Precision medicine: retrospective chart review and data analysis of 200 patients on dapsone combination therapy for chronic Lyme disease/post-treatment Lyme disease syndrome: part 1

Abstract

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 Babesia WA1/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.

Video abstract

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Keywords:

• Lyme disease
• babesiosis
• bartonella
• tick-borne co-infections
• Multiple Systemic Infectious Disease Syndrome
• MSIDS
• persister bacteria
• immune deficiency

Acknowledgments

We thank our Hudson Valley Healing Arts Center research team: Haley Moss Dillon, Sonja Siderias, Heather Orza, and Renee Nelson for their assistance, as well as Aron G Wiegand, Egamaria Alacam, and Connor Duncan who assisted us with data input. We acknowledge with thanks the Bay Area Lyme (BAL) Foundation and the MSIDS Research Foundation (MRF) for providing us research grants for the data mining portion of this study. Dr Richard I Horowitz would also like to express his appreciation to his colleagues and subcommittee members on the HHS Tick-Borne Disease Working Group for their dedication and expertise in the diagnosis and treatment of tick-borne disorders. The views expressed are those of Dr Richard I Horowitz and do not represent the views of the HHS Tick-Borne Disease Working Group. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript; and in the decision to publish the results.

Disclosure

The authors report no conflicts of interest in this work.