Handling patients with possible Lyme disease and co-infections in clinic and practice, the author reflects on the justifications of his actions as he is constantly drawn into the discussion between theoreticians and practitioners. The representatives of these two opposing camps are organised by the IDSA (Infectious Disease Society of America) and the corresponding European organisations such as EUCALB (European Union Concerted Action on Lyme Borreliosis) on the one hand, and the ILADS (International Lyme and Associated Diseases Society) and the DBG (Deutsche Borreliose Gesellschaft) on the other hand.
As a clinician that the author is, who witnesses the suffering of his patients on a daily basis, he appeals for the collaboration of all parties involved. He asks questions about the infection with borrelia, the possibility of a chronic Lyme disease, the existence of chronic infections generally in patients with weaker immune systems, the symptoms of an infection with borrelia (of different strains) and other tick-borne diseases, the sensitivity and specificity of the determination of antibodies in the everyday practice, the validity of EliSpot and the CD57 values for diagnosis, the treatment with antibiotics, the measures to control and support the patient's metabolism (adjuvants) before and during treatment, the phenomenon of erythema migrans, the biofilms that are complicating treatment and the other phenomenon of pleomorphic, slowly growing bacteria types (so called persister forms and L-forms) that may cause possible relapses.
This contribution relies on a thorough study of literature. You will find a comprehensive list of references and links in the annex to prompt and inspire every reader interested in this topic. The author shares his thoughts and questions with the only purpose to stimulate factual discussions.
Table of Contents
1. General information:
2. Does chronic Lyme exist?
3. Symptoms of Lyme disease, a multi-systemic illness, and co-infectors
4. Direct Detection of Borrelia
5. Indirect Tests: The Detection of Antibodies:
6. The EliSpot (Interferon-gamma-test)
7. CD57-NK-cells
8. Antibiotic Treatment
9. Accompanying diagnostics and supporting remedies during antibiotic treatments
10. Erythema migrans (EM), Lymphocytoma & ACA, obligation to report
11. Biofilms, pleomorphic forms, persister forms
12. Discussion
Objectives and Research Focus
This work reflects on the clinical challenges of diagnosing and treating Lyme disease and its associated co-infections, aiming to bridge the gap between theoretical medical guidelines and the practical realities faced by clinicians and their patients.
- Analysis of the persistence of pathogens and their impact on the immune system.
- Evaluation of diagnostic limitations in serology and the potential of cellular tests.
- Discussion on the necessity of multi-modal and long-term therapeutic approaches.
- Examination of the role of biofilms and pleomorphic bacteria in treatment failure.
- Advocacy for a more comprehensive, interdisciplinary understanding of multi-system illnesses.
Excerpt from the Book
1. General information:
The following observations are meant to both inform and encourage reflection. These thoughts and questions have emerged from Internet research for literature, questions from patients in the everyday practice and numerous conversations. As it appears, there is a great demand for conversation and information not only among the patients, but also among the colleagues who are confronted with these questions by their patients.
We know that there is an interdependency that exists between pathogens (viruses, bacteria, fungi, protozoa, parasites, etc.) and their corresponding virulence factors (or pathogenicity factor), and the immune system of the affected person, i.e. the host. Here, it is decisive in every case to identify if the affected person is only infected or if he or she really manifests the infection, i.e. if he or she is developing symptoms and how serious the disease is.
1. It is known that some types of bacteria and viruses have developed mechanisms to modulate, bypass and mislead the immune system, in order to persist in the organism [4, 5, 6, 7]. We know that for some infections, a later reactivation of the pathogens is possible (e.g. herpes-simplex-virus, HIV, varizella-zoster-virus, Epstein-Barr-virus, TBC, etc.). We also know that a possible latent, sub-clinical infection with borrelia and its reactivation is not strictly excluded anymore [8, 78].
Summary of Chapters
1. General information: Outlines the complex interdependency between pathogens and the host immune system, highlighting bacterial mechanisms for persistence.
2. Does chronic Lyme exist?: Challenges the common perception that chronic Lyme is rare and distinguishes between general multi-system chronic infection and chronic neuroborreliosis.
3. Symptoms of Lyme disease, a multi-systemic illness, and co-infectors: Discusses the diverse, often non-specific symptoms that necessitate thorough differential diagnosis to identify underlying chronic infections.
4. Direct Detection of Borrelia: Examines the challenges and limitations of direct detection methods, which are often laborious and not standard in everyday practice.
5. Indirect Tests: The Detection of Antibodies: Analyzes the sensitivity and specificity problems of standard serological testing and how they can lead to diagnostic errors.
6. The EliSpot (Interferon-gamma-test): Explores the use of the EliSpot as a standardized cellular test to evaluate immune system activity on a cellular level.
7. CD57-NK-cells: Discusses the potential of monitoring CD57-NK-cell fractions as a marker for immune system stability during infection.
8. Antibiotic Treatment: Compares various long-term combination treatment strategies and emphasizes the necessity of addressing persister forms and mixed infections.
9. Accompanying diagnostics and supporting remedies during antibiotic treatments: Details essential supportive measures, including lifestyle changes and naturopathic additions, to improve therapeutic success and reduce risks.
10. Erythema migrans (EM), Lymphocytoma & ACA, obligation to report: Explains the practical and bureaucratic difficulties that hinder accurate reporting and early diagnosis of Lyme disease.
11. Biofilms, pleomorphic forms, persister forms: Presents evidence that bacterial biofilms and morphological variants complicate therapy and necessitate new diagnostic and treatment strategies.
12. Discussion: Synthesizes the clinical perspective on the controversial nature of Lyme diagnostics and calls for objective, science-based collaborative discussions.
Keywords
chronic Lyme disease, chronic borreliosis, late borreliosis, direct detection of borrelia, serology of borrelia, immunology, EliSpot, CD57 natural killer cells, borrelia, co-infections, erythema migrans, pleomorphic forms of bacteria, "persister" forms of borrelia, bacterial biofilms, antibiotic treatment
Frequently Asked Questions
What is the primary focus of this work?
The book focuses on the challenges faced by clinicians when dealing with patients suffering from possible Lyme disease and various co-infections, emphasizing the need for more comprehensive diagnostic and therapeutic strategies.
Which central themes are discussed?
The text explores the complexity of chronic infections, the behavior of pleomorphic bacterial forms and biofilms, the limitations of current diagnostic tests, and the importance of supportive therapies alongside antibiotic treatment.
What is the main goal or research question?
The primary goal is to stimulate a factual discussion among medical professionals about the validity of chronic infection theories and to encourage a shift toward more individual, multi-modal, and holistic therapeutic approaches.
Which scientific methods are evaluated?
The authors analyze both direct pathogen detection (like PCR) and indirect testing methods, specifically comparing humoral (antibody-based) tests with cellular immunology tests such as the EliSpot and CD57-NK-cell analysis.
What topics are covered in the main section?
The main section covers the biology of pathogen persistence, the variety of clinical symptoms associated with multi-systemic illness, the controversy surrounding diagnostic standards, and practical treatment strategies for persistent infections.
Which keywords characterize this work?
Key concepts include chronic Lyme disease, bacterial biofilms, "persister" forms, co-infections, and the necessity of integrative diagnostics and therapies.
How do the authors differentiate between "frontal" and "stealth" pathogens?
They categorize pathogens based on their interaction style: "frontal" pathogens (e.g., those causing typical acute infections) vs. "stealth" pathogens (e.g., pleomorphic forms of borrelia) that produce long-term, chronic, and often elusive disease conditions.
What role do environmental factors play in the patient's immune health?
The authors argue that external factors such as environmental toxins, stress, diet, and lifestyle choices can weaken the immune system, thereby reducing the patient's capacity to fight off chronic or reactivated infections.
Why do the authors question current antibody-based testing?
They argue that current antibody tests lack sufficient sensitivity and specificity, often failing to detect the infection in chronic stages, and therefore should be used only as an aid rather than the sole basis for diagnosis.
Is the biopsy of tissues a routine recommendation?
No, the authors acknowledge that routine biopsies of heart or brain tissue are not feasible for everyday diagnosis, but they highlight the success of such methods in identifying pathogens in severe, fatal cases.
- Citation du texte
- Dr. med. Axel Hübner (Auteur), Dr. med Bernt-Dieter Huismans (Auteur), 2016, Thoughts and questions of a clinician related to the infection with borrelia and co-infections, Munich, GRIN Verlag, https://www.grin.com/document/313377
