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The phenomenon of 'chronic Lyme'; an observational study.

Discussion in 'Lyme Disease and Co-Infections' started by Firestormm, Apr 6, 2012.

  1. Firestormm

    Firestormm Senior Member

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    Eur J Neurol. 2012 Mar 15. doi: 10.1111/j.1468-1331.2012.03691.x. [Epub ahead of print]

    The phenomenon of 'chronic Lyme'; an observational study: http://www.ncbi.nlm.nih.gov/pubmed/22416947

    Ljstad U, Mygland A.

    Source

    Department of Neurology, Srlandet Hospital, Kristiansand, Norway Institute of Clinical Medicine, University of Bergen, Bergen, Norway Department of Habilitation, Srlandet Hospital, Kristiansand, Norway.

    Abstract

    Purposes:?

    'To chart clinical, laboratory, and psychometric profiles in patients who attribute their complaints to chronic Lyme disease.

    Methods:?

    We assessed the patients by clinical examination, laboratory tests, and questionnaires measuring fatigue, depression, anxiety, health-related quality of life, hypochondriasis, and illness perceptions.

    Results:?

    We found no evidence of ongoing Borrelia burgdorferi (Bb) infection in any of the 29 included patients using current diagnostic guidelines and an extended array of tests.

    Eight (28%) had other well-defined illnesses.

    Twenty-one (72%) had symptoms of unknown cause, of those six met the suggested criteria for post-Lyme disease syndrome.

    Fourteen (48%) had presence of anti-Bb antibodies.

    The patients had more fatigue and poorer health-related quality of life as compared to normative data, but were not more depressed, anxious, or hypochondriacal.

    Their beliefs about the illness were characterized by negative expectations.

    Conclusion:

    Our patients, who all attributed their symptoms to chronic Lyme disease, were heterogeneous.

    None had evidences of persistent Bb infection, but whether current diagnostic criteria are functional in patients with longstanding complaints is controversial.

    Other well-defined illnesses or sequelae from earlier Lyme disease were probable as main explanatory factor in some cases.

    The patients were not more depressed, anxious, or hypochondriacal than the normal population, but they had poorer health-related quality of life, more fatigue, and negative expectations about their illness.'
  2. Esther12

    Esther12 Senior Member

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    Thanks Firestromm
  3. oceanblue

    oceanblue Senior Member

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    Thanks, firestormm, very interesting.

    There seems to be a lot of debate over whether 'chronic' Lyme Disease is real in most cases or whether it might be another case of post-infectious fatigue syndrome

    from http://relative-risk.blogspot.co.uk/2012/03/yes-we-have-no-chronic-lyme.html on this paper:
    It's worth noting that this study only had 29 particpants, some of whom had no physician diagnosis and it's not clear if all patients originally had confirmed Lyme disease.

    Still, it's interesting the authors reject a 'functional' explanation. One author is a neurologist, the other is based in an institure of Clinical Medicine and a dept of 'Habilitation'.
  4. WillowJ

    WillowJ Senior Member

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    yes, that's interesting; thanks.
  5. WillowJ

    WillowJ Senior Member

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    Twenty-one (72%) had symptoms of unknown cause, of those six met the suggested criteria for post-Lyme disease syndrome.

    Fourteen (48%) had presence of anti-Bb antibodies.


    does this say something about the "suggested criteria for post-Lyme disease"? or not necessarily since one could have had Lyme, recovered, and then gotten something else? or does that not meet Occam's razor?

    also I agree that the pt or dr suspected Lyme isn't a very useful cohort; usually something is done when a given illness is suspected, to clarify whether that is or isn't the case.

    one doesn't study suspected cases to verify or deconstruct an illness construct; one studies the best cases--those with a history of tick bite or rash, confirmed coinfection, stuff like that. In other words, only the 14 with anti-Bb antibodies are relevant here.

    14 is not a very highly-powered study to make decisions by, especially considering that larger studies do find evidence of ongoing infection in patients more carefully selected:

    http://www.ncbi.nlm.nih.gov/pubmed/8923044
    also see a cerebrospinal fluid study
    http://www.ncbi.nlm.nih.gov/pubmed/1734321
    (I rearranged some elements for clarity and added paragraph breaks)

    Once again, epidemiology may be the key.

    Of course there's also this, but I think Lyme Arthritis is not the same as chronic Lyme (LA seems to be autoimmune and could theoretically be related to dead unfamiliar DNA or certainly other matter from the Bb; while that doesn't necessarily rule out CLD as having an active infection component--however, it is possible that something similar could be going on; Lupus (SLE) patients can also have neurological symptoms):
    http://www.ncbi.nlm.nih.gov/pubmed/21590753

    Then again, there's this (discussing LA):
    in http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665673/?tool=pubmed (paper on infections, including Bb, in autoimmune disease, including LA)

    Here is a recent free full text paper on how Bb might develop a chronic presence in the body:
    http://www.frontiersin.org/Microbial_Immunology/10.3389/fmicb.2012.00104/abstract

    (I have not read it all, but the full text appears to discuss mainly chronic untreated infections, while leaving such topics as CLD to others and claiming quite good effectiveness from presumably standard antibiotic treatment, in most cases, even if treatment commences many years after initial infection)

  6. Snow Leopard

    Snow Leopard Senior Member

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    There are a variety of alternative explanations:

    (1) a tick-bourne coinfection
    A number of other tick bourne pathogens (not Lyme) have been associated with CFS in Australia.

    (2) the infection could cause dysregulation of gut flora, perhaps reactivating another pathogen.

    (3) Chronic Lyme is CFS.

    Perhaps a better name is post-Lyme disease.
    WillowJ likes this.
  7. Esther12

    Esther12 Senior Member

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    I does seem a bit of a coincidence.

    One other possibility is that Lyme disease can do damage which leaves one less able to deal with other problems? So chronologically, the Lymes diseased does not immediately precede disability, but still plays a role?
    WillowJ likes this.
  8. alex3619

    alex3619 Senior Member

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    Hi Snow Leopard, this has precedence - post-Polio syndrome is also almost identical to CFS and ME - the major difference being a verified (though probably not in all cases) poliomyelitis infection. Similarly we could speak about post-EBV disease and post-Coxsackie disease. This still leads to the question: while the symptoms and pathophysiology do differ between CFS and post-Lyme, is the underlying perpetuating biochemistry substantially the same? We still don't know.

    Bye, Alex
    WillowJ likes this.
  9. Firestormm

    Firestormm Senior Member

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    And then you come up with the question: are the same treatments appropriate in all cases? Ta da! The conundrum of CFS or ME criteria. Symptoms may present similarly post-acute phase of infection, but in chronic-mode but we're all in the 'pot' together.

    Post Viral Fatigue Syndrome is a 'catch-all' and always has been. Anyone can join. But the way out might not be the same for everyone. Who knows? Who's looking?

    Maybe scientists should only be looking at those who fit the bill e.g. who presented with coxsackie or paravirus etc. and work on those little 'pots' separately. Maybe they have and still aren't getting anywhere.

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