Lyme disease is the Northern Hemisphere’s most prevalent tick-borne infection and increasingly, following the effects of climate change, areas which were inhospitable for ticks are now becoming problematic. The increase in the numbers of cases of Lyme disease each year is partly due to the better recognition of the condition, and a rise in actual tick bites leading to infection and symptoms. With increasing encroachment into the countryside, human populations are now sharing their backyards with a variety of mammals, and birds, who can act as a reservoir for tick-borne infections. In the US the ‘deer’ tick is held largely responsible for the transmission of Lyme disease, but this tick can actually use small mammals, such as mice and rats as early hosts, followed by larger mammals including foxes, deer, cougars, and wolves, as hosts in the nymphal and adult stages of their lives.
The Health Protection Agency estimates around 3000 new cases of Lyme disease occurring each year in the UK, a country which previously did not consider Lyme disease to be a problem. Around 20,000 new cases are thought to arise in the US each year, adding to the number of patients thought to be suffering from chronic Lyme disease that remains untreated. There are also those who consider themselves to be persistently infected with Lyme disease bacteria, despite antibiotic treatment, and a whole industry has materialized to provide long-term antibiotic treatment, oxygen therapy, and other pharmaceutical and natural remedies for chronic Lyme disease.
Lyme Disease History – Exploiting Vulnerable Patients
The condition has become a hotly debated political and social issue with many patients feeling that their pain and suffering is being ignored by the established medical authorities due to a lack of recognition of chronic Lyme disease as an illness. In some such cases it is thought that the symptoms attributed to persistent Lyme disease infection are actually examples of an initial misdiagnosis, or the development of a new disease or condition, such as fibromyalgia, chronic fatigue syndrome, or even multiple sclerosis. Whilst patients may test negative for the presence of infectious Borrelia bacteria even when they exhibit all the classic signs of Lyme disease, it is also thought that an autoimmune illness may have developed following the original infection.
Lyme disease is rarely fatal, with fewer than two dozen deaths attributed to the illness worldwide. Persistent infection can however cause chronic joint pain, cognitive impairment, and reduced quality of life in sufferers which are then compounded by being told that there is no reason for their symptoms in many cases. The stress of having an undiagnosed illness and the variety of tests, medications, and treatment interventions applied to symptoms may in themselves prolong the effects of the condition or even exacerbate symptoms in some patients.
There have also been reports of patients dying or suffering serious complications from long-term intravenous antibiotic therapy at the hands of so-called Lyme Literate Medical Doctors. Whilst some such doctors are practicing responsible evidence-based medicine, in many cases it appears that inappropriate and downright dangerous treatments are provided for patients at significant cost, both financially and in terms of health. Long-term antibiotic use has been shown to lead to fatal blood infections, the creation of antibiotic-resistant bacteria (‘superbugs’), serious adverse reactions in patients, and C.difficile diarrhoea in some.
The Battle with the IDSA
The reluctance of medical authorities and institutions such as the Infectious Diseases Society of America (IDSA) to recognize the existence of Chronic Lyme disease has angered Lyme advocates for many years with the Connecticut Attorney General Richard Blumenthal actually using his political influence to start an antitrust investigation against the IDSA in 2006. The basis of this investigation was a feeling in the Lyme disease community that the IDSA’s guidelines failed to consider divergent medical opinions and that the authors of the guidelines had conflicts of interest. The IDSA agreed to have the guidelines reviewed by an independent panel of scientists certified free of any conflicts of interest and the guidelines were unanimously approved by the panel in 2010. There are, however, those who claim that the ‘independent’ panel also had vested interests in the outcome of the review, thus invalidating the whole process.
Nonetheless, physicians are advised not to diagnose Lyme disease in cases where non-specific symptoms such as arthralgias, fatigue, and cognitive dysfunction are the only signs of illness as these are actually thought as prevalent in the general population as those attributing such symptoms to Chronic Lyme disease. Where complications characteristic of Lyme disease arise, such as aseptic meningitis, atrioventricular nodal block, inflammatory arthritis, and neuropathy (either cranial or peripheral), an assessment of the patient’s history of risk of Lyme exposure and the careful exclusion of other diseases is warranted prior to Lyme disease being diagnosed.
The political controversy rages on however, with many still calling for guidelines to change in light of more patients attributing their symptoms to Chronic Lyme disease. Lyme disease can cause serious disability and disruption to a sufferer’s life with some patients experiencing severe mobility problems due to joint pain, an inability to concentrate or think clearly, mood swings and psychosis leading to relationship breakdown, job loss, and a variety of other Lyme disease symptoms and effects. The sequencing of the Borrelia burgdorferi genome in 1997 has since allowed researchers to differentiate between different strains of the bacteria. This has, in turn, led to increasing recognition that different bacterial strains, such as B.afzelii, B.garinii, and B.burgdorferi s.s., often cause strikingly different patterns of symptoms, not only between themselves but also depending on the age and gender of the patient infected with the bacteria.
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