from Morbidity and mortality weekly report
Unproven treatments for so-called chronic Lyme disease can cause serious, even fatal, complications, according to five case reports published in the Morbidity and Mortality Weekly Report.
“Patients, clinicians, and public health practitioners should be aware that treatments for chronic Lyme disease can carry serious risks,” the authors wrote.
Chronic Lyme disease is a nonspecific diagnosis that has no consistent definition. Some clinicians use this label for patients who have a variety of debilitating conditions such as fatigue, generalized pain, and neurologic symptoms, even in the absence of laboratory evidence of Borrelia burgdorferi infection, objective signs of infection, or a history of tick exposure. People who support this diagnosis mistakenly believe that B. burgdorferi can cause longstanding disabling symptoms even when standard testing for the organism is negative, when the truth is that tests for the organism become more sensitive the longer the infection persists, according to Natalie S. Marzec, MD, a resident in preventive medicine at the University of Colorado, Aurora, and her associates.
Patients who cannot obtain symptom relief with conventional clinicians may consult “practitioners who might identify themselves as Lyme disease specialists (‘Lyme literate’ doctors) or from complementary and alternative medicine clinics,” where they are diagnosed with chronic Lyme disease. Such patients have been offered unproven treatments, including extended courses of intravenous antibiotics, infusions of hydrogen peroxide, immunoglobulin therapy, hyperbaric oxygen treatment, electromagnetic frequency therapy, garlic supplements, colloidal silver, and stem-cell transplantation.
Dr. Marzec and her associates presented case reports of five such patients diagnosed with chronic Lyme disease who sustained serious harm from such treatments ( MMWR 2017;66[23]:607-9 ).
A woman in her late 30s with fatigue and joint pain was given a peripherally inserted central catheter (PICC) for IV delivery of ceftriaxone and cefotaxime. After 3 weeks, she developed fever, rash, hypotension, and tachycardia. In the intensive care unit (ICU), she was given broad-spectrum IV antibiotics and vasopressors, and was mechanically ventilated, but died of septic shock related to catheter-associated bacteremia.
An adolescent was told at an alternative medicine clinic that her years of muscle and joint pain, backaches, headaches, and lethargy were due to chronic Lyme disease. A PICC was placed to deliver IV antibiotics for 5 months. She developed pallor, chills, fever, hypotension, and tachycardia consistent with septic shock. Cultures demonstrated Acinetobacter species in her blood and on the PICC, and she required several weeks of ICU care.
A woman in her late 40s was diagnosed as having chronic Lyme disease based on unvalidated tests and was treated for months with intramuscular penicillin, IV ceftriazone, and IV azithromycin administered through a tunneled IV catheter; as well as doxycycline, and the antiparasitic drug tinidazole. She was hospitalized for back pain, shortness of breath, and malaise, and cultures of the catheter and her blood yielded Pseudomonas aeruginosa. She was found to have osteodiscitis caused by the same organism, with destruction of the 9th and 10th vertebrae, and was treated, and her back pain eventually improved.
A woman in her 50s was diagnosed as having amyotrophic lateral sclerosis, but sought a second opinion and was told that she had chronic Lyme disease (along with babesiosis, and Rocky Mountain spotted fever). She was treated with herbs and homeopathic remedies, followed by intensive antimicrobial and antiviral therapies. She developed intractable Clostridium difficile colitis that lasted for 2 years until she died from complications related to amyotrophic lateral sclerosis.
A woman in her 60s who had autoimmune neutropenia, mixed connective tissue disease, and degenerative arthritis was told her neuropathy was due to chronic Lyme disease. She was treated with immunoglobulin administered through an implanted subcutaneous port. After years of treatments, she was hospitalized for fever and back pain, had blood cultures positive for methicillin-sensitive Staphylococcus aureus, was found to have inflammation of the lumbar facet joints, epidural space, and paraspinal muscles – and eventually required surgical drainage of a paraspinal abscess.
“These cases highlight the severity and scope of adverse effects that can be caused by the use of unproven treatments for chronic Lyme disease,” Dr. Marzec and her associates said.
This work was supported by the CDC. Dr. Marzec and her associates reported having no relevant financial disclosures.
