It seems as though the controversy is over what to call the syndrome, not whether it exists:
Approximately 10 to 20% of patients treated for Lyme disease with a recommended 2-4 week course of antibiotics will have lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months. Although often called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme disease Syndrome” (PTLDS).
Not really. PTLDS is over a much shorter time span than what is often being called chronic Lyme. The claims about chronic Lyme are generally for a disease lasting on the order of years.
Also, PTLDS is a way of saying that people have the same symptoms, but you shouldn’t give them antibiotics anymore, because they don’t have bacteria, they have an autoimmune disorder, or crystallized dead bacteria that irritate the tissues, or some other novel, theoretical disorder (which is in every case less likely than the simple alternative that they still have bacteria).
Given that each one of the 6 or so experiments I’ve read about performed in vitro or in vivo show that antibiotics rarely kill all the bacteria, I don’t understand why it’s so hard to believe that some bacteria survive antibiotic treatment.
There do seem to be cases of that. Recent Lyme-related news suggests that such cases may be caused by repeated infections. This would seem to contradict the “no antibiotics” advice—at least for these patients. These were patients with multiple rashes, though—chronic Lyme disease is supposed to be different from that.
That is another article by Wormser. He studied cases of people who had repeated EM (bullseye rashes). The methodology is actually clever, looking at the OpsC protein. But of course he knows this is going to be cited out of context to imply that people with chronic Lyme are really just being re-infected. As you noticed, the bullseye rash usually occurs immediately after infection. Most people with chronic Lyme don’t get repeated rashes, and this study is irrelevant to them.
Recent Lyme-related news suggests that such cases may be caused by repeated infections.
This makes sense — people who have gotten Lyme are not much more likely than others to move out of the Northeast U.S. or stay out of the woods, those being pretty much how to avoid exposure.
The article I cited suffers somewhat from sampling error though. You can’t really sample from those with migrating rashes—and then draw conclusions about the prevalence of repeat infections as an explanation for chronic cases.
It seems as though the controversy is over what to call the syndrome, not whether it exists:
http://www.cdc.gov/lyme/postLDS/
Not really. PTLDS is over a much shorter time span than what is often being called chronic Lyme. The claims about chronic Lyme are generally for a disease lasting on the order of years.
Also, PTLDS is a way of saying that people have the same symptoms, but you shouldn’t give them antibiotics anymore, because they don’t have bacteria, they have an autoimmune disorder, or crystallized dead bacteria that irritate the tissues, or some other novel, theoretical disorder (which is in every case less likely than the simple alternative that they still have bacteria).
Given that each one of the 6 or so experiments I’ve read about performed in vitro or in vivo show that antibiotics rarely kill all the bacteria, I don’t understand why it’s so hard to believe that some bacteria survive antibiotic treatment.
There do seem to be cases of that. Recent Lyme-related news suggests that such cases may be caused by repeated infections. This would seem to contradict the “no antibiotics” advice—at least for these patients. These were patients with multiple rashes, though—chronic Lyme disease is supposed to be different from that.
That is another article by Wormser. He studied cases of people who had repeated EM (bullseye rashes). The methodology is actually clever, looking at the OpsC protein. But of course he knows this is going to be cited out of context to imply that people with chronic Lyme are really just being re-infected. As you noticed, the bullseye rash usually occurs immediately after infection. Most people with chronic Lyme don’t get repeated rashes, and this study is irrelevant to them.
This makes sense — people who have gotten Lyme are not much more likely than others to move out of the Northeast U.S. or stay out of the woods, those being pretty much how to avoid exposure.
The article I cited suffers somewhat from sampling error though. You can’t really sample from those with migrating rashes—and then draw conclusions about the prevalence of repeat infections as an explanation for chronic cases.