18 nov

Insufficient evidence to deny antibiotic treatment to chronic Lyme disease patients

Insufficient evidence to deny antibiotic treatment to chronic Lyme disease patients.

This hypothesis suggests that physicians should consider the limitations of the evidence before denying antibiotic treatment for CLD. Physicians who deny antibiotic treatment to CLD patients might inform their patients that there are some clinicians who disagree with that position, and then offer to refer them for a second opinion to a doctor who could potentially present a different point of view. The hypothesis also suggests that health care insurers should consider the limitations of the evidence before adopting policies that routinely deny antibiotic treatment for CLD patients and should expand coverage of CLD to include clinical discretion for specific clinical situations.

Cameron DJ1.

Insufficient evidence to deny antibiotic treatment to chronic Lyme disease patients. – PubMed – NCBI

Med Hypotheses. 2009 Jun;72(6):688-91. doi: 10.1016/j.mehy.2009.01.017. Epub 2009 Mar 5.

Abstract

BACKGROUND:

The severity, length of illness, and cost of chronic Lyme disease (CLD) have been well described. A number of oral, intravenous, and intramuscular antibiotics have been prescribed for CLD. Surprisingly few antibiotic schedules prescribed for the treatment of CLD have been evaluated in randomized double-blind placebo-controlled clinical trials (RCTs). Physicians have increasingly turned to clinical treatment guideline (CPG) panels to judge the mixed results of the evidence. Two CPG panels have looked at the evidence only to reach opposite conclusions: (1) antibiotic therapy for CLD is not effective and (2) antibiotic therapy for CLD is effective. Physicians have been advised by guideline developers to use clinical discretion in diagnosing and treating CLD. Nevertheless, many health insurers – relying exclusively upon only one CPG – have a policy of automatically denying antibiotics to CLD patients regardless of the specifics of each case or the recommendations of the patient’s physician.

HYPOTHESES:

This paper examined the eight limitations of the evidence used to conclude that antibiotics therapy for CLD is not effective in forming the following hypothesis: insufficient evidence to deny antibiotic treatment to CLD patients.

EVIDENCE FOR THE HYPOTHESIS:

There are eight limitations that support the hypothesis: (1) the power of the evidence is inadequate to draw definite conclusions, (2) the evidence is too heterogeneous to make strong recommendations, (3) the risk to an individual of facing a long-term debilitating illness has not been considered, (4) the risk to society of a growing chronically ill population has not been considered, (5) treatment delay has not been considered as a confounder, (6) co-infections have not been considered as a confounder, (7) the design of RCTs did not address the range of treatment options in an actual practice, and (8) the findings cannot be generalized to actual practice.

IMPLICATIONS OF THE HYPOTHESES:

This hypothesis suggests that physicians should consider the limitations of the evidence before denying antibiotic treatment for CLD. Physicians who deny antibiotic treatment to CLD patients might inform their patients that there are some clinicians who disagree with that position, and then offer to refer them for a second opinion to a doctor who could potentially present a different point of view. The hypothesis also suggests that health care insurers should consider the limitations of the evidence before adopting policies that routinely deny antibiotic treatment for CLD patients and should expand coverage of CLD to include clinical discretion for specific clinical situations.

Please follow and like us:
16 nov

Seroprevalence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Francisella tularensis Infections in Belgium: Results of Three Population-Based Samples

Seroprevalence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Francisella tularensis Infections in Belgium: Results of Three Population-Based Samples.

De Keukeleire M1,2, Vanwambeke SO1, Cochez C3, Heyman P3, Fretin D4, Deneys V5, Luyasu V2, Kabamba B6, Robert A2.

“The seroprevalence of Bb was 5.4% in workers professionally exposed, 2.9% in rural blood donors, and 2.6% in urban blood donors.”

LBBP: Het gaat hier over België! Als test werd de ELISA-test gebruikt, die een ac300px-adhesioncuraatheid heeft van ergens tussen de 40% en 60%, dus waarschijnlijk ligt het aantal positieve gevallen een heel stuk hoger dan die 3%. Er is dringend nood aan meer accurate testen, om een juist beeld te krijgen van het aantal effectieve besmettingen. En zolang er geen 100% betrouwbare testen zijn, blijft een klinische diagnose, vaak onbestaande bij artsen, bijzonder noodzakelijk.

Abstract

To estimate the seroprevalence of Borrelia burgdorferi (Bb), Anaplasma phagocytophilum (Ap), and Francisella tularensis (Ft) in Belgium, we tested sera from three population-based samples in which exposure to pathogen is assumed to vary: 148 samples from workers professionally exposed, 209 samples from rural blood donors, and 193 samples from urban blood donors. Sera were tested using ELISA or the immunofluorescence assay test. The seroprevalence of Bb was 5.4% in workers professionally exposed, 2.9% in rural blood donors, and 2.6% in urban blood donors, which is similar to other studies. The fraction of negative results decreases significantly from urban blood donors and rural blood donors to workers. Regarding the seroprevalence of Ap, the cutoff titer of 1:64 recommended by the manufacturer may be set too low and produces artificially high seroprevalence rates. Using a cutoff titer of 1:128, the seroprevalence of Ap was estimated at 8.1% for workers professionally exposed, 6.2% for rural blood donors, and 5.7% for urban blood donors. Tularemia sera confirmed the presence of the pathogen in Belgium at 2.0% for workers and 0.5% for rural and urban blood donors. Our study is one of the few providing an estimation of the seroprevalences of Bb, Ap, and Ft in three different populations in Belgium, filling the gap in seroprevalence data among those groups. Our findings provide evidence that the entire Belgian population is exposed to Bb, Ap, and Ft infections, but a higher exposure is noticed for professionals at risk. Education on the risk factors for tick bites and preventive measures for both professionals exposed and the general population is needed.

 

Please follow and like us:
11 nov

Ierse documentaire (11 okt 2016)

irish-clover-lyme-disease-uk

A must-watch film….thanks for this ….this is worldwide and government denied…then denied by the medical boards..then by the very people that are supposed to care for you
– Richard Brooke-Powell

James Pembroke created the compelling documentary ‘Living with Lyme Disease’ featuring sufferers in Ireland as well as doctors speaking out about some very important issues encompassing the illness. The documentary was aired on Irish TV on 11th October 2016. Well done to all involved and James has kindly made the film available on Youtube to watch.

‘Living with Lyme Disease’

This documentary is the compelling story of people affected by Lyme disease in Ireland. Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by bacteria of the Borrelia type. Lyme disease is a bacterial infection typically transmitted through the bite of an infected tick.

Please follow and like us: