Tuesday, November 24, 2015

Acute Lyme with rash is not an easy one: it is a public health crisis.


It is clear that the IDSA and ILADS sharply disagree about everything Lyme. The two sides have come closest on the management of a patient with a tick bite and EM (bull’s eye) rash. The gap is widening. The CDC/IDSA acknowledge that about 20% of patients treated with the recommended course of doxycycline (2-3 weeks) continue to have symptoms which become chronic. This not remotely adequate. Based on the CDC estimate of 300,000 new cases yearly there are 60,000 new cases of post-treatment Lyme syndrome yearly which WE think of as chronic Lyme disease. This is the tip of an iceberg which the IDSA/CDC refuse to see. The patients with EM rashes are the lucky ones: they have robust immune responses and their disease is diagnosed in a timely fashion. The main body of the iceberg is composed of patients who: did not have the rash (perhaps as many as 75% - or more), were misdiagnosed or had a gradual insidious and atypical (mainstream viewpoint) course. Many of these and other critical facts are impassively reviewed in the latest report from the Hopkins group, Feng et al, “antibiotics” September 16, 2015. This time Auerwater did not sign as a co-author. These Hopkins researcher are tacitly admitting that Lyme is a public health catastrophe of unthinkable proportion.

The Current therapy for new cases is unacceptable. What is the best course of action? In seems that a mix of antibiotics which targets active spirochetes and persister forms may be appropriate. Have studies been done? Of course not. Are we really going to wait for them? The diversity of drugs found active against Lyme persisters is surprising. They include: antivirals, antifungals, antihelmintics (worms), antiparasitics, rifamycins, quinolones, antimalarial (including artemisinin) and a wide spectrum of exotic, unknown pharmaceutical agents. My sense is that we need to treat longer (6 weeks) and with two drugs, doxycycline and something else. I have long used Tindamax which is absent from this list. (See research of Sapi). And for God sakes – treat until the rash is gone and until all symptoms are gone. A patient already-treated for pneumonia with a standard 2 week course of antibiotics complaining of persistent fever and cough productive of bloody-green sputum would never be told: “Sorry, you have had your three weeks of antibiotics, your pneumonia is gone – whatever is wrong with you cannot be pneumonia.” Seriously. That would be a clear case of malpractice. With Lyme it is de rigueur.

It should be clear: we are dealing with a public health crisis. Drugs that are in wide use already can be safely combined. Medical treatments should be science based, not evidence base, as the termly is widely understood by physicians. Treatments should be based on clinical experience, science and common-sense with the understanding that the practice of medicine is the practice of a healing art, in measure instructed by science, but not and in and of itself a direct application of science per say.

The largely community of non-LLMD doctors needs to start getting this. How would your doctor, after reading this paper want his family member treated?


1 comment:

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