Alternative Treatments
and
HyperBaric Oxygen Therapy (HBOT):
Effective Treatments for
Chronic Lyme Disease?
HBOT is a controversial treatment for Lyme Disease. Here are two case reports: one from Europe reported in a good journal (but I cannot get full article on PubMed) & another Taiwan reported in a Chinese medical journal noted below. It is still not clear if HBOT helps with Chronic Lyme as there have been no randomized controlled blinded studies. There are some case reports online but only 2 I saw published.
Here is a list of alternative treatments for Lyme:
Examples of Alternative Medical Therapies Marketed to Patients for the Treatment of Lyme Disease
| Categories of Therapy | Examples |
|---|---|
| Oxygen |
|
| Energy and radiation |
|
| Metal/chelation |
|
| Nutritional supplements |
|
| Biological and pharmacologic |
|
Review of the Medical Literature
Scientific studies supporting the efficacy of any of the treatments discussed above could not be found on review of the medical literature. Most of the cited treatments were never evaluated with any scientific study, although we did find that a few treatments were evaluated in studies that either were poorly designed or had unclear relevance to human disease.
Two studies are worth mentioning in more detail. A study of combination therapy with cholestyramine-atovaquone enrolled 25 patients with persistent symptoms after being diagnosed with and treated for babesiosis-Lyme disease coinfection [57]. In this study, however, all patients received cholestyramine for the entirety of the trial, so no inferences could be made about its therapeutic efficacy.
The effect of hyperbaric oxygen on strains of B. burgdorferi was assessed both in vitro and in experimentally infected mice in one study [58]. The investigators found that growth of the organism in vitro was inhibited by hyperbaric oxygen in 14 of 17 cultures. In addition, the organism was cultivable from the bladders of only 20% of mice treated with hyperbaric oxygen, compared with 90% of untreated mice. No study of this therapy in humans with Lyme disease has ever been published.
Clin Infect Dis. 2015 Jun 15; 60(12): 1776–1782.
Published online 2015 Apr 6. doi: 10.1093/cid/civ186
PMCID: PMC4490322
Unorthodox Alternative Therapies Marketed to Treat Lyme Disease
These are the only case reports I could find to date on Lyme and HBOT.
Abstract
Lyme disease is the most commonly reported vector-borne illness in the United States, but it is relatively rare in Taiwan. Lyme disease can be treated with antibiotic agents, but approximately 20% of these patients experience persistent or intermittent subjective symptoms, so-called chronic Lyme disease (CLD). The mechanisms of CLD remain unclear and the symptoms related to CLD are difficult to manage. Hyperbaric oxygen therapy (HBOT) was applied in CLD therapy in the 1990s. However, reported information regarding the effectiveness of HBOT for CLD is still limited. Here, we present a patient with CLD who was successfully treated with HBOT.
1
Introduction
Lyme disease is an infectious disease with a worldwide impact, caused by the tick-carried Borrelia burgdorferi bacterium. In Taiwan, a laboratory-diagnosed human case of Lyme disease had been reported in 1998, while the spirochetes related to the causative agent, B. Burgdorferi sensu lato, were first isolated from rodents in the Taiwan area. The medical diagnosis of Lyme disease is based on a combination of manifestations, including dermatological, rheumatological, neurological, and cardiac abnormalities, as well as laboratory assays. Evidence shows that it can be treated successfully with antibiotic agents if intervention occurs soon after infection. However, some patients will continue to suffer from chronic Lyme disease (CLD) despite receiving an adequate course of therapy.
The precise mechanisms of CLD symptoms are unknown. Hyperbaric oxygen therapy (HBOT) serves as a primary or adjunctive therapy for a range of medical and surgical conditions, and has been applied in therapy of CLD since the 1990s. We present a patient with CLD who was successfully treated with HBOT.
2
Case report
In April 2003, our patient was a 31-year-old healthy man who worked in the financial industry and lived in Taipei City, who began suffering from intermittent low- and high-grade fever. These symptoms were accompanied by fatigue and multiple bone pain, especially in the sternum, ribs, and lower back, which made it difficult for the patient to walk. Since that time, the patient had only received symptomatic medications such as painkillers. In January 2004, some erythema migrans lesions were found over the patient’s legs. In addition, he suffered from joint pain in both knees, the shoulders, and temporomandibular joints. Tracing back the patient’s history 2 years prior to clinical presentation, it was noted that he was a frequent hiker in the Yang-Ming Mountains in Taipei, Taiwan, where he often sat on the grass and had contact with wild cattle. He had previously visited infection and dermatology clinics, where his Borrelia serology IgG was positive, and Lyme disease was strongly suspected. Soon thereafter, 500 mg amoxicillin twice daily was prescribed for 1 month, which caused the patient’s symptoms to subside partially. However, in the next 3 years, he was bothered by symptoms including: (1) nervous system, comprised of irritability, mood swings, poor concentration, loss of short-term memory, sleep disturbance, facial tingling, blurred vision, and photophobia; (2) cardiovascular system, consisting of chest pains and palpitations; (3) musculoskeletal system, associated with migrating arthralgias; and (4) other problems, including headache and pelvic pain.
In 2007, the patient again visited another infection clinic, where he received antibiotic agents such as doxycycline, amoxicillin 250 mg + clavulanic acid 125 mg (Augmentin), parenteral penicillin, and oral cefuroxime over the following 4 years. Because the above symptoms had not improved significantly, in October 2011 the patient visited us for HBOT. Before HBOT, some residual symptoms such as elbow and joint pain, numbness of the extremities, perioribital twitch, sleep disorder, and affected thinking ability persisted. After we excluded other infectious and noninfectious etiologies that can mimic certain appearances of the typical multisystem illness seen in CLD, HBOT at 2.5 ATA with treatment duration of 1.5 hours for 30 sessions was given. In the first 10 sessions of HBOT, nervous-system-associated symptoms such as loss of thinking ability and sleep disorder disappeared. In the second 10 sessions of HBOT, additional nervous system symptoms such as numbness of the extremities and perioribital twitch also disappeared. In the third 10 sessions of HBOT, musculoskeletal system symptoms such as migrating arthralgia also vanished. Overall, completion of 30 sessions of HBOT caused noted longstanding Lyme-disease-related symptoms affecting most of the previously affected bodily areas to disappear.
3
Discussion
Lyme disease was recognized in 1976 and is caused by the tick-borne spirochete B. burgdorferi . In the United States, it is the most common vector-borne illness, where >20,000 cases have been diagnosed annually. In Taiwan, Shih and Chao conducted a zoonotic survey for evaluating spirochetal infection of rodents in Taiwan. They reported that the overall infection rate throughout Taiwan was 16.6%, and the highest infection rate (25.8%) was observed on Kimman Island. By contrast, the infection rate in Taipei area was only 6.7%. Erythema migrans or “bulls-eye” rash following receipt of a tick bite and joint swelling typical of arthritis are the classic clinical appearances of Lyme disease. However, only 50–60% of patients remembered having received a tick bite, and often the skin lesion was either absent or atypical. Other manifestations such as multiple nonspecific symptoms that affect different organ systems, including the joints, muscles, nerves, brain, and heart are also reported.
Lyme disease is a clinical diagnosis. Laboratory testing with a two-tier testing system is advocated by the Centers for Disease Control and Prevention (CDC), United States, which involves a positive screening test using an enzyme-linked immunosorbent assay or immunofluorescence assay, followed by positive Western blotting. The two-tier system has a high specificity (99–100%); however, it has relatively poor sensitivity (50–75%). Therefore, the tests used to diagnose Lyme disease should be used to support rather than replace the physician’s judgment. That is, the diagnosis is based on a possible tick exposure history, the emergence of specific clinical symptoms, and exclusion of other causes of the symptoms. The results of serological or other diagnostic tests are not essential. In most cases, Lyme disease can be treated successfully with oral forms of antibiotics and a parenteral regimen lasting 7–21 days, depending upon the different presentations of the disease. However, 10–20% of patients have persistent or intermittent subjective symptoms (such as fatigue, arthralgia, myalgia, headache, neck stiffness, paresthesia, sleeplessness, irritability, and difficulty with memory, word finding, and concentration) after receiving an adequate course of antibiotic therapy. Lacking any alternative diagnosis, such patients are classified as CLD. The mechanisms of CLD are not clear. Possible explanations include persistent infection with B. burgdorferi (although clinical or laboratory evidence of infection is not required), postinfective fatigue syndrome, and autoimmune mechanisms. With the pathophysiological complexity ofBorrelia , CLD is a controversial illness. Multiple body systems can be involved and they can be difficult to manage. Prolonged antibiotic therapy has been used in patients who have CLD, but research suggests that such an approach is not warranted.
Several adjunctive therapies including immune system therapy, ozone therapy, vaccination, and HBOT were previously mentioned. Among these therapies, HBOT has been recommended for treatment of Lyme borreliosis, especially for patients who have received antibiotic therapy but still suffer from Lyme-related symptoms. HBOT, a treatment in which the patient intermittently breathes 100% oxygen while the treatment chamber is pressurized to a pressure greater than sea level (1 ATA), is increasingly used in many areas of medical practice. Although the method of action of such a unique intervention is not satisfactorily understood, some mechanisms such as competing anaerobes by increasing tissue oxygen tensions, inhibiting bacterial metabolic functions by increasing the generation of oxygen free radicals, enhancing leukocytes to kill bacteria by facilitating the oxygen-dependent peroxidase system, and improving the oxygen-dependent transport of certain antibiotics have been determined to be efficacious. Austin illustrated the effects of oxygen on B. burgdorferi in 1993 and showed that the ambient levels of O 2 and CO 2 can affect the infectious capacity of B. burgdorferi. Thereafter, the effect of HBOT in CLD was reported by researchers at Texas A&M University. There were 84.8% of treated patients ( n= 91) who showed significant improvement of symptoms, including mental confusion, pain, depression and fatigue, with approximately 70% of patients who showed a lasting benefit upon follow-up examination. CLD is a complicated illness. Although HBOT is not a regularly recommended therapy for CLD in Taiwan, HBOT might be an effective adjunctive treatment when a clinician is confronted with a patient with CLD.
Conflicts of interest: The authors declare that there are no conflicts of interest related to the subject matter or materials discussed in this article.
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