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Study: New Test For Finding Drugs To Fight Persistent Lyme Disease

The classic "bullseye rash" of Lyme Disease

The classic “bullseye rash” of Lyme Disease

Potentially promising news on Lyme disease: Johns Hopkins researchers report a new, improved test for determining which drugs may work against Lyme disease bacteria that persist even after antibiotic treatment.

This enters the contentious realm of “chronic” Lyme disease — medical authorities agree that the effects of Lyme disease can last, but there’s some disagreement over whether this is actually a persistent infection.

The paper is just out in the journal PLOS ONE with the title, “An Optimized SYBR Green I/PI Assay for Rapid Viability Assessment and Antibiotic Susceptibility Testing for Borrelia burgdorferi.” (Borrelia burgorferi are the Lyme disease bacteria.) From the Johns Hopkins press release:

Study leader Ying Zhang, MD, PhD, a professor in the Bloomberg School’s Department of Molecular Microbiology and Immunology, and his colleagues tweaked a test typically used for simply counting DNA in samples in the lab. Using the test, they were able to quantify how many Borrelia burgdorferi are alive and how many are dead after each drug was added to the bacteria. The method stains the living bacteria green and the dead or dying bacteria red in a way that filters out the noise that can corrupt existing tests.

“It’s superior to the current gold standard for testing Borrelia viability,” Zhang says. “This could become the new gold standard.”

The most exciting part of the development of the test, Zhang says, is that his team has already used it to identify a series of antibiotics approved to treat other infections that show promise in the lab against the lingering Borrelia burgdorferi bacteria, known as persisters. In a study published in July in the journal Emerging Microbes and Infections, Zhang and colleagues used the new test – called the SYBR Green I/PI assay – to identify several antibiotics that showed promise against the persistent bacteria that appear immune to the current Lyme antibiotics. That paper has been the most popular on the journal’s website, and patients, doctors and researchers have been contacting Zhang interested in testing out the most promising of the newly identified drugs. Continue reading

If You Find A Tick: Why I Resorted To Mooching Pills To Fight Lyme Disease

A March 2002 file photo of a deer tick under a microscope in the entomology lab at the University of Rhode Island in South Kingstown, R.I. (Victoria Arocho/AP)

A March 2002 file photo of a deer tick under a microscope in the entomology lab at the University of Rhode Island in South Kingstown, R.I. (Victoria Arocho/AP)

I’ve never done anything like this before. I’m a good little medical doobie. I’m wary of pills, take them only with prescriptions, and follow the instructions to the letter. But last month, I “borrowed” a friend’s extra 200 milligrams of doxycycline — the onetime antibiotic dose shown to help prevent Lyme disease soon after a prolonged tick bite.

What brought me to that desperate point? A doctor declined to prescribe the pills, even though this is prime Lyme disease season and the patient, my family member, fulfilled every one of mainstream medicine’s requirements for the single dose aimed at preventing Lyme. To wit:

• The tick was a fully engorged deer tick that had been attached for more than 36 hours.

• We sought treatment within three days of removing it.

• The tick came from a Lyme-endemic area.

• And the patient had no medical reason to avoid antibiotics.

The antibiotics I “borrowed” from a generous friend (Carey Goldberg/WBUR)

The antibiotics I “borrowed” from a generous friend (Carey Goldberg/WBUR)

But still. The doctor argued that the chances of contracting Lyme from the tick were very small, perhaps 1 in 50, and that overuse of antibiotics contributes to the growing problem of drug-resistant bacteria. This is what he would do for his own family member, he said: skip the doxycycline, wait to see if Lyme develops, and treat it with a full 10-day course of antibiotics if it does.

I was frustrated and frankly a bit appalled. WBUR ran a series on Lyme disease in 2012, and I knew that controversy raged around many aspects of the disease, particularly the use of long-term antibiotics to treat long-term symptoms. But I was just trying to follow the widely accepted guidelines written by the Infectious Disease Society of America, to be found in reputable medical venues like UpToDate. And I knew from that same series that Lyme is rife in New England, and so are personal stories of health and lives ruined or seriously harmed.

Still, maybe I was overreacting? I’ve since sought a reality check from three experts, including the lead author of the guidelines. And here’s what I come away with: No, I was not unreasonable in seeking the preventive doxycycline. Arguably, though I hate to admit it, the doctor was not being totally unreasonable in declining it. The guidelines say a doctor “may” prescribe the antibiotic; it’s not a “must.”

In the end, I think, the crux of the question may lie in how you see the doctor’s role: Is it to lay out the risks and benefits and then let the patient choose? Or to impose his or her own best medical judgment on the patient? (You can guess where I come down on that one.) Also, “better safe than sorry” tends to rule when it comes to my loved ones. But what if the risk is small and the benefit uncertain? Continue reading

Lyme Disease Investigation: Buyer Beware Of Unvalidated Tests

Screen shot 2014-06-18 at 11.35.38 AM

Some refer to “The Lyme Wars.” They talk about entering “The Lymelands,” where hard facts are suddenly few and far between. Many aspects of Lyme disease — particularly of the long-lasting effects some call “Chronic Lyme” — are controversial and contentious and frustratingly slippery.

It’s a reporter’s nightmare, but Beth Daley — a former Pulitzer finalist at the Boston Globe — takes a brave step into the Lyme disease world with a new investigative report on serious questions about some Lyme disease diagnostic tests: Can You Trust Lyme Disease Tests? It begins:

As Lyme disease becomes an increasingly challenging public health threat across the Northeast, a growing number of tests for the vexing ailment may be misdiagnosing patients when telling them that they have – or don’t have – the tick-borne illness.

An exemption in federal regulations allows many labs to offer Lyme tests without proof that they accurately identify the disease, leaving anxious patients and their doctors to decide which tests to believe. Continue reading

Tick Season: Scary New Stats And Five Smart Tips (Spray Your Shoes)

A tiny nymphal deer tick among poppy seeds. Can you spot it? (TickEncounter Resource Center/ Brian Mullen)

A tiny nymphal (the most dangerous stage) deer tick on a poppy seed bagel. Can you spot it? (TickEncounter Resource Center/ Brian Mullen)

Fine. I’m a nag. I tell you the same thing over and over for your own good. But only once a year, and now is the time: Caution. Especially if you live in the Northeast, Midwest or mid-Atlantic. Watch out for the deer ticks that carry Lyme and other diseases.

This is the worst season, when the voracious adolescent “nymphal” ticks come out in force, plotting (I may be projecting a bit here) to creep under your clothes and drink your blood and give you their germs, knowing you’re unlikely to notice a dark speck the size of a poppy seed — check out the photo above — until it’s too late.

A bit of added incentive this year to take preventive measures: scary new statistics and some smart new tips. We cannot know whether this will be a particularly heavy tick year, but Dr. Catherine Brown, of the Massachusetts Department of Public Health, told WBUR, “We haven’t seen any weather in the last couple of years that is particularly bad for ticks, and so my suspicion is that there’s quite a few of them out there.”

That’s a suspicion already borne out by copious anecdotes along the lines of “I pulled a dozen of them off my dog this weekend on Cape Cod.” And tick spottings appear to be up around the country.

The scary new statistics come from the CDC: Last summer, it adjusted upward its estimate of Lyme disease prevalence by a factor of 10, to about 300,000 American cases a year. Most are easily resolved with prompt antibiotic treatment but some — an estimated 10 to 20 percent — are not, and once you’ve heard a few of the lingering Lyme horror stories, you resolve to do all you can to protect yourself and your loved ones.

‘May has definitely proven itself to be the tickiest month all across America.’
– Dr. Tom Mather

So what to do? The CDC offers its tips here, and I spoke with Dr. Tom Mather, director of the University of Rhode Island’s Center for Vector-Borne Disease and its TickEncounter Resource Center, a rich repository of evidence-based tick knowledge. He offered five fresh tips, and some new findings on how humidity affects the tick population:

1. Spray your shoes with repellent containing Permethrin. Dr. Mather: “Treating your shoes is a good idea because the nymphal-stage deer ticks are in leaf litter, and so as your shoes move through the leaf litter, that’s where those ticks take hold. They’re not going to to fall out of trees, they’re not going to fly and bite you or anything like that. They’re going to latch onto your shoes and crawl up, and they can crawl up pretty fast. And they’re going to crawl up generally inside your clothes.”

2. Pants. “And so the next place that you want to create a barrier would be your lower clothes, like pants legs. You should be treating the inside as well as the outside, or buy commercially treated clothes that are treated both inside and outside.”

3. The dryer: “Just strip your clothes off as soon as you come inside and throw them in the dryer for 10 minutes on high heat and that will pretty much desiccate any ticks you might carry in.”

4. But you can’t put your dog in the dryer: “So you want to make sure that your dog has effective quick kill product on it like Advantix II. Seresto collars are also very good.” Continue reading

Video: How Ticks Chain-Saw Into Your Skin To Suck Your Blood

Tick

Sometimes I appall myself. I know perfectly well what a huge health problem Lyme disease is, infecting 300,000 Americans a year at latest count. WBUR did a series on it; I’ve been reading every word of the excellent Boston Globe series now under way. And yet, I repeatedly fail to check myself after outdoor hikes that could expose me to the ticks that carry the disease, even though I also know that if the ticks are removed promptly, that prevents transmission of Lyme.

So I made myself watch the entire wonderfully grisly science video that The New York Times just posted: How Does A Tick Do Its Dirty Work? Research Video Offers A Clue.

It shows ticks using a proboscis-like appendage whose resemblance to a chainsaw seems quite timely on the eve of Halloween. And the text by James Gorman begins with this ghoulish lead:

Chain saws, hockey masks and the undead are all classic symbols of horror. But for a true shiver of dread, take a look at a tick.
When seen with an electron microscope, a tick’s mouth has what look like twin saws (chelicerae) flanking an appendage (a hypostome) that appears to be the kind of long, barbed sword that a villain in a video game might favor.

The Times also links to a paper in the Proceedings of the Royal Society detailing those nefarious tick methods. Personally, I’m thinking the video alone will be enough to change my ways. Readers?
(H/T Tom Anthony)

Doc: Lyme Underreporting ‘No Surprise’ But Big Problem

It was big news this week when the CDC announced that cases of Lyme disease were vastly underreported and that, in fact, about 300,000 Americans are diagnosed with the disease each year — 10 times its previous estimate. Lyme disease now has this distinction according to the public health authorities: It’s the most commonly reported tick-borne illness in the United States.

In the latest NEJM Journal Watch’s HIV and ID Observations blog post, Dr. Paul Sax, clinical director of the HIV Program and Division of Infectious Diseases at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, writes that he’s not at all surprised by the Lyme disease underreporting and offers a few theories on what’s behind it:

Go ahead, check my math — that’s a whopping 10:1 ratio of actual to reported patients with Lyme, highlighting that this reporting is something we clinicians just don’t do very well.
lymedisease

And it’s no surprise to me at all.

Here’s why:

–Clinicians are busy doing other stuff, most importantly taking care of their patients.
Lyme is one of many reportable diseases — take a look at this list!
–It’s annoying. If you asked 100 doctors and nurses what they like least about practicing medicine, 74.39% would say “the paperwork.”
–The forms can’t be completed quickly, as they request detailed information about dates of exposure and onset of illness, presence of diverse associated symptoms, and evaluations for ancillary diseases. Plus, they’re paper forms — a particular problem in an increasingly web-based and electronic medical record world. As for the specific dates of possible exposure and onset of symptoms? “I just lie,” one PCP told me.
–“Soft calls” won’t get reported at all. Think about the febrile, achy patient in the summer who’s just spent a weekend hiking in the woods, saying ticks were everywhere, then gets treated (appropriately) for suspected Lyme. That may be the billing code the clinician uses, but often as not, no Lyme test is sent.
–No one’s paying for these reports. Forgive the mercenary tone to the comment, but as these folks will tell you, humans are very predictable creatures — give them some incentive to do something, and they’ll often do it, even if the task is unpleasant.

Sax suggests that those seeking a fix for the underreporting problem might benefit from looking at the history of HIV, Continue reading

New CDC Estimate: 300K Americans Diagnosed With Lyme Disease Each Year

Tick

If you follow Lyme disease at all, you know that there’s no question that the official prevalence figures fail to capture the true extent of the toll those nasty little disease-spreading deer ticks take. The only question is just how far the official figures fall short of reality.

WBUR’s Lyme Disease series last summer cited these official figures for Massachusetts: 2-4,000 confirmed cases each year. But everyone knows those numbers are laughably low. Dr. Catherine Brown of the Massachusetts Department of Public Health said a more realistic figure might be the 12-14,000 positive lab tests for Lyme disease reported statewide each year. But that’s clearly still low. A leading tick expert estimated that in much of Massachusetts, about 1 percent of the population contracts Lyme each year.

Now, at a major conference on Lyme disease and other tick-borne illnesses under way in Boston, federal health authorities have just released their own more realistic estimate, and it’s about ten-fold their old one. From the CDC press release:

Preliminary estimates released by the Centers for Disease Control and Prevention indicate that the number of Americans diagnosed with Lyme disease each year is around 300,000. The preliminary estimates were presented Sunday night in Boston at the 2013 International Conference on Lyme Borreliosis and Other Tick-Borne Diseases.

This early estimate is based on findings from three ongoing CDC studies that use different methods, but all aim to define the approximate number of people diagnosed with Lyme disease each year. The first project analyzes medical claims information for approximately 22 million insured people annually for six years, the second project is based on a survey of clinical laboratories and the third project analyzes self-reported Lyme disease cases from a survey of the general public.

Each year, more than 30,000 cases of Lyme disease are reported to CDC, making it the most commonly reported tick-borne illness in the United States. The new estimate suggests that the total number of people diagnosed with Lyme disease is roughly 10 times higher than the yearly reported number. This new estimate supports studies published in the 1990s indicating that the true number of cases is between 3- and 12-fold higher than the number of reported cases. Continue reading

Tick-Killing Tip: Dry Then Wash, Brief Dryer Spin Could Do It

Tip #1 on www.tickencounter.org/ticksmart/tips (Courtesy of TickEncounter Resource Center)

Tip #1 on www.tickencounter.org/ticksmart/tips (Courtesy of TickEncounter Resource Center. Note the tiny black tick in center foreground.)

It sounds so odd, like being told, “Put on your shoes, and then your socks.” But indeed, one useful tip for killing the ticks that carry Lyme disease is to put the clothes you were wearing outside into the dryer for a few minutes before you wash them — the better to kill the ticks, you see.

How long exactly to dry them? Well, today’s Boston Globe features a delightful story about a Braintree teenager, Jacqueline Flynn, who set out to find out, and whose preliminary research suggests that ticks can be killed in just five minutes of drying at low heat.

That discovery by the 16-year-old Braintree High School student has won top local science prizes and has caught the attention of scientists at the Centers for Disease Control and Prevention, the nation’s massive health watchdog.

As part of its tick prevention recommendations, CDC literature urges tumbling tick-infected clothing in a dryer on high heat for at least an hour as one way to eliminate the bloodsucking arachnids. But the agency had not studied the method further…

“This could have significant implications for Lyme disease prevention,’’ said Christina Nelson, an epidemiologist at the CDC’s office in Fort Collins, Colo., who became intrigued by the teenager’s finding. “If it is true that five minutes in a dryer kills ticks vs. a full hour, that is a lot easier for people, and that could also spark further investigations.”

With tick season, and thus Lyme disease season, soon upon us, however, we wouldn’t want to draw half-cooked conclusions and under-dessicate any of the little buggers. So I checked in with tick expert Tom Mather of the University of Rhode Island and its TickEncounter Resource Center.

He confirmed that a fairly quick spin in the dryer can kill nymphal deer ticks that carry Lyme disease, as the TickEncounter Resource Center has been recommending:

TickSmart™ Tip #1: DRY CLOTHES FIRST – THEN WASH
Most ticks are VERY sensitive to dryness. The very first action to take after working in the yard is to strip clothing off and throw it in the dryer. Deer ticks are most susceptible, while American dog ticks, Lone Star ticks and other Amblyomma species are more robust. To be sure that each species achieves fatal crispiness, leave clothes in the dryer on high for 15 minutes. Continue reading

Lyme Disease Study: New Infections Explain Relapses

The classic “bullseye rash” of Lyme Disease

 

Parts of Lyme disease are clear: It’s caused by bacteria, which are carried by ticks, and it’s a growing problem across much of the United States.

And parts of Lyme disease are so contentious that people talk about “the Lyme Wars.”

Chronic effects from Lyme disease — including terrible fatigue, trouble thinking and pain — constitute the central Lyme Wars battlefield, and the central practical issue is whether chronic sufferers should take long-term antibiotics. Mainstream medical experts warn that the longterm antibiotics are dangerous and ineffective; some patients and doctors disagree.

Now comes the latest salvo, in the New England Journal of Medicine: A gene study that found that in Lyme patients with relapses, the bacteria were different the second time around, and thus the recurrence must be due to a new infection by new bacteria rather than a relapse from bacteria that lingered in the body despite antibiotic treatment. Continue reading

Boston Globe Editorial: Lyme Disease Vaccine Needs Second Look

Canine vaccines protect against Borrelia burgdorferi, the bacterium that causes Lyme disease. (Jesse Costa/WBUR)

Among all the extensive coverage in WBUR’s recent Lyme disease series, it was reporter Curt Nickisch’s story, Why your dog can get vaccinated against Lyme disease and you can’t, that really took off online and went viral. It lays out the frustrating history of the human vaccine for Lyme disease, introduced in 1998 and pulled from the market in 2002.

Sunday’s Boston Globe cites Curt’s story in a masthead editorial: “Lyme disease vaccine deserves a second look.” It reads in part:

Never-proven claims that the Lyme vaccine caused arthritis and other symptoms scared off some patients and raised the possibility of big legal judgments. For the manufacturer, the limited sales didn’t justify the risks.

But with a decade of hindsight, people in the areas most affected by Lyme disease deserve a second look. Not everyone will be accepting; opposition to the measles, mumps, and rubella vaccine has become entrenched among some parents, even as the research that initially fueled it has been discredited. Yet it’s precisely because of that controversy that medical authorities, the media, and the general public may weigh claims by vaccine critics more carefully.

As Lyme disease cases continue to emerge, public health authorities in New England need to lead the drive to bring existing vaccines back — or promote research on new and better ones.

Debate about the Lyme vaccine remains; some patient advocates challenge the claims that the vaccine was safe. But perhaps this Globe editorial and Curt’s story will add new impetus to the discussion about vaccines in the new state commission on Lyme disease. Curt blogs about his story here.