Recent Progress In Lyme Disease And Remaining Challenges
Lyme disease is the most common vector-borne disease in the United States with an estimated 476,000 cases per year. While historically, the long-term impact of Lyme disease on patients has been controversial, mounting evidence supports the idea that a substantial number of patients experience persistent symptoms following treatment. The research community has largely lacked the necessary funding to properly advance the scientific and clinical understanding of the disease, or to develop and evaluate innovative approaches for prevention, diagnosis, and treatment. Given the many outstanding questions raised into the diagnosis, clinical presentation and treatment of Lyme disease, and the underlying molecular mechanisms that trigger persistent disease, there is an urgent need for more support. This review article summarizes progress over the past 5 years in our understanding of Lyme and tick-borne diseases in the United States and highlights remaining challenges.
When Is It Too Late To Treat Lyme Disease
If Lyme disease isnt treated in its early stages with some form of antibiotic treatment, chronic Lyme disease may develop. In later stages of Lyme disease, a healthcare provider may choose to try intravenous antibiotics in an attempt to calm symptoms down. Some natural or home remedies may help chronic symptoms of pain.
Herbal And Rx Antimicrobials That Treat Persisters
This is a newer area in Lyme treatment. To help justify these various antimicrobial options, I describe the experimental basis behind my recommendations. These options are ones I am using with various degrees of success in my Seattle practice. They all have either laboratory experiments supporting their use or published human experiments.
Laboratory-Based Experiment Options
Here is a list of prescription and herbal medicine options shown in lab experiments to kill persisters that I am incorporating into my treatments of Lyme and/or Bartonella.
- Disulfiram – work slowly up to 4 to 5 mg/kg body weight 1 time a day.
- Methylene Blue 50 mg 2 times a day.
- Liposomal Oregano, Cinnamon, and Clove Oils 1 capsule 2 times a day.
- Cryptolepis 5 ml 3 times a day.
- Japanese Knotweed½ tsp 3 times a day – start at ¼ tsp 1 time a day and then increase after two weeks to ½ tsp 3 times a day.
- Cats Claw 30 drops 2 times a day.
Human-Based Experiment Options
Here is a list of prescription medications shown in human experiments to help with persister Lyme.
- Disulfiram – work slowly up to 4 to 5 mg/kg body weight 1 time a day.
- Dapsone – work up to 100 mg or 200 mg 1 time a day.
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Stages Of Lyme Disease
Lyme disease is typically classified as either early or late-stage. Early-stage Lyme disease occurs hours or weeks after an initial tick bite and is when symptoms can start to appear. At this point, the bacterial infection will begin to spread throughout the body. Some people may experience what is called post-treatment Lyme disease syndrome months or even years after an initial tick bite. PTLDS can happen when Lyme disease isnt treated in its earliest stage, and can even occur after someone has received earlier treatment for Lyme disease. With late-stage Lyme disease, the infection spreads throughout the body and can affect the nervous system, joints, or heart.
Penicillin Plus Azole Plus Lipsomal Cinnamon Clove & Oregano Oil
- amoxicillin 500 mg 4 pills 3 times a day
- tinidazole 500 mg 1 pill 2 or 3 times a day for 4 days on and 3 days off in 7-day cycles.
- liposomal cinnamon, clove, and oregano oil capsules 1 pill 2 times a day.
- This is a very high dose of amoxicillin, which is four times stronger than physicians prescribe for other infections like ear infections. I consider this dose to be nearly as effective as IV antibiotics.
- This is a pulse dose regimen of the tinidazole. It may be more effective than continuous regimens.
- The essential oils are added to treat persister Lyme.
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What Are Some Common Side Effects Of Lyme Disease Medication
As with any medication, there are always potential side effects. Contact your doctor or pharmacist if your side effects persist or worsen.
Antibiotics are commonly used to treat Lyme disease and may cause allergic reactions that result in hives, difficulty breathing, or dry eyes, throat, and mouth. Some people may experience diarrhea, headaches, or chest pain as well. You should seek immediate medical care if you believe you are experiencing an allergic reaction.
This list of side effects is not comprehensive. Ask a healthcare professional for more details regarding the possible side effects of a particular medication.
Antimicrobials That Kill Growing Phase Spirochetes
- Amoxicillin 500 mg 1 to 2 pills 3 times a day. Alternatively as an alternative to IV antibiotics take 3 to 4 pills 3 times a day.
- Amoxicillin/Clavulanic Acid 875 mg/125 mg 1 pill 2 times a day
- Bicillin LA 2.4 million units IM 3 times a week with one day between each injection
- Ceftriaxone 2 gm IV 2 times a day for 4 days in a row then off for 3 days of each 7 days
- Cefotaxime 2 gm IV every 8 hours
- Cefuroxime 500 mg 1 pill 2 times a day
- Cefdinir 300 mg 1 pill 2 times a day
Additional IV Antibiotics
Vancomycin, imipenem, and ertapenem are possible alternatives if someone is allergic to Ceftriaxone or Cefotaxime.
Intracellular and Extracellular
- Clarithromycin 500 mg 2 pills 2 times a day
- Azithromycin 500 mg 1 time a day or 500 mg IV 1 time a day
- Doxycycline 100 mg 1 or 2 pills 2 times a day or 200 to 400 mg mg IV 1 time a day
- Minocycline 100 mg 1 pill 2 times a day
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Using Antibiotics To Treat Lyme Disease
Lyme disease is typically treated with antibiotics, although the type of antibiotic used depends on what stage of the disease you have.
After you remove a deer tick that has been attached to you for at least 36 hours the amount of time it takes for the tick to transmit the bacteria Borrelia burgdorferi theres a 72-hour window during which your doctor may give you a single dose of the antibiotic doxycycline to prevent the development of Lyme disease.
Doxycycline is prescribed to patients age 8 and older, except for pregnant women. Not everyone in this situation will receive doxycycline the deer tick bite needs to have occurred in a highly endemic area .
If you have localized Lyme disease with the telltale bulls-eye rash, also known as erythema migrans, but no other significant symptoms, your doctor will most likely treat you with oral doxycycline, amoxicillin, or cefuroxime for 10 to 14 days. If you have early disseminated Lyme disease, which may include the characteristic rash along with cardiac or neurologic symptoms, the treatment duration is lengthened to 14 to 21 days.
Late disseminated Lyme disease is also treated with various antibiotics:
Symptoms Of Lyme Disease
Signs and symptoms of Lyme disease can vary from person to person after being bitten by a tick.
Lyme disease occurs in stages. The signs and symptoms of each stage can overlap. In some people, Lyme disease may present in a later stage without a history of prior signs or symptoms.
The most commonly reported sign of Lyme disease is an expanding skin rash that typically begins at the site of the tick bite. This rash is called erythema migrans. It slowly grows to more than 5 cm in diameter over several days, and can sometimes:
- be circular or oval-shaped
- look like a target or bull’s eye
- go unnoticed, especially if it’s on:
- a part of the body that’s difficult to see
Some people may not develop a rash.
Other early signs and symptoms include:
If left untreated, the infection could spread to the joints, heart and nervous system.
Images of erythema migrans rash
Image 1Footnote a: A rash that looks like a bull’s eye at the site of a tick bite.
Image 2Footnote a: An oval-shaped red rash.
Image 3Footnote a: A red rash that has expanded across the width of a limb.
Image 4Footnote a: A red rash and blisters on a forearm.
Image 5Footnote b: A rash on a shoulder.
Image 6Footnote c: A rash on the back of a knee.
- Footnote a
Later symptoms of Lyme disease can appear days to months after an infected tick bite, and may include:
- migratory pain that spreads in the:
Other later stage symptoms include:
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The Prescription Antibiotic Study
The latest study is Antibiotic Treatment Response in Chronic Lyme Disease: Why Do Some Patients Improve While Others Do Not? published October 3, 2020. In the study people that got well or responded very well with treatment were studied to see what worked. You can see more details about this study at LymeDisease.org here.
Related Resources For Lyme Disease
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This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
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What Is Lyme Disease
Lyme disease is a bacterial infection that occurs when the bacteria Borrelia burgdorferi is transferred to humans by animals or insects. Tick bites are the most common way that people acquire Lyme disease deer ticks are well-known carriers of B. burgdorferi. Its estimated that there are more than 300,000 cases of Lyme disease in the United States every year, according to the Centers for Disease Control and Prevention .
Sometimes called Lyme borreliosis, Lyme disease is often characterized by the appearance of erythema migrans, which is a bulls-eye or target-looking rash. Other symptoms include joint pain, weakness of the limbs, swollen lymph nodes, or flu-like symptoms. Treatment of Lyme disease requires a medical diagnosis, and most cases are treated successfully with antibiotics.
Ixodes scapularis, commonly known as the deer tick, is the most common way the disease is transferred. Anyone can contract Lyme disease, but those who live where disease-carrying ticks are prevalent have an increased likelihood of getting Lyme disease. Boys aged 5-9 are most likely to be affected by Lyme disease, as they spend the most time outdoors. The first case of Lyme disease was reported in the state of Connecticut in 1975. The Northeastern corner and upper midwest of the United States have the highest reported rates of Lyme disease.
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.
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Who Is At Risk
With climate change, tick season is lasting longer, and the parasites are spreading to larger geographic territories. The map below, from the CDC, shows where ticks carrying Lyme disease were identified last year in the U.S.
If you live in or visit these areas, its important to protect yourself when you go outside.
Questions To Ask Your Veterinarian
If your dog has a positive Lyme test but no symptoms of the disease or protein in the urine, ask your veterinarian why he or she is recommending treatment. Experts currently recommend against antibiotic therapy under these circumstances because the dogs immune system is holding the bacteria in check and antibiotics are unable to eliminate the infection.
Dogs who have contracted Lyme disease do not develop prolonged, protective immunity and can be reinfected at a later date. Talk to your veterinarian about how best to prevent future infections. Options include measures to prevent the ticks that carry Lyme disease from biting your dog and Lyme vaccination.
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False Negatives And Positives
Since early treatment is crucial to prevent complications, accurate diagnosis is essential. Those who have a history of tick bites and a bullseye rash do not need to be tested and should be treated as if they have Lyme disease. However, when the picture is less clear but Lyme disease is suspected, laboratory testing is recommended. False negative results are common in early Lyme disease because the standard test detects antibodies to the Borrelia bacteria and these take several weeks to develop. In addition, some people who receive antibiotics within the first few weeks of a tick bite may not develop antibodies or may only develop them at levels too low to be detected by the test.
In line with this, the NHS Highland National Lyme Borreliosis Testing Laboratory advises that patients with a clinical history consistent with early Lyme disease who have a negative test should be retested six to eight weeks after symptom onset. It is also possible for the antibody test to give a false positive result, so positive tests are confirmed using a second test, called a Western Blot.
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.
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Does Immediate Treatment After Bite Negate Lyme Disease
Sadly, immediate treatment doesnt negate Lyme disease. The treatment must not be solely based on the tick bite. Perhaps, you may think that ticks are the main source of Lyme disease. Actually, they are not. Truth is, the infection rate of ticks would vary as well on their location.
Say that the tick was infected, then it is essential to perform treatment right away. Though the tick should feed for a minimum of 1 day on its host for it to successfully transmit the Borrelia burgdorferi virus.
But if antibody levels are present, then the treatment can be performed almost immediately. In this stage, the treatment works effectively in negating Lyme disease in dogs.
Herbal And Prescription Antimicrobials By Function
Be aware the doses I provide below are for adults. These same prescriptions can be used with children but have lower doses. For pediatric dosing, talk with your family physician or pediatrician. Tetracyclines can be used in children under eight, but there is a risk of tooth staining. This staining seems not to be an issue if they are used for a month or less.
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Possible Complications To Watch For With Lyme Disease
Talk to your veterinarian if you have any questions or concerns about your dogs condition.
- Some dogs who take antibiotics can develop loss of appetite, vomiting and diarrhea.
- Once infected, a dog will always have the bacteria that cause Lyme disease in his or her body. Therefore, relapses are possible, and owners should be on the lookout for unexplained fever, swollen lymph nodes, and/or lameness.
- A small percentage of dogs develop kidney failure as a result of Lyme disease. Clinical signs include vomiting, weight loss, poor appetite, lethargy, increased thirst and urination, and abnormal accumulations of fluid within the body.
Azlocillin An Amazing Compound
The study team first tested to see whether different doses of the drugs could kill drug-tolerant borrelia bacteria grown on laboratory plates better than a standard Lyme disease antibiotic .
They carried out each experiment three times in triplicate . The team tested the drugs on different ages of bacteria, colonies that were 3 days old and growing rapidly, and colonies that were 710 days old and had reached a growth plateau.
At high concentrations, both drugs could kill all the drug-resistant borrelia cells and outperformed the standard Lyme disease antibiotic. When the study team tested the drugs at lower doses, azlocillin outperformed the standard antibiotic and cefotaxime, which left 20% of the drug-resistant cells alive.
The researchers tested the drugs in a small number of laboratory-bred mice that they infected with the bacteria. They treated the mice at different stages of the disease at 7, 14, and 21 days after infection.
They gave each mouse a daily dose of either azlocillin, cefotaxime, or the standard treatment for Lyme disease for 5 days. They cultured the mouse organs and checked for live bacteria using microscopy and genetic testing 2 days after the last dose.
The researchers found that both the standard treatment and azlocillin completely cleared the infection in the early stages of the disease, while cefotaxime did not.
We have been screening potential drugs for 6 years, Venkata Raveendra Pothineni, Ph.D., the lead study author says.
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