LYMEPOLICYWONK: Part 1–New Study Shows Lyme Persists in Monkeys
This is Part 1 of a series of posts I will do on this study. A new study by Drs. Monica Embers, Stephen Barthold and colleagues has found that the bacteria that cause Lyme disease, Borrelia burgdorferi (Bb) persist in monkeys after antibiotic treatment. It is the latest in a number of studies that have demonstrated persistent infection in animal models despite treatment. The issue of persistent infection in Lyme disease is a highly controversial issue. Probably the most controversial issue actually. The authors conclude that their studies “offer proof of the principle that intact spirochetes can persist in an incidental host comparable to humans, following antibiotic therapy.” The study also found that the C6 antibody test gave false negative results in all of those treated with antibiotics and in more than ½ of those untreated. The presence of the bacteria was confirmed by other means. Both the lab tests and evidence of persistence are very important for Lyme patients because they show that Bb may persist after treatment even when antibody tests are negative.
Before drilling down into the details in other posts, let me give you the 10,000 foot elevation overview. The Embers study asks three important questions that are critical to understanding what is going on with Lyme disease.
Does the IDSA 28 day protocol for treating early disseminated Lyme disease (defined as 4 months after inoculation) eradicate Bb or does Bb persist notwithstanding short term treatment?
Answer: Bb persisted in 100% of treated monkeys. This suggests that at 4 months post infection 28 days of treatment with doxycycline may be insufficient to eradicate infection. (Persistent infection was demonstrated by other means including PCR, culture, immunofluorescence, and xenodiagnosis.)
Does the Klempner 90 day treatment protocol (30 days IV Rocephin, followed by 60 days oral doxycycline) for treating late disseminated Lyme disease (approximately 7 months after inoculation) eradicate Bb or does Bb persist notwithstanding this treatment?
Answer: Bb persisted in approximately 75% of the infected monkeys. This suggests that different treatment approaches that are longer or involve different or combined antibiotics may be more appropriate when Lyme disease has been present for more than 6 months. The authors state: “[T]he use of variable and pulse-dosing regimens of antibiotics may improve efficacy [43] and this warrants testing in an appropriate model.”
Does the C6 antibody test accurately measure active infection?
Answer: The C6 antibody test detected active infection 100% of the time 27 weeks after inoculation for untreated monkeys. After 27 weeks, however, antibody response began returning to baseline and the test failed to detect active infection in approximately 60% of the untreated monkeys. In addition, the antibody test failed to detect active infection in 100% of the treated monkeys. This suggests that the C6 test is not sensitive enough to detect active disease in those who have had the disease for more than a few months or who in those who have been treated for the disease, but have persistent infection.
What is the take away message? Lyme disease is hard to treat, may persist, and negative lab tests may not accurately reflect actual infection.
Because this study is so important, I am going to publish additional blog posts exploring in depth the implications of the study for chronic Lyme disease, early disseminated Lyme disease and diagnostic antibody testing.
Read additional parts of the series here:
Part 2–Treatment and Persistence
Part 3–IDSA 28-day treatment protocol fails to clear infection
Part 4–Lab tests fail to detect Lyme disease
Part 5–Of mice and men and monkeys
Read the journal article here.
References:
Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, Hodzic E, et al. Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection. PLoS ONE. 2012;7(1):e29914. Available at: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029914.
Klempner M, Hu L, Evans J, Schmid C, Johnson G, Trevino R, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. The New England journal of medicine. 2001 Jul 12;345(2):85-92.
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134
The LYME POLICY WONK blog is written by Lorraine Johnson, JD, MBA, who is the Chief Executive Officer of LymeDisease.org, formerly CALDA. Contact her at lbjohnson@lymedisease.org.
Thank you Lorraine. You always put things into very understandable terms.
Lorraine, what an important article…look forward to your posts about it. Here’s a link to the online article for those who would like to see it:
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029914
Thanks, Nancy. I added the url to the post!
Thank you for this post, it helps understand the study and it remarks the importance of analyzing if the guidelines to treat are correct or not? Not treating properly and enough is condemning us people with Lyme Disease and co-infections to live sick and to die suffering, while proper treatment could permit us to go back to the workforce and to have decent lives!
Thank you for your work!
Maria.
Thanks Lorraine! Keep up the good work. It’s so helpful to have you doing some consolidation and interpretation of research for us. I know it can’t always be easy!
Christina
How was Bb detected in the monkeys.?..not clear?
Persistent infection was demonstrated by other means including PCR, culture, immunofluorescence (visualization of spirochetes in inflammatory lesions), and something called xenodiagnosis.
after misdiagnosed for 7 years and receiving only guidelines treatment in 2007 I tested positive for lymes in 2009 so much so that my insurance covered a second pic line and IV treatment(I should said only guidelines treatment the rest of it was paid by me).why test monkeys if there is so many of us out there to prove guidelines wrong.what is going to take to change all this nonsense.
Thank you so much for this! Even though it doesn’t help me personally (I’m allergic to doxycycline and penicillin, so ID docs don’t even *try* to treat me), it helps me get information to my friends, who are very supportive of the cause. They’ve seen my struggle, and want *REAL* solutions.
So I can be very afraid if I tested positive two times with cdc standard tests and 1 negative test? I mean I got the 21 day course of doxy 2 times and I “must have been bitten by two ticks” accounting for the 2 positive tests according to a infectious disease specialist in Massachusetts! I have symptoms still, but it is all in my head? I am just a loony “antibiotic seeking patient” -because the antibiotics make me high??????
Dr. Barthold said today that there is persistent infection but no disease ie no inflammation and that spirochetes from one mouse treated with antibiotics can be injected into another and cause inflammation. Inflammation was the marker for disease and that may be one problem but not the only one. We do know Bb persists and we need to know if it is still causing disease. Mycoplasmas, Chlamydias and Brucella are all known to be chronic and they are all pathogens transmitted by vectors we encounter outdoors. So we can have multiple chronic infections.
Well right now you have two options.1. go see a dtoocr. require some TESTS to be done see what it is, what could be causing it. if they don’t do any kind of swab test, GO TO ANOTHER DOCTOR that will do it. you are paying for the visit! if it is a real sinus infection, then don’t take any prescription medicine or anything OTC because then you’ll have sinus infections FOR LIFE.2. Decide that your sinus infections can be due to your DIET. if you drink a lot of milk, eat a lot of sugar, eat a lot of white bread (bread with yeast in it) , all of that can cause mucus to build up. (there’s mucus in milk from the cows, you cant exactly filter it out) so that’s making your mucus worse. Eat a lot of vegetables. Eat rye bread with no yeast in it. Try taking a supplement like GSE (Grapefruit Seed Extract) which is a natural anti fungal. Fungus in your body is linked to allergies (food allergies especially). Never eat out (no mcdonalds or even subway is somewhat unhealthy) . Don’t drink coffee or alcohol or tea because all those dehydrate you. Make sure you drink a lot of water. (But not too much to where you start throwing it up ) If you go days without having JUST WATER (juice doesn’t count) it can all lead to mucus buildup b/c your system is dry and i think that causess more things to stick to you. Well i’m not a dtoocr, but i’ve learned quite a few things from dealing with health problems. And one thing i’ve learned is that 70% of the time, your dtoocr makes you sicker