Comment; Using an anti-inflammatory antibiotic for a disease such as Lyme et al, difficult due to intracellular location & biofilm production. I’m aware of using it for Leprosy, this is promising!

Richard I Horowitz,1,2 Phyllis R Freeman2

1Health and Human Services, Tick-Borne Disease Working Group, Washington, DC 20201 USA; 2Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA

Purpose: We collected data from an online survey of 200 of our patients, which evaluated the efficacy of dapsone (diaminodiphenyl sulfone, ie, DDS) combined with other antibiotics and agents that disrupt biofilms for the treatment of chronic Lyme disease/post-treatment Lyme disease syndrome (PTLDS). We also collected aggregate data from direct retrospective chart review, including laboratory testing for Lyme, other infections, and associated tick-borne coinfections. This helped us to determine the frequency of exposure to other infections/coinfections among a cohort of chronically ill Lyme patients, evaluate the efficacy of newer “persister” drug regimens like DDS, and determine how other infections and tick-borne coinfections may be contributing to the burden of chronic illness leading to resistant symptomatology.
Patients and methods: A total of 200 adult patients recruited from a specialized Lyme disease medical practice had been ill for at least 1 year. We regularly monitored laboratory values and participants’ symptom severity, and the patients completed the online symptom questionnaire both before beginning treatment and after 6 months on DDS combination therapy (DDS CT). Paired-samples t-tests and Wilcoxon signed-rank nonparametric test were performed on each of eight major Lyme symptoms, both before DDS CT and after 6 months of therapy.
Results: DDS CT statistically improved the eight major Lyme symptoms. We found multiple species of intracellular bacteria including rickettsia, Bartonella, Mycoplasma, Chlamydia, Tularemia, and Brucella contributing to the burden of illness and a high prevalence of Babesia complicating management with probable geographic spread of BabesiaWA1/duncani to the Northeast. Borrelia, Bartonella, and Mycoplasma species, as well as Babesia microti had variable manifestations and diverse seroreactivity, with evidence of persistence despite commonly prescribed courses of anti-infective therapies. Occasional reactivation of viral infections including human herpes virus 6 was also seen in immunocompromised individuals.
Conclusion: DDS CT decreased eight major Lyme symptoms severity and improved treatment outcomes among patients with chronic Lyme disease/PTLDS and associated coinfections.

What is it about?

A retrospective chart review of 200 patients on dapsone combination therapy showed it to be efficacious in treating 8 major Lyme symptoms, even among those failing prior traditional therapy. Evaluation of infections and co-infections in those suffering with chronic Lyme symptoms revealed problems with standard antibody testing, the need for broader screening methods i.e., DNA and RNA testing (PCR, FISH), as well as evidence of persistence of intracellular infections and viruses among individuals suffering with chronic illness. Immune deficiency was also present in over 20% of those with chronic Lyme disease.

Why is it important?

There is no broad scientific consensus on why patients with chronic Lyme symptoms remain ill. This study highlights the need to address different forms of borrelia (especially intracellular and biofilm forms, as well as “persisters”) and associated co-infections in those suffering with resistant chronic Lyme/PTLDS. This includes Babesia, Bartonella, tularemia, brucella, mycoplasma rickettsia spp. and viruses including HHV6. Evaluating individuals for immune compromise is also important among this group of patients.