Updated 22 May 2013
Econintersect: Lyme disease is a prevalent infectious disorder in the north central and northeastern United States and parts of Europe. It is also reported infrequently in a number of southern and western U.S. states. There is a Lyme disease hot spot along the northern California coast. It derives its name from the town of Lyme, CT, where it was diagnosed in 1975. There is generally accepted evidence that the disease has existed without the formal name for at least 100 years.
Click on image for wider view of Borrelia burgdorferi.
A previous GEI News article reported on the mapping of Lyme disease risk based on tick population measurements in the eastern 2/3 of the U.S. The diagnosis of the disease is more widespread than the areas where the ticks have been detected in the research reported previously. The following map was found at the Lyme Disease Association website.
Click on map for larger image.
The CDC data shows about 20,000 reported cases of Lyme disease annually. The CDC estimates that nine out of ten Lyme disease infections are not reported. That means that more than 4 million have been affected by this disease in the last 20 years and likely as many as 10 million over the last half century.
The following map shows the distribution of infected ticks for the entire country (more extensive mapping than reported a year ago).
Click on map for larger image.
The Cause of Lyme Disease
Lyme disease is caused by the bacterium Borrelia burgdorferi. It is from a small group of bacteria known as spirochetes. Here is an excerpt from a University of California Berkeley website containing an introduction to sphirochetes:
Spirochetes are long and slender bacteria, usually only a fraction of a micron in diameter but 5 to 250 microns long. They are tightly coiled, and so look like miniature springs or telephone cords. Members of this group are also unusual among bacteria for the arrangement of axial filaments, which are otherwise similar to bacterial flagella. These filaments run along the outside of the protoplasm, but inside an outer sheath; they enable the bacterium to move by rotating in place.
The best-known spirochetes are those which cause disease, including syphilis and Lyme disease in humans and leptospirosis in animals. Some spirochetes provide beneficial functions, such as those aiding digestive function in the bovine rumen.
Many cases of Lyme disease are accompanied by “companion” infections carried by the same ticks that transmitted by Borrelia burgdorferi.
See “Lyme Disease 101” later in this article.
Treatment Disagreements
A major debate has raged over the proper treatment for Lyme Disease for almost as long as the disease has been formally identified. In the 1980s and even through most of the 1990s a significant number of practicing physicians did not even think the disease existed. Slowly, however, recognition of the disease spread so a majority of doctors in heavily infected areas consider Lyme disease when presented with symptoms. However, the proper treatment of Lyme disease remains a matter of significant debate. The history and current status of this debate can be seen in the following video, which is accompanied by a long investigative journalism article in The Poughkeepsie Journal.
Update 22 May 2013: Non-subscribers may be restricted in the number of accesses allowed by the Poughkeepsie Journal. We apologize for the inconvenience.
Lyme disease treated in the early stages, within a few weeks of receiving an infected tick bite, are usually resolved satisfactorily with 30 days of oral antibiotic treatment. The disputes arise in how to treat cases months or even years after infection. Some practitioners who have encountered and recognized recurring Lyme disease symptoms in the absence of further exposure to ticks have come to the conclusion that cases exist where the initial antibiotic treatment did not completely eradicate the spirochetes. This has given rise to the diagnosis “chronic Lyme disease”. And that is how the debate was started.
Two “Political” Lyme Parties
Two organizations are spearheading the opposing sides of the debate. The IDSA (Infectious Diseases Society of America), whose guidelines are accepted by the U.S. Department of Health and the CDC (Center for Disease Control), maintains there is no evidence to support the existence of chronic Lyme. The ILADS (International Lyme and Associated Diseases Society) is comprised of doctors in regions where Lyme disease is endemic who have come to the conclusion that chronic (recurring) Lyme disease is found in some of their patients.
The video below is an extended trailer for the full-length documentary film on Lyme disease, “Under Our Skin“.
Below is the ABC News coverage of the film.
Disclosure: Treatment for Lyme disease has been received by this editor from a member of ILADS. This editor’s personal experience with Lyme disease over the past 30 years is recounted as an editor’s note in a previous GEI News article.
Potential for Improved Treatment
A recent research report by teams headed by Mak Saito and Valeria Culotta from the Woods Hole Oceanographic Institute and Johns Hopkins University, respectively, reported that a new treatment vector might be possible for Lyme disease. Researchers from the University of Texas also participated. Iron is a commonly required metal for many pathogens. But the Lyme spirochete is different: unlike any other known organism, it can exist without iron. From a 23 March 2013 press release from Woods Hole:
In 2000, groundbreaking research on Borrelia’s genome by James Posey and Frank Gherardini at the University of Georgia showed that the bacterium has no genes that code to make iron-containing proteins and typically do not accumulate any detectable iron.
Culotta’s lab at JHU investigates what she called “metal-trafficking” in organisms—the biochemical mechanisms that cells and pathogens such as Borrelia use to acquire and manipulate metal ions for their biological purposes.
“If Borrelia doesn’t use iron, what does it use?” Culotta asked.
To find out, Culotta’s lab joined forces with Mak Saito, a marine chemist at WHOI, who had developed techniques to explore how marine life uses metals. Saito was particularly intrigued because of the high incidence of Lyme Disease on Cape Cod, where WHOI is located, and because he specializes in metalloproteins, which contain iron, zinc, cobalt, and other elements often seen in vitamin supplements. The metals serve as linchpins, binding to enzymes.
The treatment methods for Lyme disease to date involve the use of antibiotics. But the press release discusses why that is problematic:
The experiments revealed that instead of iron, Borrelia uses that element’s next-door neighbor on the periodic chart, manganese, in certain Borrelia enzymes. These include an amino peptidase and an important antioxidant enzyme called superoxide dismutase.
Superoxide dismutase protects the pathogens against a second defense mechanism that the body throws against them. The body bombards pathogens with superoxide radicals, highly reactive molecules that cause damage within the pathogens. Superoxide dismutase is like an antioxidant that neutralizes the superoxides so that the pathogens can continue to grow.
The discoveries open new possibilities for therapies, Culotta said. “The only therapy for Lyme Disease right now are antibiotics like penicillin, which are effective if the disease is detected early enough. It works by attacking the bacteria’s cell walls. But certain forms of Borrelia, such as the L-form, can be resistant because they are deficient in cell walls.”
“So we’d like to find targets inside pathogenic cell that could thwart their growth,” she continued. “The best targets are enzymes that the pathogens have, but people do not, so they would kill the pathogens but not harm people.” Borrelia’s distinctive manganese-containing enzymes such as superoxide dismutase may have such attributes.
Lyme Disease 101
In conclusion, the following is a 49 minute interview with two Lyme disease specialists in California, Dr. Steven Harris and Dr. Linda Williams, which covers the basics of Lyme disease in great detail. This is a fundamentally important discussion of the nature, scope, diagnosis and treatment issues with Lyme disease.
The nature of the problems faced by those who are attempting to advance the knowledge of how to treat advanced Lyme disease is exemplified by statements such as those by Philip Baker, the head of research funding for Lyme disease at the NIH (National Institutes of Health). Before his retirement, he wrote to a colleague in 2007 (from an article by Mary Beth Pfeiffer in the Poughkeepsie Journal):
“I will certainly miss all of you people – the scientists, but not the Lyme loonies.”
The Poughkeepsie Journal reports that Dr. Baker told them directly that:
The term [“loonies”], he told the Poughkeepsie Journal, “might be too kind a description.”
The NIH is the predominant source of Lyme Reseach funding.
Editor’s note: This editor has personally met only two doctors who formerly ascribed only to the CDC/ISDA defined treatment regimen and “converted” to the ILADS procedures: In one case the doctor changed after contracting Lyme disease which went untreated for an extended period of time and the other case involved the same experience by a member of their immediate family.
This editor is reminded of the story of Ignaz Semmelweis, an early clinical observer of the affect of hand washing on reducing infections in hospitals. Dr. Semmelweis wrote a book Etiology, Concept and Prophylaxis of Childbed Fever, which was ridiculed because it conflicted with establish thinking at the time. From Wikipedia:
Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis’s practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister, acting on the French microbiologist‘s research, practiced and operated, using hygienic methods, with great success.
Semmelweis was deemed to be insane because of his clinical observations and conclusions. He died 14 days after commitment to a sanitarium due to beatings at the hands of attendants. So medical clinician “loonies” are not a new thing.
Update 22 May 2013:
The Poughkeepsie Journal has a deep investigative journalism archive on Lyme Disease, based on the work which garnered Mary Beth Pfeiffer a Pulitzer Prize nomination and the Sigma Delta Chi Award for investigative journalism. There is limited access for non-subscribers. If you are successful in accessing a page, review everything you will want to see on that visit – you may not be allowed access again without purchasing a subscription. The specific resources there:
1. This is a selection of disturbing excerpts from more than 3,000 pages of emails exchanged between various IDSA members and people at the NIH and CDC. These were obtained after five years of stonewalling requests for public information access by the maker of the documentary “Under Our Skin“. When several months of emails were finally finally released recently (with massive amounts of redaction), the emails were made available to Pfeiffer and the Poughkeepsie Journal.
2. There is also an investigative article regarding the many thousand emails.
Sources: (Note: Source links to the Poughkeepsie Journal may encounter restricted access for non-subscribers.)
- Introduction to the Spirochetes (University of California Museum of Paleontology, UC Berkeley website)
- Scientists Reveal Quirky Feature of Lyme Disease Bacteria (Press release, Woods Hole Oceanographic Institute, 23 March 2013)
- A Manganese-Rich Environment Supports Superoxide Dismutase Activity in a Lyme Disease Pathogen, Borrelia burgdorferi (Jessica Daphne Aguirre, Hillary M. Clark, Matthew McIlvin, Christine Vazquez, Shaina L. Palmere, Dennis Grab, JanaKiram Seshu, P. John Hart, Mak Saito and Valeria C. Culotta, Journal of Biological Chemistry, 02 February 2013)
- VIDEO: Chronic Lyme disease: Is it real? (Mary Beth Pfeiffer, Poughkeepsie Journal, 19 May 2013)
- Lyme Disease: Basics of Diagnosis and Treatment (Joseph J. Burrascano, ILADS 2012 Conference)
- Lyme Disease: the Great Controversy (John J. Halperin, Phillip Baker and Gary P. Wormser, Chapter 17, Lyme Disease: An Evidence-based Approach, John J. Halperin (editor), CABI)
- International Lyme and Associated Diseases Society (ILADS Website)
- Treatment Guidelines (ILADS)
- Infestious Diseases Society of America (IDSA Website)
- Treatment Guidelines (IDSA)
- Treatment (CDC Website)
- Lyme Disease: Risk Areas Mapped (GEI News, 05 February 2013)
- Lyme Disease Association (lymediseaseassociation.org Website)
- Interactive: The Ties that Bind (Mary Beth Pfeiffer, Poughkeepsie Journal, 17 May 2013)
- Lyme emails took five years. Officials blame scope and fee waiver (Mary Beth Pfeiffer, Poughkeepsie Journal, 19 May 2013)