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Thursday, June 5, 2008

What is P:ost-Lyme syndrome and how is it different from chronic Lyme disease?

This question describes a critical piece of the paradigm war between the IDSA and ILADS. According to the IDSA model, persistent symptoms, such as joint pain or brain fog which persist after standard antibiotic therapy are not related to ongoing infection. They are instead the result of an autoimmune process which was triggered by the infection and which persists after the organisms are cleared from the host. There is precedent for this sort of thinking. Rheumatologists have been proponents of this type of thinking for decades. A common cause of inflammatory arthritis is Reiter's syndrome. This is classically a triad of eye symptoms (uveitis or conjuctivitis) with urethritis (urinary tract disease) and arthritisl. It occurs after infection with Chlamydia( yes, the kind that causes an STD), Mycoplasma, or Ureaplasma. It is interesting that these bacteria are intracellular L-forms which according to chronic Lyme paradigms may be hard to treat. Rheumatologists believe that these infections induce an autoimmune process and that the organisms are no longer present in the patients. Another designation for inflammatory arthritis is called reactive arthritis. It is designated ReA. This is usually associated with infections of the gastrointestinal tract, including, Shigella, Salmonella, Yersinia and Campylobacter. There are all bacteria which cause infections associated with diarrhea. It can also be caused by Chlamydia and similar bacteria. It tends to be associated with certain HLA genetic types, including HLA B27. These organisms also have the ability to exist intracellularly. Antigens, meaning pieces of the germs, as well as DNA and RNA of these organisms has been shown to be present in tissues which line the joints (synovium) and joint fluid (synovial fluid) for years after the initial infection. This "controversial" data comes from Harrison's Textbook of Medicine, the most respected source of information for mainstream doctors throughout the world. Harrison's claims that studies have shown that antibiotics have not shown to be effective and that patients should be treated with anti-inflammatory medicati0ns, like Motrin. The essence of the theory is that the persistent arthritis in these patients is a post-infection autoimmune process. The science demonstrates that viable organisms persist in these patients. In the example of Chlamydia, newer information as developed by Stratton demonstrates that these organisms are very difficult to eradicate and that a specific multi-drug regimen, over a long period of time is necessary. I have found that antibodies directed against Salmonella bacteria can be found in the majority of my patients. This is a hardy organism which is difficult to eradicate and has many tricks to evade the immune system. It can lodge in the gallbladder where it causes chronic inflammation. (There are numerous strains of Salmonella, I am not speaking of the strain which causes Typhoid fever and is rare in the U.S.). The Post-lyme syndrome suggests that the persistent symptoms are not causally related to persistent infection. There is a great deal of medical research and literature which supports the contention that the organism persists despite antibiotic therapy. The argument of ILADS proponents would be that there really is no post-Lyme syndrome. Persistent symptoms equate with persistent infection. Long term antibiotics are required. And patients feel better on antibiotics and relapse when they are discontinued. IDSA proponents argue back that this benefit is derived from anti-inflammatory properties of antibiotics, unrelated to their germ killing affects. ILADS doctors ask why only antibiotics work, which have weak anti-inflammatory properties at best, while potent anti-inflammatory drugs provide no benefit for the patients. Beyond reactive arthritis, symptoms related to dysfunction of nerves, muscles, tendons, ligaments, peripheral nerves, cranial nerves and the central nervous system, all frequently improve dramatically with antibiotic therapy. There is no such thing as post-Lyme syndrome. Patients are suffering with chronic Lyme disease. ILADS doctors can point to laboratory markers of infection and inflammation which improve with antibiotic therapy as well. IDSA doctors are mute on this point.

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