It is a well-known fact, and Germany is no exception, that a large number of chronic cases are not recognised as being the result of Lyme borreliosis. Part 2.
Dr. Jan-Olaf Reinhardt is one of Germany’s leading Lyme disease experts and lives in Pforzheim in the German state of Baden-Württemberg. Weborvos had the opportunity to interview him about the situation regarding Lyme borreliosis in Germany and his views on diagnosis and treatment.
We concluded our first interview with a truly interesting case study. Are there similar success stories among younger patients?
We had a 16-year-old female patient who was diagnosed with Lyme neuroborreliosis. She was discharged from hospital as a healthy girl, but a year later she noticed the same symptoms: headaches, difficulty concentrating, joint pain. Unfortunately, no one believed her; they thought she had recovered and that her symptoms were related to growing pains during puberty or some kind of psychosomatic background. She lost a year at school, during which time her family found us. We performed another test and discovered that Lyme borreliosis had returned. We treated her with more intensive therapy, her headaches and stomach problems disappeared, most of her other symptoms faded, and today she can live an almost normal life.
So more active and longer treatment is what counts?
Sometimes that is the right approach. A middle-aged teacher was once bitten by a tick. After that, she developed joint pain throughout her body, which changed location, she had skin problems, and a cardiologist diagnosed her with minor myocarditis. She had severe hyperreflexia, but the biggest problem was that her body trembled like that of an epileptic. However, epilepsy and other neurological diseases were subsequently ruled out. She was unable to work and could not look after her child. This example also shows that if we could make a more reliable diagnosis and spend more time on therapy, patients like her could be cured.
What is the biggest problem in recognising and diagnosing Lyme borreliosis?
Diagnosing Lyme borreliosis is a complex issue. Our role as doctors is similar to that of detectives. The patient’s medical history is extremely important. Their personal history and medical history also play a huge role, and we need to talk to the patient about exactly what happened. We have to go through a lot of questions to get a picture of the patient’s past and current condition. As far as laboratory tests are concerned, in our experience, we have to perform more than the usual tests on about 50% of our patients. We use all available tests, we know the various advantages and disadvantages, and we are certain that it would be very good to have a reliable diagnostic method. There is no test that is 100% sensitive. We need to be familiar with all possible symptoms, and only after treating hundreds of patients with the same symptoms can we understand the exact nature of the disease.
What diagnostic tests do you use, and how many per patient? How do you see the advantages of direct diagnostic methods?
This is one of the biggest problems with Lyme borreliosis. Sometimes we perform PCR diagnostics from tissue, skin, joint or stomach biopsies, but this is rare. A direct diagnostic method would be very useful! With antibody diagnostic tools such as Western blot and ELISA, we cannot be sure whether we are dealing with a chronic disease or a previous infection. If we had a direct method, everything would be much easier and diagnostics could be much more effective.
What advice can you give to your colleagues who are not experts in this field?
Everyone needs to know that the current tests are not 100% reliable, which is the biggest problem. I have many patients whose tests were negative, so their GPs did not suspect Lyme borreliosis. There have also been numerous articles confirming seronegative Lyme disease, even in later stages. Having examined and diagnosed hundreds of Lyme disease patients, you know that GPs must always examine the patient’s medical history and symptoms. The symptoms vary widely, but the most common are joint pain, neuralgia (tingling, burning sensations, pain, paralysis), headaches, fatigue, muscle or tendon pain, bladder and stomach problems, and chronic skin rashes (Acrodermatitis chronica atrophicans). If we recognise these symptoms, it is worth considering that Lyme borreliosis may be the cause…
You are a member of the Deutsche Borreliosegesellschaft, the largest German Lyme organisation, and were even a member of its board of directors. You are also familiar with the different opinions in the United States, primarily the guidelines of the IDSA and ILADS. In your opinion, to what extent are German doctors able to exercise their freedom of diagnosis and treatment appropriately? What is the position of the Borreliosegesellschaft on this?
Unfortunately, the usual therapeutic recommendations are often unsuccessful. Institutions such as ILADS and the Deutsche Borreliosegesellschaft have recognised this problem. As I said earlier, we often have to continue treatment with other antibiotics in higher doses and for longer periods of time in order for our patients to be able to return to work. The situation is similar to TB treatments: no one would treat them for only two weeks; successful therapy takes several months or even longer. Of course, Lyme borreliosis is a different bacterium, but its therapeutic strategy is comparable to TB. This is the main idea that must be understood in order to provide successful treatment for our patients.
Source: weborvos.hu
