"Lyme Disease May Linger for 1 in 5 Because of "Persisters"" Scientific American article

[Kyla]

http://www.scientificamerican.com/a...ecause-of-persisters/?WT.mc_id=send-to-friend

I'm not really up-to-date on the Lyme stuff, but this seems like a fairly balanced article.
... And Sci-Am is a pretty major main-stream science publication!

Excerpt:

Lyme disease is a truly intractable puzzle. Scientists used to consider the tick-borne infection easy to conquer: patients, diagnosed by their bull's-eye rash, could be cured with a weeks-long course of antibiotics. But in recent decades the U.S. Centers for Disease Control and Prevention has realized that up to one in five Lyme patients exhibits persistent debilitating symptoms such as fatigue and pain, known as post-treatment Lyme disease syndrome, and no one understands why. The problem is growing. The incidence of Lyme in the U.S. has increased by about 70 percent over the past decade. Today experts estimate that at least 300,000 people in the U.S. are infected every year; in areas in the Northeast, more than half of adult black-legged ticks carry the Lyme bacterial spirochete, Borrelia burgdorferi. Although the issue is far from settled, new research lends support to the controversial notion that the disease lingers because these bacteria evade antibiotics—and that timing drug treatments differently could eliminate some persistent infections.

 

[Valentijn]

These ideas stem from the observation of a few rogue bacterial cells. Kim Lewis, director of the antimicrobial discovery center at Northeastern University, and his colleagues grew B. burgdorferi in the laboratory, treated them with various antibiotics and found that whereas most of the bacteria died within the first day, a small percentage—called persister cells—managed to survive the drug onslaught.

So it sounds pretty certain that some of the Lyme cells can survive by going dormant, which makes them immune to the antibiotics until they reactivate. And that led to the successful trial of pulsed antibiotics in vitro. Next step is to try the same technique in infected mice.

 

[duncan]

"Identifying the causes of and treatments for post-treatment Lyme disease syndrome is 'one of the highest priority research needs in the field' according to C. Ben Beard...CDC..."

Really?

 

[Martial]

Lots of LLMDS attempt different ways of timing doses of antibiotics, unfortunately no matter what is used most treatments are pretty hit or miss dependent on the patient. We need a real cure soon enough, something like extracting the protein from the western fence lizard to neutralize the infection entirely.

 

[alex3619]

This is not the first time this research has been discussed on PR, but the article is new. Its entirely possible that antibiotic evasion is a big issue. It may also mean, because of biofilms and other factors, that detection is a problem. However its also likely that its no longer an acute infection, but an occult infection (yes, that is a term used in medicine).

We used to think that, for example, latent herpes virus infections did nothing. We now know this is false. Latent infection, that is other than acute, can have serious and more subtle consequences, and without lots of scientific attention those consequences go unfound.

 

[duncan]

The article is new, and is doubly interesting because it incorporates a response to studies demonstrating persisters (from Lewis and Zhang; there is a third from Embers out of Tulane) by both the CDC, and from what some might think is the de facto spokesperson for the IDSA's position on Lyme, Wormser. The former made a statement which does not seem to be backed by any thorough search on US-Based NIH-sponsored studies. The latter sounded to me positively defensive.

Whether one says it is an occult infection or simply late stage Lyme is to a degree a matter of perspective. Yes, science/technology, too, although that is its own onion. Also definitions. Also politics.

And dollars.

 

[valentinelynx]

The article is new, and is doubly interesting because it incorporates a response to studies demonstrating persisters (from Lewis and Zhang; there is a third from Embers out of Tulane) by both the CDC, and from what some might think is the de facto spokesperson for the IDSA's position on Lyme, Wormser. The former made a statement which does not seem to be backed by any thorough search on US-Based NIH-sponsored studies. The latter sounded to me positively defensive.

Whether one says it is an occult infection or simply late stage Lyme is to a degree a matter of perspective. Yes, science/technology, too, although that is its own onion. Also definitions. Also politics.

And dollars.

Specifically Wormser said, "“There's been no evidence that this persister phenomenon has any relevance for animals or humans,” says Gary Wormser, chief of the division of infectious diseases at New York Medical College. First, he says, lab studies of B. burgdorferi cannot account for the potential effects of the body's immune system, which might be able to eliminate persisters once the brunt of the infection has cleared. Second, labs have yet to grow B. burgdorferi isolated from people treated with antibiotics, and that raises questions about whether the persisters are even viable and capable of making someone sick."

One of the comments (BruceAlanFries) refuted Wormser's statement about "labs have yet to grow Bb isolated from people treated with antibiotics" by saying,

"Contrary to Gary Wormser's assertion that labs have yet to grow B. burgdorferi isolated from people treated with antibiotics, researchers have been able to successfully culture Lyme spirochetes from people who have previously been treated with standard courses of antibiotics since at least 1993 when Lyme bacteria was cultured from Vikki Logan's tissue after extensive antibiotic treatment."

The argument that the "persister phenomenon" may not be clinically significant keeps showing up. For example, in the UC Davis mouse study (full text here: http://aac.asm.org/content/52/5/1728.full) ...

Antimicrob Agents Chemother. 2008 May;52(5):1728-36. doi: 10.1128/AAC.01050-07. Epub 2008 Mar 3.
Persistence of Borrelia burgdorferi following antibiotic treatment in mice.
Hodzic E1, Feng S, Holden K, Freet KJ, Barthold SW.

the authors found persistence of spirochetes by PCR AND visualization in tissue, although they were unable to culture them. The UC Davis press release (http://news.ucdavis.edu/search/news_detail.lasso?id=8584)was headlined:
"Lingering Bacteria Don't Indicate Chronic Lyme Disease"

as if that was the key finding rather than simply an opinion they felt necessary to express to avoid exciting the dreaded Chronic Lyme believers!

Oddly, people aren't so quick to dismiss persistence of bacteria if the bacterium involved is Staph aureus:
Medicine (Baltimore). 2003 Sep;82(5):333-9.
Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study.
Chang FY1, Peacock JE Jr, Musher DM, Triplett P, MacDonald BB, Mylotte JM, O'Donnell A, Wagener MM, Yu VL.

 

[msf]

Wow, Scientific American - alternative Lyme is going mainstream!

 

[Hip]

There is another thread on Lewis's work on Lyme persisters here.