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Saturday, 19 May 2012

Borreliosis/Lyme & M.E.

Introduction

Many people in the United Kingdom with M.E. who are now being tested privately are finding they are infected with bacteria from the Borrelia Burgdorferi species that cause Borreliosis or Lyme disease. It wouldn't be surprising if a very significant percentage of those currently with a diagnosis of M.E. are actually infected with Borrelia or similar bacteria. An e-mail group poll showed that 80% of those with a diagnosis of Borreliosis or Lyme disease had a previous diagnosis of M.E.
Borreloisis & Lyme Disease

Borrelia is the name of a group of bacteria, of which there are many species, over 300 I believe, some of which are pathogenic. Borreliosis is the name of the disease caused by infection with these bacteria. Lyme disease has a narrower definition and can only be caused by 3 strains of Borrelia so it can exclude many people with long term illness caused by the bacteria. The terminology used to define infections caused by Borrelia are not clearly defined. Lyme disease and Borreliosis are often wrongly used interchangeably in the literature and sometimes the terms Lyme Borreliosis and Neuroborreliosis are used. Although the term Borreliosis would be far more appropriate, it is seldom used in the UK which is why I often refer to the term Borreliosis/Lyme.

Lyme disease was first recognised in the USA in 1975, when an outbreak occurred in Lyme, Connecticut, USA. The Borrelia bacteria were only discovered in 1982 which is one of the reasons why many people, including doctors, don’t know much about it.

Some people who have Borreliosis/Lyme have co-infections with other tick-borne pathogens such as babesia, erlichia or bartonella, and these cause illness too. Babesia are malarial-like protozoa which infect red blood cells, while the others are bacteria.

More about Borrelia

Borrelia bacteria are very large spirochaetes with a long thin spiral type shape and are similar to those causing syphilis. They can exist in several different forms including a dormant cyst, a motile spirochete and intracellular cell wall deficient forms. The spirochaete is able to change to a different form when a threat occurs (e.g. from the immune system or antibiotics) making it very difficult to eradicate. Borrelia can rapidly invade every type of tissue and every system in the body causing havoc in the host. Many symptoms are caused by Borrelia as it causes the immune system to produce cytokines (chemical messengers that help to regulate the immune response) and it produces many biotoxins, mainly neurotoxins, which are attracted to many areas of the body such as the central nervous system, peripheral nerves, muscles, joints, lungs, etc.

A main source of Borrelia infection is by a tick bite from an infected tick. Just one bite is all you need from an infected tick - this is only the size of a pinhead and may go unnoticed by the victim. If you read the literature on Lyme disease, it often refers to the American Deer Tick as being the source of infection, but in the UK the main vector is the Sheep Tick. Its small creatures like mice and birds which are natural reservoirs for the infections in the UK and it is they who provide the first meal for the newly hatched baby ticks. However, any animal could have ticks which carry Borrelia, including pets. Migrating birds can carry all sorts of bugs and infected ticks from other countries such as Africa.

It is not just ticks that can transmit the infection. Any biting insect such as mosquitoes and fleas are now believed to be able to carry and transmit Borrelia too. It is possible that Borrelia bacteria can sometimes be transmitted from mother to baby via the placenta, in breast milk, between sexual partners, and also by blood transfusions, though this is not yet widely accepted and more evidence is required. Borrelia has been isolated in human body fluids such as semen, tears and urine, unpasteurized cow’s milk and even found in African dust.

There are 3 strains of Borrelia defined as causing Lyme disease, but there are also other strains which are pathogenic. In the USA it is Borrelia burgdorferi sensu stricto which causes Lyme disease, while in the UK and Europe it is B. burgdorferi ss, B. garinii or B. afzelii. B garinii is thought to cause more neurological symptoms than B. burgdorferi ss and B. afzelii is thought to cause more coetaneous symptoms.

Ticks in the UK are infected with Borrelia

Many UK doctors don't know that you can get infected with Borrelia from ticks in the UK. The Natural History Museum tested many of its UK specimen ticks (PCR testing) and found between 8 and 97% were infected depending on the species of the tick. Some of the specimens were 100 years old. Another study from Swansea showed 30% of ticks in woods in South Wales were infected with Borrelia and 7% with a co-infection erlichosis. It can only take one tiny tick bite from an infected tick for a human to become infected – a bite that goes totally unnoticed more often than not.

Symptoms

Some people get a bull’s eye rash after a tick bite, which is a classic symptom of Lyme disease, but not everyone does. The symptoms of Borreliosis/Lyme can be the same as M.E., e.g. painful joints and muscles, ‘brainfog’, memory problems, headaches, Flu-like, neurological symptoms, stiff neck, numbness, tingling, extreme fatigue, sleep problems, neurally mediated hypotension, noise or light sensitivity and many more. Like M.E., there is a vast array of symptoms, but not everyone gets all of them. Borreliosis/Lyme can also mimic other diseases such as Fibromyalgia Syndrome, Multiple Sclerosis, Lupus and Motor Neurone Disease.

Some people get symptoms of Borreliosis/Lyme within a few days or weeks of a tick bite, but for some it is much longer, even years. The symptoms can be cyclical and they are often worse in women around the time of menstruation. As with M.E. some of the symptoms may vary from one day to the next in an unpredictable fashion. Some people get the illness more mildly or more severely than others. If it is left untreated some people may go on to develop long term or life-long severe debilitating illness. Some people can go into remission after a period of time, only for the disease to recur at a later stage – this is because the bacteria can change into a dormant cyst form and then change back again into the spirochaete form when the time is right, for example when the person is stressed or immunosuppressed.

The literature about Lyme disease often refers to early stage disease and late stage disease (often called late Lyme). The early stage symptoms may have fewer symptoms such as Flu-like, malaise, headaches, joint and muscle pain and/or fatigue and with or without a bull’s eye rash. This rash is called localized erythema migrans and may occur a few days before the other symptoms. Its not very clear cut though and some people may get many more symptoms early on including neurological ones. The spirochaete has been shown to enter the central nervous system within 12 hours of entering the blood stream. If the illness is left untreated it can progress and become a chronic multisystem disease within a few weeks or months. Some people, however, may just develop the symptoms of this late stage without having or recognising an early stage. For example, some may only have mild early stage symptoms and just think it’s a cold or a bout of Flu, without realising what it really is. All too often the early stage, which is so much easier to treat, goes unrecognised and untreated, as some people do not get a rash or do not notice the tick bite. In fact even if a tick bite is reported to a doctor in the UK, the doctor may well not realise its importance. Some people may go into remission after the early stage, even if it is left untreated, and maybe just forget about it. The illness, however, can recur in its chronic late form weeks, months or maybe even years later. It’s the late stage of the disease that all too often goes undiagnosed in the UK as standard NHS tests are usually negative by this time and it’s often the symptoms of this chronic stage that can be misdiagnosed as M.E.

Its quite possible that those who are chronically infected with Borreliosis/Lyme also have collateral conditions which may give additional symptoms.


• Evidence has shown that the hypothalamic-pituitary link is malfunctioning causing pituitary suppression. Pituitary and endocrine abnormalities could be quite common.

• It is possible that the cellular hormone receptors may be blocked. For example thyroid receptors could be blocked resulting in symptoms of subclinical hypothyroidism. This implies that blood testing may not pick up the hypothyroidism as there will be more thyroid hormone in the blood and less in the cells due to the receptor blockade.

• Magnesium deficiency is also often present which can give rise to several symptoms.

• Deficiency in vitamin B12 could also be present.

Diagnosis & Testing

In the early 1990s the United States Center for Disease Control and Prevention (CDC) set up a definition of Borreliosis/Lyme for an epidemiological study into this disease.

These narrow rigid criteria have been followed throughout the world ever since. More recently the CDC revised these guidelines, which now clearly state that these criteria are NOT intended for diagnostic purposes and that patients must be primarily diagnosed by clinical symptoms. Despite this, the new advice seems to have gone unheeded resulting in many cases going undiagnosed, especially late/chronic ones.

The original outdated guidelines are still rigidly adhered to in the UK. Most UK doctors, including Infectious Diseases specialists, are UNAWARE that:-

• The illness can be spread by factors other than ticks. This is not indicated in the new guidelines as it is not widely accepted yet.

• Ticks in the UK can carry and transmit Borrelia.

• Different strains of Borrelia which are defined as causing Lyme disease can give different disease expressions. One of the common strains in the UK, B. garinii, tends to cause more neurological symptoms, while another common strain found in the UK, B. afzelii, tends to cause more coetaneous symptoms, when compared with B. burgdorferi ss which tends to cause more arthritic symptoms. Although this is mentioned briefly in the CDC guidelines, much of the literature about Lyme disease refers to symptoms caused by B. burgdorferi ss which is commonly found in the USA.

• There are more strains of Borrelia that can cause illness than those defined to cause Lyme disease.

• The illness should be diagnosed by clinical evidence rather than by tests alone since these are not reliable enough.

• If a bull’s eye rash occurs, treatment should start immediately without testing, as tests may be negative in the very early stages.

• An active infection can exist when there is a negative serology test.

• There can still be an active infection when symptoms persist or recur after antibiotic treatment.


Most NHS doctors do not understand the pathophysiology of Borreliosis/Lyme and seem unaware of its extremely diverse symptoms. The illness is fairly new in the medical world and so is poorly described in medical textbooks.

In some Eastern European countries where it is endemic, they diagnose borreliosis/Lyme by symptoms but in the UK doctors won't normally do that, in fact most wouldn't even know what to look for. NHS doctors in the UK rely on highly unreliable two-tier antibody tests to diagnose Borreliosis/Lyme. First they do the Elisa test and if that is negative the patient is deemed not to be infected – end of story. If the patient is fortunate enough to get a positive Elisa test a Western Blot test is then carried out – this is just as unreliable as the first test and excludes even more infected patients! Some people may be positive for the Western Blot but not the Elisa, but they would never be tested. Apparently the UK Western Blot tests don’t test for every strain of Borrelia, even all those pathogenic strains found in the UK let alone those contracted overseas, but many doctors, even Infectious Diseases specialists, don't realise this. The UK tests may pick up some cases but would miss many many more – maybe more than 90% are missed. There are many people who have been found negative with NHS tests and positive by other private testing.

The above indicates that there could be many misdiagnosed cases of Borreliosis/Lyme in the UK, especially chronic ones. All too often people with chronic active infection are fobbed off as having post-Lyme disease or M.E.

Antibody tests for Borreliosis/Lyme are highly unreliable for a number of reasons some of the main ones being:-

• Borrelia infections cause malfunctioning of the immune system. Co-infections only add to this.

• The infection can go into cyst form which reduces the immune response.

• The infection can go into intracellular cell wall deficient form which cannot be detected by antibodies as there is no cell wall.

• The antibodies are in immune complexes, and so cannot be detected by the test.

• The spirochetes can be encapsulated in host tissue (lymphocytic cell walls) and thus hide from the immune system. I’ve seen them described as wolves in sheep’s clothing.

• The spirochetes are deep in the host tissue, especially tissue with a very poor blood supply.

• Recent infection - before the immune response has taken hold.

• The disease is in the late stage. Those who are chronically infected very often have negative antibody tests.

• Recent treatment with various drugs including antibiotics and anti-inflammatories.

• Factors which cause immunosuppression.

• Lab techniques.

• The lab does not test for the strain. The UK Western Blot does not test for every pathological strain, even all those found in the UK let alone those found abroad.


The only decent tests you can do at the moment are private. These are costly and include:-

• The Bowen Research & Training Institute Inc. test in the USA. This is an antigen test, i.e. they actually look for the Borrelia rather than antibodies to it and they also test for co-infections at no extra cost.

• IGeneX, Inc. tests in the USA. IgeneX do a Western Blot test that may sometimes give a false negative as it looks for antibodies but it is far better than the UK Western Blot and may sometimes help convince doctors that you have Borreliosis/Lyme, though not all will believe it. They also do PCR tests.

• There is also private blood microscopy to test for Borrelia-type bacteria done in the UK. I think there is a considerable waiting list for this.

• Someone in the UK is trying to set up PCR tests (looking for DNA fragments of Borrelia) and cultures - these will be a while yet - private again I'm afraid. It is very very difficult to culture Borrelia, which is why it isn't detected by NHS bacterial culture tests.

• There is also the Acarus vet's lab in the UK which can test humans for babesia, a co-infection, as some pets are diagnosed with this.


Testing is important so you know what infections you’ve got, so you can at least begin to get doctors to believe you have a treatable disease. However, if tests are negative the illness should not be ruled out if you have the symptoms. The CDC state that “there is no reliable test for Lyme disease at this time”.

Information on Borreliosis/Lyme

Details of tests and information on Borreliosis/Lyme can be found on the links/files on the EuroLyme and the Infections groups for patients and professionals.
Other useful sources of information on Borreliosis/Lyme are Lyme Disease Network which is actually recommended to UK doctors, and International Lyme And Associated Dieases Society for health professionals.

Treatments

Details of possible treatments are all in the files of Eurolyme. “Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illnesses” by Dr J Burrascano is a good starting point. There are various antibiotic treatments for Borreliosis/Lyme, what suits one may not suit another. The illness is much easier to treat in the early stages, the longer a person has had the illness the harder it is to treat. It may not be completely curable in long term chronic cases, but there are a growing number of people much much improved after treatment with long courses of antibiotics. Some people are lucky and can get their GPs to prescribe the antibiotics, but many have problems and have to pay privately. All too often, especially when prescribed by NHS doctors including infectious disease specialists, the antibiotics are given for too short a time or too low a dose to eradicate the bacteria fully. Some people who have babesiosis as a co-infection (similar to malaria) need an expensive antimalarial drug costing approximately £700 a month for several months and the NHS are refusing treatment on the grounds of cost. A consultant was willing to prescribe drugs privately to one person with Lyme disease, but not on the NHS.

At the moment there are a few of us on Samento (TAO free cats claw), an immune modulating herb, including myself. Apparently some of us are doing well on Samento, and some are not, but its early days yet. Some people need to take the herb for quite a long time before symptoms start to improve. More information on Samento can be found on www.samento.com.ec (also has some information on Borreliosis/Lyme) or www.samento-faq.eu.kz.

The Marshall Protocol is fairly new, so it’s early days yet, but it has potential. For this protocol benicar, known as Olmesartan or Olmetec in the UK, is given in high doses to suppress inflammation which allows antibiotics to work better and be given in lower doses. Some people with M.E. are being helped by this and again some are not. There was an article on ImmuneSupport.com not so long ago. Some are getting benicar on the NHS some are not, it depends on the doctor. “Lyme disease (Borreliosis). A Plague of Ignorance Regarding the Ignorance of a Plague” by Scott Taylor which can be found in the Eurolyme files also covers this protocol.
http://www.mesupport.co.uk/index.php...iosis-lyme-m-e