Efficacy of Double-Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-infections: A Report of Three Cases and Retrospective Chart Review

Abstract

Three patients with multi-year histories of relapsing and remitting Lyme disease and associated co-infections despite extended antibiotic therapy were each given double-dose dapsone combination therapy (DDD CT) for a total of 7–8 weeks. At the completion of therapy, all three patients’ major Lyme symptoms remained in remission for a period of 25–30 months. A retrospective chart review of 37 additional patients undergoing DDD CT therapy (40 patients in total) was also performed, which demonstrated tick-borne symptom improvements in 98% of patients, with 45% remaining in remission for 1 year or longer. In conclusion, double-dose dapsone therapy could represent a novel and effective anti-infective strategy in chronic Lyme disease/ post-treatment Lyme disease syndrome (PTLDS), especially in those individuals who have failed regular dose dapsone combination therapy (DDS CT) or standard antibiotic protocols. A randomized, blinded, placebo-controlled trial is warranted to evaluate the efficacy of DDD CT in those individuals with chronic Lyme disease/PTLDS.

Seroprevalence of Antibodies against Tick-Borne Pathogens in Czech Patients with Suspected Post-Treatment Lyme Disease Syndrome

“…There is an ongoing medical debate about the duration of antibiotic treatment of LD patients and the effectiveness of repeated treatment of these patients and patients suffering from PTLDS. Although longterm antibiotic therapy, repeated antibiotic treatments, or a combination of antimicrobial therapies are not currently recommended by most official health authorities [12], a number of published studies support the benefit or efficacy of prolonged antibiotic treatment (for a review, see [13,14]). Although significant improvements were noted after prolonged treatment, relapse of LD symptoms was observed by several authors after the discontinuation of medication [15].…”

“…The controversy about the treatment strategy cannot easily be resolved because Lyme disease is a complex condition that requires a complex solution. Possible explanations for the impairment of the results of prolonged or repeated therapy of patients could be found in multiple etiologies of disease, including persistent spirochete infection or other multiple causes leading to an overlap of sources of inflammation (for a review, see [13]). Recently, the possibility of the presence of persistent coinfections with pathogens commonly transmitted by ixodid ticks together with LD spirochetes, especially coinfections with Babesia or Bartonella, has received increasing attention [16,17].…”

“…), parasites (Babesia spp. ), or viruses (tick-borne encephalitis virus, Powassan virus) [13,26]. The most commonly discussed types of microorganisms are the bacteria Anaplasma phagocytophilum and Bartonella henselae and the parasitic piroplasma Babesia microti.…”

“…When LD and frequent coinfections cannot be treated with currently used drugs, it could be due to the emergence of persistent or dormant forms of spirochetes [21] or drug-resistant concomitant bacteria or parasites, or metabolic differences between pathogens [27]. The need to develop new, more effective LD or PTLDS treatment protocols directed on new drug targets or involving newer drug regimens or therapeutic strategies is clear and must target the primary cause of LD and possible tick-borne co-infections, as well as alternative/persistent/dormant forms of pathogens, including biofilms [13].…”

Borreliae Part 1: Borrelia Lyme Group and Echidna-Reptile Group

“…is widespread in areas where Ixodes ticks and reservoirs, mainly deer mice (Peromyscus species) in the USA [82] and Apodemus flavicollis in Europe [83], are present. Ixodes ticks are essential in the transmission of LB, but they can also transmit other infectious agents in humans such as viruses (tick-borne encephalitis-TBE/FSME, Powassan) [84], Borrelia of the RF (Borrelia miyamotoi) [85], intracellular bacteria (Anaplasma/Ehrlichia, Rickettsia, Bartonella sp.) and Protozoa (Babesia sp.…”