Treatment For Chronic Lyme Disease
Sometimes, people go through treatment for Lyme disease but their symptoms donât go away. If this lasts over 6 months, itâs known as chronic Lyme disease or âpost-treatment Lyme disease syndromeâ .
Doctors still arenât sure why some people get PTLDS. Some believe that getting Lyme disease may cause damage to your tissues or immune system. Others believe itâs because the bacteria that causes Lyme hasnât completely gone away.
There is little evidence that taking more antibiotics at this stage will help. They may actually be harmful. Instead, your doctor will focus on treating the symptoms youâre still having. This will be different for everyone. Some people could benefit from a medicine that relieves fatigue, while others may need a drug that can help with headaches or very sensitive skin.
Your doctor could also have you try a treatment that helps people with chronic fatigue syndrome or fibromyalgia.
More research is needed to figure out how best to treat PTLDS. Itâs something that can be frustrating. Just remember: Many people who have this condition do start feeling like their old selves after a few months.
When Should I Call The Doctor
If a tick bites you, call your doctor. Other conditions can cause similar symptoms, so its always a good idea to discuss them with your doctor. That way you can get checked and treated, if needed. Call right away if you get a red-ringed rash, lasting flu-like symptoms, joint pain or a swollen joint, or facial paralysis.
What Blacklegged Ticks Look Like
Blacklegged ticks are small and hard to see. They attach themselves to humans and animals and feed on their blood. They can range in size depending on how long they have been feeding.
You can find out if its a blacklegged tick by:
- calling your local public health unit or checking their website
- submitting a photo of the tick to etick.ca
Adult female blacklegged tick at various stages of feeding. Photo: Government of Canada
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Why Lyme Disease Is Hard To Treat
Lyme disease, which is caused by Borrelia burgdorferi bacteria, is a tick-borne illness. It doesnt circulate in the blood like many bacterial infections.
Instead, it hides in your bodys tissues. That makes it more difficult to detect and harder to treat.
If an infected tick bites you, you may begin to show signs of Lyme disease in one to four weeks.
Primary Lyme disease is what most of us are familiar with, May said. The symptoms include fever, fatigue, body and joint aches, and in some cases, the characteristic bulls-eye rash where red rings appear around the site of the tick bite.
If caught early, Lyme disease can be treated with antibiotics.
If its not caught, untreated Lyme disease may progress and become a bit more serious.
Secondary Lyme disease can include swollen or painful joints, extreme fatigue, numbness, headaches, muscle weakness, conjunctivitis, poor memory, confusion, and heart palpitations, May said.
If its still not diagnosed at this stage, the bacteria may invade the central nervous symptom and cause problems, such as mental status changes and effects on mood, sleep, and memory, May said.
Loss of muscle control, tics, a lack of coordination, and potentially deadly heart complications are also possible, she added.
Today, 90 percent of cases of Lyme disease are reported in just 14 states, according to the CDC. The majority of these states are in the Middle Atlantic region and New England.
The Gathering Storm: The Fda Meets
With lawsuits pending and questions from the public and the media, and facing an increasingly complex and explosive situation, the FDA reconvened its advisory panel on 31 January 2001 to discuss the future of the Lyme vaccine. The participants included the FDA scientific advisors, the LYMErix manufacturer, independent experts, practising physicians, the vaccine victims and their lawyers.
This panel, described by one participant as raucous and riotous , provided a forum for all of the stakeholders . In support of the vaccine, the FDA summarized the VAERS data and concluded that the evidence did not support a causative association. The vaccine manufacturer, now GlaxoSmithKline following a corporate merger, assured the assembled parties that the LYMErix vaccine did not cause harm to its recipients. They reviewed the status of their phase IV post-marketing surveillance. Practising physicians spoke of vaccine efficacy by describing the dramatic reduction in Lyme disease cases in their own practices.
Others raised concerns about the vaccine’s safety. Scientists argued a potential role for genetic susceptibility and OspA-related autoimmunity in vaccine complications. Poignant presentations by several vaccine victims described in detail their suffering. The prosecuting lawyers for the largest class action suit claimed that manufacturers suppressed reports of adverse events from the licensing trial and provided inadequate warnings to genetically susceptible individuals.
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Why It Took So Long To Develop A New Vaccine For Lyme Disease
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In May, an article with the unprepossessing title Detecting Borrelia Spirochetes: A Case Study with Validation Among Autopsy Specimens was published in the medical journal Frontiers in Neurology. The deceased person in question was a sixty-nine-year-old woman who suffered from severe cognitive impairment. Fifteen years before her death she had been treated for Lyme disease, the most prevalent tick-borne illness in the United States, and was thought to have fully recovered. Yet, when her brain and spinal-cord tissue were examined, researchers found intact Borrelia spirochetes, the bacteria responsible for Lyme. If the womans cognitive decline did result from Lyme diseasewhich the paper suggested was a strong possibilitythen it was further evidence that the illness could persist and wreak havoc long after a tick bite, and long after treatment.
It was the first time an F.D.A.-licensed vaccine was removed because of a concerted public-opinion campaign, even as the number of infections were rising. People say, Why cant I do for myself what I can do for my dog? Well that, you know, is thanks to the people who brought down LYMErix, Mark Klempner, a professor of medicine at the University of Massachusetts and one of the vaccines developers, told me. It was a great disappointment to have worked all those years and feel successful at the end of it, only to see it pulled. It was a tragedy.
Questions About The Arthritogenic Ospa Hypothesis
Importantly, no difference was found between early or late onset arthritis when comparing vaccine recipients with placebo recipientsincluding among those with preexisting musculoskeletal disorders. In addition, the FDA had found no statistical evidence of elevated rates of arthritis in vaccine recipients, compared with background rates or rates in placebo recipients.
Thus, the overall conclusion was that no compelling scientific evidence or biologic plausibility existed supporting the idea that the administration of recombinant OspA to an individual with a given HLA haplotype would increase the risk of an autoimmune arthritis. This conclusion was justified by the lack of direct evidence, the theoretical rather then scientific basis for the hypothesis, and the lack of evidence for such a sequence of events in phase III trials. Still, one could argue that, at least in genetically susceptible individuals, such an adverse effect might occur at a level of magnitude below what studies to date have been powered to detect. Unfortunately, it is impossible to know. As is the case in all such questions, it is impossible to completely disprove a safety concern. However, as shown by Livey et al in their companion article in this issue, it is possible to remove the OspA epitope that prompted concern in the first place and still immunize against Lyme borreliosis.
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Lyme Disease Frequently Asked Questions
If you have not done so already, remove the tick with fine-tipped tweezers.
The chances that you might get Lyme disease from a single tick bite depend on the type of tick, where you acquired it, and how long it was attached to you. Many types of ticks bite people in the U.S., but only blacklegged ticks transmit the bacteria that cause Lyme disease. Furthermore, only blacklegged ticks in the highly endemic areas of the northeastern and north central U.S. are commonly infected. Finally, blacklegged ticks need to be attached for at least 24 hours before they can transmit Lyme disease. This is why its so important to remove them promptly and to check your body daily for ticks if you live in an endemic area.
If you develop illness within a few weeks of a tick bite, see your health care provider right away. Common symptoms of Lyme disease include a rash, fever, body aches, facial paralysis, and arthritis. Ticks can also transmit other diseases, so its important to be alert for any illness that follows a tick bite.
References:
Moody KD, Barthold SW, 1991. Relative infectivity of Borrelia burgdorferi in Lewis rats by various routes of inoculation.external iconAm J Trop Med Hyg 44: 135-9.
There are no reports of Lyme disease being spread to infants through breast milk. If you are diagnosed with Lyme disease and are also breastfeeding, make sure that your doctor knows this so that he or she can prescribe an antibiotic thats safe for use when breastfeeding.
Why Was Lymerix Discontinued
Over 1 million doses of LYMERix had been given the year following approval. This significantly lowered the number of new Lyme disease cases in the U.S.
During that time, concerns about vaccine safety emerged. But these concerns werent supported by the FDAs findings upon investigation. And yet, the number of people getting the vaccine dropped significantly. Because of this, LYMERix was discontinued in 2002.
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What Can I Expect Long Term If My Child Has Lyme Disease
If Lyme disease is caught and treated early, most children will make a full recovery. Some children with Lyme disease go on to experience whats called a post-infectious syndrome with symptoms that may include feeling fatigue, joint aches and pains, headaches, difficulty sleeping, and problems concentrating. Since the infection itself is gone by this time, doctors generally dont prescribe antibiotics. Each child is different, but its not uncommon for symptoms of post-infectious syndrome to linger for months, or even years, and they can be made worse by stress or other illness. But most children do make a full recovery.
Blacklegged, or deer, ticks are very small, so it helps to know what to look for when doing a tick check. Adults are about the size of sesame seeds and in the nymph or larva stage, they can be as tiny as a poppy seeds.
Vaccine Licensure Recommendation And Initial Use
In response to growing reports of Lyme disease cases in the United States from 1982 to 1996, the number of reported cases increased by 32 times SmithKline Beecham developed LYMERix, which was licensed in 1998. The licensed product was a recombinant vaccine containing an outer surface protein from theBorrelia burgdorferi bacteria. Before licensure, 6,478 people received 18,047 doses of the vaccine during clinical testing. The most common adverse events noted within 30 days of receiving at least one dose of the vaccine included pain or reaction at the injection site, joint pain, muscle pain, and headache. Of these, only pain and reactions at the injection site occurred much more frequently in the vaccine recipients than in those who received a placebo.
The efficacy trial for the vaccine showed that it was 78% effective in preventing Lyme disease after all three doses were given. It was also shown to be 100% effective at preventing asymptomatic cases, where an individual would get the disease and develop antibodies against it but never develop any symptoms.
Based on the clinical trial data, the vaccine was given a permissive recommendation by the Advisory Committee on Immunization Practices. A permissive recommendation means a vaccine is not added to the childhood or adult immunization schedules, like vaccines against common childhood diseases . Instead, the vaccine is considered for use only in individuals or groups with specific risk factors for a disease.
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Vaccines: Our Greatest Hope In Defeating Aids Ebola Tb And Other Infectious Diseases
Safety concerns began to emerge soon after people began getting LYMErix. Some recipients began to report joint pain and other effects that they attributed to the vaccine. Within a year of the vaccines approval, a class action lawsuit was filed against SmithKline Beecham on behalf of 121 people. Although the suit was eventually settled it provided no compensation to the plaintiffs publicity about it dampened interest in the vaccine.
Meanwhile, growing distrust of vaccines may have compounded LYMErixs struggles.
When a 1998 report in the Lancet identified a purported link between the common MMR vaccine and autism, the study since retracted and considered fraudulent sparked a spike in worry about the safety of vaccines. In October 1999, a new vaccine against rotavirus, the most common cause of diarrhea in infants and young children, was withdrawn from the market after its use was linked to a higher than expected risk of a potentially deadly bowel blockage known as intussusception.
An advisory panel convened in 2001 by the FDA did not find any evidence that LYMErix caused arthritis in humans or an unexpected number of adverse events. But growing suspicion of vaccines in general and publicity about possible side effects had already taken a toll on LYMErixs uptake. SmithKline Beecham projected sales of only 10,000 doses for 2002.
The company withdrew LYMErix in February 2002, citing poor market performance.
What Happened To The Lyme Vaccine
You can vaccinate your dog against Lyme disease, but theres no vaccine for humans. Why?
A black-legged tick responsible for spreading the bacteria that cause Lyme disease.
Theres significant and understandable concern about Lyme disease today. The spirochete Borellia burgdorferi was only discovered in 1982, and the disease only became reportable in the United States in 1991. Today, Lyme is the most common vector-borne disease in the United States with 25,000 cases being reported annually. Understandably, efforts have been growing to find ways to prevent Lyme disease, focusing on personal protection primarily, with environmental protection as a secondary measure. Some may recall that there was a vaccine on the market almost two decades ago, but its no longer marketed today. The story of the Lyme vaccines rise and fall is fascinating, and raises questions about whether there will ever be another Lyme vaccine marketed again.
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If You Have Lyme Disease You May Have Another Illness Too
Ticks have been called the dirty syringes of the animal kingdom, swapping infected blood indistriminately amongst their hosts. So if Lyme disease were the only thing we could get from these vermin, wed be lucky. And were not. There are a half dozen or more other tick-born pathogens that can get passed on along with Borrelia, including Babesia microti and Anaplasma phagocytophila . When someone is diagnosed with Lyme disease they should at least be tested for other pathogens, Telford says.
While waiting for new treatments to come along, your best bet is to take some simple precautions to avoid encountering Borrelia in the first place: wear long-sleeved clothes when in tick habitat, apply DEET insect repellent, and check yourself for embedded ticks. And if worse comes to worse and you come down with symptoms, talk to your doctor about getting tested. Antibiotics like doxycycline are highly effective against the disease even in its more serious later stages.
After all, says Telford, Lyme disease is a drag, but you shouldnt let the fear of it ruin your life: People should enjoy the outdoors, he says.
Yale Researchers Develop Mrna
Yale researchers have developed an mRNA vaccine that targets the antigens found in tick saliva in order to alert individuals to tick bites as well as prevent the tick from feeding correctly, thereby reducing its ability to transmit pathogens.
12:45 am, Dec 02, 2021
Contributing Reporter
Cate Roser
Yale researchers have developed an mRNA vaccine against lyme disease that triggers an immune response at the site of a tick bite and provides partial protection against the disease-causing bacteria.
In a paper published on Nov. 17 in the Science Translational Medicine journal, scientists studied specific ticks called Ixodes scapulari that carry a lyme-disease-causing bacteria called Borrelia burgdorferi.According to Gunjan Arora, one of the co-first authors of the paper and an associate research scientist at the Yale School of Medicine, lyme disease is the fastest-growing vector-borne illness in the United States, with close to half a million people affected every year. Currently, there are no commercially available vaccines for lyme disease. This novel vaccine is unique in that it targets the vector of transmission, the tick, rather than the actual pathogen itself.
Traditionally, vaccines are developed to target specific viruses or bacteria that can cause disease. However, this new lyme disease vaccine is designed to target tick salivary proteins, according to Matias dos Santos.
Ticks are classified as arachnids and are closely related to spiders and scorpions.
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A New Option To Stop Lyme Disease
Tick populations show no signs of shrinking and the spread of tick-borne illnesses are likely to continue increasing, so a Lyme disease vaccine could be big business.
Wendy Adams, research grant director at the Bay Area Lyme Foundation, said the real number of Lyme disease cases is likely much higher than the reported number.
Due to reporting requirements, only about 30,000 cases are reported to health authorities, which the CDC has acknowledged is likely less than 10 percent of actual cases, Adams said. There are 329,000 or more new cases of Lyme disease diagnosed each year in the U.S.
That puts new cases of Lyme disease higher than almost any other reportable infectious disease, including HIV and AIDS.
Different groups suggest that the global market for a vaccine against Lyme disease is estimated at approximately $1 billion annually, based on current estimates of the cost of treating patients with acute and more chronic Lyme disease, said , PhD, professor of medical microbiology and immunology in the College of Medicine and Life Sciences at The University of Toledo.
With that in mind, in 2017, the Food and Drug Administration approved a Fast Track designation for a new Lyme disease vaccine.
French company Valnevas vaccine for Lyme disease, VLA15, completed initial trials in early 2018 and is currently in phase II of clinical testing, Thomas Lingelbach, the companys CEO, said.