For Memory Concentration And Focus
Improving memory is a challenge. In Lyme disease, short-term memory problems and word-retrieval problems are common. These often improve substantially with appropriate antibiotic therapy. Over time, most patients regain their cognitive function.
When memory is a problem, consider that this could be due to a primary problem with attention or with mood. An individual who can’t focus won’t be able to remember because he/she didn’t “attend” to the item in the first place. This happens to all of us when we hear someone’s name at a party if we don’t focus on the name and perhaps make a mental association to the name to enhance memory storage, we will forget that name within minutes. Patients with depression often experience problems with memory and verbal fluency when the depression is resolved, the memory and verbal fluency typically resolve as well.
- Medications: Attention can be improved with certain medications, such as bupropion , atomoxetine , modafinil , or stimulants . Medications that temporarily slow cognitive decline in Alzheimer’s disease or memantine ) have not been studied in Lyme disease.
- There is some evidence that online brain training programs can enhance concentration or processing speed.
- Neurofeedback may be helpful in improving attention, as well as in improving sleep and reducing pain. This has been studied for migraines, fibromyalgia, and ADHD.
Assisting Lyme Disease Research At Tulane
Monica Embers, associate professor of microbiology and immunology and director of Vector-Borne Disease Research at the Tulane National Primate Research Center
Unlike many bacterial infections, antibiotic treatment for Lyme disease often fails. And the people who suffer from long-term or post-treatment Lyme disease may be frustrated that they dont get better sooner, or at all. Monica Embers, associate professor of microbiology and immunology and director of Vector-Borne Disease Research at the Tulane National Primate Research Center, studies Borrelia burgdorferi, the bacteria that causes Lyme disease. She recently shared insights from her research with the On Good Authority podcast.
Embers research centers on finding antibiotics that are effective against persistent Lyme disease, innovative therapies that fight the infection, better diagnoses and eventually a cure for the infection. She is also a member of the Department of Health and Human Services Federal Tick-Borne Disease Working Group, a DHHS division that provides a report on Lyme and other illnesses every two years.
Post-treatment Lyme disease is still a mystery to many physicians, especially since a delayed diagnosis makes it that much harder to treat.
A recent study found 14% of people across the world have had Lyme disease. And even with tens of thousands of new cases reported every year, health experts fear the disease is significantly underreported.
Common Conditions Requiring Medication Treatment For Lyme Disease
Lyme disease requires medication treatment. If you dont take proper medication, your condition can get much worse. It is important to continue seeing your doctor, even if you are feeling better, until your doctor says you are free of the disease. Be sure to share if you are getting new symptoms or have found your symptoms are not improving.
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An Alternative To A Vaccine
Its not just a Lyme vaccine thats in the pipeline. Theres also something called a pre-exposure prophylaxis in the works. This is a treatment in this case a monoclonal antibody shot that would be given once a season to help prevent infection.
Maybe the world will be more receptive to a monoclonal antibody to prevent Lyme disease than they will be to a vaccine because there’s so much vaccine antipathy, he said. But, one way or another, I’m hopeful that we will have a medicine in the next two years to prevent what is a very significant public health problem in the United States.
This month, Klempners team is wrapping up a trial testing dosage and ensuring there are no nasty side effects from the monoclonal antibody. He said there are none, even at the highest dosage. The earliest it could be ready for the general public, he said, is 2024.
How To Prevent Lyme Disease
Education and awareness is the most valuable form of prevention against Lyme Disease. Prevention measure may include
- Watching for early signs of a tick bite
- Personal environment modification
- Using proper insect repellent
- Inspecting clothing when in wooded areas
Avoidance may be the most effective way to prevent a tick bite. The highest concentration of ticks are found in damp, wooded areas. It may be beneficial to avoid these areas, but if one cannot, stick to marked trails and paths.
âThe New York State Department of Healthâs public-affairs office recommends doing âa final, full-body tick check at the end of the day, and also check children and pets,â in order to protect against ticks and tick-borne illness.â
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Is There A Cure For Lyme Disease
If treated early, yes, Lyme Disease can be cured with the proper antibiotic regimen. However, if the condition is left untreated, symptoms such as arthritis, heart, and nervous system issues can occur. These symptoms can become increasingly difficult to impede and may require an alternative form of therapy.
Myth: Lyme Disease Doesn’t Cause Chronic Illness
The biggest Lyme disease controversy centers on post-treatment Lyme disease syndrome , a chronic illness often called “Chronic Lyme Disease” . A paper published in the Journal of Pharmacy and Pharmaceutical Sciences states that 10-20% of patients who get infected with Lyme disease will have long-term symptoms after initial treatment. However, the difficulties with diagnosing and treating Lyme disease have led to a deep divide within the medical community. Some believe that the lingering symptoms are caused by an active, persistent Lyme disease infection. Others believe that they are the manifestation of a post-infection autoimmune condition. Still others believe that the symptoms are unrelated to Lyme disease and that PTLDS/CLD doesn’t exist at all. The Centers for Disease Control and Prevention recognizes PTLDS as a chronic illness, but acknowledges that a lot doctors, scientists, and researchers don’t know about it.
Regardless of the medical community’s views on PTLDS/CLD, thousands of people in the United States are struggling with the chronic illness, per a study published in BioMed Central Public Health. And it has a major impact on their well-being. One study found that people diagnosed with PTLDS experience a poorer quality of life and greater symptom severity than people with other chronic illnesses.
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A Lyme Vaccine: Past And Future
Once upon a time, there was a Lyme vaccine. But 20 years ago, after just a few years on the market, it was discontinued. While the vaccine worked well reducing Lyme infections by nearly 80% some people said it caused concerning side effects like arthritis. That was never proven, but market pressure led the manufacturer to stop making the vaccine.
This month, a new Lyme vaccine entered the final stages of clinical testing. Its made by Pfizer and another pharmaceutical company, Valneva. It uses a similar approach to the previous vaccine, but its been adjusted to leave out the protein region that caused the controversy before.
If all goes well, the companies could seek authorization for this new vaccine in 2025. But Massachusetts residents and others in Lyme-endemic areas can already sign up to be part of the trial.
Drug Combinations Against Stationary Phase Borrelia
In March of 2015, some of the researchers from the above study expanded upon the results from the 2014 drug screen. They took the top 27 drug candidates and drug combinations and tested their activity against microcolony . They published their results in a research paper titled Drug Combinations against Borrelia burgdorferi persisters in vitro: eradication achieved by using daptomycin, cefoperazone, and doxycycline.
The researchers discovered the biofilm forms of Borrelia bacteria were more resistant to antibiotics that had good activity against round body persister forms suggesting antibiotics used alone had limited effect. Then they evaluated 81 drug combinations against microcolony and round body forms. Daptomycin alone could not eradicate microcolonies, but when combined with other drugs, daptomycin was effective against round body forms and microcolonies. The most effective drug combination against microcolonies was daptomycin + doxycycline + cefoperazone.
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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.
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Its the middle of tick season, in the heart of tick country. And when there are ticks, there are worries about Lyme disease. While theres a Lyme vaccine for dogs, there isnt one available for humans. But, that may change.
Our approach to Lyme disease may look very different in just a few years. Here’s why and what you need to know about this tick-borne illness right now.
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Is There A Vaccine For Lyme Disease
A vaccine for Lyme disease was once available in the United States, but it is no longer available. The vaccines manufacturer discontinued its production in 2002, citing low sales.
According to a 2011 analysis, there were likely a number of factors leading to the decision to suspend the vaccine. These factors included:
- Class-action lawsuits
- Low public support due to efforts by anti-vaccine groups
- Concerns that the vaccine could cause arthritis
- A difficult vaccination schedule.
The CDC also notes that the vaccine loses effectiveness over time, meaning that youre probably no longer protected against Lyme disease today if you received the vaccine when it was available.
In July 2017, the FDA granted Fast Track designation for another Lyme disease vaccine candidate, VLA15. The FDA designation is intended to facilitate development and expedite review of drugs that treat serious conditions in order to get them to patients faster.
Additional reporting by George Vernadakis.
The Direction Of Antibiotics For Persistent Lyme
It is great to see multiple research studies attempting to identify effective treatments for chronic Lyme disease. None of the antibiotics in current use for Lyme disease were developed for the bacteria that causes Lyme. Newer technology allows hundreds of existing drugs to be screened for their effectiveness against Borrelia. The limitation of most of these studies is that they were performed in vitro , but they establish a starting point for future in vivo studies.
Drug combinations were most effective at eradicating stationary phase Borrelia burgdorferi. Since the drugs used in the screening studies were from research drug libraries, some of the effective medications are not available commercially. The results of these studies are helping the Lyme community move closer to finding a cure for chronic Lyme disease. Future in vivo research identifying effective treatments for stationary phase Borrelia will have a significant impact against chronic Lyme.
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Doxycycline Doesnt Clear All Lyme Bacteria
One of the more surprising revelations in the lecture is that doxycycline, the drug of choice for treating adults with Lyme disease, doesnt clear all of the causative bacteria. It only slows their proliferation, disrupting cell-wall creation as each forms a copy of itself by splitting into two. When the Lyme bacteria sense doxycycline, they shapeshift into spherical, dormant forms called persister cells, so they can wait out the chemical storm.
Dr. Embers backs up these claims with a series of thoughtfully designed experiments on nonhuman primates, our closest mammalian relatives. In one study, she treated five rhesus macaques with a 28-day course of doxycycline and five without. A year after the trial began, nine out of the 10 macaques, both treated and untreated, showed signs of ongoing illness and live Lyme spirochetes were isolated. In addition, those that received doxycycline had more bacteria in the brain.
The studys conclusion: We observed evidence of persistent, intact, metabolically-active B. burgdorferi after antibiotic treatment of disseminated infection and showed that persistence may not be reflected by maintenance of specific antibody production by the host.
Simply put, treating with doxycycline didnt seem to be a cure for everyone, and the Lyme bacteria appear to have ways of suppressing antibody production so that it can fly under the radar of the immune system.
Azlocillin As A Potential Treatment Against Borrelia
Stanford researchers that identified azlocillin as an effective antibiotic against stationary phase Borrelia in culture in 2016 performed another study in 2020, but this time with mice. Azlocillin at relatively low concentrations eliminated stationary phase Borrelia. Cefotaxime required higher concentrations and only killed 80% of stationary phase Borrelia. They also determined that the combination of azlocillin and cefotaxime was more effective at killing Borrelia persisters than azlocillin alone.
They published their findings in the paper Azlocillin can be the potential drug candidate against drug-tolerant Borrelia burgdorferi sensu stricto JLB31.
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Genomic Insights From Borreliaceae Lineages
Between 1982 and 2010, the B. burgdorferi species complex, known as B. burgdorferi sensu lato, steadily expanded from 1 to 18 species as isolates from tick vectors, their hosts, and patient samples were characterized . A subset of these species are associated with human disease. B. burgdorferi sensu stricto in the USA, as well as B. afzelii and B. garinii in Eurasia are the most common agents of LD in the Northern hemisphere. Cases of LD in Europe are also caused by Bb and B. bavariensis , but are less common. B. spielmanii , B. bisettiae , and B. lusitaniae have been identified in human specimens but their clinical importance is less clear. B. valaisiana has been identified in human specimens , but others have recently provided compelling reasons why existing evidence does not support it being considered a human pathogen . Additional species have been identified in tick vectors or their hosts, but not in patient samples.
What Is Lyme Disease
Lyme disease is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete that is carried by deer ticks. An infected tick can transmit the spirochete to the humans and animals it bites. Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe. Often, an erythema migrans rash appears within 7-14 days at the site of a tick bite .
LD manifests itself as a multisystem inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later, disseminated stages. If diagnosed and treated early with antibiotics, LD is almost always readily cured. Generally, LD in its later stages can also be treated effectively, but because the rate of disease progression and individual response to treatment varies from one patient to the next, some patients may have symptoms that linger for months or even years following treatment. In rare instances, LD causes permanent damage.
Although LD is now the most common arthropod-borne illness in the U.S. , its diagnosis and treatment can be challenging for clinicians due to its diverse manifestations and the limitations of currently available serological tests.
Borrelia burgdorferi
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Biorepositories And Research Cohorts
Well-characterized samples are an essential tool to help researchers develop and validate new diagnostic tests and to better understand the complexities of LD. Well-characterized sample sets can benefit medical providers, test developers, and the public at risk for LD . It is critical that sample users understand the criteria used to enroll participants, how samples were collected and stored, and what additional clinical and testing data may be available. Additional benefits can be realized when multiple sample users are using the same well-characterized sample sets. Current sample sets available for researchers include the CDC Lyme Serum Repository , the Lyme Disease Biobank , and samples from the Studies of Lyme Immunology and Clinical Events at Johns Hopkins University School of Medicine. Additionally, some investigators also have their own sample collections with, in some cases, blood samples, skin biopsy specimens and synovial fluid which form the basis for collaborative studies .
Lyme Disease Biobank
Lyme Disease Research Center
Long Island Outdoor Worker Cohort
Myth: Lyme Disease Is Easy To Treat
Unfortunately, getting successfully treated for Lyme disease is just about as difficult as getting diagnosed because there is no standard treatment protocol, per a paper in the medical journal Expert Review of Anti-infective Therapy. Though doctors generally agree that antibiotics are effective when Lyme disease is diagnosed within a few weeks of infection, recommendations for the course of antibiotics vary. Most commonly, though, someone can expect to take antibiotics for between 14 and 21 days, though depending on the medication the stage of infection, the course could be as little as seven days or as many as 28 . Though many doctors prefer doxycycline, some prescribe amoxicillin or cefuroxime .
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