Wednesday, 19 July 2017
Thursday, 29 June 2017
Sunday, 25 June 2017
Thanks to Dr Robert Bransfield for this important work published 16th June 2017
Video abstract of original research paper “Suicide and Lyme and associated diseases” published in the open access journal Neuropsychiatric Disease and Treatment by Bransfield RC
Purpose: The aim of this paper is to investigate the association between suicide and Lyme and associated diseases (LAD). No journal article has previously performed a comprehensive assessment of this subject.
Introduction: Multiple case reports and other references demonstrate a causal association between suicidal risk and LAD. Suicide risk is greater in outdoor workers and veterans, both with greater LAD exposure. Multiple studies demonstrate many infections and the associated proinflammatory cytokines, inflammatory-mediated metabolic changes, and quinolinic acid and glutamate changes alter neural circuits which increase suicidality. A similar pathophysiology occurs in LAD.
Method: A retrospective chart review and epidemiological calculations were performed.
Results: LAD contributed to suicidality, and sometimes homicidality, in individuals who were not suicidal before infection. A higher level of risk to self and others is associated with multiple symptoms developing after acquiring LAD, in particular, explosive anger, intrusive images, sudden mood swings, paranoia, dissociative episodes, hallucinations, disinhibition, panic disorder, rapid cycling bipolar, depersonalization, social anxiety disorder, substance abuse, hypervigilance, generalized anxiety disorder, genital–urinary symptoms, chronic pain, anhedonia, depression, low frustration tolerance, and posttraumatic stress disorder. Negative attitudes about LAD from family, friends, doctors, and the health care system may also contribute to suicide risk. By indirect calculations, it is estimated there are possibly over 1,200 LAD suicides in the US per year.
Conclusion: Suicidality seen in LAD contributes to causing a significant number of previously unexplained suicides and is associated with immune-mediated and metabolic changes resulting in psychiatric and other symptoms which are possibly intensified by negative attitudes about LAD from others. Some LAD suicides are associated with being overwhelmed by multiple debilitating symptoms, and others are impulsive, bizarre, and unpredictable. Greater understanding and a direct method of acquiring LAD suicide statistics is needed. It is suggested that medical examiners, the Centers for Disease Control and Prevention, and other epidemiological organizations proactively evaluate the association between LAD and suicide.
Read the full paper here: https://www.dovepress.com/suicide-and-lyme-and-associated-diseases-peer-reviewed-article-NDT
Friday, 12 May 2017
Chronic Lyme Disease: A Working Case Definition
Stricker RB* and Fesler MC International Lyme & Associated Diseases Society, Bethesda, MD; Union Square Medical Associates, San Francisco, CA, USA *Corresponding author: Raphael B. Stricker, Union Square Medical Associates, 450 Sutter Street, Suite 1504, San Francisco, CA 94108, USA Received: April 07, 2017; Accepted: April 25, 2017; Published: May 03, 2017
Although Lyme disease is the most common tickborne illness in the USA and Eurasia, the pathophysiology and clinical course of chronic Lyme disease (CLD) have not been formally defined. The purpose of this paper is to present a working case definition of CLD based on analysis of more than 700 peerreviewed publications. According to this definition, CLD is a multisystem illness with diverse musculoskeletal, neuropsychiatric and/or cardiovascular manifestations that result from ongoing infection with pathogenic members of the Borrelia spirochete complex often associated with other tickborne disease (TBD) pathogens. To qualify for the diagnosis of CLD, patients must have Lymecompatible symptoms and signs that are either consistently or variably present for six or more months. Two subcategories of CLD include untreated chronic Lyme disease (CLD-U) and chronic Lyme disease following a limited course of antibiotic treatment (CLD-T). The symptom patterns and optimal therapy of CLD require further study
There is some important information in this study which is available as pdf from the link above.
These are some short extracts that I find helpful. Anyone interested though should go to the full pdf to read further details.
Categories of CLD Untreated chronic Lyme disease (CLD-U) Patients whose exposure was not clearly identified and thus have prolonged untreated infection.
Chronic Lyme disease following limited antibiotic treatment (CLD-T) Patients who were diagnosed with Lyme disease and completed a limited course of antibiotic therapy, but whose symptoms persist.
This category differs from “Post-Treatment Lyme Disease Syndrome” (PTLDS), a research case definition proposed by the Infectious Diseases Society of America (IDSA) that excludes ongoing TBD infection as the cause of persistent CLD symptoms.
Clinical Judgment Until technological advances provide reliably sensitive and specific diagnostics, some patients will continue to have a diagnosis that remains unclear. Under these circumstances, the value of clinical judgment will remain an important component in treating these individuals. According to the American Medical Association Code of Medical Ethics, the primary responsibilities of clinical medicine are to alleviate patient suffering and prevent disease . As previously described by Johnson et al  and Cameron et al [156,157]. patients with CLD are often quite ill, and physicians are charged with finding balanced and effective management strategies for such patients.
Uncertainty about a CLD diagnosis may confound clinical decision making, but clinical uncertainty should not exclude that diagnosis. This process involves both inclusionary and exclusionary criteria. Patient care is dynamic, and clinical judgment requires vigilance in assessing clinical outcomes. As described by Kienle and Kiene, “Clinical judgment is a central element of the medical profession, essential for the performance of the doctor” . Thus given the current absence of a “gold standard” test for Lyme disease, it is essential that healthcare providers should consider this condition if symptoms and/or clinical signs occur in patients with a history consistent with CLD, as summarized in the guidelines of the International Lyme and Associated Diseases Society (ILADS) .
Conclusions This is the first study that provides a working case definition of chronic Lyme disease (CLD) and its subcategories. We propose that CLD is the result of persistent, active infection by pathogenic members of the Borrelia spirochete complex often associated with other TBD pathogens.
Thanks to PRweb which first alerted me to this paper
Interesting comments on this paper can be found :- https://sites.google.com/site/marylandlyme/chronic-lyme-disease/definition-of-chronic-lyme-disease/why-the-definition-paper-is-so-important