cell wall. Tetracyclines and Erythromycins.
? Cyst ? protected form. Difficult to kill. Use Flagyl, Tinidazole, and possibly Rifampin,