Symptoms of Lyme Borreliosis infection(s) can be serious and debilitating. Due to co-infections treatment needs to have multiple antimicrobials against not only bacteria but also to protozoa and viruses. In addition symptoms may also need to be managed by medication (eg:depression) and/or complementary medication and detoxing.
Lyme disease/Lyme Borreliosis, relapsing fever, if diagnosed and treated in stage 1 and 2 usually recovery is rapid and complete (Vanoisova & Hercogova 2008). Treatment of co-infections is also important for full recovery.
The antibiotics used, the mode of administration, duration of treatment depends on the stage of the infection, the clinical manifestations and the age of the patient.
Prophylaxis treatment is usually not recommended after an occasional tick bite. It is currently debated whether antibiotics should be given under certain exceptional circumstances such as repeated multiple exposure to tick bite in indeterminate areas. The duration of treatment has not been studied (Nau et al 2009).
Doxycyline should not be prescribed for patients under 9 years as it can affect bone development (Vanousova & Hercogova 2008).
Stage 1 and 2 Lyme disease/ Borreliosis is treated with doxycycline, a broad spectrum antibiotic which also has anti-protozoal properties for malaria prophylaxis (Australian Medicines Handbook, 2014).
As pleamorphism of Borrelia becomes more accepted, nitroimidazoles and hydroxychloroquinine which address the potential cyst form of Borrelia, may be beneficial for Stage 1 and 2 Borrelia infection also (Brorson & Brorson 2004, 1999, 1997). (treatment table) * Gerstenblith & Stern 2014).
The impact of antibiotics on Borrelia and co-infection also depends on the presence of biofilm (Anastasiadis et al 2014). Serine proteases may help to decrease or break down biofilm (Kahrstrom, 2014).
One complication of treating borreliosis with antibiotics is the Herxheimer reaction (Maloy et al 1998). Herxheimer reaction occurs when dying Borrelia release toxins, both exotoxins and endotoxins, which can worsen symptoms. It is very important that the patient understands this aspect of the treatment. The higher the bacterial kill, potentially the worse the Herxheimer reaction. The toxins need to be removed otherwise they can cause tissue damage (Farrow et al 2013). There are many ways of detoxing. The water soluble toxins can be eliminated by dilution, drinking a lot of water and renal excretion, while fat soluble toxins are more difficult to remove and they potentially can cause more serious tissue damage. The use of lipid binding agents like cholestyramine, (Weiss 2009, Insull Jr 2006) increased number of bowel motions, better gut bacteria and a high fibre diet can help to eliminate fat soluble toxins. Borrelia utilise the host tissue components as a source of nutrients such as manganese, phospholipids, nucleotides, magnesium (Ouyang et al 2009, Parveen & Cornell 2011). These nutrients, as well as antioxidants need to be supplemented to maintain health and to combat the ROS (reactive oxygen species) damage to cells.
The detoxing pathways/mechanism/ methods can vary between patients. Some may use infrared sauna to excrete toxins via the skin especially ammonia products. If toxins are not removed and they accumulate recovery will be delayed (Sribar et al 2014).
Stage III Treatment
The length of treatment of Stage III, chronic Lyme disease is debated. Some patients still have symptoms post 28 days of antibiotic treatment as per IDSA (Infectious diseases Society America). This symptomology is referred to as post Lyme syndrome. There is ongoing debate whether Borrelia is still present post antibiotic treatment. Those clinicians that believe that Borrelia is still present given its long replication life use prolonged antibiotic therapy comparable to Tuberculosis mycobacterium infection (Gropper et al 1995).
Treatment Addressing the Pleomorphism of Pathogenic Bacteria
Treatment with three different antibiotics is required to address the three different forms of Borrelia beta-lactams to kill the spirochete stage (Nau et al 2009); tetracyclines or macrolides to kill the intracellular form Brorson et al 2009 and metronidazole, tinidazole, nitrofurantoin and hydroxychloroquine to kill the cyst form Brosson and Brorson 1999, 1997. Three-antibiotic treatment can also give rise to multiple side effects and strong herxheimer reaction so the dose and the frequency need to be adjusted to the patient’s tolerance (ILADS guidelines 2014). In very sensitive, chronically ill patients three different antibiotics may not be able to be administered at the same time. The use of the tinidazole/metronidazole need to be intermittent to minimise very strong herxheimers reaction (ILADS guidelines 2014).
Lyme disease patients’ need to be monitored and supported by their doctor regularly and the treatment protocol adjusted accordingly at regular intervals so that recovery is within sight. See treatment table.
Treating Stage 1 and 2 Borreliosis is relatively simple compared to Stage 3. Due to the chronicity of the infection, treatment can be complicated by:
1. Multiple antimicrobials required to target multiple pathogens.
2. Dissemination of pathogens to protected niches (eg intracellular, joints and the CNS protected from immune response and where antimicrobials cannot penetrate easily).
3 Immune dysfunction created by multiple virulent pathogens overwhelming the immune system.
4. Complex antigenic variation in pathogens such as Borrelia which can increase the stress on the immune system.
5. Pleomorphic forms, persister cells or antibiotic resistant pathogens.
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Growing evidence of an emerging tick-borne disease that causes a Lyme like illness for many Australian patients
On 12 November 2015, the Senate referred the following matter to the Senate Community Affairs References Committee for inquiry and report:
The growing evidence of an emerging tick-borne disease that causes a Lyme‑like illness for many Australian patients.