Thursday, August 4, 2011

Biofilms

Biofilms are ubiquitous. Their role in chronic infections in mainstream. Biofims have been found in chronic sinusitis, chronic ear infections, chronic skin and bone infections, kidney stones and many other clinical scenarios.In these other diseases biofilms can be readily identified because the occur on surfaces. The existence of biofilms in Lyme disease is more difficut to establish because of infection within deeper, inaccessible tissues. It is commonly cited that biofilms may play a role in up to 80%of human infections.

Biofilms are indeed complex structures. Previously freely motile bacteria become frozen in a gel-like matrix due to the result of complex molecular and genetic swiching. The organisms within these films are able to communicate and establish a social network. Frequently these bacteria go into a starvation mode and exhibit a very low metabolic rate. Biofilms may release motile bacteria when enviromental factors become favorable. Biofilms may be polymicrobial or consist of a single organism. Biofilms have been cited as a mechanism by which opportunistic germs, eg Pseudomonas, can become pathogenic. Bacteria turn out to be very clever little fellows, after all, they have been on the earth for 3.5 billion years. Biofilm fossils have been uncovered evincing their antiquity.

Bacteria within these biofilms are difficult to kill. They exist in a highly protected niche. They frequently become extremely resistant to antibiotics and destruction through normal immune responses.

Antibiotics such as Beta-lactams (penicillins and cephalosporins) are generally ineffective because these cell wall inhibitors work only when bacteria are rapidly dividing or remodelling their cell walls. Biofilm bacteria are frequently in a state of suspended animation.

The biological characteristics of biofilm contained bacteria quickly begin to resemble those attributed to cystic forms of Borrelia burdorferi (Lyme). Both have a slow metabolic rate and are not typically killed by Beta-lactams, except for the amoxicillin paradox described in my last blog.

One could postulate that antibiotics which are effective against cyst forms of Lyme could also be effective against biofilm forms.

Some have been very critical of Dr. Sapi's work. She has developed "biofilm like" colonies which she does not define. These are not the same thing as actual biofilms which develop within infected tissues.

There are no published studies (in peer reviewed journals) documenting the existence of Lyme biofilms let alone which treatments might be effective.

When you Google the words Lyme and Biofilm it inevitably leads you to MacDonald and Sapi. MacDonald's work is fascinating but unpublsihed or vallidated by other investigators. It also is unhelpful from a clinical perspective.

In the meantime, my patients tell about earthworm extracts, mushroom extracts and a variety of other enzymes. I have found no compelling reasons to believe that any of these treatments would be effective.

At this point we are left at the same place we were two years ago. Lyme may persist because of many mechanisms. The contribution of biofilms remains unknown. Treatments (from the perspective of my allopathic mind) should be rational and based on what we do know from the the science at hand and what we have garnered from clinical experience.

It appears that Lyme infection within the brain is frequently manifested through biofilms and atypical cystic, granular/pleomorphic forms of the organism.

I only discus patient cases after I have recieved their consent. (Some have questioned this)

I have continued to treat patients with severe encephlopathic neuroborreliosis including some diagnosed with premature Alzheimer's disease.

My clinical experiences have been consistent. The addition of IV Flagyl has been very effective for such patients. Perhaps this relates to mechanisms alluded to above.

11 comments:

Jess1ca318 said...

How does a lyme patient get in contact with you to schedule an appointment?? A consultation? Currently being treated for lyme on abx. I'm 25--but I have been reading your blogs for a couple of months. Actually--reading and re reading and I really love your take on the disease and how to heal it. Please email me more information (A phone number to schedule an appointment location etc) at Jess1ca318@aol.com Thank you so much in advance.

LLinCO said...

Thank you. I am so glad you're back. I've been well for the past 2 years, but my brother is suffering heart damage and Bartonella. Your posts have helped us. God bless.

Allison said...

Sorry to leave an unrelated comment, but I couldn’t find any contact info for you. I’m wondering if you’d be interested in a guest post. Please drop me an e-mail at alliegamble81@gmail.com. Thanks!

Liz said...

Hi,

I am a resident of CT, currently being treated for Lyme. I don't seem to be getting better, and I'm wondering if it might be possible to have a phone consultation with you? If you could email me at eliza.zim@gmail.com, I would greatly appreciate it. I would make an effort to follow up with a visit to your office at some point down the road.

Thanks so much,

Liz

lisabeth said...

Have you heard about the Fry lab and his theories? I have had several tests there and have seen him personally. He found biofilm communities (? Not sure this is the right word) and a Protozoa infection of an unknown name. He has strong beliefs about Lyme, some I don't agree with. He seems to think if his lab can't find it, then it isn't there. He seems devoted though, but he thinks this other infection and not Lyme are causing me to be ill.
It's very difficult to say the least to live in a nonendemic area. I'd give anything for a physician who seems to understand the disease like you do. I am much worst in the past year despite so much treatment.

I don't want to ask too many questions. You seem very busy. If you have time though, the only other question I have is whether you have seen any viruses consistently with Lyme. Could that be a missing link? If so what viruses, tests and treatments would be considered?

Please keep writing when you can. It is very appreciated.

Lyme report: Montgomery County, MD said...

The few of us who recoognize the significance of the chronic Lyme disease syndrome are very few. Unfortunately, there is a dearth or research from the medical/scientific communities to help us (at least on the clinical end). Treatments are largely empirical - based on experience. In my view, one should be careful not to impute clinical significance to things of which we know little or nothing.
For a while, their was a lot of buzz about XMRV, and now it appears to be a laboratory contaminant.

There are unknown organisms in our bodies. I believe they exists in everyone's body. Research to elucidate this can only happen at very sophisticated research facilities such as NIH. Piecing together the gentics sequences of newly discovered organisms can be a very daunting task. If and when such results are pulished it will be very exciting but perhaps not clinically helpful.

Assuming "unknown" organisms are present in everyone's body they are passive parasites or symbionts and make very few people sick.

The presence of these organisms, protozoa and bacteria, observed in the blood, may be more of a bell weather which corresponds to the level of immune suppression and likely clinical illness present in the patient.


We may discover we have already targeting certain germs without even knowing it.

When new results are published in major scientific journals it will at lest add credence to our treatments.

There must be some balance of factors: genetic, environmental, the particular species of the individual TBD, the particular tissues invaded, that make the treatment so challenging.

I believe treatments should be empirical, but - based upon some sort of logical thought process which can and must be explained to the patient and documented in the patient's medical record.

Margo said...

Good Morning, I found your posts purely by chance. However, I don't believe in chance. I was actually in the process of researching band IgG41 because I have been diagnosed with Fibromyalgia for almost 20 years and had it even longer and I am looking for a LLMD. I live in Mt. Airy, MD. I was going to go write a letter to try and see a doc in Towson, however, Germantown is a lot closer. Please email me at margolmiller@gmail.com to let me know if you are taking new patients and if you take insurance.
Thank you so much for your time.
Margo

SpringOwl said...

I have late stage Lyme and am confused on the use of Plaquinil. I have read via Internet it is a "cyst form buster" but on this blog, it is said to drive Lyme into cyst form.

I am scheduled to start it tomorrow along with zithromax but I want this stuff dead not buried.

I have lost the use of my left side so I don't want to mess around with antibiotics that are band-aids.

Please advise on Paquinel/zithro.


THANKS!

TwoFrogs said...
This comment has been removed by the author.
GoodbyeLyme said...

Hi Dr. LymeMD,

Here is research on how the herb terminalia chebula cuts through the pseudonomas biofilm and kills the bacteria beneath it:

http://www.synapticdigitalvideo.com/siemens/2006/webcasts/sc2006_vodw_madhavi_gavini.html

When we started giving this herb to our patients, they noticed that their symptoms would occur with much less frequency. They felt better for greater periods between treatments.

Here is an article on this herb and how we use it:

http://goodbyelyme.com/free-articles/biofilm/infiltrator

I appreciate your excellent blog posts.

Geoflier said...

I found your blog yesterday while doing a little research on some extremely annoying Bartonella herx symptoms I've been having. I was struck by the care you obviously have for your patients and I very much appreciate the technical information you include in your posts. I am healing slowly from chronic Lyme (and co-infections) and while I am I going the mixed allopathic-CAM route (with considerable success) I highly respect the LLMDs such as yourself who are doing the best they can within their realm and continually trying new approaches. Your open mind seems to serve your patients well. Thank you for doing what you do! It makes a huge difference.