Nyheter – februari 2017

Dr Steven Phillips ger Dr Kenneth Sandström stöd

Publicerad måndag 6 mar, 11:00

NYHETERDr Steven Phillips, medlem i det vetenskapliga rådet för FSI, är en av världens främsta experter inom vektorburna infektioner. I denna artikel (engelska) beskriver han när och varför Rifampicin (Rifampin) bör användas (56 källhänvisningar),

Dr. Steven Phillips
Dr. Steven Phillips är en Yale-utbildad läkare som specialiserat sig på diagnos och behandling av borrelia och andra vektorburna infektioner. Han har genomfört omfattande forskning inom mikrobiologi och immunologi av Borrelia burgdorferi. Han är väl publicerad i den medicinska litteraturen inom temat borrelia och har behandlat patienter från praktiskt taget varje stat i USA samt över 20 andra länder. Förutom hans läkarpraktik och forskning är han en erkänd borreliaexpert för delstaterna Connecticut, New York, Rhode Island och Vermont. Han har föreläst vid ett flertal medicinska konferenser. Dr. Steven Phillips är tidigare ordförande för The International Lyme and Associated Diseases Society (ILADS), och är en återkommande expert för olika tv-program. Han var också en av de läkare som ombads att lämna expertutlåtande vid Infectious Diseases Society of America Hearing, Washington DC, 2009. Hans skriftliga vittnesmål består av 81 sidor med 226 medicinska referenser och förblir hittills en av de mest omfattande översyner på temat kronisk borrelia. Han är för närvarande involverad i en innovativ och omfattande forskning i ett försök att få till stånd en mer definitiv och förhoppningsvis botande behandling av kronisk borrelia och bartonella.
Presentation in English

March 5th, 2017

If ever there was an earnest, kind, and humane physician who deserves to be in clinical practice, it's Dr. Kenneth Sandström. I just found out that his license was revoked for the successful use of long term antibiotics, and more specifically rifampin, in chronic Lyme disease with suspected bartonellosis. I think that a tragedy has occurred, both for him and for the patients who depended on him. As such, I’ve included some germane medical information below, in the hopes that this can be educational and helpful to those suffering from chronic Lyme and bartonellosis in Sweden.

Rifampin can be a useful drug for the treatment of bartonellosis, which studies demonstrate is a prevalent co-infection in patients with chronic illness associated with Lyme disease. Rates of seronegativity in documented bacteremic bartonellosis patients have been reported at up to 50-75% [i],[ii] Bartonellosis can also occur without Lyme disease, be hard to diagnose due to the insensitivity of lab tests[iii],[iv],[v],[vi], and be a cause of chronic illness, even in immunocompetent patients, with a spectrum of illness which includes fever of unknown origin,[vii],[viii],[ix],[x],[xi] arthropathy,[xii] and neurologic illness.[xiii],[xiv] . Persistent infection has been documented in seronegative bartonellosis patients despite antibiotic therapy,[xv],[xvi] with rifampin being among the more effective antibiotics in vivo.

Lastly, rifampin, although not useful against the Lyme bacteria, B. burgdorferi, when used as a single agent, when used in combination with other antibiotics increases antimicrobial activity against B. burgdorferi, as published by researchers at Johns Hopkins.[xvii]

Seronegative Lyme disease has been documented commonly in the peer reviewed medical literature. For example, in a study of 41 patients with positive culture and/or PCR proven active late Lyme disease, 63.5% did not have fully reactive Lyme serologies despite that 54% had been symptomatic for over a year.[xviii] The authors state, “We conclude that antibodies to B. burgdorferi often are present in only low levels or are even absent in culture or PCR positive patients who have been suffering for years from symptoms compatible with LB. [Lyme borreliosis]. In a second study, of 32 patients hospitalized for late Lyme whose disease activity was confirmed by positive PCR, 56.3% were seronegative.[xix] In addition to these studies, many others, including but not limited to those that are referenced as follows, demonstrate that seronegative late active Lyme disease is common.,[xx],[xxi],[xxii],[xxiii],[xxiv],[xxv],[xxvi],[xxvii],[xxviii],[xxix],[xxx],[xxxi],[xxxii],[xxxiii],[xxxiv],[xxxv],[xxxvi],[xxxvii],[xxxviii],[xxxix],[xl],[xli],[xlii],[xliii],[xliv],[xlv],[xlvi],[xlvii],[xlviii],[xlix],[l],[li],[lii],[liii],[liv],[lv],[lvi],[lvii],[lviii],[lix],[lx],[lxi],[lxii],[lxiii]

Persistent infection despite long term antibiotics in late Lyme disease with a paucity of objective clinical features has been well documented. Published data out of Finland evaluated 165 Lyme patients initially meeting CDC surveillance case definition, who were treated with antibiotics for a median duration of 16 weeks.[lxiv] Of this group, 32 patients (19%) relapsed after treatment. Thirteen of these relapsed patients (41%) had confirmation of persistent infection by positive B. burgdorferi blood culture (1 patient), positive plasma B. burgdorferi PCR (10 patients), or both positive B. burgdorferi culture and positive plasma PCR (2 patients). The following table illustrates the clinical findings in these patients. Highlighted patients had at least one objective finding described by CDC surveillance case definition. This study demonstrates that in late Lyme disease with documented persistent infection, 6 out of 13 patients (46%) did not have specific objective features described by CDC surveillance case definition.

Patient #

1

2

3

4

5

6

7

8

9

10

11

12

13

Arthritis

+

Arthralgias

+

+

+

+

+

+

+

+

Myalgia

+

+

+

+

+

+

+

+

Headache

+

+

+

+

+

Dizziness

+

+

+

+

+

+

Meningitis

+

+

+

Radiculoneuropathy or Neuritis

+

+

Neuropathy

+

+

+

+

+

Carpal Tunnel

+

+

Diplopia

+

Seizure

+

Encephalitis

+

+

+

Hemiparesis

+

Fever

+

+

+

+

+

+

Hepatitis

+

+

Retinitis or Uveitis

+

Pleurisy or Pericarditis

+

+

Vasculitis-biopsy proven

+

+

+

Abnormal Brain MRI

+

ND

+

ND

ND

+

+

+

ND

ND

Steven Phillips, MD

[i] Maggi RG, Mascarelli PE, Pultorak EL, Hegarty BC, Bradley JM, Mozayeni BR, Breitschwerdt EB. Bartonella spp. bacteremia in high-risk immunocompetent patients. Diagn Microbiol Infect Dis. 2011 Dec; 71(4):430-7.

[ii] Maggi RG, Mozayeni BR, Pultorak EL, Hegarty BC, Bradley JM, Correa M, Breitschwerdt EB. Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Emerg Infect Dis. 2012 May; 18(5):783-91.

[iii] Maggi RG, Ericson M, Mascarelli PE, Bradley JM, Breitschwerdt EB. Bartonella henselae bacteremia in a mother and son potentially associated with tick exposure. Parasit Vectors. 2013 Apr 15;6:101. doi: 10.1186/1756-3305-6-101.

[iv] Shin OR, Kim YR, Ban TH, Lim T, Han TH, Kim SY, Seo KJ1. A case report of seronegative cat scratch disease, emphasizing the histopathologic point of view. Diagn Pathol. 2014 Mar 19;9:62. doi: 10.1186/1746-1596-9-62.

[v] Chondrogiannis K, Vezakis A, Derpapas M, Melemeni A, Fragulidis G. Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella henselae DNA in lymph node samples. Braz J Infect Dis. 2012 Jan-Feb;16(1):96-9.

[vi] Lin YY, Hsiao CH, Hsu YH, Lee CC, Tsai HJ, Pan MJ. Immunohistochemical study of lymph nodes in patients with cat scratch disease. J Formos Med Assoc. 2006 Nov;105(11):911-7.

[vii] Zenone T. Systemic Bartonella henselae Infection in Immunocompetent Adult Presenting as Fever of Unknown Origin. Case Rep Med. 2011;2011:183937. doi: 10.1155/2011/183937. Epub 2011 May 5.

[viii] Lin JW, Chen CM, Chang CC. Unknown fever and back pain caused by Bartonella henselae in a veterinarian after a needle puncture: a case report and literature review. Vector Borne Zoonotic Dis. 2011;11(5):589–591. doi: 10.1089/vbz.2009.0217

[ix] Boggs SR, Fisher RG. Bone pain and fever in an adolescent and his sibling. Cat scratch disease (CSD) Pediatr Infect Dis J. 2011;30(1):89. doi: 10.1097/INF.0b013e3181ebeade. 93–84.

[x] Myint KS, Gibbons RV, Iverson J, Shrestha SK, Pavlin JA, Mongkolsirichaikul D, Kosoy MY. Serological response to Bartonella species in febrile patients from Nepal. Trans R Soc Trop Med Hyg. 2011;105(12):740–742. doi: 10.1016/j.trstmh.2011.08.002.

[xi] Bhengsri S, Baggett HC, Peruski LF Jr, Morway C, Bai Y, Fisk TL, Sitdhirasdr A, Maloney SA, Dowell SF, Kosoy M. Bartonella spp. infections, Thailand. Emerg Infect Dis. 2010;16(4):743–745. doi: 10.3201/eid1604.090699.

[xii] Giladi M, Maman E, Paran D, Bickels J, Comaneshter D, Avidor B, Varon-Graidy M, Ephros M, Wientroub S. Cat-scratch disease-associated arthropathy. Arthritis Rheum. 2005 Nov; 52(11):3611-7.

[xiii] Breitschwerdt EB, Sontakke S, Hopkins S. Neurological manifestations of Bartonellosis in immunocompetent patients: A composite of reports from 2005-2012. J Neuroparasitol. 2012;3:15. doi: 10.4303/jnp/235640.

[xiv] Mascarelli PE, Maggi RG, Hopkins S, Mozayeni BR, Trull CL, Bradley JM, Hegarty BC, Breitschwerdt EB. Bartonella henselae infection in a family experiencing neurological and neurocognitive abnormalities after woodlouse hunter spider bites.Parasit Vectors. 2013 Apr 15;6:98. doi: 10.1186/1756-3305-6-98.

[xv] Bradley JM, Mascarelli PE, Trull CL, Maggi RG, Breitschwerdt EB. Bartonella henselae infections in an owner and two Papillon dogs exposed to tropical rat mites (Ornithonyssus bacoti). Vector Borne Zoonotic Dis. 2014 Oct;14(10):703-9. doi: 10.1089/vbz.2013.1492.

[xvi] Breitschwerdt EB, Maggi RG, Lantos PM, Woods CW, Hegarty BC, Bradley JM. Bartonella vinsonii subsp. berkhoffii and Bartonella henselae in a father and daughter with neurological disease. Parasit Vectors. 2010;3:29. doi: 10.1186/1756-3305-3-29.

[xvii] Feng J, Auwaerter PG, Zhang Y. Drug combinations against Borrelia burgdorferi persisters in vitro: eradication achieved by using daptomycin, cefoperazone and doxycycline.PLoS One. 2015 Mar 25;10(3)

[xviii] Oksi J, Uksila J, Marjamäki M, Nikoskelainen J, Viljanen MK. Antibodies against whole sonicated Borrelia burgdorferi spirochetes, 41-kilodalton flagellin, and P39 protein in patients with PCR- or culture-proven late Lyme borreliosis. J Clin Microbiol. 1995 Sep;33(9):2260-4

[xix] Chmielewski T, Fiett J, Gniadkowski M, Tylewska-Wierzbanowska S. Improvement in the laboratory recognition of lyme borreliosis with the combination of culture and PCR methods. Mol Diagn. 2003;7(3-4):155-62.

[xx] Lawrence C, Lipton RB, Lowy FD, Coyle PK Seronegative chronic relapsing neuroborreliosis. Eur. Neurol. 1995;35(2):113-7.

[xxi] Coyle PK, Schutzer SE, Deng Z, Krupp LB, Belman AL, Benach JL, Luft BJ Detection of Borrelia burgdorferi-specific antigen in antibody-negative cerebrospinal fluid in neurologic Lyme disease. Neurology. 1995 Nov;45(11):2010-5.

[xxii] Mouritsen CL, Wittwer CT, Litwin CM, Yang L, Weis JJ, Martins TB, Jaskowski TD, Hill HR Polymerase chain reaction detection of Lyme disease: correlation with clinical manifestations and serologic responses.Am. J. Clin. Pathol. 1996 May;105(5):647-54.

[xxiii] Paul A. [Arthritis, headache, facial paralysis. Despite negative laboratory tests Borrelia can still be the cause]. MMW Fortschr. Med 2001 Feb 8;143(6):17.

[xxiv] Pikelj F, Strle F, Mozina M. Seronegative Lyme disease and transitory atrioventricular block. Ann Intern Med 1989 Jul 1;111(1):90.

[xxv] Oksi J, Mertsola J, Reunanen M, Marjamaki M, Viljanen MK. Subacute multiple-site osteomyelitis caused by Borrelia burgdorferi. Clin Infect Dis 1994 Nov; 19(5): 891-6.

[xxvi] Reimers CD, de Koning J, Neubert U, Preac Mursic V, Koster JG, Muller Felber W, Pongratz DE, Duray PH. Borrelia burgdorferi myositis: report of eight patients. J Neurol 1993 May; 240(5): 278-83.

[xxvii] Bertrand E, Szpak GM, Pi?kowska E, Habib N, Lipczy?ska-Lojkowska W, Rudnicka A, Tylewska-Wierzbanowska S, Kulczycki J.. Central nervous system infection caused by Borrelia burgdorferi. Clinico-pathological correlation of three post-mortem cases. Folia Neuropathol. 1999;37(1):43-51.

[xxviii] Brown SL, Hansen SL, Langone JJ. (FDA Medical Bulletin) Role of serology in the diagnosis of Lyme disease. JAMA. 1999 Jul 7;282(1):62-6.

[xxix] Fraser DD, Kong LI, Miller FW. Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyositis. Clin Exp Rheumatol 1992 Jul-Aug;10(4):387-90.

[xxx] Brunner M, Sigal LH. Immune complexes from serum of patients with lyme disease contain Borrelia burgdorferi antigen and antigen-specific antibodies: potential use for improved testing. J Infect Dis. 2000 Aug;182(2):534-9. Epub 2000 Jul 28.

[xxxi] Wang P, Hilton E. Contribution of HLA alleles in the regulation of antibody production in Lyme disease. Front Biosci. 2001 Sep 1;6:B10-6.

[xxxii] Dejmkova H, Hulinska D, Tegzova D, Pavelka K, Gatterova J, Vavrik P. Seronegative Lyme arthritis caused by Borrelia garinii. Clin Rheumatol. 2002 Aug;21(4):330-4.

[xxxiii] Schubert HD, Greenebaum E, Neu HC. Cytologically proven seronegative Lyme choroiditis and vitritis. Retina. 1994;14(1):39-42.

[xxxiv] Oksi J, Kalimo H, Marttila RJ, Marjamaki M, Sonninen P, Nikoskelainen J, Viljanen MK. Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature. Brain 1996 Dec; 119 ( Pt 6): 2143-54.

[xxxv] Breier F, Khanakah G, Stanek G, Kunz G, Aberer E, Schmidt B, Tappeiner G. Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus. Br J Dermatol. 2001 Feb;144(2):387-92.

[xxxvi] Brunner M. New method for detection of Borrelia burgdorferi antigen complexed to antibody in seronegative Lyme disease. J Immunol Methods. 2001 Mar 1;249(1-2):185-90.

[xxxvii] Dinerman H, Steere AC. Lyme disease associated with fibromyalgia. Ann Intern Med. 1992 Aug 15;117(4):281-5.

[xxxviii] Keller TL, Halperin JJ, Whitman M. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of Lyme neuroborreliosis patients. Neurology. 1992 Jan;42(1):32-42.

[xxxix] Tylewska-Wierzbanowska S, Chmielewski T. Limitation of serological testing for Lyme borreliosis: evaluation of ELISA and western blot in comparison with PCR and culture methods. Wien Klin Wochenschr. 2002 Jul 31;114(13-14):601-5.

[xl] Hulinska D, Krausova M, Janovska D, Rohacova H, Hancil J, Mailer H. Electron microscopy and the polymerase chain reaction of spirochetes from the blood of patients with Lyme disease. Cent Eur J Public Health 1993 Dec; 1(2): 81-5.

[xli] Liegner KB, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, Kong L. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection. J. Am. Acad. Dermatol. 1993 Feb;28(2 Pt 2):312-4.

[xlii] Preac Mursic V, Marget W, Busch U, Pleterski Rigler D, Hagl S. Kill kinetics of Borrelia burgdorferi and bacterial findings in relation to the treatment of Lyme borreliosis. Infection. 1996 Jan-Feb;24(1):9-16.

[xliii] Kmety E. Dynamics of antibodies in Borrelia burgdorferi sensu lato infections. Bratisl Lek Listy. 2000;101(1):5-7.

[xliv] Pachner AR. Borrelia burgdorferi in the nervous system: the new "great imitator".Ann N Y Acad Sci. 1988;539:56-64.

[xlv] Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Infect Dis 1997 Jul;25 Suppl 1:S52-6.

[xlvi] Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Seronegative Lyme disease. Dissociation of specific T- and B-lymphocyte responses to Borrelia burgdorferi. N Engl J Med. 1988 Dec 1;319(22):1441-6.

[xlvii] Aberer E, Kersten A, Klade H, Poitschek C, Jurecka W. Heterogeneity of Borrelia burgdorferi in the skin. Am J Dermatopathol. 1996 Dec;18(6):571-9.

[xlviii] Steere AC. Seronegative Lyme disease. JAMA. 1993 Sep 15;270(11):1369.

[xlix] Preac-Mursic V, Pfister HW, Spiegel H, Burk R, Wilske B, Reinhardt S, Bohmer R. First isolation of Borrelia burgdorferi from an iris biopsy. J. Clin. Neuroophthalmol. 1993 Sep;13(3):155-61.

[l] Oksi J, Viljanen MK, Kalimo H, Peltonen R, Marttía R, Salomaa P, Nikoskelainen J, Budka H, Halonen P. Fatal encephalitis caused by concomitant infection with tick-borne encephalitis virus and Borrelia burgdorferi. Clin Infect Dis. 1993 Mar;16(3):392-6.

[li] Skripnikova IA, Anan'eva LP, Barskova VG, Ushakova MA. [The humoral immunological response of patients with Lyme disease.]Ter Arkh 1995;67(11):53-6.

[lii] Klempner MS, Schmid CH, Hu L, Steere AC, Johnson G, McCloud B, Noring R, Weinstein A. Intralaboratory reliability of serologic and urine testing for Lyme disease. Am J Med. 2001 Feb 15;110(3):217-9.

[liii] Banyas GT. Difficulties with Lyme serology. J Am Optom Assoc. 1992 Feb;63(2):135-9.

[liv] Faller J, Thompson F, Hamilton W. Foot and ankle disorders resulting from Lyme disease. Foot Ankle. 1991 Feb;11(4):236-8.

[lv] Mursic VP, Wanner G, Reinhardt S, Wilske B, Busch U, Marget W. Formation and cultivation of Borrelia burgdorferi spheroplast-L-form variants. Infection 1996 Jul-Aug;24(4):335.

[lvi] Millner M. Neurologic manifestations of Lyme borreliosis in children Wien Med Wochenschr. 1995;145(7-8):178-82.

[lvii] Pleyer U, Priem S, Bergmann L, Burmester G, Hartmann C, Krause A. Detection of Borrelia burgdorferi DNA in urine of patients with ocular Lyme borreliosis. Br J Ophthalmol. 2001 May;85(5):552-5.

[lviii] Eldøen G, Vik IS, Vik E, Midgard R. [Lyme neuroborreliosis in More and Romsdal] Tidsskr Nor Laegeforen. 2001 Jun 30;121(17):2008-11.

[lix] Kaiser R. False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays. J Med Microbiol. 2000 Oct;49(10):911-5.

[lx] Mikkilä H, Karma A, Viljanen M, Seppälä I. The laboratory diagnosis of ocular Lyme borreliosis. Graefes Arch Clin Exp Ophthalmol. 1999 Mar;237(3):225-30.

[lxi] Nields JA, Kueton JF. Tullio phenomenon and seronegative Lyme borreliosis. Lancet. 1991 Jul 13;338(8759):128-9.

[lxii] Schutzer SE, Coyle PK, Belman AL, Golightly MG, Drulle J. Sequestration of antibody to Borrelia burgdorferi in immune complexes in seronegative Lyme disease. Lancet. 1990 Feb 10;335(8685):312-5.

[lxiii] Holl-Wieden A, Suerbaum S, Girschick HJ. Seronegative Lyme arthritis. Rheumatol Int. 2007 Sep;27(11):1091-3.

[lxiv] Oksi J, Marjamaki M, Nikoskelainen J, et al. Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Ann Med. 1999 Jun;31(3):225-232.

Av datatekniska skäl presenteras källorna med romerska siffror, vilket inte originalartikeln gör

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