2012 was a big year for Lyme disease as it became a part of the Romney election campaign, made headline news across the US, Canada, and even in Germany, and saw Australians taking to the streets http://lymediseaseguide.org/lyme-disease-protest-in-sydney-australia-steps-to-recognition-of-lyme-disease in protest over government policy. All of this and a raft of new research papers published on the fastest-growing infectious disease in North America. If 2012 was Lyme Disease Awareness Year then is 2013 the year for fresh answers on Lyme disease?
Lyme Disease and Politics
First, to Mitt Romney and his, perhaps unwitting, claims in opposition to the official stance of the US Centers for Disease Control. Pushing campaign flyers through the door of those in northern Virginia, Romney declared Lyme disease an epidemic that was ‘wreaking havoc’ in the district. Proposing legal protection for physicians going against the orthodox medical establishment, Romney courted favour with many Lyme disease advocates but lost a whole lot of possible voters by choosing fear as an election tactic and flying in the face of many scientists.
Lyme Disease and Climate Change
There was also a certain irony to the Romney juggernaut choosing an issue increasingly tied to climate-change, a problem that a Romney administration would have done little, if anything to help. Many scientists in 2012 heralded increasing numbers of cases of Lyme disease due to a wider area populated by ticks, a longer tick season because of milder winters, and a larger host reservoir of white-footed mice courtesy of an abundant acorn harvest.
Lyme Disease Ecology
Some wildlife researchers noted that the gradual demise of the gray wolf has led to an increase in coyotes over recent years and that their population surge has, in turn, led to fewer foxes and less predation on white-footed mice. Coupled with this abundant acorn harvest, the main carrier of ticks infected with Borrelia have enjoyed a considerable increase in population. Ecology, climate change, and orthodox medicine are all pieces of the Lyme disease picture that came together in 2012.
Contradictory Science and Lyme Disease
In regards to scientific papers published last year, a couple really stood out: A paper suggesting reinfection rather than relapse was the true cause of persistent symptoms of Lyme disease, and a paper demonstrating evidence of the ability of Borrelia to form antibiotic-evading biofilms. That these, seemingly contradictory, papers were published within weeks of each other caused considerable confusion over Lyme disease in 2012, amongst patients and health professionals.
Chronic Lyme Disease Doesn’t Exist
The piece in the New England Journal of Medicine, by Robert B. Nadelman, et al, has since been criticised for the study’s small sample size (just 17 patients). Intriguingly, none of the patients enrolled had the same surface protein genotype (suggesting the same cause of infectious symptoms) found in the skin and blood samples taken during each episode of Lyme disease. That a range of different strains of Lyme disease bacteria were causing repeated infections in these patients appears certain but that some patients considered successfully treated for Lyme disease continue to have chronic symptoms remains unresolved.
Allen Steer on Chronic Lyme Disease
Allen Steere, the physician whose work resulting in the naming of Lyme disease back in the 1980s, wrote an editorial alongside Nadelman’s research. In this he claimed that “Rather than persistent infection, infection-induced autoimmunity, retained spirochetal antigens, or both may play a role in the outcome,” meaning that active Lyme disease bacteria were not responsible for chronic Lyme disease symptoms and, therefore, lengthy antibiotic protocols were not advised for such patients.
Lyme Disease Biofilms
The paper on Lyme disease biofilms was published by Dr Eva Sapi and sparked a debate about the potential for Borrelia to continually change their structure and thus evade antibiotics. This restructuring from spirochaete to cyst form to biofilm may also allow Lyme disease bacteria to remain undetected, challenging assumptions over persistence of infection. Focusing on how Lyme disease bacteria form biofilms could allow for treatments that actively target key steps in that process in order to prevent their formation and leave the bacteria open to attack from antibiotics. It is all too apparent that without recognising the possibility that Lyme disease biofilms exist there is unlikely to be an effective treatment forthcoming.
Babesia and Lyme Disease – A Growing Problem
Another paper published in 2012 highlighted the risks of missed co-infections with Lyme disease, such as Babesiosis. Carried by ticks predominantly feeding on white-footed mice, Babesia microti was found to be present in much higher levels when the same mouse also carried Lyme disease bacteria. The Borrelia appear to prime the mice to transmit both infections to ticks and, following a switch of tick host, to humans.
Lyme Disease: The Big Picture
In addition to working actively on vaccination against Lyme disease, improving treatments for the infection and its chronic symptoms, 2012 highlighted the need to pay greater attention to how Lyme disease fits into a wider ecological system. Patterns of predation, harvests, urban sprawl, antibiotic use in livestock, family pets and humans are all part of the Lyme disease puzzle and changing these can have a huge impact on human disease. Perhaps the strangest story of 2012 connected to Lyme disease was the news that a tick-bite could trigger a delayed but potentially life-threatening allergy to meat. Although the lonestar tick is not thought to carry or transmit Lyme disease bacteria, the complex interplay between zoonosis, ticks and health continues to perplex. In 2012, Lyme disease awareness was raised, perhaps 2013 will see steps further steps taken to conquer it.
Peter J. Krause, Lindsay Rollend, et al, ASTMH 61st Annual Meeting, Presentation: Borrelia burgdorferi coinfection enhances Babesia microti infection in white-footed mice and transmission to Ixodes scapularis ticks. Abstract 61.
Sapi E, Bastian SL, Mpoy CM, Scott S, Rattelle A, et al. (2012) Characterization of Biofilm Formation by Borrelia burgdorferi In Vitro. PLoS ONE 7(10): e48277. doi:10.1371/journal.pone.0048277
Robert B. Nadelman, M.D., Klára Hanincová, Ph.D., Priyanka Mukherjee, B.S., Dionysios Liveris, Ph.D., John Nowakowski, M.D., Donna McKenna, A.N.P., Dustin Brisson, Ph.D., Denise Cooper, B.S., Susan Bittker, M.S., Gul Madison, M.D., Diane Holmgren, R.N., Ira Schwartz, Ph.D., and Gary P. Wormser, M.D., Differentiation of Reinfection from Relapse in Recurrent Lyme Disease, N Engl J Med 2012; 367:1883-1890. November 15, 2012. DOI: 10.1056/NEJMoa1114362.