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Lyme disease bacteria eradicated by new drug in early tests

816 points by dempedempe 7y ago

PragmaticPulp 7y ago
Note that they're carefully dancing around the elephant in the room: As far as I know, no one has ever demonstrated that Lyme spirochetes survive a course of standard antibiotics (Emphasis mine): > Standard treatment of Lyme disease is oral antibiotics, typically doxycycline, in the early stages of the disease; but for reasons that are unclear, the antibiotics don't work for up to 20% of people with the tick-borne illness. One possibility is that drug-tolerant bacteria cause the lingering symptoms. Many people experience lingering symptoms after contracting Lyme disease. Officially, this is known as "Post-Treatment Lyme Disease Syndrome". The CDC page for the PTLDS has more information: https://www.cdc.gov/lyme/postlds/index.html https://www.cdc.gov/lyme/postlds/index.html These PTLDS symptoms are definitely real, but the idea that persistent lyme infection is the cause of the lingering problems is more of a hypothesis at this point. It will be interesting to see if this new antibiotic produces different outcomes in PTLDS patients, but it's misleading to claim that this is the only antibiotic known to act on the Lyme disease spirochetes. The original study specifically explored the action of Azlocillin on Doxycycline-resistant spirochetes. From the study: > Our results also demonstrate that azlocillin and cefotaxime can effectively kill in vitro doxycycline-tolerant B. burgdorferi. The authors point to indirect evidence suggesting that spirochetes might still be present in PTLDS patients, but acknowledge that no one has yet been able to culture a viable spirochete from PTLDS patients: > A recent study in humans demonstrated that B. burgdorferi DNA was identified in PTDLS patient by xenodiagnosis but unable to culture viable spirochete17. In about 85% of Lyme arthritis patients, B. burgdorferi DNA was detected in synovial fluid by polymerase chain reaction (PCR) testing It would be great if this antibiotic could produce positive outcomes for PTLDS patients, but I wouldn't get too excited until we see some human studies. PTLDS (aka "chronic lyme") has a long history of promising treatments failing to produce results in patients.
- tempestn 7y ago
  I don't have any knowledge beyond what's in this article, but it appears that there is some evidence of Lyme bacteria surviving antibiotics, and the reason why this can occur: "According to the recent study, azlocillin shows promise because it appears to be able to kill the two morphological forms of the Lyme bacteria -- the actively replicating spiral forms and the semi-dormant round-body forms. Azlocillin also appears to kill drug-tolerant persisters very effectively. These protective persisters form when the bacteria are threatened with defensive immune system biochemicals or antibiotics. After the threat has passed, the bacteria can reemerge to cause active disease. Many researchers believe that doxycyline's inability to clear the persisters may account for the ongoing symptoms of some Lyme sufferers."
  - PragmaticPulp 7y ago
    Yes, but note that they also admit that we only have some indirect suggestions that persistent infection is the cause of PTLDS symptoms: > Many researchers believe that doxycyline's inability to clear the persisters may account for the ongoing symptoms of some Lyme sufferers "Many researchers believe" is not the language you use when you have concrete evidence supporting the claim. To date, no one has been able to culture these supposedly persistent bacteria from a PTLSD patient. Researchers are relying on indirect evidence, with no explanation for why the spirochetes can't be found in PTLSD patients.
    - smallnamespace 7y ago
      Your evidence bar may be unrealistically high here—Lyme has never been successfully cultured in any context (unless you count xenodiagnosis as a form of culturing).
      - PragmaticPulp 7y ago
        > Lyme has never been successfully cultured in any context Not true. Not sure where you are reading that. Lyme is difficult to culture, but it can be cultured: Scroll down to the "Culture" section: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441761/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441761/ Regardless, my bar for evidence would be human trials in PTLDS patients with Azlocillin. Given that Azlocillin is already FDA approved and the researchers initially started studying it in 2016, I'm surprised no one has tried it yet.
- mrfusion 7y ago
  Do PTLDS patients actually show active antibodies against lyme? That would be a good indication what’s going on.
  - megous 7y ago
    "Antibodies normally persist in the blood for months or even years after the infection is gone; therefore, the test cannot be used to determine cure." https://www.cdc.gov/lyme/diagnosistesting/index.html https://www.cdc.gov/lyme/diagnosistesting/index.html
    - mrfusion 7y ago
      Sorry I meant IgM not IgG.
      - megous 7y ago
        The page says that: "Positive IgM results should be disregarded if the patient has been ill for more than 30 days." The reason may be this: https://www.sciencedirect.com/science/article/pii/S1198743X14608120 https://www.sciencedirect.com/science/article/pii/S1198743X1...
        mrfusion 7y ago
        Thanks for responding. But that study says they assumed the results were false positives. Maybe for the purpose of that paper that’s fine. But I’m not sure if it supports your statement.
        megous 7y ago
        They also list a few reasons for the assumption. Anyway, the study itself is not the reason for the quoted statement on the CDC page. I was just trying to find some relevant basis for the statement, and this study has some reasons listed in the dicussion/conclusion.
        7y ago
- James_Henry 7y ago
  >> A recent study in humans demonstrated that B. burgdorferi DNA was identified in PTDLS patient by xenodiagnosis but unable to culture viable spirochete17. In about 85% of Lyme arthritis patients, B. burgdorferi DNA was detected in synovial fluid by polymerase chain reaction (PCR) testing The previous sentence is also important: >Many research studies has [sic] shown that B. burgdorferi establishes persistent infections after antibiotic treatment in various animal models.
  - PragmaticPulp 7y ago
    I'll review the citations in this study once again, but the evidence for lingering spirochetes in humans is always thin. Much of it relies on indirect testing that is difficult to replicate or prone to laboratory errors. I'd love to be completely wrong and for this to be a game-changing solution, but after years of following this research I'm suspicious of the idea that persistent yet mysteriously undetectable (in humans) spirochetes are responsible for PTLSD symptoms.
    - wolco 7y ago
      The idea of lingering unwanted resistant bacteria not being killed by antibiotics have been shown true with other spore type bacteria. I don't have the background in this specific bacteria, why do you believe it would be so different?
      - loeg 7y ago
        It seems like their opinion is informed on the basis of the existing scientific evidence, which is eminently reasonable, IMO.
    - power 7y ago
      I'm interested in your opinion of the citations too. They purport to show persistence beyond standard treatment in mice, dogs, macaques and humans, the latter via xenodiagnosis and PCR. PCR is pretty direct.
- Alex3917 7y ago
  > no one has ever demonstrated that Lyme spirochetes survive a course of standard antibiotics This is true, but what I think most people don't realize is that the evidence that antibiotics kill the bacteria in the first place is also extremely dubious. If you read the main paper, it literally boils down to "people who take antibiotics are less likely to get a rash."[1] [1] https://www.nejm.org/doi/full/10.1056/nejm200107123450201 https://www.nejm.org/doi/full/10.1056/nejm200107123450201
  - PragmaticPulp 7y ago
    You linked to a study of single-dose Doxycycline as potential prophylaxis. That's not how Lyme disease is treated. Lyme disease treatment protocols are shown here: https://www.cdc.gov/lyme/treatment/index.html https://www.cdc.gov/lyme/treatment/index.html Doxycycline is generally used for 14-21 days, twice daily, not a one-time dose as used in your linked study. Even the linked study shows that Doxycycline acts on B. burgdorferi, even in the difficult stationary phase. Scroll down to Figure 6: https://www.nature.com/articles/s41598-020-59600-4 https://www.nature.com/articles/s41598-020-59600-4 . Obviously Azlocillin is superior in this in vitro study, hence the news. But it still shows that Doxycycline is active against the bacteria. It's too bad that the authors didn't continue the test long enough to see Doxycycline either reach zero (presumably) or level off. Seems like a crucial piece of data that they strangely neglected to measure.
    - Alex3917 7y ago
      https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophy...
      - PragmaticPulp 7y ago
        > https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophy... Please read the study and the CDC web page you're linking to. They don't support your point. From the CDC link you provided: > Doxycycline (100 mg orally BID X 14 days) is generally recommended for prophylaxis in adults. From the study you linked to above: > A single 200-mg dose of doxycycline given within 72 hours The CDC recommends a 14-day course of twice-daily dosing (BID = twice daily). It has no relationship to the single-dose NJEM study you linked to above.
- deleted 7y ago
  [deleted]
- foobarian 7y ago
  Out of curiosity how come you have such detailed familiarity with the topic? Sorry if may be a sensitive question but it seems a relatively obscure thing to randomly get into. And to be sure I really appreciate your posts.
  - shmageggy 7y ago
    Hundreds of thousands of people have been diagnosed with Lyme, so probably millions know someone who has. There are posters about ticks at nearly every trailhead I've visited in the northeast US in the past five years. It's not obscure.
  - PragmaticPulp 7y ago
    > Out of curiosity how come you have such detailed familiarity with the topic? I developed the typical Lyme symptoms after spending a lot of time outdoors in a Lyme area and removing ticks from myself several different times. I tested positive for Lyme under the relatively strict CDC criteria from a trusted laboratory. A 28-day course of Doxycycline changed something, but the fatigue and general malaise stuck around. I've spent the next decade consuming every bit of research I could find on the topic. I'd love as much as anyone for this already FDA-approved antibiotic like Azlocillin to be a miracle cure for my problems. I would gladly welcome properly structured RCTs. However, I've learned to be extremely skeptical of antibiotic therapies for Lyme. Patients who self identify as having "chronic Lyme" are notorious for holding strong beliefs that antibiotics improve their condition after reading about hidden spirochetes and undetectable infection theories for years, but double-blind studies show no benefit. I think the much more likely explanation is that Lyme can trigger long-lasting alterations in the body somewhere, even after the infection is eliminated. Sadly, the topic has become so political that mainstream researchers won't touch it. Now that "chronic Lyme" is so closely intertwined with the alternative medicine community, anyone who denies the persistent infection theory is treated as if they are denying the persistent symptoms of sufferers. That couldn't be farther from the truth for me, as I suffer the symptoms myself. The topic is so politically charged that I only use my pseudonymous alternate account for discussing it online. I've had chronic Lyme sufferers dox me and send vaguely threatening messages in the past, just for discussing the research online. It's no wonder that more researchers don't want to investigate Lyme disease.
- vimy 7y ago
  Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease. >RESULTS: Motile spirochetes identified histopathologically as Borrelia were detected in culture specimens, and these spirochetes were genetically identified as Borreliaburgdorferi by three distinct polymerase chain reaction (PCR)-based approaches. Spirochetes identified as Borrelia burgdorferi were cultured from the blood of seven subjects, from the genital secretions of ten subjects, and from a skin lesion of one subject. Cultures from control subjects without Lyme disease were negative for Borrelia using these methods https://www.ncbi.nlm.nih.gov/pubmed/29662016 https://www.ncbi.nlm.nih.gov/pubmed/29662016 The CDC is wrong and negligent about persistent Lyme. Just like they are about the masks for covid-19. This is just one study demonstrating spirochetes surviving. I'm not gonna bother digging up the others, honestly not worth my time to try and convince one random person. Look up disulfiram and it's effects on Lyme patients. It's another drug discovered in the same way as this one. Miraculous.
  - torgoguys 7y ago
    The linked study's lead author is Middelveen. Isn't she the one who tried to say Lyme is an STD a few years back? I know nothing about the linked study, haven't read it, but her sloppiness with scientific rigor makes me nervous about taking the abstract at face value...
  - djsumdog 7y ago
    > Just like they are about the masks for covid-19 What is the CDC saying about masks for covid-19? Are you saying they're not effective or the CDC is downplaying their effectiveness?
    - voldacar 7y ago
      Weeks ago the CDC lied, saying that masks aren't effective and that the general public shouldn't wear them. They did this ostensibly to keep the existing mask supply available only to medical workers. Needless to say, if they're ineffective for the general public, they're ineffective for doctors and nurses. And so people saw through the bullshit
- hinkley 7y ago
  Lyme disease talk just makes me think of Nicholas Zakas and then I get bummed out. I know there's a guy, or maybe he represents a group of researchers, who thinks that Chronic Fatigue Syndrome is caused by inflammation in the brain, either due to some undetectable infection, or just a misfiring that is a lingering effect of some other insult (sounds to me like a histamine response aka allergy). If your body thought you had the flu but you didn't, you'd be knocked on your ass not unlike many people with CFS or Lyme. And if it never stopped you'd be in pretty bad shape a year in. So. Are we treating microbes that don't culture in a petri dish, or are we solving an autoimmune response gone whacky? You could really ask the same question about Crohn's or IBS. I recall years ago reading a long story about a consultant who was called in to figure out why this black soot was all over a neighborhood around a brewery. The brewery said it was diesel exhaust. But why only this neighborhood? He heard of a similar problem is some town in the UK. But Petri dish after Petri dish cultured nothing that could explain the black soot. Ergo, it's not microbial. Our intrepid consultant pours a small amount of distilled spirits onto a sample dish, and gets a bunch of black shit. The 'soot' was feeding off the Angel's Share (evaporative losses from the brewery), and would barely grow without it. Vigorous growth in vivo, negligible growth in vitro. We've come up with a cure or treatment for so many microbes that we can detect, but how do we know we're detecting them all? People die of cancer not because cancer is getting worse (well, pollution notwithstanding) but because Cancer is patient. There's a lot of space in the middle for new vectors to slip in.
  - kortex 7y ago
    I really enjoy your writing style. Flows extremely well.
  - jamisteven 7y ago
    Great writing.
    - hinkley 7y ago
      Thanks. I can be hit or miss. Maybe I need an editor :) Sometimes I read old stuff and think, "wow, I said that?" other times, "I have no idea what point I was trying to make."
- Ericson2314 7y ago
  Not to get in this heavily politicized fray, but PTDLS sure sounds easiest to explain as permanent damage after the disease. I mean, we already know nerves heal poorly. Why don't I hear more about this hypothesis?
- caycep 7y ago
  In my (brief) experience with PTLDS sufferers, there have been a couple of disturbing realizations/experiences: 1) it seems that "chronic lyme specialists" are physicians who realized that each patient they diagnose with "chronic lyme" is potentially a cash cow. In that they can be persuaded to pay out of pocket for regimens of IV infusions of antibiotics costing up to tens of thousands of dollars (and which make no antimicrobial sense). For years, because the "spirochete is hiding, round bodies, etc etc". The agents used also make no antimicrobial sense - when we show the med history to ID specialists and PharmD's, they just roll their eyes... 2) As a resident, we had a couple of cases roll through the door of a) temporal lobe epilepsy with mesial temporal sclerosis, b) Parkinson's disease, both pretty clear diagnoses, told by various "chronic lyme specialists" that their symptoms were due to Lyme,taken off their meds and put on strange regimens of IV ceftriaxone (at out of pocket expense) and ending up hospitalized as a result. With such severity that efforts were made to have the state board revoke the medical licenses of these practitioners.
  - matthewdgreen 7y ago
    I don’t doubt everything you’re saying, and that unscrupulous physicians are genuinely taking advantage of their patients. However, as someone with a family member who was recently diagnosed with a (largely untreatable) autoimmune disease, I want to explain why patients become so desperate that they’re willing to try anything. The basic problem here is that anyone who goes online and reads about their condition (eg PTLDS) will find ample scientific evidence that there’s a real condition there — however, a huge majority of medical practitioners aren’t as caught up on the research as their desperate patients, and will often express skepticism that the condition even exists. (Note that this is different from acknowledging the condition is real and being unable to offer a treatment.) This destroys credibility in the conservative medical establishment, and makes it much easier for charlatans to make inroads, simply by acting like they believe the patient. My point here is that a little empathy can go a long way to protecting patients from this outcome.
    - stainforth 7y ago
      Doctors are being empathetic when they restrain from pushing the nonsense quacks do, just to satisfy a patient's anxiety, no?
- hhas01 7y ago
  “As far as I know, no one has ever demonstrated that Lyme spirochetes survive a course of standard antibiotics” QFT. While PTLDS is a real thing (being long-term sequelae to the original Lyme infection), be very wary of anything labeled “chronic lyme”, which is a common code-word concoction of “Lyme-literate” MDs/DOs, naturopaths, and other quacks for peddling their nostrums (including permanent courses of antibiotics; a great way to make anyone sick as a dog). https://sciencebasedmedicine.org/?s=lyme https://sciencebasedmedicine.org/?s=lyme -- Bonus irony: GSK actually created a successful vaccine against Lyme 30 years ago: https://www.vox.com/science-and-health/2018/5/7/17314716/lyme-disease-vaccine-history-effectiveness https://www.vox.com/science-and-health/2018/5/7/17314716/lym... No prizes for guessing who destroyed that.
  - ejstronge 7y ago
    This is amazing - thanks so much for the LYMERix link. I'm nearly done with medical school and somehow never heard this story!
- krisn 7y ago
  I wrote up the blog for this study, and I agree it was poorly written and an incremental finding at best. To me, the most important point is that the IDSA/CDC has been recommending doxy for decades knowing that other drugs are more effective. To PragmaticPup: There is, however, lots of evidence supporting the point that Lyme spirochetes easily survive 2 to 4 weeks of doxy through the formation of blebs. Look up the primate studies by Monica Embers @Tulane and the mice studies by Barthold @UCDavis. Borrelia, like Syphilis, is notoriously hard to culture, and Barthold says that persistence is the "rule rather that the exception." I think there have only been 7 randomized double blind clinical treatment trials on humans since the 1981 discovery, and they all tested single drugs, rather than the drug cocktails, which might address both the spirochete and bleb forms of the bacteria. Michal Tal at Stanford is doing groundbreaking work on ways the Lyme bacteria evades the human immune system. I don't want to steal her thunder, but we definitely need new approaches to treating this formidable disease.
ericand 7y ago
"but for reasons that are unclear, the [traditional] antibiotics don't work for up to 20% of people with the tick-borne illness" This is very exciting for a group of people that have felt forgotten and ignored by the medical industry
jonathanjaeger 7y ago
When I got Lyme as a teenager I was very lucky to notice a bulls-eye pattern (which not everyone gets) and quickly get treatment, with no complications after. I wonder if this new drug, or any future drugs, that work for the 20% of the people that doxycycline doesn't help, will also help people who figured out they had Lyme very late after being infected.
- rzimmerman 7y ago
  I had a similar experience. I had a tick bite on my ear and didn't think much about it. A week or two later I noticed a secondary bullseye rash on my leg. I am also very lucky that my mother knew what it was and I was treated quickly with no complications.
- dd36 7y ago
  Yes, those are the ones that most desperately need treatment.
- ncmncm 7y ago
  I got rashes like those, in New York, and saw a dermatologist who seemed to have great difficulty recognizing them. I got the regular treatment and it all cleared up, but it was an odd experience.
heelix 7y ago
As someone who is a very active camper (pre-zombie-apocalypses summers) a human vaccination would be wonderful. When our kid was bitten, she had the same textbook bulls eye pattern so it was easy to see a clue. They use to have one, but it was pulled off the market.
- James_Henry 7y ago
  They're working on the new one: https://www.newsweek.com/lyme-disease-vaccine-valneva-fda-approva-641796 https://www.newsweek.com/lyme-disease-vaccine-valneva-fda-ap...
  - wgjordan 7y ago
    Currently in Phase 2 Clinical Development since Dec 2018, with interim data expected mid-2020 [1]. [1] https://valneva.com/wp-content/uploads/2019/06/2018_12_17_VLA_Lyme_Phase2_Initiation_PR_EN.pdf https://valneva.com/wp-content/uploads/2019/06/2018_12_17_VL...
    - toomuchtodo 7y ago
      Clincialtrials.gov tracking at https://clinicaltrials.gov/ct2/show/NCT03769194 https://clinicaltrials.gov/ct2/show/NCT03769194
- mc32 7y ago
  Yes definitely agree. With deer pop growth and climate change the ticks are found in most places now. It’d be nice to know that if bitten they’d be more of a nuisance than a threat to health.
  - acheron 7y ago
    There are still other tick-borne diseases. Let’s see if we can treat alpha-gal allergy too.
mrfusion 7y ago
Great news! Let’s hope the FDA doesn’t hold this up for years.
- James_Henry 7y ago
  It's an FDA-approved drug. Doctors could potentially just prescribe it for off-label use.
- greenburger 7y ago
  Let's hope the FDA does its job of ensuring it is safe and actually works as its proponents say. I'd rather they not give it 737 MAX style review.
  - jseliger 7y ago
    The issue is not "current practice" or "737 MAX," which is a false binary; the main issue is whether the FDA is optimally hitting the space between "safety" and "getting new drugs and treatments fast," and it appears that the FDA is overly conservative. See for example Launching the Innovation Renaissance https://marginalrevolution.com/marginalrevolution/2011/12/launching-the-innovation-renaissance.html https://marginalrevolution.com/marginalrevolution/2011/12/la...
    - greenburger 7y ago
      Not sure that I understand the argument. The FAA is also clearly not hitting optimal space between "safety" and "getting new planes flying fast". Sometimes it appears the FDA hasn't been conservative enough, see Vioxx and labelling/guidance around opioids.
      - evanpw 7y ago
        The difference is that preventing new planes from entering the market doesn't kill people.
        7y ago
mrfusion 7y ago
Has anyone tested hydroxychloroquine against Lyme disease?
- danielhlockard 7y ago
  ah yes, the flavor of the month drug. What makes you think it'd work on Lyme.
  - mrfusion 7y ago
    Did we have any reason to think it would work on corona? (I really don’t know)
    - James_Henry 7y ago
      Yes, it is an antiviral.
      - wetpaws 7y ago
        It also failed clinical trials for covid
        James_Henry 7y ago
        Which trials has it failed? I've really only read through the French one and the one from Wuhan. There are plenty that are still ongoing, of course.
        hannob 7y ago
        As far as I'm aware there has been only one small RCT overall on hydroxychlroquine from china and there it failed. All the other things that were cited in HCQs favor were essentially garbage. That's not to say it doesn't work. It was a small trial with issues. But right now it's the best evidence there is.
        wetpaws 7y ago
deleted 7y ago
[deleted]
nyxtom 7y ago
This is neat, very curious about how this process has been scaled/automated: >>> This process entails acquiring "libraries" of thousands of known chemical compounds and drugs, then mixing Lyme bacteria with each in tiny wells to see which ones are best at killing the organisms. The best drug candidates were retested in larger culture dishes, then the safest of these were tested in vivo in seven mice.
dj_gitmo 7y ago
The author gave an interesting interview on the War Nerd podcast https://www.krisnewby.com/media/radio-war-nerd https://www.krisnewby.com/media/radio-war-nerd
cryptogoth 7y ago
To me, this is an interesting result for three reasons: 1) it appears to be effective against three main forms of the Borrelia spirochete: the normal corkscrew shape, the round-body cyst, and biofilm (they don't call it by that name, but say "drug-tolerant persisters" whose meaning I'm inferring from rest of the literature). 2) it was approved to be tested in mice, which is a step on the way to human clinical trials. Other results, such as the active compound in honeybee venom, melittin, were only tested "ex vivo" on pigskin at body temperature. 3) it has the potential to work as quickly as antibiotics, and not 9 months to 2 years as many plant-based protocols take. Potentially without killing human gut flora. There is anecdotal evidence of PTLDS patients who are skilled with phlebotomy being able to culture lyme bacteria from their blood samples after letting them sit for a day or two, something that no conventional blood lab has time to do. Self-directed guide to blood microscopy to identify lyme borrelia (unverified by me): https://www.healingwell.com/community/default.aspx?f=30&m=3753190 https://www.healingwell.com/community/default.aspx?f=30&m=37... Videos of spirochetes emerging from red blood cells (unverified by me), please excuse funky beats. This one is a little too horrifying for me to watch, as the bacteria is super creepy-looking. https://howirecovered.com/lyme-disease-under-the-microscope/ https://howirecovered.com/lyme-disease-under-the-microscope/ Unfortunately, the lack of peer-reviewed results to verify this could mean either this method is not reliably reproducible, or there is no funding / appropriately prestigious or profitable way to pursue this line of research. It's a question I'm interested in, and would help fund as a citizen scientist. Even without a proposed treatment, the methodology of reliably detecting Lyme borrelia in blood could itself be patented. I'm very grateful this kind of research continues!
- fludlight 7y ago
  Re: #1 I think you missed the caption on the black and green picture: > This image shows how the Lyme bacteria, Borrelia burgdorferi, form protective round body "persisters" when threatened by defensive immune system biochemicals in blood serum. Re: #2 You don't need approvals to test in mice. Re: #3 Antibiotics kill/greatly-diminish gut flora. Azlocillin is an antibiotic related to penicillin. The other promising drug mentioned, disulfiram, is nothing to be trifled with, either: https://www.drugs.com/mtm/disulfiram.html https://www.drugs.com/mtm/disulfiram.html https://www.drugs.com/sfx/disulfiram-side-effects.html https://www.drugs.com/sfx/disulfiram-side-effects.html
rb808 7y ago
I can't go out of my apartment because of the virus and can't hang out in the forest because of the bacteria in ticks. What century is this?
oblib 7y ago
This has no bearing on the tests of this new drug, but it's worth noting that the best prevention is getting ticks off of you quickly. I know this because I live in a very tick infested area (Ozark Mountains) and very few people who've grown up here in families that have lived here for generations get lyme disease. I don't personally know anyone who has. Since I was kid in the `60s, and long before that, parents here did "tick checks" every evening. After calling us in mom's would strips us little kids down naked and pick any off they found and demand the older kids do it themselves and it becomes a habit. So does being aware. I mean, I don't ignore it when I think I feel one on me and I'm always aware there might be. I'm 61 now and I've been bit more times than I can count, but I still make a point to do a tick check every evening. Check out this video I made a couple years ago. They can get thick here... https://youtu.be/TFVDv8swzxQ https://youtu.be/TFVDv8swzxQ
- dempedempe 7y ago
  I also live in the Ozarks. Pretty sure that the ticks that bear Lyme disease bacteria are practically non-existent in the Ozarks. They're more relegated to the North East. Not to downplay the importance of tick checks and other prevention techniques.
  - liopleurodon 7y ago
    The midwest is pretty infested too. Especially parts of WI and MN
  - ourlordcaffeine 7y ago
    As a FYI, Slovenia is also a lyme disease hotspot. Do tick checks, wear long sleeve shirts and tuck trousers into your boots and your shirt into your trousers. Don't give the ticks any opportunity to crawl onto your skin.
  - alexhutcheson 7y ago
    This is correct - you can confirm from the CDC charts here: https://www.cdc.gov/lyme/datasurveillance/maps-recent.html https://www.cdc.gov/lyme/datasurveillance/maps-recent.html Note that cases are reported by state of residence, so even the handful of cases in Arkansas and Missouri are probably attributable to travel to the upper Midwest or Northeast. However, the Ozarks do have a high incidence of Rocky Mountain Spotted Fever, so you should still be careful about preventing tick bites and removing them ASAP: https://www.cdc.gov/rmsf/stats/index.html https://www.cdc.gov/rmsf/stats/index.html
nsxwolf 7y ago
Well shit, wrong disease right now.
- mtremsal 7y ago
  Because of lockdowns? I find some comic relief in concurrent studies on "Corona and Lyme".
onetimemanytime 7y ago
So while the FDA has not approved it for this, it is an already approved drug and people can get it, one way or another. Pretty good news
tenant 7y ago
Coming from a farming background I spent a lot of time in close contact with grass etc. No one I know of ever came down with something like this but now it's becoming increasingly common though not among farmers. I have a suspicion that a lot of the people who would have formerly complained of Fibromyalgia, or mercury allergy, or ME are now getting this.
AndyMcConachie 7y ago
I heard a great interview with the author, Kris Newby, concerning her recent book, Bitten. I haven't read her book, but it sounded good, and she definitely knows what she's talking about. Bitten: The Secret History of Lyme Disease and Biological Weapons, By Kris Newby.
- krisn 7y ago
  Thanks. I've spent 3.5 years on research for the Lyme documentary UNDER OUR SKIN, and 5.5 years of research for the book. I believe that some of the 20% of treated patients who go on to have chronic symptoms have undetected co-infections. The book explains the reasoning behind this. I'm giving a 20 minute online presentation on this Sat. at 11EST: https://zoom.us/webinar/register/6715850012795/WN_KUIbToN3S_OPp7cnWtIP0w https://zoom.us/webinar/register/6715850012795/WN_KUIbToN3S_... Tick Talk
deesep 7y ago
The roots of the plant Cryptolepis, also known as yellow-dye root, was found to be very effective against Lyme disease. So was the the Japanese Knotweed: https://blog.frontiersin.org/2020/02/21/ethnobotanical-medicine-is-effective-against-the-bacterium-causing-lyme-disease/ https://blog.frontiersin.org/2020/02/21/ethnobotanical-medic... Cryptolepis contains quinine and used by some tribes in West Africa to treat malaria.
dumbneurologist 7y ago
I am a neurologist. My main comments are the same from a thread about lyme on HN 7 months ago [1]. If you follow it to it's terminal conclusion, it shows that neurologists had a standard course of therapy for lyme. The alt-lyme community insisted that it was too short, and you needed long term treatment (with a duration based on their own experiences/treatment regimens). So conventional medicine studied the longer courses of treatment, and found there was no difference when studied in an objective way (randomized double blind comparison). Well, as soon as that happened, the goal posts got moved back, and they alt-lyme community said "well of course the study was negative! the treatment course wasn't long enough! It needs to be 12 weeks, not 8 weeks" (or whatever), even though they had consistently been saying 8 prior to the study. And still conventional medicine is open minded about any evidence that can be provided. That's how science works! But you are going to need to pay for the evidence, lyme people, because we feel like we did our due diligence with the first study, and don't need a repeat of the public health resources that were wasted searching for the autism-vaccine link over and over again. Even the other treatment outlined in this blog post (disulfuram) has an open study that is still looking for volunteers. That tells you a little bit about the level of need (modest, but not zero) and the disinterest of the patient community in advancing science (you can draw your own conclusions here). Related to this Stanford post specifically, I'm disappointed. > We'd been bitten by unseen ticks harboring the parasites that cause Lyme disease and babesiosis, a malaria-like disease It's far (far!) less like malaria than it is to syphilis. It's a bit like saying "this is a border collie, which is similar to a Maine Coone". Ok, well... kind of. To the extent that they are both mammals. But why are we not comparing the border collie to a great dane or a poodle? Because those are just as familiar, and way more similar. What syphilis and lyme have in common is that they are both spirichete bacteria, and a huge portion of the disease burden if it's not diagnosed quickly (and it's often not...) is due to autoimmune injury. You can completely kill all the bacteria in the chronically infected person, and their life will not get any better, because the autoimmunity is present, and unrelenting. Which is the second big criticism of this blog post: killing all the bacteria is not the challenge, and this discovery, while awesome, is not awesome for the reasons described. PragmaticPulp really nailed it here with what is now the top comment on this thread. > for reasons that are unclear, the antibiotics don't work for up to 20% of people with the tick-borne illness. One possibility is that drug-tolerant bacteria cause the lingering symptoms. these reasons are only unclear to the alt-lyme community. > Many researchers believe that doxycyline's inability to clear the persisters may account for the ongoing symptoms of some Lyme sufferers. Yes, the same researchers that are working on climate change for Exxon. It doesn't mean they won't disprove climate change, but it means they are outside the conventional understanding of this area of science. Overall, though, the science story here is legitimately cool! The scientists are using the application of a high-throughput system to test multiple compounds with known safety profiles against a pathogenic organism. That's an awesome form of problem solving consistent with the hacker ethos, and is done a disservice when presented along side this alt-lyme woo. [1] https://news.ycombinator.com/item?id=20749216 https://news.ycombinator.com/item?id=20749216
hhas01 7y ago
Something starting to really itch here, and, no, it’s not a tick bite. Is there a reliable scientific cite† for this PR piece’s statement that “antibiotics don't work for up to 20% of people with [Lyme disease]”? Because the only “20%” I’m seeing commonly mentioned elsewhere describes the 10-20% of patients who develop post-infection sequelae. Which is NOT the same as “antibiotics don’t work”. Or has Stanford PR just put its size thirteen in its mouth? (†And I don’t mean the “Lyme-literate” quacks and other AltMed scammers.)
OliverJones 7y ago
COOL! I live in a tick-infested beach community in northeast Mass, USA. Maybe soon it won't be such a high-stakes deal for summer houseguests to inspect themselves carefully. One guest got the dreaded, but she was lucky: antibiotics dealt with it. Thanks docs!
nickysielicki 7y ago
I come from Wisconsin and I've been bit by ticks so many times. If you don't deal with them you probably miss out on how tiny these little motherfuckers are. They look like freckles. That pic with the dime is the same one on my leg there. https://photos.app.goo.gl/vs4d1k8CGPekvPUC7 https://photos.app.goo.gl/vs4d1k8CGPekvPUC7 Now imagine if it's not on your leg but in your hair. Yeah, good luck finding that. I think it's also relevant to say that the bullseye appears less than half the time that people get lyme, and it's not always a bullseye. I've had weird scaly white rashes, etc. My advice is go here and buy medicine so you don't have to bother with a doctor. https://fishmoxfishflex.com/collections/fish-antibiotics https://fishmoxfishflex.com/collections/fish-antibiotics Sucks, but that's the life. Take care of yourself. edit: I highly recommend this video if you're interested in learning more about tick-bourne diseases in the midwest, Lyme is often just the name applied to a bunch of diseaes. https://www.youtube.com/watch?v=-N9rx1Vqxbc https://www.youtube.com/watch?v=-N9rx1Vqxbc
Metacelsus 7y ago
Reading the actual paper (the journal is Scientific Reports, which will publish anything: https://www.nature.com/articles/s41598-020-59600-4 https://www.nature.com/articles/s41598-020-59600-4) does not inspire confidence. In vitro killing is definitely not the same as in vivo efficacy. Furthermore, the authors try to build a homology model of a putative target protein and then dock the antibiotic. However they provide no evidence to show their model is correct, and speaking as a biochemist, they use completely inappropriate techniques. Their structural analysis is meaningless. And this casts doubt on the competence of the authors. (Also, the numerous grammar errors show that the paper wasn't edited or reviewed at all!)
olliej 7y ago
Wait they’ve patented the use of this drug to treat Lyme disease? That’s something you can do?
fallingfrog 7y ago
Of course if we had a vaccine for Lyme, which already exists for dogs, this wouldn’t even be necessary, but hey, cures are more profitable than prevention...
- ncmncm 7y ago
  The story of how the Lyme disease vaccine trials were successfully sabotaged is among the most shameful episodes in modern medicine.

816 points by dempedempe 7y ago

Note that they're carefully dancing around the elephant in the room: As far as I know, no one has ever demonstrated that Lyme spirochetes survive a course of standard antibiotics (Emphasis mine): > Standard treatment of Lyme disease is oral antibiotics, typically doxycycline, in the early stages of the disease; but for reasons that are unclear, the antibiotics don't work for up to 20% of people with the tick-borne illness. One possibility is that drug-tolerant bacteria cause the lingering symptoms. Many people experience lingering symptoms after contracting Lyme disease. Officially, this is known as "Post-Treatment Lyme Disease Syndrome". The CDC page for the PTLDS has more information: https://www.cdc.gov/lyme/postlds/index.html https://www.cdc.gov/lyme/postlds/index.html These PTLDS symptoms are definitely real, but the idea that persistent lyme infection is the cause of the lingering problems is more of a hypothesis at this point. It will be interesting to see if this new antibiotic produces different outcomes in PTLDS patients, but it's misleading to claim that this is the only antibiotic known to act on the Lyme disease spirochetes. The original study specifically explored the action of Azlocillin on Doxycycline-resistant spirochetes. From the study: > Our results also demonstrate that azlocillin and cefotaxime can effectively kill in vitro doxycycline-tolerant B. burgdorferi. The authors point to indirect evidence suggesting that spirochetes might still be present in PTLDS patients, but acknowledge that no one has yet been able to culture a viable spirochete from PTLDS patients: > A recent study in humans demonstrated that B. burgdorferi DNA was identified in PTDLS patient by xenodiagnosis but unable to culture viable spirochete17. In about 85% of Lyme arthritis patients, B. burgdorferi DNA was detected in synovial fluid by polymerase chain reaction (PCR) testing It would be great if this antibiotic could produce positive outcomes for PTLDS patients, but I wouldn't get too excited until we see some human studies. PTLDS (aka "chronic lyme") has a long history of promising treatments failing to produce results in patients.

tempestn 7y ago
I don't have any knowledge beyond what's in this article, but it appears that there is some evidence of Lyme bacteria surviving antibiotics, and the reason why this can occur: "According to the recent study, azlocillin shows promise because it appears to be able to kill the two morphological forms of the Lyme bacteria -- the actively replicating spiral forms and the semi-dormant round-body forms. Azlocillin also appears to kill drug-tolerant persisters very effectively. These protective persisters form when the bacteria are threatened with defensive immune system biochemicals or antibiotics. After the threat has passed, the bacteria can reemerge to cause active disease. Many researchers believe that doxycyline's inability to clear the persisters may account for the ongoing symptoms of some Lyme sufferers."
- PragmaticPulp 7y ago
  Yes, but note that they also admit that we only have some indirect suggestions that persistent infection is the cause of PTLDS symptoms: > Many researchers believe that doxycyline's inability to clear the persisters may account for the ongoing symptoms of some Lyme sufferers "Many researchers believe" is not the language you use when you have concrete evidence supporting the claim. To date, no one has been able to culture these supposedly persistent bacteria from a PTLSD patient. Researchers are relying on indirect evidence, with no explanation for why the spirochetes can't be found in PTLSD patients.
  - smallnamespace 7y ago
    Your evidence bar may be unrealistically high here—Lyme has never been successfully cultured in any context (unless you count xenodiagnosis as a form of culturing).
    - PragmaticPulp 7y ago
      > Lyme has never been successfully cultured in any context Not true. Not sure where you are reading that. Lyme is difficult to culture, but it can be cultured: Scroll down to the "Culture" section: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441761/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441761/ Regardless, my bar for evidence would be human trials in PTLDS patients with Azlocillin. Given that Azlocillin is already FDA approved and the researchers initially started studying it in 2016, I'm surprised no one has tried it yet.
mrfusion 7y ago
Do PTLDS patients actually show active antibodies against lyme? That would be a good indication what’s going on.
- megous 7y ago
  "Antibodies normally persist in the blood for months or even years after the infection is gone; therefore, the test cannot be used to determine cure." https://www.cdc.gov/lyme/diagnosistesting/index.html https://www.cdc.gov/lyme/diagnosistesting/index.html
  - mrfusion 7y ago
    Sorry I meant IgM not IgG.
    - megous 7y ago
      The page says that: "Positive IgM results should be disregarded if the patient has been ill for more than 30 days." The reason may be this: https://www.sciencedirect.com/science/article/pii/S1198743X14608120 https://www.sciencedirect.com/science/article/pii/S1198743X1...
      - mrfusion 7y ago
        Thanks for responding. But that study says they assumed the results were false positives. Maybe for the purpose of that paper that’s fine. But I’m not sure if it supports your statement.
        megous 7y ago
        They also list a few reasons for the assumption. Anyway, the study itself is not the reason for the quoted statement on the CDC page. I was just trying to find some relevant basis for the statement, and this study has some reasons listed in the dicussion/conclusion.
      - 7y ago
James_Henry 7y ago
>> A recent study in humans demonstrated that B. burgdorferi DNA was identified in PTDLS patient by xenodiagnosis but unable to culture viable spirochete17. In about 85% of Lyme arthritis patients, B. burgdorferi DNA was detected in synovial fluid by polymerase chain reaction (PCR) testing The previous sentence is also important: >Many research studies has [sic] shown that B. burgdorferi establishes persistent infections after antibiotic treatment in various animal models.
- PragmaticPulp 7y ago
  I'll review the citations in this study once again, but the evidence for lingering spirochetes in humans is always thin. Much of it relies on indirect testing that is difficult to replicate or prone to laboratory errors. I'd love to be completely wrong and for this to be a game-changing solution, but after years of following this research I'm suspicious of the idea that persistent yet mysteriously undetectable (in humans) spirochetes are responsible for PTLSD symptoms.
  - wolco 7y ago
    The idea of lingering unwanted resistant bacteria not being killed by antibiotics have been shown true with other spore type bacteria. I don't have the background in this specific bacteria, why do you believe it would be so different?
    - loeg 7y ago
      It seems like their opinion is informed on the basis of the existing scientific evidence, which is eminently reasonable, IMO.
  - power 7y ago
    I'm interested in your opinion of the citations too. They purport to show persistence beyond standard treatment in mice, dogs, macaques and humans, the latter via xenodiagnosis and PCR. PCR is pretty direct.
Alex3917 7y ago
> no one has ever demonstrated that Lyme spirochetes survive a course of standard antibiotics This is true, but what I think most people don't realize is that the evidence that antibiotics kill the bacteria in the first place is also extremely dubious. If you read the main paper, it literally boils down to "people who take antibiotics are less likely to get a rash."[1] [1] https://www.nejm.org/doi/full/10.1056/nejm200107123450201 https://www.nejm.org/doi/full/10.1056/nejm200107123450201
- PragmaticPulp 7y ago
  You linked to a study of single-dose Doxycycline as potential prophylaxis. That's not how Lyme disease is treated. Lyme disease treatment protocols are shown here: https://www.cdc.gov/lyme/treatment/index.html https://www.cdc.gov/lyme/treatment/index.html Doxycycline is generally used for 14-21 days, twice daily, not a one-time dose as used in your linked study. Even the linked study shows that Doxycycline acts on B. burgdorferi, even in the difficult stationary phase. Scroll down to Figure 6: https://www.nature.com/articles/s41598-020-59600-4 https://www.nature.com/articles/s41598-020-59600-4 . Obviously Azlocillin is superior in this in vitro study, hence the news. But it still shows that Doxycycline is active against the bacteria. It's too bad that the authors didn't continue the test long enough to see Doxycycline either reach zero (presumably) or level off. Seems like a crucial piece of data that they strangely neglected to measure.
  - Alex3917 7y ago
    https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophy...
    - PragmaticPulp 7y ago
      > https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophy... Please read the study and the CDC web page you're linking to. They don't support your point. From the CDC link you provided: > Doxycycline (100 mg orally BID X 14 days) is generally recommended for prophylaxis in adults. From the study you linked to above: > A single 200-mg dose of doxycycline given within 72 hours The CDC recommends a 14-day course of twice-daily dosing (BID = twice daily). It has no relationship to the single-dose NJEM study you linked to above.
deleted 7y ago
[deleted]
foobarian 7y ago
Out of curiosity how come you have such detailed familiarity with the topic? Sorry if may be a sensitive question but it seems a relatively obscure thing to randomly get into. And to be sure I really appreciate your posts.
- shmageggy 7y ago
  Hundreds of thousands of people have been diagnosed with Lyme, so probably millions know someone who has. There are posters about ticks at nearly every trailhead I've visited in the northeast US in the past five years. It's not obscure.
- PragmaticPulp 7y ago
  > Out of curiosity how come you have such detailed familiarity with the topic? I developed the typical Lyme symptoms after spending a lot of time outdoors in a Lyme area and removing ticks from myself several different times. I tested positive for Lyme under the relatively strict CDC criteria from a trusted laboratory. A 28-day course of Doxycycline changed something, but the fatigue and general malaise stuck around. I've spent the next decade consuming every bit of research I could find on the topic. I'd love as much as anyone for this already FDA-approved antibiotic like Azlocillin to be a miracle cure for my problems. I would gladly welcome properly structured RCTs. However, I've learned to be extremely skeptical of antibiotic therapies for Lyme. Patients who self identify as having "chronic Lyme" are notorious for holding strong beliefs that antibiotics improve their condition after reading about hidden spirochetes and undetectable infection theories for years, but double-blind studies show no benefit. I think the much more likely explanation is that Lyme can trigger long-lasting alterations in the body somewhere, even after the infection is eliminated. Sadly, the topic has become so political that mainstream researchers won't touch it. Now that "chronic Lyme" is so closely intertwined with the alternative medicine community, anyone who denies the persistent infection theory is treated as if they are denying the persistent symptoms of sufferers. That couldn't be farther from the truth for me, as I suffer the symptoms myself. The topic is so politically charged that I only use my pseudonymous alternate account for discussing it online. I've had chronic Lyme sufferers dox me and send vaguely threatening messages in the past, just for discussing the research online. It's no wonder that more researchers don't want to investigate Lyme disease.
vimy 7y ago
Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease. >RESULTS: Motile spirochetes identified histopathologically as Borrelia were detected in culture specimens, and these spirochetes were genetically identified as Borreliaburgdorferi by three distinct polymerase chain reaction (PCR)-based approaches. Spirochetes identified as Borrelia burgdorferi were cultured from the blood of seven subjects, from the genital secretions of ten subjects, and from a skin lesion of one subject. Cultures from control subjects without Lyme disease were negative for Borrelia using these methods https://www.ncbi.nlm.nih.gov/pubmed/29662016 https://www.ncbi.nlm.nih.gov/pubmed/29662016 The CDC is wrong and negligent about persistent Lyme. Just like they are about the masks for covid-19. This is just one study demonstrating spirochetes surviving. I'm not gonna bother digging up the others, honestly not worth my time to try and convince one random person. Look up disulfiram and it's effects on Lyme patients. It's another drug discovered in the same way as this one. Miraculous.
- torgoguys 7y ago
  The linked study's lead author is Middelveen. Isn't she the one who tried to say Lyme is an STD a few years back? I know nothing about the linked study, haven't read it, but her sloppiness with scientific rigor makes me nervous about taking the abstract at face value...
- djsumdog 7y ago
  > Just like they are about the masks for covid-19 What is the CDC saying about masks for covid-19? Are you saying they're not effective or the CDC is downplaying their effectiveness?
  - voldacar 7y ago
    Weeks ago the CDC lied, saying that masks aren't effective and that the general public shouldn't wear them. They did this ostensibly to keep the existing mask supply available only to medical workers. Needless to say, if they're ineffective for the general public, they're ineffective for doctors and nurses. And so people saw through the bullshit
hinkley 7y ago
Lyme disease talk just makes me think of Nicholas Zakas and then I get bummed out. I know there's a guy, or maybe he represents a group of researchers, who thinks that Chronic Fatigue Syndrome is caused by inflammation in the brain, either due to some undetectable infection, or just a misfiring that is a lingering effect of some other insult (sounds to me like a histamine response aka allergy). If your body thought you had the flu but you didn't, you'd be knocked on your ass not unlike many people with CFS or Lyme. And if it never stopped you'd be in pretty bad shape a year in. So. Are we treating microbes that don't culture in a petri dish, or are we solving an autoimmune response gone whacky? You could really ask the same question about Crohn's or IBS. I recall years ago reading a long story about a consultant who was called in to figure out why this black soot was all over a neighborhood around a brewery. The brewery said it was diesel exhaust. But why only this neighborhood? He heard of a similar problem is some town in the UK. But Petri dish after Petri dish cultured nothing that could explain the black soot. Ergo, it's not microbial. Our intrepid consultant pours a small amount of distilled spirits onto a sample dish, and gets a bunch of black shit. The 'soot' was feeding off the Angel's Share (evaporative losses from the brewery), and would barely grow without it. Vigorous growth in vivo, negligible growth in vitro. We've come up with a cure or treatment for so many microbes that we can detect, but how do we know we're detecting them all? People die of cancer not because cancer is getting worse (well, pollution notwithstanding) but because Cancer is patient. There's a lot of space in the middle for new vectors to slip in.
- kortex 7y ago
  I really enjoy your writing style. Flows extremely well.
- jamisteven 7y ago
  Great writing.
  - hinkley 7y ago
    Thanks. I can be hit or miss. Maybe I need an editor :) Sometimes I read old stuff and think, "wow, I said that?" other times, "I have no idea what point I was trying to make."
Ericson2314 7y ago
Not to get in this heavily politicized fray, but PTDLS sure sounds easiest to explain as permanent damage after the disease. I mean, we already know nerves heal poorly. Why don't I hear more about this hypothesis?
caycep 7y ago
In my (brief) experience with PTLDS sufferers, there have been a couple of disturbing realizations/experiences: 1) it seems that "chronic lyme specialists" are physicians who realized that each patient they diagnose with "chronic lyme" is potentially a cash cow. In that they can be persuaded to pay out of pocket for regimens of IV infusions of antibiotics costing up to tens of thousands of dollars (and which make no antimicrobial sense). For years, because the "spirochete is hiding, round bodies, etc etc". The agents used also make no antimicrobial sense - when we show the med history to ID specialists and PharmD's, they just roll their eyes... 2) As a resident, we had a couple of cases roll through the door of a) temporal lobe epilepsy with mesial temporal sclerosis, b) Parkinson's disease, both pretty clear diagnoses, told by various "chronic lyme specialists" that their symptoms were due to Lyme,taken off their meds and put on strange regimens of IV ceftriaxone (at out of pocket expense) and ending up hospitalized as a result. With such severity that efforts were made to have the state board revoke the medical licenses of these practitioners.
- matthewdgreen 7y ago
  I don’t doubt everything you’re saying, and that unscrupulous physicians are genuinely taking advantage of their patients. However, as someone with a family member who was recently diagnosed with a (largely untreatable) autoimmune disease, I want to explain why patients become so desperate that they’re willing to try anything. The basic problem here is that anyone who goes online and reads about their condition (eg PTLDS) will find ample scientific evidence that there’s a real condition there — however, a huge majority of medical practitioners aren’t as caught up on the research as their desperate patients, and will often express skepticism that the condition even exists. (Note that this is different from acknowledging the condition is real and being unable to offer a treatment.) This destroys credibility in the conservative medical establishment, and makes it much easier for charlatans to make inroads, simply by acting like they believe the patient. My point here is that a little empathy can go a long way to protecting patients from this outcome.
  - stainforth 7y ago
    Doctors are being empathetic when they restrain from pushing the nonsense quacks do, just to satisfy a patient's anxiety, no?
hhas01 7y ago
“As far as I know, no one has ever demonstrated that Lyme spirochetes survive a course of standard antibiotics” QFT. While PTLDS is a real thing (being long-term sequelae to the original Lyme infection), be very wary of anything labeled “chronic lyme”, which is a common code-word concoction of “Lyme-literate” MDs/DOs, naturopaths, and other quacks for peddling their nostrums (including permanent courses of antibiotics; a great way to make anyone sick as a dog). https://sciencebasedmedicine.org/?s=lyme https://sciencebasedmedicine.org/?s=lyme -- Bonus irony: GSK actually created a successful vaccine against Lyme 30 years ago: https://www.vox.com/science-and-health/2018/5/7/17314716/lyme-disease-vaccine-history-effectiveness https://www.vox.com/science-and-health/2018/5/7/17314716/lym... No prizes for guessing who destroyed that.
- ejstronge 7y ago
  This is amazing - thanks so much for the LYMERix link. I'm nearly done with medical school and somehow never heard this story!
krisn 7y ago
I wrote up the blog for this study, and I agree it was poorly written and an incremental finding at best. To me, the most important point is that the IDSA/CDC has been recommending doxy for decades knowing that other drugs are more effective. To PragmaticPup: There is, however, lots of evidence supporting the point that Lyme spirochetes easily survive 2 to 4 weeks of doxy through the formation of blebs. Look up the primate studies by Monica Embers @Tulane and the mice studies by Barthold @UCDavis. Borrelia, like Syphilis, is notoriously hard to culture, and Barthold says that persistence is the "rule rather that the exception." I think there have only been 7 randomized double blind clinical treatment trials on humans since the 1981 discovery, and they all tested single drugs, rather than the drug cocktails, which might address both the spirochete and bleb forms of the bacteria. Michal Tal at Stanford is doing groundbreaking work on ways the Lyme bacteria evades the human immune system. I don't want to steal her thunder, but we definitely need new approaches to treating this formidable disease.

ericand 7y ago

"but for reasons that are unclear, the [traditional] antibiotics don't work for up to 20% of people with the tick-borne illness" This is very exciting for a group of people that have felt forgotten and ignored by the medical industry

jonathanjaeger 7y ago

When I got Lyme as a teenager I was very lucky to notice a bulls-eye pattern (which not everyone gets) and quickly get treatment, with no complications after. I wonder if this new drug, or any future drugs, that work for the 20% of the people that doxycycline doesn't help, will also help people who figured out they had Lyme very late after being infected.

rzimmerman 7y ago
I had a similar experience. I had a tick bite on my ear and didn't think much about it. A week or two later I noticed a secondary bullseye rash on my leg. I am also very lucky that my mother knew what it was and I was treated quickly with no complications.
dd36 7y ago
Yes, those are the ones that most desperately need treatment.
ncmncm 7y ago
I got rashes like those, in New York, and saw a dermatologist who seemed to have great difficulty recognizing them. I got the regular treatment and it all cleared up, but it was an odd experience.

heelix 7y ago

As someone who is a very active camper (pre-zombie-apocalypses summers) a human vaccination would be wonderful. When our kid was bitten, she had the same textbook bulls eye pattern so it was easy to see a clue. They use to have one, but it was pulled off the market.

James_Henry 7y ago
They're working on the new one: https://www.newsweek.com/lyme-disease-vaccine-valneva-fda-approva-641796 https://www.newsweek.com/lyme-disease-vaccine-valneva-fda-ap...
- wgjordan 7y ago
  Currently in Phase 2 Clinical Development since Dec 2018, with interim data expected mid-2020 [1]. [1] https://valneva.com/wp-content/uploads/2019/06/2018_12_17_VLA_Lyme_Phase2_Initiation_PR_EN.pdf https://valneva.com/wp-content/uploads/2019/06/2018_12_17_VL...
  - toomuchtodo 7y ago
    Clincialtrials.gov tracking at https://clinicaltrials.gov/ct2/show/NCT03769194 https://clinicaltrials.gov/ct2/show/NCT03769194
mc32 7y ago
Yes definitely agree. With deer pop growth and climate change the ticks are found in most places now. It’d be nice to know that if bitten they’d be more of a nuisance than a threat to health.
- acheron 7y ago
  There are still other tick-borne diseases. Let’s see if we can treat alpha-gal allergy too.

mrfusion 7y ago

Great news! Let’s hope the FDA doesn’t hold this up for years.

James_Henry 7y ago
It's an FDA-approved drug. Doctors could potentially just prescribe it for off-label use.
greenburger 7y ago
Let's hope the FDA does its job of ensuring it is safe and actually works as its proponents say. I'd rather they not give it 737 MAX style review.
- jseliger 7y ago
  The issue is not "current practice" or "737 MAX," which is a false binary; the main issue is whether the FDA is optimally hitting the space between "safety" and "getting new drugs and treatments fast," and it appears that the FDA is overly conservative. See for example Launching the Innovation Renaissance https://marginalrevolution.com/marginalrevolution/2011/12/launching-the-innovation-renaissance.html https://marginalrevolution.com/marginalrevolution/2011/12/la...
  - greenburger 7y ago
    Not sure that I understand the argument. The FAA is also clearly not hitting optimal space between "safety" and "getting new planes flying fast". Sometimes it appears the FDA hasn't been conservative enough, see Vioxx and labelling/guidance around opioids.
    - evanpw 7y ago
      The difference is that preventing new planes from entering the market doesn't kill people.
      - 7y ago

mrfusion 7y ago

Has anyone tested hydroxychloroquine against Lyme disease?

danielhlockard 7y ago
ah yes, the flavor of the month drug. What makes you think it'd work on Lyme.
- mrfusion 7y ago
  Did we have any reason to think it would work on corona? (I really don’t know)
  - James_Henry 7y ago
    Yes, it is an antiviral.
    - wetpaws 7y ago
      It also failed clinical trials for covid
      - James_Henry 7y ago
        Which trials has it failed? I've really only read through the French one and the one from Wuhan. There are plenty that are still ongoing, of course.
        hannob 7y ago
        As far as I'm aware there has been only one small RCT overall on hydroxychlroquine from china and there it failed. All the other things that were cited in HCQs favor were essentially garbage. That's not to say it doesn't work. It was a small trial with issues. But right now it's the best evidence there is.
        wetpaws 7y ago

deleted 7y ago

[deleted]

nyxtom 7y ago

This is neat, very curious about how this process has been scaled/automated: >>> This process entails acquiring "libraries" of thousands of known chemical compounds and drugs, then mixing Lyme bacteria with each in tiny wells to see which ones are best at killing the organisms. The best drug candidates were retested in larger culture dishes, then the safest of these were tested in vivo in seven mice.

dj_gitmo 7y ago

The author gave an interesting interview on the War Nerd podcast https://www.krisnewby.com/media/radio-war-nerd https://www.krisnewby.com/media/radio-war-nerd

cryptogoth 7y ago

To me, this is an interesting result for three reasons: 1) it appears to be effective against three main forms of the Borrelia spirochete: the normal corkscrew shape, the round-body cyst, and biofilm (they don't call it by that name, but say "drug-tolerant persisters" whose meaning I'm inferring from rest of the literature). 2) it was approved to be tested in mice, which is a step on the way to human clinical trials. Other results, such as the active compound in honeybee venom, melittin, were only tested "ex vivo" on pigskin at body temperature. 3) it has the potential to work as quickly as antibiotics, and not 9 months to 2 years as many plant-based protocols take. Potentially without killing human gut flora. There is anecdotal evidence of PTLDS patients who are skilled with phlebotomy being able to culture lyme bacteria from their blood samples after letting them sit for a day or two, something that no conventional blood lab has time to do. Self-directed guide to blood microscopy to identify lyme borrelia (unverified by me): https://www.healingwell.com/community/default.aspx?f=30&m=3753190 https://www.healingwell.com/community/default.aspx?f=30&m=37... Videos of spirochetes emerging from red blood cells (unverified by me), please excuse funky beats. This one is a little too horrifying for me to watch, as the bacteria is super creepy-looking. https://howirecovered.com/lyme-disease-under-the-microscope/ https://howirecovered.com/lyme-disease-under-the-microscope/ Unfortunately, the lack of peer-reviewed results to verify this could mean either this method is not reliably reproducible, or there is no funding / appropriately prestigious or profitable way to pursue this line of research. It's a question I'm interested in, and would help fund as a citizen scientist. Even without a proposed treatment, the methodology of reliably detecting Lyme borrelia in blood could itself be patented. I'm very grateful this kind of research continues!

fludlight 7y ago
Re: #1 I think you missed the caption on the black and green picture: > This image shows how the Lyme bacteria, Borrelia burgdorferi, form protective round body "persisters" when threatened by defensive immune system biochemicals in blood serum. Re: #2 You don't need approvals to test in mice. Re: #3 Antibiotics kill/greatly-diminish gut flora. Azlocillin is an antibiotic related to penicillin. The other promising drug mentioned, disulfiram, is nothing to be trifled with, either: https://www.drugs.com/mtm/disulfiram.html https://www.drugs.com/mtm/disulfiram.html https://www.drugs.com/sfx/disulfiram-side-effects.html https://www.drugs.com/sfx/disulfiram-side-effects.html

rb808 7y ago

I can't go out of my apartment because of the virus and can't hang out in the forest because of the bacteria in ticks. What century is this?

oblib 7y ago

This has no bearing on the tests of this new drug, but it's worth noting that the best prevention is getting ticks off of you quickly. I know this because I live in a very tick infested area (Ozark Mountains) and very few people who've grown up here in families that have lived here for generations get lyme disease. I don't personally know anyone who has. Since I was kid in the `60s, and long before that, parents here did "tick checks" every evening. After calling us in mom's would strips us little kids down naked and pick any off they found and demand the older kids do it themselves and it becomes a habit. So does being aware. I mean, I don't ignore it when I think I feel one on me and I'm always aware there might be. I'm 61 now and I've been bit more times than I can count, but I still make a point to do a tick check every evening. Check out this video I made a couple years ago. They can get thick here... https://youtu.be/TFVDv8swzxQ https://youtu.be/TFVDv8swzxQ

dempedempe 7y ago
I also live in the Ozarks. Pretty sure that the ticks that bear Lyme disease bacteria are practically non-existent in the Ozarks. They're more relegated to the North East. Not to downplay the importance of tick checks and other prevention techniques.
- liopleurodon 7y ago
  The midwest is pretty infested too. Especially parts of WI and MN
- ourlordcaffeine 7y ago
  As a FYI, Slovenia is also a lyme disease hotspot. Do tick checks, wear long sleeve shirts and tuck trousers into your boots and your shirt into your trousers. Don't give the ticks any opportunity to crawl onto your skin.
- alexhutcheson 7y ago
  This is correct - you can confirm from the CDC charts here: https://www.cdc.gov/lyme/datasurveillance/maps-recent.html https://www.cdc.gov/lyme/datasurveillance/maps-recent.html Note that cases are reported by state of residence, so even the handful of cases in Arkansas and Missouri are probably attributable to travel to the upper Midwest or Northeast. However, the Ozarks do have a high incidence of Rocky Mountain Spotted Fever, so you should still be careful about preventing tick bites and removing them ASAP: https://www.cdc.gov/rmsf/stats/index.html https://www.cdc.gov/rmsf/stats/index.html

nsxwolf 7y ago

Well shit, wrong disease right now.

mtremsal 7y ago
Because of lockdowns? I find some comic relief in concurrent studies on "Corona and Lyme".

onetimemanytime 7y ago

So while the FDA has not approved it for this, it is an already approved drug and people can get it, one way or another. Pretty good news

tenant 7y ago

Coming from a farming background I spent a lot of time in close contact with grass etc. No one I know of ever came down with something like this but now it's becoming increasingly common though not among farmers. I have a suspicion that a lot of the people who would have formerly complained of Fibromyalgia, or mercury allergy, or ME are now getting this.

AndyMcConachie 7y ago

I heard a great interview with the author, Kris Newby, concerning her recent book, Bitten. I haven't read her book, but it sounded good, and she definitely knows what she's talking about. Bitten: The Secret History of Lyme Disease and Biological Weapons, By Kris Newby.

krisn 7y ago
Thanks. I've spent 3.5 years on research for the Lyme documentary UNDER OUR SKIN, and 5.5 years of research for the book. I believe that some of the 20% of treated patients who go on to have chronic symptoms have undetected co-infections. The book explains the reasoning behind this. I'm giving a 20 minute online presentation on this Sat. at 11EST: https://zoom.us/webinar/register/6715850012795/WN_KUIbToN3S_OPp7cnWtIP0w https://zoom.us/webinar/register/6715850012795/WN_KUIbToN3S_... Tick Talk

deesep 7y ago

The roots of the plant Cryptolepis, also known as yellow-dye root, was found to be very effective against Lyme disease. So was the the Japanese Knotweed: https://blog.frontiersin.org/2020/02/21/ethnobotanical-medicine-is-effective-against-the-bacterium-causing-lyme-disease/ https://blog.frontiersin.org/2020/02/21/ethnobotanical-medic... Cryptolepis contains quinine and used by some tribes in West Africa to treat malaria.

dumbneurologist 7y ago

I am a neurologist. My main comments are the same from a thread about lyme on HN 7 months ago [1]. If you follow it to it's terminal conclusion, it shows that neurologists had a standard course of therapy for lyme. The alt-lyme community insisted that it was too short, and you needed long term treatment (with a duration based on their own experiences/treatment regimens). So conventional medicine studied the longer courses of treatment, and found there was no difference when studied in an objective way (randomized double blind comparison). Well, as soon as that happened, the goal posts got moved back, and they alt-lyme community said "well of course the study was negative! the treatment course wasn't long enough! It needs to be 12 weeks, not 8 weeks" (or whatever), even though they had consistently been saying 8 prior to the study. And still conventional medicine is open minded about any evidence that can be provided. That's how science works! But you are going to need to pay for the evidence, lyme people, because we feel like we did our due diligence with the first study, and don't need a repeat of the public health resources that were wasted searching for the autism-vaccine link over and over again. Even the other treatment outlined in this blog post (disulfuram) has an open study that is still looking for volunteers. That tells you a little bit about the level of need (modest, but not zero) and the disinterest of the patient community in advancing science (you can draw your own conclusions here). Related to this Stanford post specifically, I'm disappointed. > We'd been bitten by unseen ticks harboring the parasites that cause Lyme disease and babesiosis, a malaria-like disease It's far (far!) less like malaria than it is to syphilis. It's a bit like saying "this is a border collie, which is similar to a Maine Coone". Ok, well... kind of. To the extent that they are both mammals. But why are we not comparing the border collie to a great dane or a poodle? Because those are just as familiar, and way more similar. What syphilis and lyme have in common is that they are both spirichete bacteria, and a huge portion of the disease burden if it's not diagnosed quickly (and it's often not...) is due to autoimmune injury. You can completely kill all the bacteria in the chronically infected person, and their life will not get any better, because the autoimmunity is present, and unrelenting. Which is the second big criticism of this blog post: killing all the bacteria is not the challenge, and this discovery, while awesome, is not awesome for the reasons described. PragmaticPulp really nailed it here with what is now the top comment on this thread. > for reasons that are unclear, the antibiotics don't work for up to 20% of people with the tick-borne illness. One possibility is that drug-tolerant bacteria cause the lingering symptoms. these reasons are only unclear to the alt-lyme community. > Many researchers believe that doxycyline's inability to clear the persisters may account for the ongoing symptoms of some Lyme sufferers. Yes, the same researchers that are working on climate change for Exxon. It doesn't mean they won't disprove climate change, but it means they are outside the conventional understanding of this area of science. Overall, though, the science story here is legitimately cool! The scientists are using the application of a high-throughput system to test multiple compounds with known safety profiles against a pathogenic organism. That's an awesome form of problem solving consistent with the hacker ethos, and is done a disservice when presented along side this alt-lyme woo. [1] https://news.ycombinator.com/item?id=20749216 https://news.ycombinator.com/item?id=20749216

hhas01 7y ago

Something starting to really itch here, and, no, it’s not a tick bite. Is there a reliable scientific cite† for this PR piece’s statement that “antibiotics don't work for up to 20% of people with [Lyme disease]”? Because the only “20%” I’m seeing commonly mentioned elsewhere describes the 10-20% of patients who develop post-infection sequelae. Which is NOT the same as “antibiotics don’t work”. Or has Stanford PR just put its size thirteen in its mouth? (†And I don’t mean the “Lyme-literate” quacks and other AltMed scammers.)

OliverJones 7y ago

COOL! I live in a tick-infested beach community in northeast Mass, USA. Maybe soon it won't be such a high-stakes deal for summer houseguests to inspect themselves carefully. One guest got the dreaded, but she was lucky: antibiotics dealt with it. Thanks docs!

nickysielicki 7y ago

I come from Wisconsin and I've been bit by ticks so many times. If you don't deal with them you probably miss out on how tiny these little motherfuckers are. They look like freckles. That pic with the dime is the same one on my leg there. https://photos.app.goo.gl/vs4d1k8CGPekvPUC7 https://photos.app.goo.gl/vs4d1k8CGPekvPUC7 Now imagine if it's not on your leg but in your hair. Yeah, good luck finding that. I think it's also relevant to say that the bullseye appears less than half the time that people get lyme, and it's not always a bullseye. I've had weird scaly white rashes, etc. My advice is go here and buy medicine so you don't have to bother with a doctor. https://fishmoxfishflex.com/collections/fish-antibiotics https://fishmoxfishflex.com/collections/fish-antibiotics Sucks, but that's the life. Take care of yourself. edit: I highly recommend this video if you're interested in learning more about tick-bourne diseases in the midwest, Lyme is often just the name applied to a bunch of diseaes. https://www.youtube.com/watch?v=-N9rx1Vqxbc https://www.youtube.com/watch?v=-N9rx1Vqxbc

Metacelsus 7y ago

Reading the actual paper (the journal is Scientific Reports, which will publish anything: https://www.nature.com/articles/s41598-020-59600-4 https://www.nature.com/articles/s41598-020-59600-4) does not inspire confidence. In vitro killing is definitely not the same as in vivo efficacy. Furthermore, the authors try to build a homology model of a putative target protein and then dock the antibiotic. However they provide no evidence to show their model is correct, and speaking as a biochemist, they use completely inappropriate techniques. Their structural analysis is meaningless. And this casts doubt on the competence of the authors. (Also, the numerous grammar errors show that the paper wasn't edited or reviewed at all!)

olliej 7y ago

Wait they’ve patented the use of this drug to treat Lyme disease? That’s something you can do?

fallingfrog 7y ago

Of course if we had a vaccine for Lyme, which already exists for dogs, this wouldn’t even be necessary, but hey, cures are more profitable than prevention...

ncmncm 7y ago
The story of how the Lyme disease vaccine trials were successfully sabotaged is among the most shameful episodes in modern medicine.