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Doxycycline
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
A first-time debate arose when the Infectious Diseases Society of America (IDSA) stated that there was no evidence to support the authenticity of entities referred to as post–Lyme disease syndrome, post-treatment chronic Lyme disease, and chronic Lyme disease, that are purported to occur after the completion of treatment for Lyme disease (Johnson and Stricker, 2009; 2010). Therefore the IDSA guidelines recommend against the use of antibiotics for any of these “syndromes” (Klempner et al., 2001; Wormser et al., 2006; Lantos et al., 2010). Indeed, a randomized, placebo-controlled trial involving patients with persistent symptoms attributed to Lyme disease showed no improvement in a health-related quality of life score after prolonged antibiotic therapy. Both trial groups were treated with a two week course of ceftriaxone. The intervention group then received 12 weeks of doxycycline and clarithromycin plus hydroxychloroquine (Berende et al., 2016).
Lyme Disease and the Heart
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2015
Considerable evidence has accumulated that Lyme disease is quite capable of evading the patient’s immune system, especially when treated with pharmaceutical antibiotics.64 Because B. burgdorferi can invade and remain alive inside the white blood cells called macrophages65 and lymphocytes66 and even suppress the numbers of natural killer lymphocytes called CD57+ NK cells,67 the immune system is often hard hit by Borrelia and therefore not very effective in eliminating Borrelia from the body. Further, chronic Lyme disease can even produce persistent inflammation from an autoimmune-like reaction induced by the Borrelia.68
Borrelia burgdorferi and related species
Published in Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward, Case Studies in Infectious Disease, 2010
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward
The existence of an entity termed ‘chronic Lyme disease’ is controversial and is the subject of a recent critical appraisal by the Ad Hoc International Lyme Disease Group comprising clinicians and microbiologists from North America and Europe (see References section). The term chronic Lyme disease is used in North America and in Europe as a diagnosis for patients with persistent pain, neurocognitive symptoms, fatigue, either separately or together, with or without clinical or serologic evidence of previous early or late Lyme disease. The conclusions of the International Lyme Disease Group are that ‘… the assumption that chronic, subjective symptoms are caused by persistent infection with B. burgdorferi is not supported by carefully conducted laboratory studies or by controlled treatment trials. Chronic Lyme disease, which is equated with chronic B. burgdorferi infection, is a misnomer, and the use of prolonged, dangerous, and expensive antibiotic treatments for it is not warranted.’
The clinical toxicology of sodium hypochlorite
Published in Clinical Toxicology, 2019
Robin J. Slaughter, Martin Watts, J. Allister Vale, Jacob R. Grieve, Leo J. Schep
An 18-year-old woman was brought to the emergency room by her mother with black urine less than 2 h after self-injection of Clorox® Lemon Fresh Bleach (≤ 5% sodium hypochlorite and ≤1% sodium hydroxide) 100 mL through a tunneled catheter intended for treatment of purported chronic Lyme disease. The mother witnessed an opened Clorox® container and a syringe smelling of bleach in the bathroom. On admission, she was drowsy but rousable to voice and normally orientated, with a regular heart rate of 106/min, respiratory rate of 16/min, blood pressure of 124/92 mmHg, and oxygen saturation of 97% on room air. Normal saline 2 L was infused and the patient was transferred to the critical care unit. For the first 12 h after presentation, all blood chemistries performed on an automated analyser were rejected due to hemolysis. Thereafter, laboratory studies demonstrated acute kidney injury, intravascular hemolysis, and mild myocardial injury. She required hemodialysis after becoming anuric [105].
Why Bioethics Should Be Concerned With Medically Unexplained Symptoms
Published in The American Journal of Bioethics, 2018
Finally, it is important to note that public concern about error of this kind is heating up with respect to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In the last few years, the U.S. Academy of Medicine (Institute of Medicine 2015), National Institutes of Health (Green et al. 2015), and Department of Health and Human Services (Chronic Fatigue Syndrome Advisory Committee 2015) have embraced the conclusion that it is now a “misconception” to understand ME/CFS as a psychogenic illness (Institute of Medicine 2015, 2). This dramatic reversal of opinion leaves patients, physicians, and policymakers scrambling to make sense of patients’ right to access biological care in countries where researchers disagree with U.S. authorities. Outcomes in this controversy will have a powerful impact on public debate about access to biological care for other contested conditions, such as fibromyalgia and chronic Lyme disease.
Morgellons disease: experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes
Published in Journal of Dermatological Treatment, 2018
Padma Mohandas, Anthony Bewley, Ruth Taylor
The syndrome can be associated with psychiatric co-morbidities, including depression, bipolar disorder, obsessive–compulsive disorder, schizophrenia and substance abuse (5). It has also been reported to be associated with other illnesses including chronic fatigue syndrome, fibromyalgia, chronic Lyme disease and conditions that can cause itching such as renal failure, lymphoproliferative disorders and psoriasis (6). There is a scarcity of literature on Morgellons due to its relatively recent description in modern medical literature. This may be due to diagnostic uncertainties, the challenges of recruiting patients for research (7) and a lack of clear understanding of the condition from health care professionals. Patients have usually seen at least three or four clinicians before they reach our service. Many patients are referred based on the patients’ own efforts to reach a diagnosis. In our case series, a significant proportion (28.5%) arrived with information either from the internet or from the newspapers. A seminal study conducted to establish potential aetiology was inconclusive (8). Recently Middelveen et al. (9,10) reported a strong association between Morgellons and Borrelia spirochaetes. Roncati et al. (11) have however disputed this theory with spectroscopic evidence of environmental filaments.