Translated by Celine Thoma and Rachel Landau
The following observations are meant to inform and to encourage reflection. We do not pretend to know everything about the complex and complicated interdependency that exists between pathogens (viruses, bacteria, fungi, protozoa, parasites, etc.) and the corresponding virulence factors between those pathogens and the immune system of the affected person, which is systematically involved with all pathogenic agents. However, it is decisive (imperative) in every case to know if the affected person is only infected or if s/he really manifests the infection, i.e. if s/he is developing symptoms and how seriously s/he diseased.
We would like to invite everyone to join us in the research of this complex field and to share ideas. The attached studies in every single chapter were not performed nor commissioned by the BCA-clinic. The author only collected these studies for your information and presentation.
To start, we would like to give a few incentives for discussions:
An interdisciplinary and more complex consideration is necessary (holistic view) !
These points of discussion mentioned above are regularly documented in scientific studies of certain fields such as psychology, psychiatry, environmental medicine, occupational medicine, immunology, infection medicine and nutritional science. However, the interdisciplinary intervention of all these factors and influences (a comprehensive observation) is missing in our understanding of disease processes and management of illness, because the patient is exposed to all those factors simultaneously, with varying intensities. What does this mean, in summation, for the immune system, especially when the patient has a genetically weak immune system on top of all?
More incentives for discussions
The spreading of ticks
The proliferation of infected ticks depends on climatical, temporal and geographical variations. In this sense, the living environment of the various wild animals and (already modified) immigration routes of some birds have to be considered. All of these animals are hosts for borrelias; they carry many ticks and spread them (3). In the spreading of infected ticks by birds we may focus on birds living mainly in grass, hedges and undergrowth. They got the ticks there and then starts the transport (5), (14), (27), (28), (29). It seems that also dogs are interesting (15) and other animals (18). Furthermore, we wonder if due to climate changes, more ticks and pathogens may be able to survive in different (new) regions. And finally, our travel behavior in this new globalised world also favours the spreading of infected ticks (means of transport, clothing, and luggage). There are also various types of ticks that are infected with different pathogens (31). Indeed, a new borrelia strain was discovered as human-pathogenic, the borrelia miyamotoi (6), (13). It is questionable if our current test procedures for antibodies are capable of detecting this strain since neither the strain nor its antigens were known until now as necessary. It is a matter of fact that this strain was transported and distributed by birds. Who knows how many more undiscovered and human-pathogenic borrelia strains (33) and other tick-borne pathogens there are?
Mixed infections and complex survival mechanisms
Another fact appears to be important: borrelias can survive and live in various hosts such as different types of animals, e.g. many mammals, birds, ticks and even humans. This is why the infector has to have a complex survival mechanism (escape-mechanism) (1), (2), (7), (13) i.e. creation of persistent forms, blocking or resistant against the complement-system, hiding in tissues with poor blood supply, to mention only a few.
In this contribution, we would like to focus on intra-cellular pathogens (e.g. chlamydia and ehrlichia among others) or even intra-cellular forms that some pathogens can develop (e.g. mykoplasma and rickettsia, to mention a few). Intra-cellular pathogens are often acid-resistant and fat-dissolving, just as the pathogens of tuberculosis or leprosy. These intra-cellular pathogens and their various shapes have a number of mechanisms to avoid the immune system of their host and the effects of antibiotics. They also change their appearance according to their environment. They are pleomorphic and therefore, difficult to identify for the diagnosis. The spiral form of borrelias does not fit into
an erythrozyten (red blood cells) but maybe other persistent forms of borrelias and in bigger cells.
There must to be persistent forms of borrelia “in vivo”, otherwise there would be no research to develop new strategies for treating those (2).
Many affected patients do not show single infections, but a mixture of various infections which are, in turn, affected by the mentioned environmental influences and mental stress factors. A lack of vitamins, minerals and trace elements may exist simultaneously. A healthy person might not need substitutions, but sick people can benefit from them (e.g. vitamin B12, H, D, zinc, etc.). The importance of vitamin- D is ever more evident (9), (10). Maybe it is important not only for the bone metabolism (24). To reduce the risk of an overtreatment during a substitution therapy, the vitamin levels can be checked.
An important immunological organ
Concurrently, do we know everything about the intestine where also many immune processes take place? Probiotics were added to the S3-guidelines for treating irritable bowel syndrome. This shows how important it is to study further in this field. For now, we do not have enough information to discuss (17,21). Thankfully, there are already a handful of professors who have embraced this task (1st Microbiom conference in Berchtesgaden).
Patients react differently. We know today that some patients have problems with their metabolism (absorption, processing und detoxification) also of medicine (keyword: cytochrom P450-enzymes and cascades, etc.) There are also indications of a direct influence of an infection on the cytochrome P450-system (19). We also know today that females, males (keyword: gender medicine) and children have differing metabolisms. Therefore, every therapy must be designed according to every person’s profile and specific needs.
Dosage of Doxycycline
Lastly, we would like to mention that doxycycline is often used to treat Lyme disease. Officially, 200mg/d is recommended, but sometimes 400mg/d is applied. It is indeed possible to measure the doxycycline levels in the patient’s blood after around 3 or 4 days of the treatment, in order to verify that the prescribed 200mg/d is sufficient to place the patient within the therapeutic range. If those aims are not met, then a higher dose can be adapted individually. Due to a variety of reasons, there are indeed patients who do not reach a therapeutic range when using 200mg/d of doxycycline. In this case, the patient would be under-dosed and this would obviously not be ideal. Measuring the doxycycline levels in the blood can also help to explain or discover some “therapy failures”. Other reasons for so called “therapy failures” may also be an incorrect intake of the antibiotic, i.e. in combination with milk products.
Economical reasons for insurance companies
It is important for us to trigger discussions and hopefully apply efficient therapies to these patients all around the world. As long as there is no solution to the suffering, patients will understandably continue to search. This fact should not be underestimated – be it for economical reasons (20). The aim should be that patients’ symptoms improve or disappear all together so that repeated visits to the doctors or hospitals resulting in multiple diagnostics and unsatisfactory therapies are avoided, as they may result in long term incapacity to work. In an recent article from the Johns Hopkins Bloomberg School of Public Health have researchers concluded, that the problems with this diesease are apparently more common than previously assumed. This costs much money, but on the other hand seems it also doesn’t make sense to continue to ignore the patients and this disease. We quote:” These patients are lost. No one really knows what to do with them. It’s a challange, but the first thing we need to do is to recognize this is a problem…” (23).
Suction period of the tick (nymph) and transmission of infectious pathogens
Fortunately there is an overview of an indenpent researcher ( after checking of scientific studies ) regarding the often emotionally debate concerning “suction period of the tick (or nymph) and the likelihood of transmission of germs (pathogens) esp. borrelia. The overview states that the transmission of borrelia could also be possible in less than 24 or 48 hours. The possibility that the pathogen could be transmitted earlier, can not be excluded. Because Borrelia were also detected in the salivary glands of ticks (and nymphs). The next question is the time for transmission of other infectious pathogenes (ehrlichia, rickettsia, bartonella, babesia.. etc.). Furthermore, the person affected often can not state an exact time specification, since when the tick (or nymph) has been sucking; if he/she even notice the tick (nymph). Perhaps this overview also helps to conduct the debate on this topic more factual (22).
We think, there are problems with tick-borne diseases generally. We are not allone with this opinion. Also the Entomological Society of America (ESA) and Dr. John Aucott from the Johns Hopkins University in the USA see these problems and ask for more research, studies and a factual discussion about it. The problems are not only in the USA.
For anyone who is interested, we have selected just a few points of discussion so that you can now research further and develop your own opinions.
It would also be a pleasure to organize constructive and factual discussions through presentations and workshops, which may lead to many more points of discussion.
(1) Norbert Satz: Klinik der Lyme-Borreliose; 3. Auflage 2010, Huber Verlag, S. 173 ff
(2) Jie Feng et. al. „Identification of novel activity against Borrelia burgdorferi persisters using an FDA approaved drug library“, Emerging microbes and Infections (2014) 3,e49;doi:10
(3) Obsomer, V. et. al.:“Spatial disaggregation of tick occurence and ecology at a local scale as a preliminary step for spatial surveillance of tick born diseases: general framework and health implications in Belgium”, in parasites&vectors, 22.6:190 Epub 2013, Jun. 22
(4) Marion Blaschitz et al.: “Babesia Species Occurring in Austrian Ixodes ricinus Ticks”, Applied and environmental Microbiology, Aug. 2008, Vol. 74, No. 15, p. 4841-4846
(5) study from the University of Coimbra, Portugal, and University Neuchatel, Switzerland: „First study on birds as hosts of Lyme Disease“, vgl. Pravda.ru from 09.01.2013
(6) Borrelia miyamotoi: A Lesson in Disease Discovery, Annals of Internal Medicine, 2013 American College of Physicians; vgl. Centers for Disease Control and Prevention 24/7: Saving Lives. <protecting People™; www.cdc.gov/ticks/miyamotoi.html
(7) Axel Teegler et.al. „The relapsing fever spirochaete borrelia miyamotoi resists complement-mediated killing by human serum”, Tick and Tick-borne Diseases (2014), www.elsevier.com/locate/ttbdis
(8) Mark W. Eshoo et.al. „Broad-Range Survey of Tick-Borne Pathogens in Southern Germany Reveals a High prevalence of Babesia microti and a Diversity of Other Tick-Borne Pathogens”, Vector-Borne and Zoonotic Diseases, Volume 14, Number 8, 2014
(9) Gurmukh Singh, Aaron J Bonham:” A Predictive Equation to Guide Vitamin D Replacement Dose in Patients”, J Am Board Fam. Med. 2014;27(4):495-509
(10) Prof. Dr. Jörg Spitz: „Vitamin D“, ISBN 978-3-00-027740-5
(11) Platonov AE et al. : Human Infected with Relapsing Fever Spirochete Borrelis miyamotoi, Russia. Emerg Infect Dis. 2011 Oct
(12) Lorraine Michelet et al: High-throughput screening of tick-borne pathogens in Europe. Frontiers in Cellular and Infection Microbiology, July 2014, Volume 4, Article 103
(13) Wagemakers A., Oei Anneke et.al “The relapsing fever spirochete Borrelia miyamotoi is cultivable in a modified Kelly-Pettenkofer medium, and resistant to human complement” Academic Medical Center Amsterdam, The Netherlands
(14) Dingler RJ, Wright SA et.al. “Survaillance for Ixodes pacificus and the tick-borne pathogens Anaplasma phagocytophilum and Borrelia burgdorferi in birds from California`s Inner Coast Range”, Ticks Tick Borne Dis. 2014, Jun;5(4):436-45
(15) McCown ME, Monterroso VH, Cardona W “Surveillance for Ehrlichia canis, Anaplasma phagocytophilum, Borrelia burgdorferi, and Dirofilaria immitis in Dogs From Three Cities in Colombia”, J Spec Oper Med 2014 Spring;14(1):86-90
(16) Dibernardo Antonia et al.: The prevalence of Borrelia miyamotoi infection, and co-infections with other Borrelia spp. in Ixodes scapularis ticks collected in Canada; Parasites & Vectors 2014, 7:183.
(17) Bohorquez DV et.al. “Neuroepithelial circuit formed by innervation of sensory enteroendocrine cells”, J Clin Invest. doi:10.1172/JCI78361, Nov 2014
(18) Hornok et.al. “Synanthropic rodents and thier ectoparasites as carriers of an novel haemoplasma and vector-borne, zoonotic pathogens indoors”, Parasites & Vectors (2015) 8:27 DOI 10.1186/s13071-014-0630-3
(19) Shimamoto Yoshinori et.al. “Downregulation of Hepatic Cytochrome P450 3A in Mice Infected with Babesia microti”, J.Vet.Med.Sci. 74(2):241-245, 2012
(20) Rizzoli A et.al. “Ixodes ricinus and its transmitted pathogens in urban and peri-urban areas in Europe: new hazards and relevance for public health”, frontiers in Public Health, Dezember 2014, volume 2, Article 251, doi:10.3389/fpubh.2014.00251
(21) Bravo JA et.al. “Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via vagus nerve”, www.pnas.org/cgl/doi/10.1073/pnas.1102999108; Sep. 2011, vol.. 108, no. 38
(22) Michael J Cook: “Lyme borreliosis: a review of data on trasmission time after tick attachment”, International Journal of General Medicine 2015:8 1-8
(23) “Lyme disease costs up to $ 1.3 billion per year to treat, study finds” (2015, February 5) retrieved 6 February 2015 from Http://medicalxpress.com/news/2015-02-lyme-disease-billions-year.html
(24) Alleskönner Vitamin-D? Bei niedrigen Spiegeln sind Hirninfarkte verheerender. Medscape. 17. Feb 2015. ; 1. International Stroke Conference (ISC), 11. bis 13. Februar 2015 Nashville/Tennessee – Henninger N, et al: Abstract W MP62, 11. Februar 2015
(25) K. Brangulis, etal., “Crystal structures of the Erp protein family members ErpP and ErpC from Borrelia burgdorferi reveal the reason for different affinities for complement regulator factor H” Biochim. Biophys. Acta (2015). http://dx.doi.org/10.1016/j.bbapap.2014.12.025
(26) Godefroy Devevey et. al.: “First arrived takes all: inhibitory priority effects dominate competition between co-infecting Borrelia burgdorferi strains”, BMC Microbiology (2015) 15:61, DOI 10.1186/s12866-015-0381-0
(27) Comstedt P et. al.: “Migratory passerine birds as reservoirs of Lyme borreliosis in Europe”, Emerg Infect Dis. 2006 Jul; 12(7): 1087-95
(28) Marie-Angele Poupon et.al.: “Prevalence of Borrelia burgdorferi Sensu lato in Ticks collected from migratory birds in Switzerland”, Appl. Environ. Microbiol. 2006; 72:1, 976-979, doi: 10.1128/AEM.72.1.976-979.2006
(29) Fobito Ishiguro et. al.: “Prevalence of Lyme Disease Borrelia spp in Ticks from Migratory Birds on the Japanese Mainland”, Appl. Environm. Microbiol. March 2000; 66:3, 982-986 doi: 10.1128/AEM.66.3.982-986.2000
(30) Muqing Li et.al.:”Lyme Disease Borrelia Species in Northeastern China resemble those isolated from far Eastern Russia and Japan”, Appl. Environm. Microbiol. July 1998; 64:7, 2705-2709
(31) Medlin, J.S., et al.:”Vector potential and population dynamics for Amblyomma inornatum”, Ticks Tick borne Dis. (2015), http://dx.doi.org/10.1016/j.ttbdis.2015.03.014
(32) May K et al.: “Borrelia burgdorferi sensu lato and co-infections with Anaplasma phagocytophilum and Rickettsia spp. in Ixodes ricinus in Hamburg, Germany”. Med. Vet. Entomol. 2015(Jun), DOI: 10.1111/mve.12125
(33) N. Rudenko et.al.; “Isolation of live Borrelia burgdorferi senso lato spirochetes (also Borrelia bissettii-like strain) from patients with undefined disorders and symptoms not typical for Lyme borreliosis”, doi:10.1016/j.cmi.2015.11.009