P.Weintraub: Borrelioosiepidemia - hoito tuntematon.
Weintraub käsittelee kirjassaan mm. borrelioosin diagnostiikasta ja hoidosta käytävää, aika ajoin voimakastakin, mielipiteidenvaihtoa.
http://lymeblog.com/modules.php?name=Ne ... =0&thold=0
Book Review: Cure Unknown: Inside the Lyme Disease Epidemic
http://www.amazon.com/gp/redirect.html? ... ative=9325
Lexington, KY USA
By Rita L. Stanley, Ph.D., LymeBlog News editor
Finally, coming soon is a must read for anyone who craves an intelligent insightful account about Lyme disease and the controversies surrounding the illness: Cure Unknown: Inside the Lyme Disease Epidemic by Pamela Weintraub (Saint Martins Press).
Well established science writer, and now senior editor at Discover, Pamela Weintraub spent countless hours interviewing key players in the Lyme disease saga and researching exhaustively to come up with the definitive Lyme disease story. She also grappled with the infection personally as a patient and as part of a family with Lyme disease.
The foreword is written by Hillary Johnson, author of Osler?s Web ,the groundbreaking book about chronic fatigue syndrome that zeroed in on the relentless government and medical opposition in recognizing the legitimacy of the illness.
With a solid background in science journalism, editorial positions, and book authorships, Weintraub is one of the very few who possessed the skills, scientific chops and personal experience needed to tackle such a project.
Literally years in the making, this book will undoubtedly become a benchmark in how Lyme disease is regarded in years to come.
Cure Unknown: Inside the Lyme Disease Epidemic is set to be released this spring. It is available for presale at Internet bookstores such as Amazon.com and Borders.com.
Book Description (from Amazon.com)
A groundbreaking and controversial narrative investigation into the science, history, medical politics, and patient experience of Lyme disease told by a science journalist whose entire family contracted the disease.
Pamela Weintraub paints a nuanced picture of the intense controversy and crippling uncertainty surrounding Lyme disease and sheds light on one of the angriest medical disputes raging today. She also reveals her personal odyssey through the land of Lyme after she, her husband and their two sons became seriously ill with the disease beginning in the 1990s.
From the microbe causing the infection and the definition of the disease, to the length and type of treatment and the kind of practitioner needed, Lyme is a hotbed of contention. With a CDC-estimated 200,000-plus new cases of Lyme disease a year, it has surpassed both AIDS and TB as the fastest-spreading infectious disease in the U.S. Yet alarmingly, in many cases, because the disease often eludes blood tests and not all patients exhibit the classic "bulls-eye" rash and swollen joints, doctors are woefully unable or unwilling to diagnose Lyme. When that happens, once-treatable infections become chronic, inexorably disseminating to cause disabling conditions that may never be cured.
Weintraub reveals why the Lyme epidemic has been allowed to explode, why patients are dismissed, and what can be done to raise awareness in the medical community and find a cure. The most comprehensive book ever written about the past, present and future of Lyme disease, this exposes the ticking clock of a raging epidemic.
?Pamela Weintraub's book is compelling, clear and troubling.?
?Patti Adcroft, editorial director of Discover magazine
?In Cure, Unknown, Pamela Weintraub has produced both the definitive book about Lyme disease and associated disorders and a survivor?s account of a grueling medical odyssey.
Weintraub is a masterful science writer and storyteller, and she tackles the quarrels and quagmires surrounding this baffling illness with intelligence and pathos. This is an important and unforgettable book, destined to make a lasting contribution to the field of investigative health journalism.?
?Kaja Perina, editor in chief of Psychology Today
B. Rosner 2008. Chronic Lyme disease: Real disease or Medical myth?
Rosner esittää kirjassaan taustaa sille miksi jotkut Amerikan infektiotautien järjestön edustajista ovat ottaneet sen kannan että kroonista borrelioosia ei ole olemassakaan. He ovat sitä mieltä, vaikka lukuisat tutkimukset ovat osoittaneet (myös suomalaisia tutkimuksia) bakteerin kykenevän selviytymään elimistössä pitkistäkin antibioottihoidoista huolimatta. Rosnerin kirjassa esitellään esim. allaolevat muutamat tutkimukset joissa bakteerin selviytyminen on todettu. Ensimmäisessä tutkimuksessa tsekkiläiseltä naiselta löydettiin borrelibakteeria (elektronimikroskooppinen tutkimus) kudoksista, nivelnesteestä ja verestä antibioottihoidon jälkeenkin.
Saksalaisten tutkimusten mukaan antibioottihoitojen epäonnistumisia on havaittu toistuvasti kaikkia käytettyjä antibiootteja kohtaan. Tutkimuksissa oli löydetty myös epätyypillisiä bakteerimuotoja. Antibioottihoidot eivät välttämättä auttaneet edes ihomuutosvaiheessa. Ihomuutos saattaa pysyä tai ilmaantua uudelleen hoidosta huolimatta. Hoidon epäonnistumisia on tässäkin vaiheessa havaittu kaikilla käytetyillä antibiooteilla.
Turussa tutkittiin 165 pidemmälle edennyttä borrelioosia sairastavaa henkilöä antibioottihoitojen jälkeen. 10 %:ssa tapauksista bakteeri löydettiin edelleenkin verestä PCR-testillä. (Suom.huom. Mielenkiintoista että testiä edes tehtiin verestä sillä yleensä laboratorioiden mukaan bakteeria on erittäin vaikea saada kiinni verinäytteistä eikä sitä sen vuoksi suositella käytettäväksi. Bb pakenee tunnetusti nopeasti pois verenkierrosta eri puolille elimistöä. Elektronimikroskooppista tutkimusta ei jostakin syystä näytetä käytettävän näissä tutkimuksissa vaikka useissa tutkimuksissa juuri sillä menetelmällä bakteereita on löydetty.)
Kirjan yksi kappale on luettavissa kokonaisuudessaan sivulta
The science is clear
Let's start by examining the findings of the Institute of Rheumatology, in Prague, Czech Republic. Physicians in Prague report a case of a female patient suffering from Lyme Disease. Her case was confirmed by detection of Borrelia garinii DNA present in her blood and synovial fluid. After treatment with antibiotics, symptoms persisted and six months later, Borrelia garinii DNA was "repeatedly detected in the synovial fluid and the tissue of the patient." Additionally, even after antibiotic therapy, antigens and parts of spirochetes were detected by electron microscopy in the synovial fluid, tissue, and blood.
A similar discovery was made in Germany at the University Hospital of Frankfurt. Researchers describe Lyme Disease as a "disorder of potentially chronic proportions." They also note that "therapeutic failures have been reported for almost every suitable antimicrobial agent currently available and resistance to treatment...continues to pose problems for clinicians in the management of patients suffering from chronic Lyme Disease." Another University in Germany, Ludwig-Maximilians-University, located in Munich, reported that "failures in the antibiotic therapy of Lyme Disease have repeatedly been demonstrated by post-treatment isolations of the infecting Borreliae."
One of the most interesting German studies, completed at Ludwig-Maximilians-Universitat Munich, attributed the clinical persistence of Lyme Disease after antibiotic therapy to the presence of variants and atypical forms of B. burgdorferi. In fact, similar to the conclusion I draw in my book Lyme Disease and Rife Machines, German researchers conclude that "B. burgdorferi produce spheroplast- L-form variants...these forms without cell walls can be a possible reason why Borrelia survive in the organism for a long time (probably with all beta-lactam antibiotics) and the cell wall-dependent antibody titers disappear and emerge after reversion."
Researchers at the University of Dermatologische Privatpraxis, Munich, Germany, agree with their German peers in a 1996 study which notes that patients with erythema migrans can fail to respond to antibiotic therapy. ?Persistent or recurrent erythema migrans, major sequelae such as meningitis and arthritis, survival of Borrelia burgdorferi and significant and persistent increase of antibody titres against B. burgdorferi after antibiotic therapy are strong indications of a treatment failure. Most, if not all, antibiotics used so far have been associated with a treatment failure in patients with erythema migrans.?
In Austria, in 2001, the Lainz Municipal Hospital in Vienna admitted a 64 year-old woman who presented with various systemic symptoms hinting of Lyme Disease. Spirochetes were detected in samples of her skin lesions. Shortly thereafter, a diagnosis of Lyme Disease was made. According to doctors, "despite treatment with four courses of intravenous ceftriaxone for up to 20 days, progression of [Lyme symptoms] was only stopped for a maximum of one year.? A nearby hospital in Graz, Austria, studied four cases of verified late stage Lyme Disease and found that serology was Lyme-positive even after repeated courses of high-dose intravenous penicillin-G and/or cephalosporins. Itävaltalainen nainen sai 4 suoensiäistä antibioottihoitoa ja siitä huolimatta Borreliosioireet palasivat. Pisimmillään oireet pysyivät poissa vuoden ajan.
Researchers at the Turku University Central Hospital, Finland, conducted a study in which 165 patients with disseminated Lyme Disease were followed after antibiotic treatment. Approximately 10% of the patients experienced a clinical relapse with positive PCR tests and spirochetes successfully cultured from the blood of the patients. Note, in this case, that the Lyme Disease relapse was not evidenced only by continuing symptoms, but also by two independent testing methods: both PCR testing and blood culture. This single study, even without aid from the numerous other studies presented in this chapter, should be enough to call into question the IDSA's staunch and dogmatic stance on chronic Lyme Disease.
Italy also has experience with chronic Lyme Disease. In 1992, the Universita di Genova, located in Genoa, Italy, reported on two patients with "chronic Lyme arthritis resistant to the recommended antibiotic regimens." These patients were eventually cured by long term treatment with benzathine penicillin. The Italian researchers who conducted this study offered two possible reasons why antibiotic therapy finally worked, and both of these reasons involve active, persistent infection: "the sustained therapeutic levels of penicillin were effective either by the inhibition of germ replication or by lysis of the spirochaetes when they were leaving their sanctuaries."
Moving across the globe to Thailand, scientists at KhonKaen University write that "Electron microscopy adds further evidence for persistence of spirochetal antigens in the joint in chronic Lyme Disease. Locations of spirochetes or spirochetal antigens both intracellulary and extracellulary in deep synovial connective tissue as reported here suggest sites at which spirochetes may elude host immune response and antibiotic treatment."
In France, a study was published in the Journal of Antimicrobial Agents and Chemotherapy in 1996, conducted by the University of Marseille. The study notes that "despite appropriate antibiotic treatment, Lyme Disease patients may have relapses or may develop chronic manifestations."
It would be understandable for the IDSA to neglect, or at least take less seriously, research conducted outside the borders of the United States, since the IDSA is an organization that operates inside, and is accountable to, U.S. citizens and the U.S. government. However, as we move in to examine studies conducted in the United States, you will see that a significant portion of the evidence in favor of chronic Lyme Disease actually originated here on American soil.
In 1996, the Fox Chase Cancer Center in Philadelphia, Pennsylvania, conducted a study in which it was discovered that urine samples from 97 patients clinically diagnosed with chronic Lyme Disease contained Borrelia Burgdorferi DNA. The interesting aspect of this finding is that most of these patients had previously been treated with extended courses of antibiotics, the implications of which are simply that antibiotic therapy (even extended courses) does not always eradicate the infection. The study concludes that "a sizeable group of patients diagnosed on clinical grounds as having chronic Lyme Disease may still excrete Borrelia DNA, and may do so in spite of intensive antibiotic treatment."
The State University of New York at Stony Brook conducted a study in 1996 to determine which of two types of antibiotic (azithromycin or amoxicillin) is more efficacious for the treatment of early Lyme Disease. The study found that amoxicillin was more effective than azithromycin. However, more interestingly, patients from each group did experience relapses despite antibiotic therapy.
While the IDSA was releasing their guidelines in which it was concluded that chronic Lyme Disease is not a medical condition that justifies extended antibiotic therapy, researchers at the New York State Psychiatric Institute were discovering just the opposite. The authors of a report produced at that institution describe a case of fatal neuropsychiatric Lyme Disease that was "expressed clinically by progressive frontal lobe dementia and pathologically by severe subcortical degeneration." When describing the situation, doctors note that "antibiotic treatment resulted in transient improvement, but the patient relapsed after the antibiotics were discontinued...prolonged antibiotic therapy may be necessary [in some cases]."
In Boston, Massachusetts, researchers at Tufts University School of Medicine encountered similar findings when investigating Borrelia's ability to attach to and invade human fibroblasts in vitro. "By scanning electron microscopy, B. burgdorferi were tightly adherent to fibroblast monolayers after 24-48 hours but were eliminated from the cell surface by treatment with ceftriaxone (1 microgram/mL) for 5 days. Despite the absence of visible spirochetes on the cell surface after antibiotic treatment, viable B. burgdorferi were isolated from lysates of the fibroblast monolayers. B. burgdorferi were observed in the perinuclear region within human fibroblasts by laser scanning confocal microscopy. Intracellular spirochetes...were also identified by fluorescent laser scanning confocal microscopy. These observations suggest that B. burgdorferi can adhere to, penetrate, and invade human fibroblasts in organisms that remain viable.?
In a separate report, Tufts University researchers conducted a study to investigate neurologic abnormalities found in chronic Lyme Disease sufferers; 27 patients were followed. Six months after a two-week course of intravenous ceftriaxone (2 g daily), 17 patients showed improvement, 6 had improvement but then relapsed, and 4 had no change in their condition. Researchers conclude that "months to years after the initial infection with B. burgdorferi, patients with Lyme Disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis." With regard to the cause of chronic Lyme Disease, Tufts University implies a bacterial origin with their closing statement in the study: "These chronic neurologic abnormalities usually improve with antibiotic therapy."
In 1992, Tufts University presented a hypothesis which might explain how Lyme Disease bacteria become resistant to antibiotics and host immune response. Researchers note that "since B. burgdorferi first infects skin, the possible protective effect of skin fibroblasts from antibiotics was examined. We found that human foreskin fibroblasts protected B. burgdorferi from the lethal action of a 2-day exposure to ceftriaxone." The researchers conclude that "the Lyme Disease spirochete, Borrelia burgdorferi, can be recovered long after initial infection, even from antibiotic-treated patients, indicating that it resists eradication by host defense mechanisms and antibiotics."
At Thomas Jefferson University, Philadelphia, Pennsylvania, urologists who treated seven patients with Lyme Disease found that "neurological and urological symptoms in all patients were slow to resolve and convalescence was protracted...relapses of active Lyme Disease and residual neurological deficits were common."
In direct opposition to IDSA statements, researchers at the Department of Pathology, Southampton Hospital, New York, note that active cases of Lyme Disease may show clinical relapse following antibiotic therapy. It is noted that "the latency and relapse phenomena suggest that the Lyme Disease spirochete is capable of survival in the host for prolonged periods of time." In their studies of 63 patients with Lyme Disease, the researchers conclude that "some patients with Lyme Borreliosis may require more than the currently recommended two to three week course of antibiotic therapy..."
Also in the State of New York, the New York University School of Medicine conducted a study which evaluated antibiotic treatment of 215 patients between the years 1981 and 1987. Of those with "major" Lyme Disease manifestations, a relapse rate of over 20% was observed.
This next study is interesting for several reasons, as we will see. The Albert Einstein College of Medicine, New York, reported in 1995 an "unusual" case of Lyme Disease in which the patient experienced repeated neurologic relapses despite aggressive antibiotic therapy. What makes this study interesting is that each subsequent course of antibiotics given after the relapses was followed by Jarisch-Herxheimer reactions, which are known to occur only when active bacteria are dying, which implies that active bacteria were still present in the body after multiple courses of antibiotics. Additionally, subsequent to the various courses of antibiotics, the patient?s cerebral spinal fluid tested positive "on multiple occasions" for not only complex anti-Borrelia antibodies, but also Borrelia nucleic acids and free antigen proteins. This study demonstrates persistent infection via two separate indicators: repeated Jarisch-Herxheimer reactions, and repeated observation of antibodies and antigens. Both indicators were found after not just one, but multiple courses of "adequate antibiotic therapy" had been administered!
One of the peculiar aspects of the above study is that the patient was referred to as "unusual.? Is this an accurate characterization? Are such incidences really unusual? Actually, they are quite common. In Aurora, Colorado, at the Fitzsimons Army Medical Center, a patient presented with chronic septic Lyme arthritis of the knee. This patient had experienced symptoms for seven years despite "multiple antibiotic trials and multiple arthroscopic and open synovectomies." Polymerase chain reaction (PCR) analysis of the tissue was consistent with Borrelia infection, so a diagnosis of Lyme Disease followed. The most interesting part of this study is that, after the diagnosis of Lyme Disease was made, and after multiple courses of antibiotics were administered, spirochetes were documented in synovium and synovial fluid.
Another similar case observed in Bethesda, Maryland, further calls into question the statement that chronic, persistent Lyme Disease infection is "unusual." Doctors in Maryland working with the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a part of the National Institutes of Health (NIH), report a 40-year-old white man who developed clinical Lyme Disease after being bitten by a tick. He was treated with oral tetracycline, after which his symptoms were resolved. However, at a later date, the man was re-tested and Borrelia was detected by PCR in his peripheral blood leukocytes. After being re-treated with a longer course of ampicillin, probenicid, and concurrent cytotoxic therapy, symptoms improved significantly. This individual's case of Lyme Disease illustrates two important points: First, ongoing symptoms after antibiotic therapy were confirmed by PCR testing to be caused by active bacteria. Second, re-treatment with antibiotics resulted in significant clinical improvement.
Turning our attention back to New York, let?s look at a study conducted on animals at the Baker Institute for Animal Health at Cornell University in Ithaca. Antibiotic treatment of Lyme-infected dogs was studied over the course of 30 days. The study concludes that "B. burgdorferi disseminates through tissue by migration following tick inoculation, produces episodes of acute arthritis, and establishes persistent infection...the spirochete survives antibiotic treatment and disease can be reactivated."
The Baker Institute for Animal Health conducted a second, similar study which drives the point home even more clearly. This time, researchers experimentally infected healthy dogs via tick bites with Borrelia burgdorferi. The infected dogs were then treated for 30 days with high doses of amoxicillin or doxycycline. Interestingly, although symptoms declined significantly after treatment, skin punch biopsies and multiple tissues from necropsy samples remained PCR positive. Moreover, and in direct support of the presence of an actual, persistent bacterial infection, Borrelia organisms were found in post-therapy dogs. Some dogs that were treated with antibiotics were kept in isolation for six months post-treatment. In most of these dogs, after six months, Lyme antibody levels began to increase again, "presumably in response to proliferation of the surviving pool of spirochetes."
In the year 2008, the number of organizations and researchers who do not acknowledge the chronic form of Lyme Disease can be counted on one hand. You want credible evidence? How about the Yale University School of Medicine. In a report published by Yale in September of 2004, researchers describe a newly-discovered ?protective niche for Borrelia burgdorferi? that allows the infection to ?evade immunity? leading to ?chronic infection.? You can add Yale to the list of institutions that acknowledge Lyme Disease in its persistent, chronic form.