Ik heb eens een poging gedaan hier duidelijkheid over te creeeren. Jullie reacties zijn welkom.
This is a post regarding de controversy of Chronic Lyme Disease.
There is very little controversy regarding the existence of Lyme Disease and neuroborreliosis. Therefore I will regard the existence of these Diseases as self-evident. I will, therefore, focus on the discussion regarding Chronic Lyme Disease. This first question to ask is: What is meant by Chronic Lyme Disease? Usually, two things are meant by it:
1. Lyme Disease and it's symptoms that exists for a long time (e.g. more than 6 months), and
2. Lyme Disease that continues to exist and hurt patients even after 2 - 4 weeks of antibiotic treatment.
Let's first imagine what it would mean if indeed Chronic Lyme Disease doesn't exist because Lyme cannot exist for a long time. For this, we have to assume everybody's immune system will quickly kill all Borrelia bacteria, shortly after getting infected and getting sick. If this were true, surely no Lyme patient would ever need any antibiotics. This is not the case, so we can safely state that this argument is untrue; if no treatment is offered to a Lyme patient (for example because it took a long time to get a diagnosis) the disease is very likely to continue to exist, a situation we call Chronic Lyme Disease. So yes, this version of Chronic Lyme Disease does exist.
But now let's look at interpretation nr. 2: Lyme Disease that continues to exist after 2 - 4 weeks of antibiotic treatment. Can the bacteria survive antibiotic treatment?
To answer this question, we need to dive a little deeper into what antibiotics are and how the Borrelia bacteria reacts to it. One of the most popular antibiotics to treat Lyme Disease is Doxycycline. Doxycycline is a bacteriostatic antibiotic. Bacteriostatic means it doesn't kill the bacteria; it puts it to 'sleep' (deactivates it). Because during this treatment it is asleep, it will not multiply. Therefore the normal human immune system has more time to find and kill the bacteria. Now we have to ask: Will every bacteria be asleep during treatment and will your immune system kill every single sleeping bacteria? Unfortunately, the answer to these questions is no. There are places where the bacteria can hide and where both antibiotics and the immune system cannot reach them well enough to kill them, like in bones, eyes and the brain. The bacteria that have managed to hide in these places will likely survive antibiotic treatment. Moreover, the bacteria has a lot of tricks to survive antibiotic treatment. It can curl up to a little ball (cyst) and make a protective slimy layer (biofilm) around it's body so that neither the immune system nor antibiotics can kill it.
Some antibiotics work differently, like Ceftriaxon/Rocephin. Ceftriaxon is a bactericidal antibiotic (meaning it directly kills bacteria) that is taken intravenously (directly in the blood). This antibiotic works by stopping the skin of the bacteria to grow together with the bacteria. So the bacteria grows, but the skin gets weaker and weaker until the bacteria's skin (cell wall) breaks and the bacteria dies. However, Ceftriaxon can also not penetrate the protective slimy biofilm that the bacteria can create as a defense mechanism. And this antibiotic is powerless against yet another shape the bacteria can take: the cell wall-deficient shape. It this shape, the bacteria exists without a skin. So the method that Ceftriaxon uses to kill bacteria cannot be effective against bacteria in this shape. These are just a few examples of the survival techniques the bacteria has.
But let's look at it from the other way. Is there any proof of bacteria that survived an antibiotic treatment? There is currently no test available to check if all bacteria were killed by an antibiotic treatment. But there are some techniques available to test if an antibiotic treatment has been unsuccessful in killing the bacteria. One is just looking for the bacteria in the blood of a patient with a (dark-field) microscope. If you cannot find bacteria, this means nothing because they are usually hard to find. If you do however find a living bacteria you know that some bacteria have survived the antibiotic treatment. However, it is difficult to your blood tested under a (dark-field) microscope. Another method is taking the blood from a patient and allowing the bacteria to multiply outside the body in a laboratory (making a culture). However, this is also difficult and expensive. A third method is testing for the existence of DNA of the Borrelia bacteria (PCR). However, this test cannot distinguish between dead or alive bacteria. More commonly available tests are the ELISA and the more reliable Western Blot blood test. These tests measure antibodies against Borrelia, IgM, and IgG. Usually, the body first makes IgM antibodies and later switches to making IgG antibodies and continues to do so, often even after the infection has been cleared (IgG production has immunological memory). However sometimes (in about 36% of the cases) the body doesn't switch to making IgG antibodies and continues to make IgM antibodies. To make an IgM antibody the immune system requires an actual live bacteria, because the so-called T cell that makes these antibodies needs a model /mold /example, and only the Borrelia bacteria itself can be that model. This is because the T-cell doesn't have immunologic memory to make IgM cells. IgM antibodies cannot remain in the body for longer than 6 months without a live bacteria as an example to make more new antibodies. So if a patient gets her or his blood tested more than 6 months after an antibiotic treatment and gets a positive IgM result of a Western Blot test, there is only one more thing that you have to look at before you have hard physical proof that the infection is still active. You have to rule out the very slim chance of a false positive. Some IgM antibodies can be a physical reaction to another bacteria than Borrelia. Therefore you have to look for Borrelia-specific clues/bands in the Western Blot lab-result. One example of such a Borrelia-specific band is OspC (the Outer surface protein C). If the OspC band is also positive on the Western Blot result more than 6 months after antibiotic treatment you have the hard scientific proof that the Borrelia infection survived the antibiotic treatment. There have been countless examples of such blood results (despite the CDC's efforts to prevent late IgM results from surfacing) e.g.
http://jcm.asm.org/content/31/12/3090.full.pdf+html or
http://www.pdf-archive.com/2014/09/29/l ... tivity.pdf , so yes, the bacteria can survive antibiotic treatment and yes, this version of Chronic Lyme Disease does exist as well.
The arguments above explain the logic en evidence of the existence of Chronic Lyme Disease. I will also present some common arguments one can present in a discussion with someone who does not believe in Chronic Lyme Disease:
Skeptic: "There is no proof that Chronic Lyme Disease exists"
Believer: "Yes there is (explain the workings of Lyme, the serology etc., and show the blood results)".
Skeptic: "The CDC (Centers for Disease Control), IDSA etc. all say it does not exist."
Believer: "Please explain their argument. You will see that they have none. Currently, there is no scientific test available that can provide evidence a patient is freed of a bacterial infection after an antibiotic treatment. Therefore those who believe all antibiotic treatments against Borrelia are 100% effective, should realize this is a completely unfounded assumption without any logic or scientific basis. For more info on this, read
http://module.lymeDiseaseassociation.or ... Report.pdf "
Skeptic: "There is no proof any of the treatments offered to Chronic Lyme Disease patients are effective."
Believer: "That may be true, but this means we have to find better treatments. This does not mean the disease does not exist. It is very understandable that, when regular medical institutions lack the ability to heal patients, patients become desperate and try alternative treatments."
Skeptic: "Many of the symptoms of Chronic Lyme Disease can be caused by other Diseases too."
Believer: " That may be true, but these can also be caused by Chronic Lyme Disease, which is often by far the most probable cause. This does not mean the disease does not exist. And 'diseases' like Fibromyalgia and Chronic Fatigue Syndrome that Lyme patients are often misdiagnosed with, aren't real diseases, they are syndromes. A syndrome is a set of medical signs and symptoms that are correlated with each other without a well-known cause, unlike Lyme Disease, that does have a well-known cause."
