6
MNiSW
58.21
ICV
PRACA POGLĄDOWA
 
CC BY-NC-ND 3.0
 
 

Kontrowersje związane z diagnozą i leczeniem boreliozy na świecie

 
1
Katedra Chirurgii i Pielęgniarstwa Chirurgicznego, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny, Lublin
2
Pracownia Pielęgniarstwa Środowiskowego, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny, Lublin
MONZ 2015;21(4):372–377
SŁOWA KLUCZOWE:
STRESZCZENIE ARTYKUŁU:
Wprowadzenie:
Choroba z Lyme jest najczęstszą chorobą przenoszoną przez kleszcze na świecie i jedną z najbardziej kontrowersyjnych chorób w historii medycyny. Wywołują ją krętki z rodzaju Borrelia, ma przebieg fazowy, jest chorobą przewlekłą, wielonarządową.

Cel pracy:
Celem pracy jest pokazanie odmiennych poglądów w sprawie kryteriów rozpoznawania i sposobów leczenia boreliozy, prezentowanych przez dwa amerykańskie towarzystwa naukowe, tj.: IDSA (Infectious Diseases Society of America) i ILADS (International Lyme And Associated Diseases Society), oraz zwrócenie uwagi na problemy prawne jednego z nich.

Stan wiedzy:
Towarzystwo naukowe IDSA ma znaczący wpływ na kształt opieki medycznej, którą uzyskują chorzy na boreliozę w Stanach Zjednoczonych, jak i w Europie. Jest to wpływowe stowarzyszenie medyczne, a jego wytyczne stanowią podstawę podobnych zaleceń diagnostyki i leczenia boreliozy w całej Europie, w tym w Polsce. W opozycji do ich poglądów jest inna grupa lekarzy – ILADS. Praca pokazuje istniejący pomiędzy nimi spór. Jak stwierdza R.B. Stricker, A. Lautin i J.J. Burrascano, jedną z istotnych przyczyn kontrowersji dotyczących leczenia jest brak wiarygodnych testów, dzięki którym byłoby możliwe monitorowanie leczenia i określenie momentu wyleczenia oraz obecności koinfekcji, które mogą komplikować przebieg choroby. Należy zauważyć, że dominacja poglądów IDSA i znaczący ich wpływ na kształt opieki medycznej powoduje, że wydane przez nich wytyczne, dotyczące diagnozy i leczenia boreliozy, mogą zamykać możliwości leczenia pacjentom

Podsumowanie:
Towarzystwa medyczne mają obowiązek potwierdzić uzasadnione kontrowersje w metodach leczenia, zwłaszcza w sytuacji, gdy spór dotyczy braku dostatecznych dowodów. Oznacza to, że różne punkty widzenia powinny być reprezentowane na panelach odpowiedzialnych za tworzenie wytycznych, a uzasadnione kontrowersje powinny być uznane i uwzględnione w tekście tych wytycznych.


Introduction:
Lyme disease is the most frequent ticks-borne disease worldwide, and one of the most controversial diseases in the history of medicine. It is caused by spirochaete Borrelia burgdorferi, a multi-organ and chronic disease with a multiphase course.

Objective:
The aim of the study is presentation of opposite views of two American scientific societies, IDSA (Infectious Diseases Society of America) and ILADS (International Lyme And Associated Diseases Society), regarding the criteria of diagnosing and methods of treating Lyme borreliosis, and attracting attention to the legal problems of one of these societies.

State of knowledge:
The IDSA has a significant impact on the healthcare available for people suffering from Lyme borreliosis, both in the United States and in Europe. This medical society is very influential and its guidelines constitute a basis for similar recommendations concerning diagnosis and treatment of borreliosis in Europe, including Poland. Another group of physicians, the ILADS, has an opposite view. This article shows the debate between these two groups. According to Stricker RB, Lautin A and Burrascano JJ, one of the most important factors leading to the treatment-related controversy is the lack of reliable tests that could be used in monitoring the treatment and determining the moment of recovery or presence of co-infection which could complicate the course of the disease. It should be noted that the domination of the IDSA views and their significant effect on healthcare lead to the situation in which the IDSA guidelines concerning the diagnosis and treatment of Lyme borreliosis can hinder the possibilities of treating patients.

Summary:
Medical societies are under obligation to confirm justified controversies in the treatment methods, especially if the debate concerns the lack of sufficient evidence. This means that different points of view should be represented in guidelines-creating panels, and that justified controversies should be acknowledged and included in the text of those guidelines.

AUTOR DO KORESPONDENCJI:
Edyta Gałęziowska   
Pracownia Pielęgniarstwa Środowiskowego, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie, ul. Staszica 6 (Collegium Maximum), 20–081 Lublin
 
REFERENCJE (64):
1. Harvey WT, Salvato P. Lyme disease: ancient engine of an unrecogni¬zed borreliosis pandemic? Med Hypotheses. 2003 May; 60(5): 742–59.
2. Johnson L, Stricker RB. Treatment of Lyme disease: a medicolegal assessment. Expert Rev Anti Infect Ther. 2004 Aug; 2(4): 533–57.
3. Johnson L, Stricker RB. Attorney General forces Infectious Diseases Society of America to redo Lyme guidelines due to flawed development process. J Med Ethics. 2009 May; 35(5): 283–8.
4. Stricker RB, Lautin A, Burrascano JJ. Lyme disease: point/counterpoint. Expert Rev Anti Infect Ther. 2005 Apr; 3(2): 155–65.
5. Cuber P, Asman M, Solarz K, Szilman E, Szilman P. Pierwsze stwierdze¬nia obecności wybranych patogenów chorób transmisyjnych w klesz¬czach Ixodes ricinus (Acari: Ixodiae) zebranych w okolicach zbiorników wodnych w Rogoźniku (województwo śląskie). XII Międzynarodowe Sympozjum „Stawonogi pasożytnicze, alergogenne i jadowite – sta¬wonogi. Ekologiczne i patologiczne aspekty układu pasożyt-żywiciel”. Kazimierz Dolny, 7–9 czerwca 2010: [12th International Symposium „Parasitic and Allergic Arthropods – Arthropods. Ecological and pathological aspects of parasite-host relationships”, Kazimierz Dolny, Poland, 7–9 June, 2010].
6. Skotarczak B, Wodecka B, Cichocka A. Coexistence DNA of Borrelia burgdorferi sensu lato and Babesia microti in Ixodes ricinus ticks from north-western Poland. Ann Agric Environ Med. 2002; 9: 25–29.
7. Stańczak J, Racewicz M, Krumis-Łozowska W, Kubica-Biernat B. Coin¬fection of Ixodes ricinus (Acari: Ixodidae) in northern Poland with the agents of Lyme borreliosis (LB) and human granulocystic ehrlichiosis (HGE). Int J Med Microbiol. 2002; 33: 198–201.
8. Steere AC. Lyme disease. N Engl J Med. 2001; 345: 115–24.
9. Witecka-Knysz E, Klimczak M, Lakwa K, Zajkowska J, Pancewicz S, Kondrusik M, Grzegorczuk S, Świerzbińska R, Hermanowska-Szpa¬kowicz T. Borelioza: dlaczego diagnostyka jest tak trudna? Diagnosta Laboratoryjny. Kwiecień 2007.
10. Groshong AM, Blevins JS. Insights into the biology of Borrelia burgdor¬feri gained through the application of molecular genetics. Adv Appl Microbiol. 2014; 86: 41–143.
11. Jenifer Coburn, Joshua R. Fischer and John M. Leong: Solving a sticky problem: new genetic approaches to host cell adhesion by the Lyme disease spirochete. Mol Microbiol. 2005; 57(5): 1182–1195.
12. Sal MS, Li C, Motalab MA, Shibata S, Aizawa S, Charon NW. Borrelia burgdorferi uniquely regulates its motility genes and has an intricate fla-gellar hook-basal body structure. J Bacteriol. 2008 Mar; 190(6): 1912–21.
13. Stevenson B, Bono JL, Elias A, Tilly K, Rosa P. Transformation of the Lyme Disease Spirochete Borrelia burgdorferi with Heterologous DNA J Bacteriol. 1998 Sep; 180(18): 4850–4855.
14. Tilly K, Rosa PA, Stewart PE. Biology of Infection with Borrelia burgdor¬feri. Infect Dis Clin North Am. 2008 Jun; 22(2): 217–234.
15. Al-Robaiy S, Dihazi H, Kacza J, Seeger J, Schiller J, Huster D, Knauer J, Straubinger RK. Metamorphosis of Borrelia burgdorferi organisms-¬-RNA, lipid and protein composition in context with the spirochetes’ shape. J Basic Microbiol. 2010 Dec; 50 Suppl 1: S5–17.
16. Brorson Ø, Brorson SH. A rapid method for generating cystic forms of Borrelia burgdorferi, and their reversal to mobile spirochetes. APMIS. 1998 Dec; 106(12): 1131–41.
17. Miklossy J, Kasas S, Zurn AD, McCall S, Yu S, McGeer PL. Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis. J Neuroinflammation. 2008 Sep 25; 5: 40.
18. Georgilis K, Peacocke M, Klempner MS. Fibroblasts protect the Lyme Disease spirochete, Borrelia burgdorferi from ceftriaxone in vitro. J. Infect Dis. 1992; 166: 440–444.
19. Goodman JL, Jurkovich P, Kodner C, Johnson RC. Persistent cardiac and urinary tract infections with Borrelia burgdorferi in experimentally infected Syrian hamsters. J Clin Microbiol. 1991 May; 29(5): 894–6.
20. Gruntar I, Malovrh T, Murgia R, Cinco M. Conversion of Borrelia garinii cystic forms to motile spirochetes in vivo. APMIS. 2001 May; 109(5): 383–8.
21. Schutzer Steven MD. Lyme Disease: Molecular and Immunologic Approaches (Current Communications 6: In Cell and Molecular Bio¬logy) (Cold Spring Harbor Monograph) Paperback – November 1, 1992.
22. Brorson Ø, Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to metronidazole. APMIS. 1999; 107: 566–576.
23. Joseph J, Burrascano JR. Advanced Topics In Lyme Disease Diagnostic Hints And Treatment Guidelines For Lyme And Other Tick Borne Illnesses. Sixteenth Edition Copyright October, 2008.
24. Øystein Brorson; Sverre-Henning Brorson: An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to tinidazole. Int Microbiol. 2004; 7: 139–142.
25. Musher DM, Daniel M. Syphilis, Neurosyphilis and AIDS. J. Infect Dis. 1991; 55: 21–34).
26. Brorson Ø, Brorson SH. Transformation of cystic forms of Borrelia burgdorferi to normal, mobile spirochetes. Infection. 1997 Jul-Aug; 25(4): 240–6.
27. Eva Sapi, Navroop Kaur, Samuel Anyanwu, David F Luecke,1 Akshita Datar, Seema Patel, Michael Rossi, and Raphael B Stricker: Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdorferi. Infect Drug Resist. 2011; 4: 97–113.
28. Barthold SW, de Souza MS, Janotka JL, Smith AL, Persing DH. Chro¬nic Lyme borreliosis in the laboratory mouse. Am J Pathol. 1993 Sep; 143(3): 959–71.
29. Hodzic E, Feng S, Freet KJ, Barthold SW. Borrelia burgdorferi popu¬lation dynamics and prototype gene expression during infection of immunocompetent and immunodeficient mice. Infect Immun. 2003 Sep; 71(9): 5042–55.
30. Hodzic E, Imai D, Feng S, Barthold SW. Resurgence of persisting non-cultivable Borrelia burgdorferi following antibiotic treatment in mice. PLoS One. 2014 Jan. 23; 9(1).
31. Moody KD, Barthold SW, Terwilliger GA, Beck DS, Hansen GM, Jacoby RO. Experimental chronic Lyme borreliosis in Lewis rats. Am J Trop Med Hyg. 1990 Feb; 42(2): 165–74.
32. Preac Mursic V, Patsouris E, Wilske B, Reinhardt S, Gross B, Mehraein P. Persistence of Borrelia burgdorferi and histopathological alterations in experimentally infected animals. A comparison with histopatho¬logical findings in human Lyme disease. Infection. 1990 Nov-Dec; 18(6): 332–41.
33. Straubinger RK, Summers BA, Chang YF, Appel MJ. Persistence of Borrelia burgdorferi in experimentally infected dogs after antibiotic treatment. J Clin Microbiol. 1997 Jan; 35(1): 111.
34. Monica E, Embers, Stephen W. Barthold, Juan T. Borda, Lisa Bowers, Lara Doyle, Emir Hodzic, Mary B. Jacobs, Nicole R. Hasenkampf, Dale S. Martin, Sukanya Narasimhan, Kathrine M. Phillippi-Falkenstein, Jeanette E. Purcell, Marion S. Ratterree, and Mario T. Philip: Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Tre¬atment of Disseminated Infection. PLoS One. 2012; 7(1).
35. Roberts ED, Bohm RP, Cogswell FB, Lanners HN, Lowrie RC, Povinelli L, Piesman J, Philipp MT. Chronic lyme disease in the rhesus monkey. Lab Invest. 1995 Feb; 72(2): 146–60.
36. Aaron J. Smith, John Oertle, Dino Prato: Chronic Lyme Disease: Per¬sistent Clinical Symptoms Related to Immune Evasion, Antibiotic Resistance and Various Defense Mechanisms of Borrelia burgdorferi. Open J Med Microbiol. 2014; 4(4): 252–260.
37. Bradley JF, Johnson RC, Goodman JL. The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann Intern Med. 1994 Mar 15; 120(6): 487–9.
38. Cameron DJ. Proof that chronic lyme disease exists. Interdiscip Perspect Infect Dis. 2010; Article ID 876450, 4 pages, doi:10.1155/2010/876450.
39. Fraser DD, Kong LI, Miller FW. Molecular detection of persistent Bor¬relia burgdorferi in a man with dermatomyositis. Clin Exp Rheumatol. 1992 Jul-Aug; 10(4): 387–90.
40. Häupl T, Hahn G, Rittig M, Krause A, Schoerner C, Schönherr U, Kalden JR, Burmester GR. Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis. Arthritis Rheum. 1993 Nov; 36(11): 1621–6.
41. Phillips SE, Mattman LH, Hulinská D, Moayad H. A proposal for the reliable culture of Borrelia burgdorferi from patients with chronic Lyme disease, even from those previously aggressively treated. Infection 1998; 26: 364–7.
42. Stanek G, Klein J, Bittner R, Glogar D. Isolation of Borrelia burgdorferi from the myocardium of a patient with longstanding cardiomyopathy. N Engl J Med. 1990 Jan 25; 322(4): 249–52.
43. Oksi J, Marjamaki M. Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated. Ann Med. 1999; 31(3): 225–32.
44. Oksi J, Nikoskelainen J, Hiekkanen H, et al. Duration of antibiotic tre¬atment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study. Eur J Clin Microbiol Infect Dis. 2007; 26(8): 571–81.
45. Stricker R.B. Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with lyme disease. Clin Infect Dis. 2007 Jul 15; 45(2): 149–57.
46. Stricker RB, Lautin A, Burrascano JJ. Lyme disease: the quest for magic bullets. Chemotherapy. 2006; 52(2): 53–9. Epub 2006 Feb 22.
47. Ronn Susan JD. In the Lymelight: Law and Clinical Practice Guidelines. South Med J. 2009; 102(6): 626–630.
48. Tonks A. Lyme wars. BMJ 2007, 335:910–912.
49. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klem¬pner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1; 43(9): 1089–134.
50. Halperin JJ. Prolonged Lyme disease treatment: enough is enough. Neurology. 2008 Mar 25; 70(13): 986–7.
51. Pelly JE, Newby L, Tito F, Redman S, Adrian AM. Clinical practice guidelines before the law: sword or shield? Med J Aust. 1998 Sep. 21; 169(6): 330.
52. http://www.dailymotion.com/video/xplliu_under-our-skin-2008¬–1–2-napisy pl_shortfilms.
53. Johnson L, Stricker RB. Research The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines. Philosophy, Ethics, and Humanities in Medicine 2010; 5: 9.
54. Treatment Guidelines Evidence Assessments and Guideline Recom¬mendations in Lyme disease – See more at: http://www.ilads.org/lyme/ treatment-guideline.php.
55. Raphael B, Stricker L, Johnson L. Lyme disease: the next decade. Infet Drug Resist. 2011; 4: 1–9.
56. Burrascano JJ. Advanced topics in Lyme disease diagnostic hints and treatment guidelines for Lyme and other ”tick borne illnesses”. ILADS 2005; 15: 1–33.
57. Cameron D, Gaito A, Harris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer-Scherrer L, Rax¬len B, Sherr V, Smith H, Smith P, Stricker R. ILADS Working Group Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther. 2004; 2 (Suppl 1): 1–13.
58. Honegr K, Hulinska D, Dostal V, i wsp. Persistence of Borrelia burgdor¬feri sensu lato in patients with Lyme borreliosis. J Epidemiol Mikrobiol Imunol. 2001; 50(1): 10–16.
59. Brorson Ø, Brorson SH. In vitro conversion of Borrelia burgdorferi to cystic forms in spinal fluid, and transformation to mobile spirochetes by incubation in BSK-H medium. Infection. 1998 May-Jun; 26(3): 144–50.
60. Phillips SE, Burrascano JJ, Harris NS, Johnson L, Smith PV, Stricker RB. Chronic infection in ”post-Lyme borreliosis syndrome”. Int J Epidemiol. 2005; 34: 1439–1440.
61. Preac-Mursic V, Wanner G, Reinhardt S, i wsp. Formation and culti¬vation of Borrelia burgdorferi spheroplast-L-form variants. Infection 1996; 24: 218–225.
62. Feder HM, Johnson BJ, O’Connell S, Shapiro ED, Steere AC, Wormser GP. the Ad Hoc International Lyme Disease Group. A critical appraisal of „chronic Lyme disease”. N Engl J Med. 2007; 357: 1422–1430.
63. http://www.ct.gov/AG/cwp/view.asp?a=2795&q=414284.
64. http://underourskin.com/news/summary-idsa-lyme-evidence-hearing.
eISSN:2084-4905
ISSN:2083-4543