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vrijdag 4 januari 2013

Issues in the diagnosis and treatment of Lyme disease.

Issues in the diagnosis and treatment of Lyme disease.

Authors: Donta ST

Citation: Open Neurol J 2012; 6: 140-5.

Location: Department of Medicine (Infectious Diseases), Falmouth
Hospital, USA.

DOI: 10.2174/1874205X01206010140

Since the identification of the causative organism more than 30 years
ago, there remain questions about the diagnosis and treatment of Lyme
Disease. In this article, what is known about the disease will be
reviewed, and approaches to the successful diagnosis and treatment of
Lyme disease described. In considering the diagnosis of Lyme disease, a
major problem is the inability of documenting the existence and location
of the bacteria. After the initial transfer of the bacteria from the
Ixodes tick into the person, the spirochetes spread locally, but after
an initial bacteremic phase, the organisms can no longer be reliably
found in body fluids. The bacteria are probably present in subcutaneous
sites and intracellular loci. Currently, the use of circulating
antibodies directed against specific antigens of the Lyme borrelia are
the standard means to diagnose the disease, but specific antibodies are
not an adequate means to assess the presence or absence of the organism.

What is needed is a more Lyme-specific antigen as a more definitive
adjunct to the clinical diagnosis. As for the treatment of Lyme disease,
the earliest phase is generally easily treated. But it is the more
chronic form of the disease that is plagued with lack of information,
frequently leading to erroneous recommendations about the type and
duration of treatments. Hence, often cited recommendations about the
duration of treatment, eg four weeks is adequate treatment, have no
factual basis to support that recommendation, often leading to the
conclusion that there is another, per-haps psychosomatic reason, for the
continuing symptoms.
B. burgdorferi is sensitive to various antibiotics,
including penicillins, tetracyclines, and macrolides, but there are a
number of mitigating factors that affect the clinical efficacy of these
antibiotics, and these factors are addressed. The successful treatment
of Lyme disease appears to be dependent on the use of specific
antibiotics over a sufficient period of time. Further treatment trials
would be helpful in finding the best regimens and duration periods.
present, the diagnosis of Lyme disease is based primarily on the
clinical picture. The pathophysiology of the disease remains to be
determined, and the basis for the chronic illness in need of additional
research. Whether there is continuing infection, auto-immunity to
residual or persisting antigens, and whether a toxin or other
bacterial-associated product(s) are responsible for the symptoms and
signs remains to be delineated.