I have recently seen two young men, in previous robust health, who have been stricken with subacute progressive Lyme disease with both neurological and` musculoskeletal manifestation. These patients had been athletes in tip-top shape. Now suddenly plagued by weakness, fatigue and cognitive issues are fully disabled. The question then comes up: why did these two become so sick. This continues to be a vexing issue.
A study published in the New England Journal of Medicine this past fall finally put to bed the debate. Not. There is no chronic Lyme according to Dr. Steere. Study subjects had discrete bouts of stage 1 LD with rash and had recovered between each discrete episode. Multiple strains of Lyme were found with separate infections. It was then suggested that chronic Lyme is a product of new infection, not relapse from the original infection.
I think most doctors are in agreement that Lyme disease can be cured when caught in the early stages with an EM rash. What this study does show is that there are a multitude of Lyme strains present in the same geographical local - the same cohort of ticks.
These various strains have difference virulence factors and predilections to cause on sort of disease over another. I suspect these two men became so ill because they were unlucky enough to be a victim of the wrong tick, one harboring a very nasty variation of Borrelia burdorferi.
In one case, the young man had already received standard care with 28 day of intravenous Rocephin. The ID specialist said there was nothing else to be done and that he might be disabled for the rest of his life. This will not happen Mr. IDSA.
There arises confusion about what is chronic Lyme disease. The IDSA defines it to be symptoms which recur after a properly treated bout of acute Lyme. But is not what we are talking about. We are talking about disseminated bacterial organisms which persist despite antibiotic therapy and continue to make the patient ill. These patients are hard to treat, but treatment can make them better.
The topic of biofilms came up in my office today, as it frequently does. There seems to be a lot of misunderstanding here. It turns out that bacteria are social creatures. They frequently form aggregates sealed off in a weird mix of muccopolysacchrides and pieces of DNA. The bacteria in these walled off areas seem to have an uncanny intelligence, communicating with one another by quorum sensing. Organisms in biofilms may be a 1000 times (or more) resistant to antibiotics compared with singular organisms. The biofilms disperse organisms from time to time which then set up new colonies.
Lyme is not unique. About 80% of human infections are associated with biofilms. Biofilms are omnipresent. They are the slime adherent to the inside of your pipes and hoses. They are the plaque on your teeth. Chronic sinusitis may never clear until the biofilms are surgically removed.
Biofilms have efflux pumps which pump out antibiotics. They clearly contribute to the chronicity of the disease, to what extent is not clear.
Patients have frequently asked me if they have cystic forms of the spirochetes? Everyone does, it goes with the territory. Likewise, everyone has biofilms.
There seems to be a mistaken notion that biofilms can be degraded with proteolytic enzymes like nattokinase. Since biofilms are not protein based this does not make sense.
I have thought there is no specific way of treating biofilms. I have felt that antibiotics like Tindamax which have better biofilm penetration, finding the right antibiotics, ones that work synergistically and using IV antibiotics to better saturate tissues were the way to go.
It does seem that dispersement of biofilms is a desired goal since bacteria are much easier to kill in free planktonic state. There are a couple of enzymes which facilitate this process but they are not available for clinical use. It has also been found that nitric acid, an important molecule, may facilitates the dispersal of biofilms. Apparently the best promoter of nitric acid is the amino acid arginine which can be taken as a supplement.