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

Figures & data

Table 1 Percent severity ratings before dapsone and with dapsone combination therapy

Symptoms	Severity rating	Pre-DDS* (%)	DDS* (%)
Fatigue	1	3	9.1
	2	9.1	26.7
	3	25.5	37
	4	39.4	20
	5	23	7.3
Muscle	1	12.7	18.8
	2	13.3	34.5
	3	30.3	27.9
	4	31.5	13.9
	5	12.1	4.8
Headache	1	35.8	40
	2	19.4	37.6
	3	24.8	12.7
	4	12.1	5.5
	5	7.9	4.2
Tingling	1	26.1	37
	2	24.8	35.8
	3	27.9	15.8
	4	13.3	7.9
	5	7.9	3.6
Sleep	1	17.6	24.8
	2	18.8	29.7
	3	25.5	24.2
	4	21.8	11.5
	5	16.4	9.7
Forgetfulness	1	9.1	20
	2	13.3	34.5
	3	30.3	23.6
	4	28.5	13.3
	5	18.8	8.5
Speech	1	23.6	35.2
	2	23	33.9
	3	29.1	18.8
	4	15.2	9.1
	5	9.1	3
Sweats	1	33.9	50.3
	2	17.6	31.5
	3	23	12.7
	4	15.8	4.2
	5	9.7	1.2

Notes:

* N=165. For each symptom, we see larger percentages for moderate or very severe ratings in the “pre” column, and those numbers shift over to none/mild/moderate in the “DDS” column. These results indicate that dapsone combination therapy decreased severity of all eight symptoms.

Abbreviations: DDS, dapsone; Pre-DDS, pre-dapsone.

Table 2 Frequency and percentage of positive CDC IgG and IgM Western blots with positive bands 31 and 34 kDa and a negative ELISA or negative C6 ELISA

		Negative tests
		ELISA (N=31)	C6 ELISA (N=49)
IgG Western blot	Band 31 (+)	4 (12.9%)	16 (32.7%)
	Band 34 (+)	4 (12.9%)	8 (16.3%)
	CDC (+)	1 (3.2%)	7 (14.3%)
IgM Western blot	Band 31 (+)	12 (38.7%)	19 (38.8%)
	Band 34 (+)	8 (25.8%)	10 (20.4%)
	CDC (+)	7 (22.6%)	23 (46.9%)

Notes: A significant percentage of positive Osp A (38%) and Osp B (25%) bands were found on CDC negative IgM Western blots (with negative ELISA or C6 ELISA). A significant percentage of positive Osp A (25%) and Osp B (15%) bands were also found on CDC negative IgG Western blots (with a negative ELISA, C6 ELISA).

Abbreviation: CDC, Centers for Disease Control and Prevention.

Table 3 Babesia subtypes by demographic region in 200 Lyme disease patients

	N	Babesia duncani	Babesia microti
East Coast (North)	155	43	44
East Coast (South)	20	6	3
Midwest	16	6	3
West Coast	1	0	0
Other (Hawaii)	1	1	1
International	7	0	0

Notes: Positive antibody testing for B. microti and B. duncani among 200 patients with Lyme disease living in diverse geographic areas of the United States.

Figure 1 Percentage of 200 patients with IgM Western blot band(s) over the course of treatment.

Notes: Percentage of positive IgM Western blot bands over the course of treatment. A high percent of Borrelia-specific bands (23, 31, 34, 39, 83/93 kDa) are present on the IgM Western blot in 200 patients.
Abbreviation: IgM, immunoglobulin M.

Figure 2 Percentage of 200 patients with IgG Western blot band(s) over the course of treatment.

Notes: Percentage of positive IgG Western blot bands over the course of treatment among 200 individuals. A significant percentage of individuals had the presence of the 30, 31, and 34 kDa bands on an IgG Western blot.
Abbreviation: IgG, immunoglobulin G.

Figure 3 Percentage of patients with EM rashes and positive Lyme testing.

Notes: Percentage of patients with EM rashes and positive Lyme testing. A low percentage of positive EM rashes with a high percentage of CDC IgM Western blots were found in our 200 patients.
Abbreviations: CDC, Centers for Disease Control and Prevention; EM, erythema migrans; IFA, immunofluorescent antibody; IgM, immunoglobulin M; LTT, lymphocyte transformation test.

Figure 4 Percent positive testing for coinfections over the course of treatment among 200 Lyme disease patients. These results demonstrate a high percentage of co-infections.

Abbreviations: CMV, cytomegalovirus; EBV, Epstein–Barr virus; H. pylori, Helicobacter pylori; HHV6, human herpes virus 6; HSV1, Herpes simplex virus 1; HSV2, Herpes simplex virus 2; RMSF, Rocky Mountain spotted fever.

Figure 5 Indirect and direct Babesia diagnostic testing among 200 patients with Lyme disease.

Note: Results demonstrate the percentage of positive B. microti and B. duncani titers, and percentage of positive direct testing (PCR, FISH, blood smear/positive Giemsa stain).
Abbreviations: FISH, fluorescent in situ hybridization; PosGi, positive Giemsa.

Figure 6 Antibody-positive Babesia duncani cases by home state in 200 patients.

Notes: US regional frequency of positive testing for B. duncani. Dark colored states indicate home states of patients with positive B. duncani testing.