Browsing by Subject "Lyme disease"
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Item Open Access Chronic coinfections in patients diagnosed with chronic lyme disease: a systematic review.(Am J Med, 2014-11) Lantos, Paul M; Wormser, Gary PPURPOSE: 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.Item Open Access Chronic Lyme disease.(Infect Dis Clin North Am, 2015-06) Lantos, Paul MChronic 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.Item Open Access Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.(Open Forum Infect Dis, 2015-12) Lantos, Paul M; Nigrovic, Lise E; Auwaerter, Paul G; Fowler, Vance G; Ruffin, Felicia; Brinkerhoff, R Jory; Reber, Jodi; Williams, Carl; Broyhill, James; Pan, William K; Gaines, David NBackground. The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods. We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results. There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions. The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years.Item Open Access Targeting Borrelia burgdorferi's Heat Shock Protein for the Diagnosis and Treatment of Lyme Disease(2020) Sell, MadelineInfections 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.
Item Open Access Tick-borne Disease Risk along the Appalachian Trail(2012-04-25) Shelus, VictoriaEach year, 2-3 million visitors walk a portion of the Appalachian Trail, engaged in outdoor activities where exposure to ticks is likely. While the trail passes through the states with the greatest number of cases of Lyme disease and Rocky Mountain Spotted Fever, it is unknown how many people become sick after visiting the trail. This paper assesses tick-borne disease risk in the National Park Service (NPS) units located along the Appalachian Trail, and finds that the disease risk is unknown, and likely under recognized. It is recommended that tick sampling as part of a larger tick-borne disease surveillance program be implemented in the national parks. As a starting point to further study, general tick habitat suitability was modeled for the NPS units along the Appalachian Trail based on land cover, elevation and moisture. Potential tick sampling sites were selected based on areas of high tick habitat suitability and high visitor use.Item 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 PBACKGROUND: 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.