New Review of Evidence Published in the International Journal of General Medicine Provides Insight into Chronic Lyme Disease

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Study Author Dr. Keith Berndtson Establishes Need for Development of New Guidelines for Treating Persistent Infection

Lyme disease tick

Based on a thorough review of these studies, we can reasonably conclude that some, possibly many, chronic Lyme disease patients suffer from symptoms related to persistent infection with Bb.

According to the U.S. Centers for Disease Control and Prevention (CDC), the 30,000-40,000 cases of Lyme disease officially recorded each year from 2008-2011 represent only 10% of actual incidences of the disease. “Lyme disease is the fastest growing vector-borne infectious disease in the country,” says Dr. Keith Berndtson of Park Ridge MultiMed, “and it presents significant challenges to both doctors and patients, not least of which is the fact that there is still no definitive answer to the question of whether the chronic illness that afflicts some Lyme patients is due to the aftereffects of infection or to a still-present infection.” In an effort to answer that question and spur new research that will help guide physicians in treating Lyme, Dr. Berndtson reviewed a wide range of peer-reviewed studies and concluded that there is indeed enough evidence to suggest that Lyme may evolve into a persistent infection. His paper, Review of evidence for immune evasion and infection in Lyme disease, was published by the International Journal of General Medicine in April 2013 (

Lyme disease has generally been considered curable with a course of antibiotics if diagnosed and treated early, while the infection is still localized. If untreated or under-treated, it can spread to other parts of the body and cause a vast array of debilitating symptoms that may persist as a chronic condition. But 10-20% of treated patients suffer from symptoms such as muscle and joint pains, cognitive defects, sleep disturbance and fatigue for months and even years following treatment. According to Dr. Berndtson, “the question is whether these symptoms are due to a persistent infection or to an autoimmune response, in which the immune system damages the body's tissues by continuing to respond even after the infection has been eliminated.”

Lyme disease Study Focus
“The focus of my inquiry was illness that lingered after completion of a course of antibiotics, sometimes to devastating effect for the patient,” says Dr. Berndtson. “The ability to help these patients hinges on knowing whether they are still infected or if they are suffering an autoimmune response. My goal was to try to clarify this question, which has divided the medical community for decades.”

Lyme disease is caused by the spirochete Borrelia burgdorferi (Bb), a spiral-shaped bacterium. In North America, virulent strains of Bb are transmitted to humans and other animals by the deer tick. In his review of the literature, Dr. Berndtson examined the known and suspected mechanisms by which Bb can evade the host's immune system, how those mechanisms can cause persistent symptoms, and the emergence of credible evidence that Bb can remain in the body despite antibiotic therapy.

Lyme disease Study Conclusions
“Based on a thorough review of these studies, we can reasonably conclude that some, possibly many, chronic Lyme disease patients suffer from symptoms related to persistent infection with Bb,” says Dr. Berndtson. “The question is no longer whether Lyme disease can survive an antibiotic challenge in order to become a persistent infection. High-quality studies show not only that it happens but they also show how it happens and why we should not be surprised that it happens. The task now is to develop evidence-based wisdom to guide the doctors who treat them.”

Continuing studies in microbiology, immunology, and genetics will translate into new treatment regimens that will bring relief to patients. At the same time, education and awareness programs can help people avoid contracting Lyme disease. “The friendliest environments for ticks and the wildlife they feed on are shady forests, places with lots of moist leaf litter and areas where woods transition into meadows or lawns,” says Dr. Berndtson. “In other words, the suburban back yard and the golf course.”

Tips for avoiding Lyme disease
The best way to avoid tick bites is to wear long-sleeved shirts and long pants tucked into socks in high-risk areas. The CDC recommends using an insect repellent containing DEET on skin and permethrin on clothing to repel ticks. It's important to check the body often, especially the legs. This is easier to do if clothing is light in color. Ticks are tiny; if it looks like a freckle that's moving, it's likely a tick. The end-of-day check for ticks attached to the skin is also critical. It can take more than 24 hours for an attached tick to transmit disease-causing bacteria, so it's still possible to avoid infection at that point. It's also important to check pets when they come in from outdoors.

“May is Lyme Disease Awareness month,” Dr. Berndtson concludes. “The onset of warm weather is the best time to ensure that the whole family knows the best ways to minimize the risk of contracting tick-borne disease.”

Bio: Keith Berndtson, MD is a board-certified family physician and Lyme disease treatment specialist.

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