Monday, September 11, 2017

Debugging the bug

Lyme disease is caused by Borrelia burgdorferi and other related species of Borrelia.  “Lyme disease” was coined by Steere in 1977.  Microbiologist Willie Burgdorfer discovered the germ in 1981 -- A thin, elongated spiral shaped bacteria, or spirochete residing in the gut of ticks. 
These bacteria are persistent and frequently cause chronic disease.   The belief that the bacteria persist has been refuted by the IDSA for decades.  The IDSA is wrong.  The narrative oft repeated describing the structure and function of the spirochete by those in my camp, is outdated and incorrect.  
This post is an effort to correct the record. 
The following statements are wrong and I explain why. 
#1 Lyme bacteria have 3 forms:  spirochete, L-form and cyst form. 
Lyme does not exist in an L-form.  An L form is a cell wall deficient bacterium derived from a bacterium that ordinarily has a cell wall.   Lyme lacks a cell wall to begin with so this is an impossibility. Lyme bacteria possess a double outer membrane and no cell wall.  Bacterial cysts do no occur. This is a feature of protozoa. Lyme bacteria are pleomorphic with “phenotypic” variation.  These chameleons of the bacterial world frequently present as a round bodied forms which are treatment resistant.  In summary: No L-forms, No true cysts. Yes, spirochetes have shape shifting ability – pleomorphic variation, commonly observed as round body forms, blebs and many others.  
#2 Lyme bacteria persist in large measure because they hide in cells (are intracellular).
Lyme bacteria primarily exist outside host cells (extracellular).  Intracellular forms exist but are relatively uncommon. The bacteria adhere to a protein matrix between cells.  Primary mechanisms of persistence are biofilm formation and pleomorphic variability.  The spirochetes are anaerobic (do not require oxygen) and therefore are able to live in tissues with a poor blood/oxygen supply, e.g. joint cartilage. These bacteria easily cross the blood brain barrier which is a safe-haven because immune responses are limited. The bacteria may survive in other “immune privileged” areas. Intracellular localization is a relatively minor means of immune evasion. 
#3 Treatment must include: cell wall drugs (beta-lactams), intracellular drugs and “cyst busters.”  
Assuming we are talking about the bacterial cells (not host) With Lyme spirochetes all antibiotics inhibit or kill Lyme work via an intracellular mechanism.   The molecules that form the bacterial cell wall are called peptidoglycans.  Borrelia spirochetes possess strands of peptidoglycans internally, acting as an internal skeleton.  When beta-lactams kill Lyme, the action is inside the cells. The other classes of antibiotics generally work inside the cells, disrupting DNA/RNA, metabolic pathways or protein synthesis.  If we are instead referring to drugs which penetrate host cells, antibiotics from many classes may penetrate host cells, including beta-lactams. 
4#  Flagyl is a cyst buster.  

If one is referred to round forms of Lyme, Flagyl is no more effective (in a test tube) than doxycycline.  Empiric evidence and clinical practice inform us that Flagyl is very effective and may be synergistic with other drugs. 
In summary:  No L forms.  No cyst forms.  No cyst busters.  Ceftin, amoxicillin, others function as intracellular antibiotics when used against Lyme. 
Lyme spirochetes have a developed ability to persist in the face of adversity.  This phenomenon is not unknown in the world of bacteriology. For example, tuberculosis.  TB is treated with a 4-drug combination for 2 months and a 2-drug combination for another 2 months.  This complicated formula is the results of decades of research.  
Lyme (chronic) has not had this sort of attention from the medical community which maintains the persistent delusion the disease does not exist.  


eric said...

Thank you very much for your blog. It has been a great help to me as I deal with this awful disease.

May I comment on the topic of the persistence of Lyme infection with the following quotation (even though no one here needs convincing)?

This is from a 1976 (!) internal publication of Walter Reed Medical Center:

"The fact that borrelia infection, especially when transmitted by ticks, can persist in the tissues of the eyeball and the brain, despite antibiotic treatment, and even despite apparent cure, IS WELL KNOWN."

The all-caps emphasis is my addition, and I'm quoting from memory here, but there is a photocopy of this document in my files somewhere. The point that I am trying to get across is that the whole "Lyme controversy" was essentially manufactured from thin air, and fairly late in the game at that. The claim -- that borrelia is always eradicated by ABX -- is simply fraudulent. This disease had already been more-or-less known and understood for decades by the time of its putative discovery in 1982.

Five minutes of Googling yield the following:

Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis.
Oksi J, Marjamäki M, Nikoskelainen J, Viljanen MK
Ann Med. 1999 Jun; 31(3):225-32.

Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane, but not in synovial fluid from patients with persisting Lyme arthritis after antibiotic therapy.
Priem S, Burmester GR, Kamradt T, Wolbart K, Rittig MG, Krause A
Ann Rheum Dis. 1998 Feb; 57(2):118-21.

Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis.
Häupl T, Hahn G, Rittig M, Krause A, Schoerner C, Schönherr U, Kalden JR, Burmester GR
Arthritis Rheum. 1993 Nov; 36(11):1621-6.

Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis.
Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann A, Prokop J
Infection. 1989 Nov-Dec; 17(6):355-9.

Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis.
Schmidli J, Hunziker T, Moesli P, Schaad UB
J Infect Dis. 1988 Oct; 158(4):905-6.

Thank you for keeping up this blog and for treating your patients. I wish you and your practice the best.

Lindsay said...
This comment has been removed by the author.
Lyme report: Montgomery County, MD said...

Thanks for the references. There certainly has been revisionist history. I think Steere and friends developed their hypothesis early and discounted studies that did not fit into their box Lyme was not described until 1977 and the spirochete was not identified until 1981. I don't get a Walter Reed discussion in 1976 unless it was a discussion re another known species of Borrelia.

I think it is easy to look back and think there is a big conspiracy with scientists covering up the truth about Lyme. I believe its about ego and god complexes and an inability of those who live in the IDSA bubble to consider the possibility they might be wrong.