THERAPY OF LYME DISEASE

BECOMES A THERAPY OF TICKBORNE DISEASES

Guidelines of CDC are based on the following hypotheses
1) Lyme disease is an infection easy to treat
2) Lyme disease is not a chronic infection
3) When the first or second treatment fails the diagnosis of Lyme disease is wrong
4) No Co-infections have therapeutic consequences
5) Lyme disease is over diagnosed and over treated

Due to my clinical experiences and studies of literature I propose the following hypotheses shared by the ILADS board
1) Lyme disease is a major infection disease
2) Lyme disease is difficult to diagnose and treat
3) Lyme disease can become chronic and relapsing in an important number of patients
4) Co- infections are frequent and can cause major therapeutic problems
5) Untreated and under-treated Lyme and Associated Diseases are responsible for major neurological and neuropsychiatric disabilities
6) Lyme disease is underdiagnosed often diagnosed too late and undertreated
7) Chronic relapsing seronegative Lyme disease with Co-infections is one of the most difficult illnesses to treat
8) Immunodeficiency and Tick borne disease is not yet understood but probably a very important condition for treatment resistance

THERAPY OF TICKBORNE DISEASES HAS THREE IMPORTANT GOALS

1) Stabilise the infections by antimicrobial substances
2) Influence the immune system
3) Alleviate the symptoms

I refer you to the guidelines written by Dr Burrascano, we developed completely independently similar treatments, he in the USA, and I in Europe. We have been in contact only since 1998. He published his guidelines in the standard book ‘Conns Current Therapy 1997’
For each therapeutic goal there are some personal remarks

1) Stabilise the infections

by antimicrobial substances Borrelia spirochaetes
Better no treatment than under treatment because of inhibiting the antibody building while infections are not cleared up

ECM must be treated for at least 3 weeks and must be continued if after this time the rash and the induration has not completely gone
The doses must be high, it has been proved that early dissemination of spirochetes is common
(Amoxycillin 750mg 4 times daily, Doxycycline 200mg twice daily Clarithromycin 500mg twice daily)

All other clinical features need intravenous treatment for at least 6 weeks
(Ceftriaxone 2g daily or Cefotaxime 2g three times daily Doxycycline 200 to 400mg once daily)
The symptoms must have cleared up for at least 4 weeks before intravenous therapy can be stopped or it must be repeated after a short break.

There is no laboratory control for infection degree only the patient’s symptoms are the parameter

Borrelia afzelii, the main responsible spirochete of Acrodermatitis chronica atrophicans reacts well to Penicillins and cephalosporins

Borrelia garinii the main responsible spirochete of neurological symptoms reacts well to intravenous therapy with Cephalasporins Doxycycline Azithromycin

Generally in children the treatment is fortunately more effective
Connatal Lyme borreliosis must be treated

Pregnant women need high doses at Amoxycillin ie. every 6 hours 750mg

Consider the generation time of spirochetes of 12 to 24h in vitro and the growth time of 4 weeks
In dormancy stage common antibiotics do not work

Babesia Co-infection

In my treatment protocol of the published twenty patients used Azithromycin in combination with Atovaquone for 2 to 4 months
About a third of these patients became positive again either after or even during treatment
Mephloquine works excellently but has major side effects

Bartonella henselae

I used the following substances (no established therapies) Cefotaxime, Azithromycin, Ciprofloxacine

Viral Co-infections
Especially the Cytomegaly Virus seems to cause immunosuppression, that's the reason for trying therapy with Ganglocyclovir (in Lyme disease not yet established)

2) Influence the immune system

Thats the big unknown factor
The whole cytokine cascade can not be controlled
We have to estimate the actual immune situation of each patient, there are great differences from one patient to the other even in the same patient it can change over the duration of the illness

How to stimulate the immune system:
Highest doses of Vitamins
Highest doses of B12 if possible in methyl formula
Antioxidants (such co-Enzyme Q)
Echinacea, Antidepressives
No emotional and psychological stress
Enough sleeptime
Enough sleep time in the early afternoon
No alcohol
No smoking
How to break a "hyperimmune situation" such as
Localised scleroderma, MS Syndrome, Raynaud and others NSAR, COX-11 inhibitor
Vitamin E, Epa-caps (Fish oil)
AIpha-4N Antagonists such Remicade, Enbrel
Avoid absolutely Steroids Methotrexat, Imurek
Beta-Interferon????
Gammaglobulins

Alleviate the symptoms
High doses of Magnesium (Spasms)
Antiparkinson therapy (Spasms)
Salicylates (Pains Arthritis cerebral vasculitis, strokes)
Gababentin against neuropathic pains and dysesthesia.
Ginkgo In high doses (cerebral hypoperfusion)
Antdepressive, anxiolytic medication
Physical rehabilitation
Patients are no longer allowed to give blood for transfusion

SOME DIFFICULTIES AND DANGERS IN TICK~BORNE DISEASE THERAPY

Avoid Yeast complication by ordering diet and drugs (LC1/Bifidus, no Fructose, Fluconazol)
Herxheimer reactions are possible any time and are a sign that therapy is probably helping (toxins of spirochetes cytokine) there are sometimes in form a pseudoallergic reactions
Drug interaction
Seizures (illness and or Herxheimer)
Central line and line problems
Other infections others illnesses
Reinfections
False diagnosis

WHAT ABOUT LONG TIME TREATMENT OF CHRONIC RELAPSING TICK-BORNE DISEASE

Between 11/2 and 5 years, perhaps open ended
Immunodeficiency must be researched and documented
The relapse must be confirmed by an accepted laboratory test (PCR, histology antigen or newer methods)
Is not accepted as a standard therapy
Problems with insurance occur
Controversial Klempner studies summer 2001
NIH study "Brian Fallen"

ABOUT RESEARCH AND PUBLICATIONS

The diversity of clinical features and stages of illness is a big problem for creating collectives for prospective studies
The chronic relapsing patients are no longer in care in Medical Universities not CDC conform) but dispersed among family practitioners, rheumatologists, neurologists, dermatologists and psychiatrists and do not exist as collective
There are plenty of case reports and a poor number of prospective studies. Case reports are not accepted from Universities as well as“peer reviewed, prospective placebo controlled doubleblind studies”
Who are the editors of the most important journals?
In chronic infection diseases Placebo controlled studies cause ethical problems

QUESTIONS TO RESEARCHERS.OF TICK-BORNE DISEASES

What is the reason of Immunodeficiency in a certain number of patients with TBD? Could it be the Co-infection with Cytomegaly Virus??
How is a degradation of the Lymphadenoma cuties benignum to the malignant Lymphoma or a Glioma or a Sarcoma possible, which control mechanism is failing?
How can we kill the dormant forms (Spherocyte, L-Forms) of Borrelia Spirochetes? Are Metronidazole or Antiprotozoids possibilities?
Can different micro-organisms make a genetic exchange and avoid the host immunity reactions?
Who is researching the connective tissue as a reservoir of Spirochetes?

FINAL 0BSERVATIONS

We shall never win the fight against TBD if we exclude the diagnosis, the chronically of disease and the physicians working on it
What is well accepted for other infections must also be applied to TBD: PCR is accepted for diagnosis of Tuberculosis, Gonorrhoea, Chlamydia, HIV, Hepatitis, B/C and others co-Infections are possible and since the discovery of AIDS obvious
Latent infections are known by Herpes zoster, Tuberculosis, Syphilis and others
We probably enter new era a infectious diseases after a time of success thanks antibiotic drugs and vaccines
It seems that, there is a comeback of infectious diseases which have. learned to evade the human immune system

We need new research

ACKNOWLEDGMENTS
Mrs. Beryl Daniel’s for invitation
My office staff: Mrs Lottaz, Mrs. Hildebrandt, Mrs Czaja,
My amity
Dr E. Mordechai, Dr Shah and Dr N. Harris for Laboratory tests in the USA
My Friends R. and W. von Lerber
Dr J. Burrascano and his wife having to suffer for his engagement in cause of Lyme disease

Mrs.Dr.med.L.Meer-Scherrer, Sept.01