Antiscience and ethical concerns associated with advocacy of Lyme disease

Auwaerter, Paul G.; Bakken, Johan S.; Dattwyler, Raymond J.; Dumler, J. Stephen; Halperin, John J.; McSweegan, Edward; Nadelman, Robert B.; O’Çonnell, Susan; Shapiro, Eugene D.; Sood, Sunil K.; Steere, Allen C.; Weinstein, Arthur; Wormser, Gary P.

doi:10.1016/s1473-3099(11)70034-2

Cited by 106 publications

(63 citation statements)

References 36 publications

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“…Vaccination could help reduce the morbidity and economic burden of LD, but no vaccines are currently available for human use. The OspA vaccine was demonstrated to be safe, but it was withdrawn from the market only a few years after introduction, as acceptance by the public was low because of a number of factors (38)(39)(40)(41). Several candidate vaccines investigated more recently have targeted proteins produced in abundant amounts by B. burgdorferi grown in the laboratory and some that are exposed on the bacterial surface, although only some of these proteins have also been assigned activities or functions in vitro and/or in vivo (6,8,(42)(43)(44)(45)(46)(47)(48).…”

Section: Discussionmentioning

confidence: 99%

Live Attenuated Borrelia burgdorferi Targeted Mutants in an Infectious Strain Background Protect Mice from Challenge Infection

Hahn

Padmore

Ristow

et al. 2016

Clin Vaccine Immunol

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Borrelia burgdorferi, B. garinii, and B. afzelii are all agents of Lyme disease in different geographic locations. If left untreated, Lyme disease can cause significant and long-term morbidity, which may continue after appropriate antibiotic therapy has been administered and live bacteria are no longer detectable. The increasing incidence and geographic spread of Lyme disease are renewing interest in the vaccination of at-risk populations. We took the approach of vaccinating mice with two targeted mutant strains of B. burgdorferi that, unlike the parental strain, are avirulent in mice. Mice vaccinated with both strains were protected against a challenge with the parental strain and a heterologous B. burgdorferi strain by either needle inoculation or tick bite. In ticks, the homologous strain was eliminated but the heterologous strain was not, suggesting that the vaccines generated a response to antigens that are produced by the bacteria both early in mammalian infection and in the tick. Partial protection against B. garinii infection was also conferred. Protection was antibody mediated, and reactivity to a variety of proteins was observed. These experiments suggest that live attenuated B. burgdorferi strains may be informative regarding the identification of protective antigens produced by the bacteria and recognized by the mouse immune system in vivo. Further work may illuminate new candidates that are effective and safe for the development of Lyme disease vaccines. L yme disease (LD) is the most common vector-borne disease in North America. In addition to Borrelia burgdorferi, the major LD agent in North America, B. garinii and B. afzelii are agents of LD in Europe and Asia. While antibiotic treatment is available and effective in the majority of cases diagnosed early in infection, significant morbidity is associated with LD, in some cases, with symptoms continuing beyond the standard antibiotic therapy regimens. In addition, the Centers for Disease Control and Prevention (CDC) recently investigated possible B. burgdorferi infection as a trigger of sudden cardiac death in relatively young, active people (1, 2). Recent estimates from the CDC also suggest that the number of cases may be as much as 10-fold higher than the number actually reported (3), with current estimates of ϳ300,000 cases/year in the United States.No vaccine against LD is currently available for use in humans. A single dose of lyophilized whole-cell Borrelia produced limited protection as a vaccine in hamsters (4, 5), and the authors suggested that further studies were warranted. In fact, whole-cell vaccines are currently available for veterinary use, but a less reactogenic multivalent subunit vaccine has more recently been developed (6-8). Live attenuated flagellumless Borrelia cells in a high-passage-number noninfectious background also elicited protective immunity in mice for a limited duration (9). A vaccine targeting outer surface protein A (OspA) (10, 11), an abundant protein on the surface of the bacteria grown in the laboratory, was av...

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Section: Discussionmentioning

confidence: 99%

Live Attenuated Borrelia burgdorferi Targeted Mutants in an Infectious Strain Background Protect Mice from Challenge Infection

Hahn

Padmore

Ristow

et al. 2016

Clin Vaccine Immunol

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“…Zudem ist die Klärung anamnestischer Hauterscheinungen und ihrer Behandlung für das Vorgehen bei Gelenksymptomen wichtig. Im Alltag des Rheumatologen ist die Situation nicht selten, dass unspezifische und ätiologisch unklare Symptome fälschlich als Lyme-Borreliose diagnostiziert werden [2].…”

Section: Empfehlungen Der Kommission Pharmakotherapie Der Dgrhunclassified

“…Weitere Therapiezyklen, Langzeittherapien über Monate, Pulstherapien, Einsatz alternativer Antibiotika, Kombinationstherapien mit mehreren Antibiotika oder Kombinationen mit Hydroxychloroquin haben sich als ineffektiv erwiesen oder wurden nicht in kontrollierten wissenschaftlichen Studien untersucht [2,10,22]. Daher sollten diese Therapieformen nicht eingesetzt werden.…”

Section: Lyme-arthritisunclassified

Diagnostik und Therapie der Lyme-Arthritis

Gaubitz¹,

Dressler²,

Huppertz

et al. 2014

Z. Rheumatol.

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These guidelines summarize the current evidence for diagnosis and treatment of Lyme arthritis and the most frequent skin manifestations of Borrelia burgdorferi infections. Lyme arthritis is a monoarticular or oligoarticular form of arthritis that typically involves the knee. A positive enzyme-linked immunosorbent assay (ELISA) for IgG antibodies should be followed by an IgG immunoblot. A positive PCR test from synovial fluid adds increased diagnostic certainty. Serum positivity for antibodies to Borrelia burgdorferi without typical symptoms does not justify antibiotic treatment. Oral antibiotic treatment for erythema migrans is recommended using doxycycline, 200 mg once per day for 10-21 days, alternative choices are amoxicillin, cefuroxime and azithromycin. For children below 8 years of age, amoxicillin is recommended.Lyme arthritis can usually be successfully treated with orally administered antimicrobial agents. Doxycycline, 1 × 200 or 2 × 100 mg for 30 days is the antibiotic agent of choice. Amoxicillin (3 × 500-1000 mg) can be alternatively chosen. Patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be treated intravenously. In this situation, ceftriaxone at 2 g per day for 14-21 days is recommended. There is no evidence to recommend long-term and combined treatments.

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“…Vielmehr werden diese Symptome antiphlogistisch mit nichtsteroidalen Antiphlogistika behandelt. Für eine Erregerpersistenz gibt es keine Hinweise [5,14]. Die Bezeichnung als "chronische Borreliose" ist deshalb irreführend.…”

Section: Therapieunclassified

Variabilität der kutanen Lyme-Borreliose

Hofmann

2012

Hautarzt

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Lyme borreliosis can affect almost all human organs. Erythema migrans is the first and most frequent manifestation in 80-90% of patients in the early stage of localized skin infection. Besides the typical clinical appearance, many atypical variants can be observed. The solitary borrelial lymphocytoma is much less common and occurs mostly in children. Due to improvement in the early recognition of Lyme borreliosis, the diagnosis is made in the disseminated and late stage in only 10-20% of patients. Multiple erythemata migrantia indicating the hematogenous dissemination of B. burgdorferi remain frequently unrecognized. Late stages of infection feature chronic plasma-cell rich cutaneous inflammation and acrodermatitis chronica atrophicans in its edematous to atrophic forms. Cultivation or DNA detection of B. burgdorferi in skin biopsies are options to prove unusual skin manifestations. Serological detection of Borrelia-specific IgG- and IgM antibodies should be performed according to the two step protocol with ELISA and immunoassay according to the criteria of the MIQ 12. Serological tests have limited utility for follow-up. Antibiotic therapy is very effective if performed according to evidence-based protocols, such as the AWMF guidelines.

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Antiscience and ethical concerns associated with advocacy of Lyme disease

Cited by 106 publications

References 36 publications

Live Attenuated Borrelia burgdorferi Targeted Mutants in an Infectious Strain Background Protect Mice from Challenge Infection

Live Attenuated Borrelia burgdorferi Targeted Mutants in an Infectious Strain Background Protect Mice from Challenge Infection

Diagnostik und Therapie der Lyme-Arthritis

Variabilität der kutanen Lyme-Borreliose

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