A small but significant number of people with Lyme disease suffer from symptoms long after completing antibiotic treatment. The mystery why the problem may have been solved by a study published on Monday, which found that even after taking antibiotics in the inflamed joints of the patient still borreliosis bacteria may be present.
Lyme arthritis, the most common feature of late Lyme disease. Stage disease, leaves patients with swollen, painful joints. Researchers who examined synovial fluid from these inflamed joints also found antibodies to the persistent molecules called peptidoglycans, which are derived from the outer envelope of the Lyme bacteria. This emerges from the study published in the Proceedings of the National Academy of Sciences.
Immune response "appears to be an important part of Lyme arthritis," said lead author of the study, Brandon Jutras, assistant professor of biochemistry at Virginia Tech. "If we can prevent this response, we suggest that it speeds recovery or completely eliminates the symptoms."
People develop Lyme disease when a black-legged tick bites them and transmits the Borrelia burgdorferi bacterium. According to the Centers for Disease Control and Prevention, approximately 30,000 new cases of Lyme are diagnosed each year in the United States. Most cases are successfully treated with antibiotics, but if left untreated, the infection can spread to the joints, heart and nervous system. Even among those who are treated early, taking antibiotics for several weeks does not always lead to a complete improvement in the symptoms controversy for decades. Initially, some doctors suggested that patients present their symptoms. However, recent studies have revealed evidence of significant changes in the body of PTLDS patients. What is not yet known is whether in some cases PTLDS symptoms are caused by bacteria that have not been eradicated by antibiotic treatments or by persistent changes in the immune system that caused the disease ̵
Knowing nothing about the condition, not knowing whether patients really have symptoms, or knowing that they are really sick, "said Armin Alaedini, immunologist and assistant professor of medicine at Columbia University. "Working in my lab over the last 10 years on PTLDS shows that something is going on with the immune system. We see objective markers indicating the persistence of inflammation. "
Scientists estimate that 10 to 20 percent of patients diagnosed and treated with Lyme continue to experience symptoms such as arthritis, brain fog, pain and fatigue.
While Jutras' work was focused In Lyme arthritis, the results may well be related to other persistent Lyme symptoms.
"Wherever the bacteria grows, they excrete peptidoglycan, so it seems plausible that it might be important in other late-stage Lyme manifestations. "Jutras said.
The new findings" could be a major new insight into Lyme arthritis and possibly other consequences of Borrelia burgdorferi infection, "said Mark Soloski, immunologist and professor of medicine at the Johns Hopkins School of Medicine and co-director of basic research for the Johns Hopkins Lyme Disease Research Center, who, like Alaedini, was not involved in the new study.
Soloski's own research center Immune System Disorders. "Our patients showed inflammation in certain regions of the brain, suggesting it suggests that an immune process triggers the symptoms, "Soloski said.
Lyme Test Challenges
Scientists have not yet found a way to confirm this Lyme bacteria have been completely banned because of certain peculiarities of this evil insect, Soloski said It does not spend much time in the blood, moving quickly into the tissues and does not grow well in a culture. This confirms most bacterial infections.
For Kim Lewis, "The question of whether bacteria are left behind is still very open. "
" My team is looking for better drugs to treat Lyme, with the goal of doing something potentially simple – finding a better drug to treat the acute disease that could prevent PTLDS, "said Lewis, director of Antimicrobial Discovery Center and professor at Northeastern University, who was not involved in the new study.
The hope is that the right compound in humans with PTLDS could eradicate all remaining bacteria, said Lewis
The new study raises the question of whether bacteria are still present in the joints of patients with Lyme arthritis so Lewis. "The authors believe that the peptidoglycan remains in the synovial fluid after elimination of the pathogen. I suspect that the pathogen remains in the joints and excretes the antigen. It would be good to know how things really are. "
In order to find physical explanations for the patient's symptoms, it does not need to be determined if PTLDS is caused by residual bacteria or a compromised immune system. Peter Novak, Assistant Professor of Neurology at Harvard Medical School and Director of the Autonomous Laboratory at Brigham and Women's Hospital. Novak, who was also not involved in the new study, and colleagues have found that patients end up damaging their small nerves and also affecting the circulation in certain areas of the brain.
He suspects that the damage is due to changes in the immune system that was triggered by Lyme disease and remains after the extinction of the bacteria. Novak believes that when patients undergo improvement, if they are treated with long antibiotic courses, many antibiotics also have anti-inflammatory effects.
While others seek ways to test the presence or absence of bacteria, Novak's strategy is to help patients feel better by treating their symptoms.