Different Treatments in Patients with Neuroborreliosis and Coinfections
Main Article Content
Abstract
In case of an acute infection of borreliosis, the best therapy is azithromycin 500 mg combined with cotrimoxazole 960 mg, 2x1 per day mostly over 10 days. For chronic and long-lasting infections rifampicin 450mg can be added. There is also a coinfection with babesia atovaquone combined with tinidazole that should be subsequently followed. In a long-lasting stadium of a neuroborreliosis with typical symptoms mostly combined with other bacterial and viral coinfections hydroxychloroquine and/or disulfiram are the best therapy. Whereas disulfiram inhibits P 450-cytochrome, fluconazole induces this elimination system so a combination with artemether is useful. Disulfiram penetrates all tissues, but also cytoplasm, nucleus, and mitochondria, and passes the blood-brain barrier. Cystic borrelia has a low and downregulated metabolism for a long period, you need a long time (about 18-21 months) to block the mechanism for energy supply (ATP) and replication. Homeopathic dispensing and plant extractions as well gamma-globulins are surely effective during chronic or relapse stadium.
Article Details
How to Cite
SCHARDT, F.W..
Different Treatments in Patients with Neuroborreliosis and Coinfections.
Medical Research Archives, [S.l.], v. 11, n. 9, oct. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4488>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i9.4488.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Boujadoux A (1922): Paralysie par les tiques. J Med Lyon.71,765-767
2. Fraser CM, Casjens S, Venter JC et al. (1997): Genomic sequence of a lyme disease spirochaete, borrelia burgdorferi. Nature,390,580-586
3. Hildenbrand P, Craven DE, Jones R, Nemeskal P (2009): Lyme neuroborreliosis: Manifestation of a rapidly emerging zoonosis. AM J Neurorad 30,6,1079-1087
4. Brorson O, Brorson SH (2002): An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to hydroxychloroquine. Int Microbiol 5,25-31
5. Liang FT, Yan J Mbow ML, Sviat SL, Gilmore RD, Mamula, Fikrig E (2004): Borrelia burgdorferi changes its surface antigenic expression in response to host immune responses. Infect Immun 72,10,5759-5767
6. Oksi J, Marjamäki M, Nikoskelainen J, Viljanen MK (1999): Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Ann Med 31,3,225-232
7. Zhang JR, Hardham JM, Barbour AG, et al. (1997): Antigenic Variation in Lyme Disease by Promiscuous Recombination of VMP- like Sequence Cassettes.Cell 96,3,447-487
8. Zückert WR (2014): Secretion of bacterial lipoproteins: through the cytoplasmic membrane, the periplasma, and beyond. Biochim Biophys Acta 1843,1509-1516
9. Sapi E, Bastian SL, Mpoy CM et al. (2012): Characterization of biofilm formation by borrelia burgdorferi in vitro. PLoS One7,10:e48277
10. Gasser R, Dusleag J (1990): Oral treatment of late borreliosis with roxithromycin plus cotrimoxazole. Lancet 336,1189-1190
11. Schardt FW (2004): Clinical effects of fluconazole in patients with neuroborreliosis. Eur J Med Res 9, 334-336
12. Busson L, Reynders M, van den Wijngaert S et al. (2012): Evaluation of commercial screening tests and blot assays for diagnosis of Lyme borreliosis. Diagn Microbiol Infect Dis. doi.10.10
13. Halperin JJ, Volkman DJ, Wu P (1991): Central nervous system abnormalities in Lyme neuroborreliosis. Neurology 41,1571-1582
14. Wormser GP, Dattwyler RJ, Shapiro ED et al. (2006): The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis and babesiosis: clinical practice guidelines by the Infectious Disease Society of America Clin Infect Dis 43,9, 1089-1134
15. Hoffmann B, Tappe D Hoepper D et al. (2015): Variedated sqirrel bornavius associated with fatal human encephalitis. N Engl J Med 373,2,154-162
16. Liu S, Bode L, Zhang L, et al. (2015): GC-MS-based metabonomic profiling displayed differing effects of Borna disease natural stain Hu-H1 and laboratory Strain V in rat cortical Neurons. Int J Mol Sci 16,8,19347-19368
17. Verhey TB, Castellanos M, Chaconas G (2018) Antigenic variation in Lyme spirochete: insights into recombinational switching with a suggested role for error-prone repair. Cell Rep 29; 23,9, 2595-2605
18. LinYP, Chen Q, Ritchie JA at al. (2015): Glycosaminoglycan binding by borrelia burgdorferi adhesin BBK32 specifically and uniquely promotes joint colonization. Cell Microbio 17; 860-875
19. Stanek G, Reiter (2011): The expanding Lyme borrelia complex-clinical significance of genomic species. Clin Microbiol Infect 17;4,487-493.
20. Khan G, Fitzmaurice C, Naghavi M et al. (2020) Global and regional incidence, mortality and disability-adjusted life-years for Epstein-Barr virus-attributable malignancies BMJ open 10;8: e037505
21. Amon W, Farrell PJ (2004): Reactivation of Epstein-Barr virus from latency Rev Med Virology 15;3,149-156
22. Khan G, Myashita EM Yang B et al. (1996): Is EBV persistence in vivo a model for B cell homeostasis? Immunity 5;2:173-179
23. Dreyfus DH (2011): Autoimmune disease: A role for new anti-viral therapies? Autoimmune Rev 11;2,:88-97
24. Popp M, Stegemann M, Riemer M et al. (2021): Intervention Antibiotics for the treatment of COVID-19. Cochrane Database of Systematic Reviews 10;10: CD015025
25. Thomas RJ, Dumler JS Carylon JA (2009): Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Expert Review of Anti-Infective Therapy 7;6:709-722
26. Krause PJ, Lepore MD, Vijay MD et al. (2000): Atovaquone and azithromycin for treatment of babesiosis. N Engl J Med 434:1454-1458
27. Longley N, Muzoora C, Taseera K et al. (2008): Dose-response effect of high-dose fluconazole for HIV-associated cryptococcal meningitis in southwestern Uganda. Clin Infect Dis 47;12:1556-1561
28. Steere AC, Angelis SM (2006) Therapy for Lyme arthritis: strategies for the treatment. Arthritis and Rheumatism, 54,10: 3079-86
29. Hurst NP, French JK, Gorjatschko L, Betts WH (1988): Chloroquine and hydroxychloroquine inhibit multiple sites in metabolic pathways leading to neutrophil superoxide release. J Rheumat 15,1,23-27
30. Fox R (1996): Anti-malaria drugs: possible mechanisms of action in autoimmune disease and prospects for drug development Lupus 5 (Suppl) 4-10
31. Paludetto NM, Kurkela M, Kahma H et al.(2023) Hydroxychloroquine is metabolized by cytochrome P450 2D6,3A4 and 2C8 and inhibits cytochrome P450 2D6 while its metabolites also inhibit cytochrome P450 3A in vitro. Drug Metab Dispos 51,3:293-305
32. Guo Z (2016): Artemisin anti-malaria drugs in China. Acta Pharmaceutica Sinica B 6;2:115-124
33. Esu EB,Effa EE Opie O et al. (2019 Artemether for severe malaria. Cochrane Database Systematic Reviews 6,6: CD 010678
34. Stover K, King ST, Robinson J (2012) Artemether-Lumefantrine: an option for malaria. Annals of Pharmacotherapy; 46,4: 567-577 Steere AC, Angelis SM (2006) Therapy for Lyme arthritis: strategies for the treatment. Arthritis and Rheumatism, 54,10: 3079-86
35. Lu J, Sun PD (2015). Structural mechanism of high affinity FcyRI recognition of immunoglobulin G. Immunological Reviews,268,1,192-201
36. Dietrich DE, Bode L, Spannhuth CW, et al. (2020): Antiviral treatment perspective against Borna disease virus 1 infection in major depression: a double-blind placebo-controlled clinical trial. BMC Pharmacology and Toxicologydoi.org/10.1186/s40360-020-0391-x
37. Bode L, Dietrich DE, Spannhuth CW, Ludwig H (2022): Prominent efficacy of amantadine against human borna disease virus infection in vivo and in vitro Comment on Fink et al. Amantadine inhibits SARS-CoV-2 in vitro. Viruses14,494
38. Berg JM, Tymoczko JL, Gatto GJ, Stryer L (2012) Biochemistry 8Th ed.,820-822
39. Azadmandesh J, Lutz WE, Coates L et al. (2021) Direct detection of coupled proton and electron transfer in human manganese superoxide dismutase. Nature Communications 12,1,2079-2085 Disulfiram as an anti-parasitic agent. Front Cell Infect Microbiol:11, 633194
40. Lin MH, Moses DC, Hsieh CH et al. (2018). Disulfiram can inhibit MERS and SARS coronavirus papain-like proteases via different modes. Antiviral Research 150,155-163
41. Tamburin S, Mantovani E, De Bernadis E et al. (2021). Covid-19 and related symptoms in patients under disulfiram for alcohol disorders. Internal and Emergency Medicine 16,6:1729-1731
42. Goc A, Rath M (2016): The anti-borrelia efficacy of phytochemicals and micronutrients: an update. Ther ADV Infect Dis; 3-4,75-82
2. Fraser CM, Casjens S, Venter JC et al. (1997): Genomic sequence of a lyme disease spirochaete, borrelia burgdorferi. Nature,390,580-586
3. Hildenbrand P, Craven DE, Jones R, Nemeskal P (2009): Lyme neuroborreliosis: Manifestation of a rapidly emerging zoonosis. AM J Neurorad 30,6,1079-1087
4. Brorson O, Brorson SH (2002): An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to hydroxychloroquine. Int Microbiol 5,25-31
5. Liang FT, Yan J Mbow ML, Sviat SL, Gilmore RD, Mamula, Fikrig E (2004): Borrelia burgdorferi changes its surface antigenic expression in response to host immune responses. Infect Immun 72,10,5759-5767
6. Oksi J, Marjamäki M, Nikoskelainen J, Viljanen MK (1999): Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Ann Med 31,3,225-232
7. Zhang JR, Hardham JM, Barbour AG, et al. (1997): Antigenic Variation in Lyme Disease by Promiscuous Recombination of VMP- like Sequence Cassettes.Cell 96,3,447-487
8. Zückert WR (2014): Secretion of bacterial lipoproteins: through the cytoplasmic membrane, the periplasma, and beyond. Biochim Biophys Acta 1843,1509-1516
9. Sapi E, Bastian SL, Mpoy CM et al. (2012): Characterization of biofilm formation by borrelia burgdorferi in vitro. PLoS One7,10:e48277
10. Gasser R, Dusleag J (1990): Oral treatment of late borreliosis with roxithromycin plus cotrimoxazole. Lancet 336,1189-1190
11. Schardt FW (2004): Clinical effects of fluconazole in patients with neuroborreliosis. Eur J Med Res 9, 334-336
12. Busson L, Reynders M, van den Wijngaert S et al. (2012): Evaluation of commercial screening tests and blot assays for diagnosis of Lyme borreliosis. Diagn Microbiol Infect Dis. doi.10.10
13. Halperin JJ, Volkman DJ, Wu P (1991): Central nervous system abnormalities in Lyme neuroborreliosis. Neurology 41,1571-1582
14. Wormser GP, Dattwyler RJ, Shapiro ED et al. (2006): The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis and babesiosis: clinical practice guidelines by the Infectious Disease Society of America Clin Infect Dis 43,9, 1089-1134
15. Hoffmann B, Tappe D Hoepper D et al. (2015): Variedated sqirrel bornavius associated with fatal human encephalitis. N Engl J Med 373,2,154-162
16. Liu S, Bode L, Zhang L, et al. (2015): GC-MS-based metabonomic profiling displayed differing effects of Borna disease natural stain Hu-H1 and laboratory Strain V in rat cortical Neurons. Int J Mol Sci 16,8,19347-19368
17. Verhey TB, Castellanos M, Chaconas G (2018) Antigenic variation in Lyme spirochete: insights into recombinational switching with a suggested role for error-prone repair. Cell Rep 29; 23,9, 2595-2605
18. LinYP, Chen Q, Ritchie JA at al. (2015): Glycosaminoglycan binding by borrelia burgdorferi adhesin BBK32 specifically and uniquely promotes joint colonization. Cell Microbio 17; 860-875
19. Stanek G, Reiter (2011): The expanding Lyme borrelia complex-clinical significance of genomic species. Clin Microbiol Infect 17;4,487-493.
20. Khan G, Fitzmaurice C, Naghavi M et al. (2020) Global and regional incidence, mortality and disability-adjusted life-years for Epstein-Barr virus-attributable malignancies BMJ open 10;8: e037505
21. Amon W, Farrell PJ (2004): Reactivation of Epstein-Barr virus from latency Rev Med Virology 15;3,149-156
22. Khan G, Myashita EM Yang B et al. (1996): Is EBV persistence in vivo a model for B cell homeostasis? Immunity 5;2:173-179
23. Dreyfus DH (2011): Autoimmune disease: A role for new anti-viral therapies? Autoimmune Rev 11;2,:88-97
24. Popp M, Stegemann M, Riemer M et al. (2021): Intervention Antibiotics for the treatment of COVID-19. Cochrane Database of Systematic Reviews 10;10: CD015025
25. Thomas RJ, Dumler JS Carylon JA (2009): Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Expert Review of Anti-Infective Therapy 7;6:709-722
26. Krause PJ, Lepore MD, Vijay MD et al. (2000): Atovaquone and azithromycin for treatment of babesiosis. N Engl J Med 434:1454-1458
27. Longley N, Muzoora C, Taseera K et al. (2008): Dose-response effect of high-dose fluconazole for HIV-associated cryptococcal meningitis in southwestern Uganda. Clin Infect Dis 47;12:1556-1561
28. Steere AC, Angelis SM (2006) Therapy for Lyme arthritis: strategies for the treatment. Arthritis and Rheumatism, 54,10: 3079-86
29. Hurst NP, French JK, Gorjatschko L, Betts WH (1988): Chloroquine and hydroxychloroquine inhibit multiple sites in metabolic pathways leading to neutrophil superoxide release. J Rheumat 15,1,23-27
30. Fox R (1996): Anti-malaria drugs: possible mechanisms of action in autoimmune disease and prospects for drug development Lupus 5 (Suppl) 4-10
31. Paludetto NM, Kurkela M, Kahma H et al.(2023) Hydroxychloroquine is metabolized by cytochrome P450 2D6,3A4 and 2C8 and inhibits cytochrome P450 2D6 while its metabolites also inhibit cytochrome P450 3A in vitro. Drug Metab Dispos 51,3:293-305
32. Guo Z (2016): Artemisin anti-malaria drugs in China. Acta Pharmaceutica Sinica B 6;2:115-124
33. Esu EB,Effa EE Opie O et al. (2019 Artemether for severe malaria. Cochrane Database Systematic Reviews 6,6: CD 010678
34. Stover K, King ST, Robinson J (2012) Artemether-Lumefantrine: an option for malaria. Annals of Pharmacotherapy; 46,4: 567-577 Steere AC, Angelis SM (2006) Therapy for Lyme arthritis: strategies for the treatment. Arthritis and Rheumatism, 54,10: 3079-86
35. Lu J, Sun PD (2015). Structural mechanism of high affinity FcyRI recognition of immunoglobulin G. Immunological Reviews,268,1,192-201
36. Dietrich DE, Bode L, Spannhuth CW, et al. (2020): Antiviral treatment perspective against Borna disease virus 1 infection in major depression: a double-blind placebo-controlled clinical trial. BMC Pharmacology and Toxicologydoi.org/10.1186/s40360-020-0391-x
37. Bode L, Dietrich DE, Spannhuth CW, Ludwig H (2022): Prominent efficacy of amantadine against human borna disease virus infection in vivo and in vitro Comment on Fink et al. Amantadine inhibits SARS-CoV-2 in vitro. Viruses14,494
38. Berg JM, Tymoczko JL, Gatto GJ, Stryer L (2012) Biochemistry 8Th ed.,820-822
39. Azadmandesh J, Lutz WE, Coates L et al. (2021) Direct detection of coupled proton and electron transfer in human manganese superoxide dismutase. Nature Communications 12,1,2079-2085 Disulfiram as an anti-parasitic agent. Front Cell Infect Microbiol:11, 633194
40. Lin MH, Moses DC, Hsieh CH et al. (2018). Disulfiram can inhibit MERS and SARS coronavirus papain-like proteases via different modes. Antiviral Research 150,155-163
41. Tamburin S, Mantovani E, De Bernadis E et al. (2021). Covid-19 and related symptoms in patients under disulfiram for alcohol disorders. Internal and Emergency Medicine 16,6:1729-1731
42. Goc A, Rath M (2016): The anti-borrelia efficacy of phytochemicals and micronutrients: an update. Ther ADV Infect Dis; 3-4,75-82