Lyme Disease: The Facts And The Fiction

1. Lyme Disease: The Facts And The Fiction Arthur Weinstein, MD Class Reunion May 2017

2. Lyme DiseaseA Tick-borne Infection Bug Vector Deer Tick Ixodes scapularis Reservoirs

3. IXODES TICK LIFE CYCLE

4. The Tick is a ‘Petri Dish’ Other organisms causing human diseases: • Babesia microti (Babesiosis) • Anaplasma phagocytophilum (Human Granulocytic Anaplasmosis) • Powassan virus (Powassan disease) • Borrelia myamotoi (Borrelia myamotoi disease)

5. Lyme disease # reported U.S. cases/yr (CDC) > 30,000 2009 -present

6. Canadian Deer are Friendly

7. Lyme Disease in Canada 2013 2016: 841 (preliminary data*) Gouvernement du Canada Statistics 2016

9. Transmission of Bb by infected Ixodes Scapularis ticks by duration of attachment < 24 hrs - 0/58 < 48 hrs - 4/50 (8%) < 72 hrs - 36/52 (69%) Des Vignes et al. JID 2001;183:773-8

10. Risk of Bb Infection After a Deer Tick Bite in Highly Endemic Areas (25% tick infection rate) of the US • Not finding the tick --->20% • Removing the tick --- 2.2% (95%CI:1.2-3.9%) • 1 dose (200mg) doxycycline (<72hrs) --- 0.4% (95%CI:0.02-2.1%) vs >3% • 10 days antibiotic --- 0% (upper limit of 95%CI= ~0.97%) J Antimicrob Chemother 2010;65:1137-1144 Nadelman et al:NEJM 2001

11. AcuteEarly LD • erythema migrans (EM) 70% • (disseminated EM - 20%) +/- constitutional symptoms – fever, myalgia, arthralgia (flu-like) • flu-like illness without EM – 10-15% • **-/+ Lyme seropositivity (~30-50% but higher % if disseminated)- pos IgM>IgG

12. Early Localized Disseminated Late Infectious ->90% cured with antibiotics (doxy, CTX) --------------------------------------- Antibiotic-Refractory Arthritis Post-Treatment Lyme Disease symptoms/syndrome Rash (EM) arthralgia/myalgia, fever Intermittent arthritis, disseminated skin lesions, meningitis, facial palsy Mono/oligo arthritis - knee(s), encephalopathy ------------------------------------------- Persistent synovitis knee(s) Arthralgia/Myalgia/Fatigue Lyme disease main features

13. Laboratory Diagnosis • 2-tier serology (ELISA screen, WB additional) essential to dx LD except for EM, >30% early cases neg • First 30 days of symptoms—immunoglobulin M (or G) • At any time in the illness—immunoglobulin G • Late Lyme dis (eg arthritis) IgG seropositivity the rule (99+%) • Be aware of + IgM WB’s (in patients symptomatic for many months to years) = False Positive

14. Lyme Disease: The Fiction “The truth is always the strongest argument.- - - Sophocles “The truth is incontrovertible. Malice may attack it. Ignorance may deride it. But in the end, there it is”- - - Winston Churchill “Falsehood flies and truth comes limping behind” - - - Jonathan Swift “An unexciting truth may be eclipsed by a thrilling lie”- - - Aldous Huxley

15. Post-Treatment Lyme Disease StudySF-36 at 180 Days (all pts) - no response to antibiotics (1 mo IV CFX + 2 mos po doxy) Klempner M et al. NEJM 2001

16. Evidence of Persisting B. burgdorferi Infection • Baseline CSF PCR 0/108 (0%) • Baseline Blood PCR 0/108 (0%) • CSF culture (BSK) 0/94 (0%) • CSF culture (hypertonic) 0/23 (0%) • Blood culture (hypertonic) 0/23 (0%) • Blood PCR during Rx 0/376 (0%)

17. Lyme Disease – The Fiction“Chronic Lyme Disease” • Patients with chronic symptoms of fatigue and joint or muscle pains are due to Lyme disease infection • Lyme disease testing is so inaccurate so that Lyme test-negative Lyme disease is common • Some alternative Lyme disease tests are more accurate • Borrelia burgdorferi can persist intracellularly for years, and thus escape detection and antibiotic killing • Long term antibiotic therapy for months or years may be necessary to “cure” chronic Lyme disease • Alternative approaches to treatment may be needed

18. Cycle of Misinformation about Lyme Disease Politicians

19. Social Networking Rapid promulgation of facts – truthful and not

20. The Lyme Disease “Fuss”

21. Be Concerned About Public Education and Government Affairs

23. CHRONIC FATIGUE SYNDROME MYALGIC ENCEPHALOMYELITIS/ CHRONIC FATIGUE SYNDROME Signs and symptoms A new onset (not lifelong) of severe fatigue for six consecutive months or greater duration which is unrelated to exertion, is not substantially relieved by rest, and is not a result of other medical conditions. The fatigue causes a significant reduction of previous activity levels. Four or more of the following symptoms that concurrently last six months or longer: impaired memory or concentration post-exertional malaise, where physical or mental exertions bring on "extreme, prolonged exhaustion and sickness" unrefreshing sleep muscle pain (myalgia) pain in multiple joints (arthralgia) headaches of a new kind or greater severity sore throat, frequent or recurring tender lymph nodes (cervical or axillary) Other common symptoms include:[19] brain fog (feeling like one is in a mental fog) difficulty maintaining an upright position, dizziness, balance problems or fainting allergies or sensitivities to foods, odors, chemicals, medications, or noise irritable bowel syndrome-like symptoms such as bloating, stomach pain, constipation, diarrhoea and nausea chills and night sweats visual disturbances (sensitivity to light, blurring, eye pain) depression or mood problems (irritability, mood swings, anxiety, panic attacks)

24. Banking on Borreliosis As early as 2010, the senior banker who has been blamed for the debacle, Ina Drew, began to lose her grip on the bank’s chief investment office, according to current and former traders. She had guided the bank through some of the most rugged moments of the 2008 financial crisis, earning the trust of Jamie Dimon, JPMorgan’s chief executive, in the process. But after contracting Lyme disease in 2010, she was frequently out of the office for a critical period, when her unit was making riskier bets, and her absences allowed long-simmering internal divisions and clashing egos to come to the fore, the traders said.

25. Wearable biosensors can flag illness, Lyme disease, risk for diabetes; low airplane oxygen Date: January 12, 2017 Source: PLOS Summary: Can your smart watch detect when you are becoming sick? A new study indicates that this is possible. By following 60 people through their everyday lives, researchers found that smart watches and other personal biosensor devices can help flag when people have colds and even signal the onset of complex conditions like Lyme disease and diabetes.

26. Symptoms after “Lyme disease” ?EQUIPOISE Alternative facts Relative truth Chronic somatic pain Chronic infection

27. Newsdesk The Lancet.com Vol 6 September 2006 Alternative health therapy for Lyme disease results in death The US Food and Drug Administration (FDA) is investigating one death and several reports of injury related to the administration of an unorthodox treatment for Lyme disease, called bismacine. Bismacine is not a licensed pharmaceutical. American Biologics Corporation (Chula Vista, California, USA), was granted a trademark for bismacine by the US Patent and Trademark Office in Jan 2005. According to the trademark record, the company designated their product, bismacine, as an antibacterial agent. The product was promoted by Bradford Research Institute, which founded American Biologics, a nutritional supplements company.

28. Lyme Disease is not Fatalbut misdiagnosis and mistreatment can be hazardous to your health Thank You