What is MSIDS ?

MSIDS is a term put forward by Dr Horowitz to describe the multiple co-infections commonly experienced by patients with Lyme disease. He defines MSIDS as Multi Systemic Infectious Disease Syndrome. The symptoms associated with MSIDS are so variable and mimic so many other diseases that it is difficult to diagnose. It is difficult to determine exactly which infectious agent(s) are responsible for the symptoms.

MSIDS is often misdiagnosed as chronic inflammatory diseases such as Fibromyalgia, Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) or Polymyalgia Rheumatica. Because the symptoms of these chronic nonspecific illnesses are shared with many other diseases—and because many of these conditions lack a diagnostic test or bio-marker—unraveling which diseases are present can be difficult. Some patients actually receive diagnoses for multiple conditions.

But all these illnesses have one thing in common. They all cause chronic pain and fatigue; they all affect multi-organs and they all can be triggered by an infection. Each of these disease has the same inflammatory cytokines processes and inflammation is the number one cause of these chronic illness. Dr Horowitz talks about the THREE I's – Infection, Inflammation and Immune dysfunction as the trigger for the symptoms associated with MSIDS as well as these other chronic diseases.

Or does the initial infection cause an abnormal immune response which sets up an auto-immune like reaction and/or allows opportunistic infections to establish and cause the symptoms described as MSIDS? Persisting Lyme disease and co-infections suppress the immune system and leave the body vulnerable to infection with opportunistic pathogens. Other factors can also play a role in suppressing our immune response.

It has been suggested by some that the name MSIDS be attributed to all of these related diseases. Some researchers have shown that long term antibiotic therapy for Lyme disease has significantly improved the symptoms of people suffering from these chronic diseases and the question therefore has to be asked is: "are these diseases related and do they have a root cause such as Borrelia which are then complicated by co-infections such as described in Lyme disease?"

So how are all these diseases similar? Below is a description of each of the chronic diseases. You can see that they all seem to have very similar and related symptoms which definitely makes you think that perhaps they are all related to MSIDS – perhaps in time a common denominator will be found as suggested above and the root cause can then be treated and/or controlled to bring relief to the sufferers of these very debilitating chronic diseases?

• Fibromyalgia 
• Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) 
• Polymyalgia Rheumatica 
• MSIDS - Co-Infections with Lyme Disease 

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Fibromyalgia is a condition in which people describe symptoms that include widespread pain and tenderness in the body, often accompanied by extreme fatigue, cognitive disturbance, increased responsiveness to sensory stimuli such as cold, heat and light, problems with sleep and emotional distress. The symptoms of fibromyalgia can vary from mild to severe. The cause is unknown but like the other diseases in this group it is thought that among other things it could be triggered by an initial infection, injury, allergy, stress or substance abuse. Fibromyalgia can be very difficult to diagnose as it does not cause any inflammation or damage, but testing can eliminate other causes.

Myalgic encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS), also known chronic fatigue and immune dysfunction syndrome (CFIDS), is a complex and debilitating chronic disease with a serious impact on one’s quality of life. On Feb. 10, 2015, the Institute of Medicine released a landmark report that contained a series of recommendations for ME/CFS, one of which called for the name to be changed to Systemic Exertion Intolerance Disease (SEID). This name has not yet been formally adopted by world and federal health agencies yet.

M.E. is a neurological disease which is a debilitating and complex disorder characterized by intense fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. It results from an injury to the Central Nervous System and may be triggered by an infectious disease such as a viral infection, or by chemicals which over stimulate the immune system. M.E. is a multi-system disease, affecting not only the neurological system but also the immune, musculoskeletal, endocrine (hormonal) and cardiovascular systems.

It causes a range of symptoms including post exertional malaise, unrefreshing sleep, concentration problems and pain in muscles, joints and headaches.

M.E. may or may not be the same as CFS (Chronic Fatigue Syndrome). This is because there are currently 10 different interpretative criteria for CFS, some with a psychiatric and others with an immunological specification. If the CFS criteria used involves damage to the Central Nervous System, then it could well be the same disease as M.E. Other CFS criteria used, especially the Oxford criteria, focus on patients whose fatigue could be of psychiatric origin and this is not M.E.

The term CFS can be harmful as a label to M.E. sufferers because it can exclude pathological findings. Sometimes, however, researchers and medical staff use the term CFS to mean M.E. So the situation is unacceptably confusing. M.E. is a more specific name implying the pathology which has been found in association with the disorder.

Polymyalgia rheumatica is a rheumatic disorder associated with moderate-to-severe musculo-skeletal pain and stiffness in the neck, shoulder, and hip area.. Stiffness is most noticeable in the morning or after a period of inactivity. This disorder may develop rapidly; in some people it comes on literally overnight. But for most people, polymyalgia rheumatica develops more gradually.

The cause of polymyalgia rheumatica is not known. But it is associated with immune system problems, genetic factors, and an event, such as an infection, that triggers symptoms. The fact that polymyalgia rheumatica is rare in people under the age of 50 and becomes more common as age increases, suggests that it may be linked to the aging process. Polymyalgia rheumatica usually resolves within 1 to several years.

Like the other diseases described above, Lyme disease can affect any part of the body and cause many different symptoms. The commonest symptoms relate to the person feeling unwell, having flu-like symptoms, extreme tiredness, muscle pain, muscle weakness, joint pain, upset digestive system, headache, disturbances of the central nervous system and a poor sleep pattern. In some cases a characteristically shaped, expanding ‘bull’s eye’ rash appears on the skin.

Many patients who suffer from Lyme disease, are also infected with a host of associated tick-borne infections, such as Borrelia hermsii (relapsing fever), Babesia, Bartonella, Mycoplasma, Chlamydia, Rocky Mountain spotted fever, Q-fever, Ehrlichia or Anaplasma. Rarely, patients also have Tularemia and Brucellosis. To see Borrelia burgdorferi by itself is unusual.

This collection of bugs and associated illness explains why the standard treatment protocol (consisting of 30 days antibiotic therapy) doesn't offer the cure for most sufferers. Detoxification, hormone balancing, heavy metal removal and ramping up immune function are equally important.

Dr. Horowitz has come up with holistic approach, a 16 step road map, for treating Lyme disease, other tick borne illness, related co-infections and offers insight into the root causes for the chronic illnesses described above. I will discuss his road map to recovery in my next blog.

WHAT ARE THE CO-INFECTIONS ASSOCIATED WITH LYME DISEASE ?

As well as transmitting Lyme disease to people, when ticks bit you they often also transmit other diseases which are referred to as co-infections.  Co-infections exacerbate Lyme disease symptoms as well as exhibit symptoms of their own. Concurrent infections frequently occur.

Most people who have Lyme disease tend to suffer from one or more co-infections as well. Ticks carry several other infectious micro-organisms in addition to the Borrelia bacteria that cause Lyme disease. These co-infections include Babesia, Bartonella, Rickettsia, Ehrlichia, Mycoplasma and HGA.

Co-infections are relatively common when you have Lyme disease. A recently published Lyme disease organisation surveyed over 3,000 patients with chronic Lyme disease and found that over 50% had at least one coinfections and 30% of those people had two or more coinfections. The most common coinfections were Babesia (32%), Bartonella (28%), Ehrlichia (15%), Mycoplasma (15%), Rocky Mountain Spotted-Fever (6%), Anaplasma (5%), and Tularemia (1%).

Co-infections complicate both the diagnoses and the treatment of Lyme disease.  The organisms which cause co-infections cause their own set of symptoms and some like Rocky Mountain Spotted-Fever cause primary symptoms and others such as some Mycoplasma species are opportunistic pathogens which wait until the immune system is damaged by Lyme disease before they are able to establish themselves and cause symptoms.

However, the importance of identifying and treating polymicrobial infections is critical in getting a patient well. Many of the organisms causing the co-infections require alternative antibiotics to cure them. The existence of these co-infections may explain why some people with Lyme disease remain chronically ill even after treatment. Doctors should consider co-infections in the diagnosis when a patient’s symptoms are severe, persistent, and resistant to antibiotic therapy. 

Babesia

Babebiosis is a parasitic infection, a protozoa belonging to the genus Babesia, which affects the red blood cells similar to a malarial parasite. It is transmitted through the bite of a deer tick. People who contract Babebiosis suffer from malaria-like symptoms. As a result, malaria is a common misdiagnosis for the disease.

Bartonella

Bartonella are bacteria which cause a disease known as bartonellosis. Bartonellosis is usually a mild, acute, and self-limiting illness. Early signs of bartonellosis include fever, fatigue, headache, poor appetite, and an unusual streaked rash that resembles stretch marks during pregnancy. ( see picture) Swollen glands are typical, especially around the head, neck and arms and many have neurological symptoms including psychiatric manifestations. 

Rickettsia

Rickettsia are very small intra-cellular bacteria which require a host cell in order to survive. Rickettsia species are carried by many vectors such as chiggers, lice, fleas and ticks. They cause a wide variety of diseases in humans, including typhus fever, rickettsial-pox, Boutonneuse fever, African tick bite fever, Rocky Mountain spotted fever, Flinders Island spotted fever and Queensland tick fever. Several different species of Rickettsia have been identified as causing infection. Rickettsial infections are classified into three groups, Spotted fever; Typhus; and Scrub typhus (Now reclassified as a new genus – Orientia) 

Ehrlichia

Ehrlichia are small, gram-negative bacteria. The two known primary agents of human Ehrlichiosis are Ehrlichia chaffeensis which typically invades mononuclear phagocytes, such as monocytes and macrophages, causing Human Monocytic Ehrlichiosis (HME); and Ehrlichia ewingii which invade neutrophils causing Human Ewingii Ehrlichiosis (HEE)

Typically Ehrlichiosis strikes older people probably due to immunological host factors but severe and even fatal cases have also been reported in children and young adults. Most patients develop symptoms 1-2 weeks after the tick bite, and over 70% will have fever, chills, severe headache and myalgia. Less common symptoms include nausea and vomiting, as well as confusion. A rash can also occur. As with many other tick-borne diseases, the symptoms are largely non-specific, thus confounding diagnosis.

Mycoplasma

Mycoplasma are very small intra-cellular bacteria which lack a cell wall and has to live within a host cell in order to replicate. The type species, Mycoplasma pneumoniae, which causes atypical pneumonia. In one study, as many as seventy five percent of Lyme patients also have a Mycoplasma infection, which suggests that Mycoplasma is the number one cause of co-infections with Lyme disease, surpassing Bartonella and Babesia. 

Like other tick borne infections the symptoms can vary and include night sweats, fibromyalgia, fatigue, headaches, fevers, memory loss, skin rashes, diarrhea, abdominal bloating, depression, and bronchitis as well as serious neurological manifestations. 

Human Granulocytic Anaplasmosis (HGA)

HGA is a tick-associated disease caused by a species of bacteria called Anaplasma phagocytophilum which affect the white blood cells specifically the neutrophils. 

The clinical course of HGA varies widely, ranging from asymptomatic infection to fatal disease. The most common symptoms are headache, fever, chills, muscle pain and fatigue similar to the symptoms of influenza. The person has a low white cell count and a low platelet count. Gastrointestinal symptoms are seen in less than 50% of the patients and a skin rash is noticed in only about 10% of the patients.

Chronic Viral Infections and Opportunistic Pathogens

Whilst not transmitted by ticks, chronic viral infections such as herpes, HHV-6, CMV, and EBV, may become active in the chronic patient, due to their weakened immune response.

Opportunistic pathogens may also become infective if a person has a weakened immune system. An opportunistic pathogen is a microbe which would not normally cause an infection but can do so if conditions in the body become favourable for it to invade.

Chronic Yeast Infections

Because patients with chronic Lyme disease have weakened defences, and are taking long term antibiotics which wipes out their normal flora they are prone to develop an overgrowth of yeast usually Candida albicans. This often begins in the mouth or vagina, and then spreads to the intestinal tract..

 

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14 Facts About Lyme Disease

ILADS recently published these statistics and facts about Lyme disease:

1)      According to the CDC, LYME DISEASE is the fastest growing vector-borne infectious disease in the USA.  

2)      The number of cases reported annually has increased 25 times since national surveillance began in 1982

3)      There are 5 subspecies of BORRELIA BURGDORFERI; over 100 strains in the USA, and 300 strains worldwide.

This diversity is thought to contribute to its ability to evade the immune system and antibiotic therapy, leading to chronic infection. It could also be why the tests for Lyme disease are so unreliable.

4)      CDC reports: Lyme disease infects 300,000 people in the USA per year. This is 10 times more Americans than previously reported.

This new preliminary estimate confirms that Lyme disease is a tremendous public health problem in the United States,” says Dr. Paul Mead, chief of epidemiology and surveillance for CDC’s Lyme disease program.

5)      NEW LYME DISEASE CASES IN USA (CDC ESTIMATE)

Cases per month: 25,000
Cases per week: 5,770
Cases per day: 822
Cases per hour: 34

6)      There are no accurate tests available to indicate that the patient is cured or if the organism has been eradicated from the body

7)      Fewer than 50% of patients with Lyme disease recall a tick bite

8)      Fewer than 50% of patients recall any rash

9)      The ELISA SCREENING TEST is unreliable.

The common Elisa test you receive at your doctor's office misses 35% of culture proven Lyme disease. Some studies indicate up to 50% of the patients tested for Lyme disease receive false negative results.

10)   Up to 50% of  TICKS in Lyme endemic areas are infected

11)   The onset of Lyme disease symptoms can be easily mistaken for other illnesses. Once symptoms are more evident the disease may have already entered the central nervous system, and could be hard to cure.

12)   About 40% of LYME PATIENTS end up with long term health problems

13)   The average patient sees 5 doctors over nearly 2 years before being diagnosed

14)   SHORT TREATMENT COURSES  have resulted in  upwards of a 40% RELAPSE RATE, especially if treatment is delayed

There has never been a study demonstrating that 30 days of antibiotic treatment cures chronic Lyme disease. However there is much documentation demonstrating that short courses of antibiotic treatment fail to eradicate the spirochete which causes Lyme disease.

To find out more about the controversies surrounding Lyme disease CLICK HERE 

Why is Lyme disease not officially recognized by authorities in Australia?

Lyme disease syndrome has been reported in Australia since 1982 (Hunter Valley, NSW) and yet the authorities still do not recognize that it is endemic in Australia and it is not recognized as a notifiable disease in Australia. However The Australian Government is monitoring Lyme disease, in consultation with the states and territories, through the Communicable Diseases Network Australia. The public health department set up a Clinical AdvisoryCommittee on Lyme Disease (CACLD). They reported back in July 2014 that there were 2 schools of thought about whether Lyme existed in Australia:

1.       Those who believe that an indigenous form of Lyme disease exists in AustraliaT
2.     Those who are not prepared to exclude the existence of an indigenous form but who require proof of its existence. Proof would be in the form of  identifying and characterising the causative microorganism; and also  identifying the indigenous blood feeding vector

Following on from that the University of Sydney, Departmentof Medical Entomology conducted a survey to ascertain whether Lyme disease occurs in the southern hemisphere in general, and in Australia in particular.

Is there atick vector of Lyme disease in Australia?

Problems with Diagnosis.

Some of the skepticism around Lyme disease in Australia is because of the difficulty in diagnosing the disease and the general controversy around which tests are best to use.

Serological testing using current methods to detect antibodies against Lyme disease are acknowledged to have limitations due to the general lack of sensitivity and specificity.  Serological tests can give false negative results especially in the early stages of the disease and because of the degree of cross reactivity of the Borrelia sp. The percent of false positive results is very high. A two tiered approach is adopted by most countries which uses the ELISA test as a screening test and positives are then followed up with the more specific Western Bloc technique.

In Australia this testing regimen is further complicated because there has been no isolation of the causative organism of Lyme disease in Australia so the antigen used in the testing to date if from the USA and Europe and may not be suitable for Australian conditions. But until the causative organism has be isolated in Australia the test using overseas antigens may not be sensitive or specific enough.

The sensitivity of serological testing for Lyme disease depends on the strain of Borrelia used in the testing and this affects results in Australia, where no local spirochete has been isolated for use as a reference antigen. This means that testing is done using.  North American and European strains of Borrelia which may not be suitable for Australian testing.

 Members of the Advisory Committee were pushing for Australian testing capability to focus more on the detection of the causative agent itself, either by cultural techniques or by detecting the causative organisms' DNA using nucleic acid amplification techniques.

In Australia, not all labs have the capability nor accreditation required to test for Lyme disease and results of the same blood being sent to various labs come up with different results many. Many pro Lyme doctors send the samples overseas for testing.

Over the past 6 years there has been an increase in serological testing for Lyme disease in Australia. However most patients request the test themselves on the basis of tick exposure and symptoms which suggest Lyme disease such as myalgia, arthralgia without objective evidence of joint disease, neurological symptoms such as frequent headaches, inability to concentrate and impairment of memory, and syndromes resembling chronic fatigue syndrome. Some have positive screening serology but many have not been confirmed with a more specific western bloc test.

None of the testing on local patients done at Westmead hospital who were positive for Lyme disease screening tests done in Australia to date have produced results that conform with internationally accepted criteria for a positive Western Bloc test. The positive screening tests are likely to be due to cross reactivity, or maybe due to the fact that the "Australian antigen" has not yet been isolated and used in testing. 

However these false positive screening tests casts doubt on whether Lyme disease has been confirmed in Australia. The diagnosis of Lyme disease outside of known endemic areas cannot be based solely on serological tests especially when they fail to conform with internationally accepted criteria, because of the high incidence of false positive results.

Problems with identifying typical skin rash, and clinical diagnosis

A few cases of Erythema Migrans rash have been reported from South-Eastern Australia. However, diagnosis can be confusing because of the erythematous hypersensitivity reaction to the bite of I. holocyclus, the most common tick biting humans.  There has been no isolation of Borrelia from skin lesions of local Australian patients. 

A clinical diagnosis in a non-endemic disease area especially in the later stages, is difficult to support without isolation of the causative agent from the patient, from other patients with similar illness or from a known vector in the region. So until diagnosis is confirmed with "concrete" evidence the symptoms of Lyme disease will not be recognized in Australia.

The proponents of long term infection and the existence of dormancy rely on the acceptance of specific bacterial pleomorphism for Borrelia species

Problems with treatment

The advisory committee say that the development of an Australian treatment protocol rests on an accepted diagnostic pathway plus a clinical evaluation of the patients with long term manifestations after an initial diagnosis of Lyme disease in Australia. It is not currently possible with the available diagnostic assays, including nucleic acid amplification assays, to determine if long term infection and disease exists in Australia. 

Vector and reservoir host Investigations – Australia

No ticks of the I. persulcatus complex which are the principal vectors of Lyme disease to humans in the northern hemisphere and in Eurasia, occur in Australia.  However, a possible vector which could transmit Lyme disease from its natural reservoir to humans has been identified in Eastern Australia. A species of tick known as I. holocyclus, which has a wide host range, is the most common tick biting humans.  But I. holocyclus, is unable to transmit the North American strain of B.burgdorferi. However the question remains as to whether there is a so far undiscovered Australian spirochete responsible for Lyme disease in Australia.

  

A natural reservoir for Lyme disease has not been identified in Australia. None of the mammal species identified as reservoir hosts in the northern hemisphere are present in Australia. There are reports of spirochetes being isolated from Australian native animals, and a local mammal could be a reservoir host for an Australian spirochete that occasionally infects humans through a tick vector and produces a clinical syndrome similar to Lyme disease; however, no spirochetes were detected in the 12,000 ticks or animals processed in a recent survey.

In this survey of over 12,000 ticks and a handful of native animals, researchers failed to identify Borrelia. Testing was done by 3 methods:

1. 1     Dark field microscopy of the tick's gut content
2. 2.       Culture to  isolate grow the causative organism
3. 3.       Detection of Borrelia genes by PCR technology (the primers were sourced from overseas and may not be specific for Australia.

Summary

The existence of Lyme disease in Australia will remain controversial until an organism is isolated from a local patient and fully characterized, or until a tick-borne organism can be shown to be responsible for the human infection. If it exists it shares few of the epidemiological or clinical characteristics of US or European patterns of Lyme disease. And this is why is Lyme disease is not officially recognized by authorities in Australia.

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Where is Lyme Disease Found?

Lyme disease was originally discovered in the town of Old Lyme, in Connecticut from where it gets its name. Lyme disease was diagnosed as a separate condition for the first time in 1975. Previously it had been mistaken for juvenile rheumatoid arthritis.

In the USA, Lyme disease is now recognized as being endemic^*1 in North America, Europe, some parts of Africa. It is becoming epidemic^*2   in its spread in the Northern Hemisphere where it is estimated that it affects as many as 300,000 people annually in the United States and as many as 65,000 people a year in Europe.

Lyme disease has been reported most often in the north eastern United States, but it has been reported in all 50 states of the USA. In the United States, it is primarily contracted in the Northeast in the states from Maine to Maryland, in the Midwest in Minnesota and Wisconsin, Mid Atlantic, in the West in Oregon and Northern California. 

Lyme disease is also found in Germany, Switzerland, Czech Republic, Slovakia, Austria, France, Portugal, United Kingdom, Ireland, Scandinavia and many regions in Eastern Europe including Russia. It has also been confirmed in North Africa, and in Asia especially in China, Japan and Korea. In Eurasia and Northern Africa.

In the Southern Hemisphere there is debate about whether Lyme disease is actually transmitted in Australia  Many medical authorities believe it is unlikely and still questionable whether the disease is endemic in Australia because the ticks which are known to transmit Lyme disease are not present. These experts believe that those with the disease are thought to have caught it outside of Australia.

However there is another school of thought that there are thousands of undiagnosed cases of Lyme disease that have been transmitted in Australia but the exact number of people with Lyme disease in Australia is unknown because unlike other countries, it is not a notifiable disease and therefore public health officials do not collect any data.

The Australian Health Department currently claim there is no Lyme disease in Australia. The Lyme Association in Australia however is collecting data and mapping it with the aim to raise awareness of Lyme disease and other tick-borne illness in Australia

Note ^*1 Endemic is often confused with the term epidemic, but they are have different meanings. An endemic disease refers to the constant presence of a disease or infectious agent within a given geographic area or population group or racial group. It refers to the usual presence of a given disease within such and area or group. Endemic diseases are not always present at high levels and can be relatively rare, but the defining feature of a regional endemic disease is that it can always be found in the population that lives there.

If Lyme disease is normally present in a geographical region it is said to be endemic in the region and that region then becomes a high risk area for the transmission of Lyme disease.

Note ^*2 In contrast, an epidemic occurs when there is a higher number than normal of occurrences of a particular disease in a given population. An epidemic refers to a wide spread outbreak of a disease that is spreading through one or more populations. Under certain circumstances, an epidemic can lead to a disease becoming endemic in a region. Pandemics are world-wide epidemics.

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