Effects of Dapsone & Intracellular Antibiotics on B. Burgdorferi


Lyme disease is a tick-borne, multisystemic disease caused by Borrelia burgdorferi. Standard treatments for early Lyme disease include short courses of oral antibiotics but relapses often occur after discontinuation of treatment. Several studies have suggested that ongoing symptoms may be due to a highly antibiotic resistant form of B. burgdorferi called biofilms. Our recent clinical study reported the successful use of an intracellular mycobacterium persister drug used in treating leprosy, diaminodiphenyl sulfone (dapsone), in combination therapy for the treatment of Lyme disease. In this in vitro study, we evaluated the effectiveness of dapsone individually and in combination with cefuroxime and/or other antibiotics with intracellular activity including doxycycline, rifampin, and azithromycin against Borrelia biofilm forms utilizing crystal violet biofilm mass, and dimethyl methylene blue glycosaminoglycan assays combined with Live/Dead fluorescent microscopy analyses.


Dapsone, alone or in various combinations with doxycycline, rifampin and azithromycin produced a significant reduction in the mass and protective glycosaminoglycan layer and overall viability of B. burgdorferi biofilm forms. This in vitro study strongly suggests that dapsone combination therapy could represent a novel and effective treatment option against the biofilm form of B. burgdorferi.

You can read the entire study on BMC Research Notes. 

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Lyme in the Arctic?

In the latest sign of climate change, Bartonella henselae, a coinfection of Lyme usually found in more temperate regions, has been detected in the blood of arctic foxes. Research suggests that migratory geese have given Bart-infected fleas a ride north, where the bacterium can now survive. Below we share the abstract of the study. You can read the entire @BioMedCentral post here. 

In a warmer and more globally connected Arctic, vector-borne pathogens of zoonotic importance may be increasing in prevalence in native wildlife. Recently, Bartonella henselae, the causative agent of cat scratch fever, was detected in blood collected from arctic foxes (Vulpes lagopus) that were captured and released in the large goose colony at Karrak Lake, Nunavut, Canada. This bacterium is generally associated with cats and cat fleas, which are absent from Arctic ecosystems. Arctic foxes in this region feed extensively on migratory geese, their eggs, and their goslings. Thus, we hypothesized that a nest flea, Ceratophyllus vagabundus vagabundus (Boheman, 1865), may serve as a vector for transmission of Bartonella spp.

We determined the prevalence of Bartonella spp. in (i) nest fleas collected from 5 arctic fox dens and (ii) 37 surrounding goose nests, (iii) fleas collected from 20 geese harvested during arrival at the nesting grounds and (iv) blood clots from 57 adult live-captured arctic foxes. A subsample of fleas were identified morphologically as C. v. vagabundus. Remaining fleas were pooled for each nest, den, or host. DNA was extracted from flea pools and blood clots and analyzed with conventional and real-time polymerase chain reactions targeting the 16S-23S rRNA intergenic transcribed spacer region.

Bartonella henselae was identified in 43% of pooled flea samples from nests and 40% of pooled flea samples from fox dens. Bartonella vinsonii berkhoffii was identified in 30% of pooled flea samples collected from 20 geese. Both B. vinsonii berkhoffii (n = 2) and B. rochalimae (n = 1) were identified in the blood of foxes.

We confirm that B. henselae, B. vinsonii berkhoffii and B. rochalimae circulate in the Karrak Lake ecosystem and that nest fleas contain B. vinsonii and B. henselae DNA, suggesting that this flea may serve as a potential vector for transmission among Arctic wildlife.

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The CDC Unveils New Prevention Framework

This week the CDC unveiled its new ‘National Public Health Framework for the Prevention and Control of Vector-Borne Diseases’. It included a lofty yet admiral vision of eliminating the threat of vector borne diseases from humanity. Some goals include better understanding of when, where and how people are exposed, getting sick and dying.

In order to achieve their goals they need to effectively engage with “a multidisciplinary set of stakeholders must be engaged, activated, and resourced. The stakeholders include the federal government; state, tribal, local, and territorial health departments; vector control agencies; healthcare providers; academic and industry partners; policy and decision-makers, including Congress and elected community leaders; public health partners, such as nonprofit organizations and associations of medical, entomological, and vector control professionals; and the public, including patients.”

Project Lyme is skeptical of these efforts because of the history between CDC and vector-borne illnesses, but hopeful nonetheless.

Read the entire CDC framework here.   

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“Living Well With Lyme Disease”

Despite being the most common vector-borne disease in America, myths about Lyme disease abound. So when we caught a U.S. News & World Report article with the somewhat provocative title “Living Well With Lyme Disease,” we simply had to take a look at the facts. And while the article deserves some credit for acknowledging the existence of chronic Lyme, which many sources refuse to do, the misinformation is legion.

  1. Transmission Time

The article claims, “If the tick latches on to a human host, it usually takes anywhere from 48 to 72 hours for the bacteria to travel from the tick’s gut to where it makes contact with human blood and results in transmission, and in turn causes Lyme disease.” This false but surprisingly resilient myth has been circulating the internet and even repeated by doctors for decades. The truth is that no one knows the minimum time it takes for Lyme to be transmitted by a tick bite under a range of circumstances.

The CDC reports 36 to 48 hours as the average transmission time for Lyme, and that gives a false sense of security as well. Other peer review says Lyme disease risk is low, but possible, if ticks are attached for at least 24 hours. But other experts point out that no minimum time has ever been established for transmission of Borrelia burgdorferi. In fact, a number of circumstances mean risk of rapid transmission could be high: For instance, if you accidentally squeeze a tick while trying to remove it, spirochetes can be inadvertently injected. And if a tick has partially bitten an animal but fallen off, spirochetes can remain in the mouth parts and salivary glands, creating the potential for efficient transmission upon a second bite. 

Finally, the microorganism matters. Different genospecies of Borrelia take more or less time to travel from the midgut to the mouth, and the deadly Powassan virus, though rare, can be transmitted by a deer tick in 15 minutes. Bottom line: Do not treat any tick attachment casually. Have the tick removed by someone who understands tick-removal techniques. And do consult with a Lyme literate M.D.

2.  Number of Annual Cases

The article cites statistics from the CDC, which acknowledges that while state health departments report approximately 30,000 cases of Lyme disease in the U.S. each year, the true number of cases is closer to ten times that amount (approximately 300,000 per year). However, a survey of large commercial laboratories using 2008 data revealed that the number of annual cases was closer to 444,000. Since Lyme rates have increased in following years, we can extrapolate that the number of annual cases has too. In other words, Lyme is more widespread than the CDC reports.

3. Lingering and Persistent Symptoms

The article calls Lyme disease in its acute form “very easily treatable” and in its chronic form “manageable.” This attitude overlooks the experiences of many actual Lyme patients, some of whom see their health crater and lives derail for years. Evidence is hardly just anecdotal. A study from Johns Hopkins (which still uses the unfortunate term “post-Lyme syndrome” to describe patients still sick with Lyme) found disturbing inflammation in the brain scans of those who were chronically ill. The New England Journal of Medicine found patients who stayed sick were as impaired as those with congestive heart failure and sicker than those with type two diabetes. A patient-run study, called My Lyme Data, has documented patient financial hardship, late diagnoses, and devastating ongoing symptoms from pain to confusion for the chronic group.  

4. The Bull’s-Eye Rash

The article claims that the erythema migrans bull’s-eye rash occurs in “70% to 80% of patients,”  but this is wildly misleading. According to some studies, as few as 27% ever see or exhibit a Lyme rash.  Depending on the study, estimates range widely. Even the CDC reports rashes in anywhere from 51%-87% of patients; in short, studies by a range of researchers fall all over the map—43% were said to have rashes in the state of Maine and less than 50% of children in Vermont. As to the famous bull’s-eye rash, it is even rarer, appearing in less than 20% of patients, studies show.  

As long as readers keep in mind these missteps, there’s a lot of information in “Living Well With Lyme Disease” that may prove useful, particularly to those who are less familiar with this common tick-borne disease. 

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Rabies To The Rescue

Utpal Pal, PhD, professor in Veterinary Medicine at the University of Maryland (UMD) will be partnering with Matthias Schnell, director of the Jefferson Vaccine Center at Thomas Jefferson University to develop a novel “next-generation” Lyme disease vaccine.

Pal, a tick immunobiologist, and Schnell, whose lab studies rabies virus as a platform for vaccination, will adapt the rabies virus platform to fight Lyme disease.  The inactivated rabies virus, which helps the body produce antibodies to fight rabies, will be repurposed to produce other types of proteins that can fight Borrelia burgdorferi, the Lyme disease bacteria, a technique found effective for other viral vaccinations.

This study will test the four already identified vaccine candidate proteins, as well as the three major types of rabies vaccine platforms– using live attenuated virus, inactivated virus, and the shell of a virus with viral proteins on the outside but no virus inside to trick the body.  Pal is also studying both Borrelia proteins and the tick proteins that keep the Borrelia alive so it can be tramsmitted to humans.

Read more here.

Based on the track records of Lyme vaccines, Project Lyme will monitor the studies progress closely for safety and efficacy. 

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Ticks Are Climbing Mountains In Italy

In mountain areas of northwestern Italy, ticks were rarely collected in the past. In recent years, a marked increase in tick abundance has been observed in several Alpine valleys, together with more frequent reports of Lyme borreliosis. We then carried out a four-year study to assess the distribution and abundance of ticks and transmitted pathogens and determine their altitudinal limit in a natural park area in Piedmont region.

Ixodes ricinus and Dermacentor marginatus were collected from both the vegetation and hunted wild ungulates. Tick abundance was significantly associated with altitude, habitat type and signs of animal presence, roe deer’s in particular. Ixodes ricinus prevailed in distribution and abundance and, although their numbers decreased with increasing altitude, we recorded the presence of all active life stages of up to around 1700 m a.s.l., with conifers as the second most infested habitat after deciduous woods.

Learn more by reading the entire study.

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University of Idaho Leads $6 million Study of Lyme Disease

 A research team with the University of Idaho will take the lead in a major nearly $6 million cooperative agreement designed to better prevent and respond to the surging numbers of tick-borne illnesses in the United States.

The four-year, $6 million National Science Foundation study will see researchers design a data framework that will help track the spread of illnesses linked to tick bites. Teams are particularly focused on the spread of disease east-to-west across the U.S., according to the University.

“The thing about tick data is, once you get out of the Midwest and East Coast, these data are very sparse,” said Lucas Sheneman, grant participant and director of U of I’s data management center, the Northwest Knowledge Network. “Databases that are out there are so siloed, they don’t communicate with each other. What we’re proposing is developing one comprehensive data framework to offer compatible resources to scientists and the general public.”

There will also be student groups at U of I’s Polymorphic Games studio working to put together a video game, among other educational resources, designed to reach K-12 students about risks and safety connected to tick-borne illnesses. Lyme disease and other tick-related illnesses disproportionately affect children ages 5 through 10.

Read the rest of the article here.  

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A New Infectious Tick-Borne Disease In China

A new infectious disease caused by a tick-borne virus has killed seven people and infected 60 others in China, official media here reported on Wednesday, warning about the possibility of its human-to-human transmission.

More than 37 people in East China’s Jiangsu Province contracted with the SFTS Virus in the first half of the year. Later, 23 people were found to have been infected in East China’s Anhui province, state-run Global Times quoted media reports.

SFTS Virus is not a new virus. China has isolated pathogen of the virus in 2011, and it belongs to the Bunyavirus category.

Virologists believe that the infection may have been passed on to humans by ticks and that the virus can be transmitted between humans, it said.

Read the entire article here.

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Symptoms Overlap

With the novel SARS-CoV-2 virus still spreading across the country, some experts worry about the overlap between COVID-19 and Lyme disease, which is caused by a bacterium carried by black-legged ticks. While it’s too soon to know exactly how the pandemic will affect Lyme disease rates this year, experts like Brinkerhoff wonder if more people spending time outside beating the quarantine blues could lead to more people being exposed to disease-carrying ticks. Some overlapping symptoms might also lead to delayed diagnosis and treatment of Lyme, he notes.

At the same time, weather patterns in some parts of the country may actually lead to fewer Lyme disease cases this year. No matter the broader trends, there are things anyone getting outside can do to protect themselves from ticks.

Read the full article from Discover magazine!

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Reimagining Non-profits Capabilities During the Virtual Era

The nonprofit sector, like the rest of the world, has been completely upended as a result of the COVID-19 pandemic. Luckily for Project Lyme, we were able to host our annual fundraising Gala in February before the lockdown and social distancing kicked in. It was imperative for our organization because this yearly fundraiser covers the costs of most operations and programming. Without it, the future of Project Lyme could have been at stake. This is a common theme for many nonprofits in this era. According to a June study by Charities Aid Foundation of America, 97.4% of organizations anticipate a decrease in fundraising over the next twelve months. Additionally, 87.9% of nonprofits chose to cancel their major events. Project Lyme was able to bank our funds from the Gala, but we cannot bank on being able to host another in-person fundraiser this year. As a result, we developed a digital strategy made to support our donors’ journeys.

As the pandemic began to grow, our Board responded to the needs of the community and created a Lyme and COVID-19 Facebook group run by Dr. Robert Bransfield. It was consistently updated with relevant information imperative to its 2,200 immunocompromised members, and provided a safe place free of misinformation. Starting in April, we filmed a series of videos addressing the impacts of the COVID-19 crisis. Seen by over 85,000 people, this series provided much needed guidance from experts in the field. Board Member David Roth hosted Dr. Richard Horowitz drew comparisons between COVID and Lyme in a discussion about David’s bout with both diseases and the similarity in treatment Dr Robert Hedaya and his son Joshua spoke about having COVID-19, treating a family member, and the psychological effects that face both Lyme and COVID patients. In May, during Lyme Awareness Month, our Advisory Board Member and notable Lyme Advocate Mellissa Bell hosted Dr Steven Phillips discussing how to overcome the unique challenges facing those needing treatments, especially in a pandemic situation. Later that month, Board Member Isabel Rose hosted Dr. Linda Lancaster, a holistic practitioner who gave an enlightening conversation to educate on alternative treatment methods. In late June, Dr Brian Fallon hosted a Facebook Live where he answered questions from our audience on some of his current studies with Columbia University, such as the use of disulfiram to treat chronic Lyme Disease and the benefits of meditation and yoga. This important content was delivered across all media platforms to ensure accessibility and reach.

In July, Project Lyme wanted to provide a unique take on awareness content. We employed Lyme survivor and The Voice Finalist Ryan Quinn to help us achieve this goal. He hosted a Facebook Live performance and PSA where he played a variety of popular songs while sharing his personal experiences with the disease. Ryan felt that “this event both built community and provided awareness. I’m sure most people that tuned-in have been affected by Lyme Disease or another tick-borne illness in some way. All the comments were positive and supportive, and provided someone like me the platform to not only sing, but to tell my own Lyme Disease story”. While the participants of the event felt rewarded, the ROI of the event was still important to the Board of Directors. The performance was an immediate hit with around 7,000 views in the first week. There was also lots of engagement from Lyme survivors thanking Ryan for his bravery and sharing their own story in the comments section.

For our programs team, the pandemic also meant quick action. Generation Lyme, a Project Lyme initiative, made the transition to virtual service almost immediately. Generation Lyme traditionally hosts in-person support meetups on a month-to-month basis, but since the pandemic hit they began hosting three virtual Zoom meetups per week. Project Lyme’s capacity for direct service and support has exploded since moving to virtual platforms, with less liability and other costs associated with it. Generation Lyme expects to serve 1,200 individuals this year.

Project Lyme is a prime example of how adversity must be met head on. The COVID-19 pandemic has altered the fabric of the non-profit industry, yet we found a way to continue to meet our mission. Not only are we thankful to our community for continuing to support and engage with our content but we encourage other nonprofits to reassess how they view their structure and achieve their goals. Moving forward, our organization will continue to think critically about how we can produce content, and engage with Lyme patients to help them live their healthiest lives.

Noah Johnston is the Administrative Director of Project Lyme, a 501(c)(3) based in New York City that focuses on mission critical investments in research, advocacy, education and awareness for Lyme disease and related tick-borne illnesses.

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