Browsing by Subject "Borrelia burgdorferi"

Now showing 1 - 8 of 8

Open Access
Chronic coinfections in patients diagnosed with chronic lyme disease: a systematic review.
(Am J Med, 2014-11) Lantos, Paul M; Wormser, Gary P
PURPOSE: Often, the controversial diagnosis of chronic Lyme disease is given to patients with prolonged, medically unexplained physical symptoms. Many such patients also are treated for chronic coinfections with Babesia, Anaplasma, or Bartonella in the absence of typical presentations, objective clinical findings, or laboratory confirmation of active infection. We have undertaken a systematic review of the literature to evaluate several aspects of this practice. METHODS: Five systematic literature searches were performed using Boolean operators and the PubMed search engine. RESULTS: The literature searches did not demonstrate convincing evidence of: 1) chronic anaplasmosis infection; 2) treatment-responsive symptomatic chronic babesiosis in immunocompetent persons in the absence of fever, laboratory abnormalities, and detectable parasitemia; 3) either geographically widespread or treatment-responsive symptomatic chronic infection with Babesia duncani in the absence of fever, laboratory abnormalities, and detectable parasitemia; 4) tick-borne transmission of Bartonella species; or 5) simultaneous Lyme disease and Bartonella infection. CONCLUSIONS: The medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses.
Open Access
Chronic Lyme disease.
(Infect Dis Clin North Am, 2015-06) Lantos, Paul M
Chronic Lyme disease is a poorly defined diagnosis that is usually given to patients with prolonged, unexplained symptoms or with alternative medical diagnoses. Data do not support the proposition that chronic, treatment-refractory infection with Borrelia burgdorferi is responsible for the many conditions that get labeled as chronic Lyme disease. Prolonged symptoms after successful treatment of Lyme disease are uncommon, but in rare cases may be severe. Prolonged courses of antibiotics neither prevent nor ameliorate these symptoms and are associated with considerable harm.
Open Access
Chronic Lyme disease: the controversies and the science.
(Expert Rev Anti Infect Ther, 2011-07) Lantos, Paul M
The diagnosis of chronic Lyme disease has been embroiled in controversy for many years. This is exacerbated by the lack of a clinical or microbiologic definition, and the commonality of chronic symptoms in the general population. An accumulating body of evidence suggests that Lyme disease is the appropriate diagnosis for only a minority of patients in whom it is suspected. In prospective studies of Lyme disease, very few patients go on to have a chronic syndrome dominated by subjective complaints. There is no systematic evidence that Borrelia burgdorferi, the etiology of Lyme disease, can be identified in patients with chronic symptoms following treated Lyme disease. Multiple prospective trials have revealed that prolonged courses of antibiotics neither prevent nor alleviate such post-Lyme syndromes. Extended courses of intravenous antibiotics have resulted in severe adverse events, which in light of their lack of efficacy, make them contraindicated.
Open Access
Empiric antibiotic treatment of erythema migrans-like skin lesions as a function of geography: a clinical and cost effectiveness modeling study.
(Vector Borne Zoonotic Dis, 2013-12) Lantos, Paul M; Brinkerhoff, R Jory; Wormser, Gary P; Clemen, Robert
The skin lesion of early Lyme disease, erythema migrans (EM), is so characteristic that routine practice is to treat all such patients with antibiotics. Because other skin lesions may resemble EM, it is not known whether presumptive treatment of EM is appropriate in regions where Lyme disease is rare. We constructed a decision model to compare the cost and clinical effectiveness of three strategies for the management of EM: Treat All, Observe, and Serology as a function of the probability that an EM-like lesion is Lyme disease. Treat All was found to be the preferred strategy in regions that are endemic for Lyme disease. Where Lyme disease is rare, Observe is the preferred strategy, as presumptive treatment would be expected to produce excessive harm and increased costs. Where Lyme disease is rare, clinicians and public health officials should consider observing patients with EM-like lesions who lack travel to Lyme disease-endemic areas.
Open Access
Lyme disease vaccination: are we ready to try again?
(Lancet Infect Dis, 2013-08) Lantos, Paul M
Open Access
Poor Positive Predictive Value of Lyme Disease Serologic Testing in an Area of Low Disease Incidence.
(Clin Infect Dis, 2015-11-01) Lantos, PM; Branda, JA; Boggan, JC; Chudgar, SM; Wilson, EA; Ruffin, F; Fowler, VG; Auwaerter, PG; Nigrovic, LE
BACKGROUND: Lyme disease is diagnosed by 2-tiered serologic testing in patients with a compatible clinical illness, but the significance of positive test results in low-prevalence regions has not been investigated. METHODS: We reviewed the medical records of patients who tested positive for Lyme disease with standardized 2-tiered serologic testing between 2005 and 2010 at a single hospital system in a region with little endemic Lyme disease. Based on clinical findings, we calculated the positive predictive value of Lyme disease serology. Next, we reviewed the outcome of serologic testing in patients with select clinical syndromes compatible with disseminated Lyme disease (arthritis, cranial neuropathy, or meningitis). RESULTS: During the 6-year study period 4723 patients were tested for Lyme disease, but only 76 (1.6%) had positive results by established laboratory criteria. Among 70 seropositive patients whose medical records were available for review, 12 (17%; 95% confidence interval, 9%-28%) were found to have Lyme disease (6 with documented travel to endemic regions). During the same time period, 297 patients with a clinical illness compatible with disseminated Lyme disease underwent 2-tiered serologic testing. Six of them (2%; 95% confidence interval, 0.7%-4.3%) were seropositive, 3 with documented travel and 1 who had an alternative diagnosis that explained the clinical findings. CONCLUSIONS: In this low-prevalence cohort, fewer than 20% of positive Lyme disease tests are obtained from patients with clinically likely Lyme disease. Positive Lyme disease test results may have little diagnostic value in this setting.
Open Access
Targeting Borrelia burgdorferi's Heat Shock Protein for the Diagnosis and Treatment of Lyme Disease
(2020) Sell, Madeline
Infections are most commonly identified by microscopy, culturing the organism, or testing the patients blood for antigens or antibodies. These methods are unreliable in bacteria that persist in a non-dividing, metabolically inactive dormant state, leading to treatment delays and an increased risk of developing chronic morbidities. Borrelia burgdorferi (B. burgdorferi), the causative spirochete in Lyme Borreliosis, is an example of a stealth pathogen difficult to culture from blood, capable of evading the host immune system, and under adverse growth conditions in host tissue, can survive in a dormant state. Despite early diagnosis and treatment, 20-35% of patients with Lyme Borreliosis experience chronic symptoms, the etiology of which remains unknown due to the lack of accurate diagnostics to demonstrate the presence of a persistent infection. In vivo diagnostic imaging of bacterial infections is currently reliant on targeting their metabolic pathways, an ineffective method to identify microbial species with low metabolic activity. Here we characterize HS-198 as a small molecule-fluorescent conjugate that selectively targets the highly conserved bacterial protein, HtpG (High temperature protein G) within B. burgdorferi, the bacteria responsible for Lyme Disease. We describe the use of HS-198 to target morphologic forms of B. burgdorferi in both the logarithmic growth phase and the metabolically dormant stationary phase. Furthermore, in a murine infection model, systemically injected HS-198 identified B. burgdorferi as revealed by imaging in post necropsy tissue sections. These findings demonstrate how small molecule probes directed at conserved bacterial protein targets can function to identify the microbe using non-invasive imaging and potentially as scaffolds to deliver antimicrobial agents to the pathogen, potentially solving both the problem of diagnosis and treatment.
Open Access
Unorthodox alternative therapies marketed to treat Lyme disease.
(Clin Infect Dis, 2015-06-15) Lantos, Paul M; Shapiro, Eugene D; Auwaerter, Paul G; Baker, Phillip J; Halperin, John J; McSweegan, Edward; Wormser, Gary P
BACKGROUND: Some patients with medically unexplained symptoms or alternative medical diagnoses suspect that they chronically suffer from the tick-borne infection Lyme disease. These patients are commonly targeted by providers of alternative therapies. This study was designed to identify and characterize the range of unorthodox alternative therapies advertised to patients with a diagnosis of Lyme disease. METHODS: Internet searches using the Google search engine were performed to identify the websites of clinics and services that marketed nonantimicrobial therapies for Lyme disease. We subsequently used the PubMed search engine to identify any scientific studies evaluating such treatments for Lyme disease. Websites were included in our review so long as they advertised a commercial, nonantimicrobial product or service that specifically mentioned utility for Lyme disease. Websites with patient testimonials (such as discussion groups) were excluded unless the testimonial appeared as marketing on a commercial site. RESULTS: More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments. CONCLUSIONS: Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful.