Lyme disease is caused by a bacterium transmitted to humans via a tick bite. The CDC (Center for Disease Control) claims that Lyme Borreliosis is the most common and fastest growing infectious illness in the United States. The disease can cause a variety of flu-like symptoms such as fever, achy joints, fatigue and headache. En outre, Anaplasmosis/Ehrlichiosis, Babésiose, Rocky fièvre pourprée des montagnes, Bartonella, Tularémie, et, plus récemment,, Borrelia Miyamotoi (un parent éloigné de la maladie de Lyme) are other recognized tick-borne infectious diseases in the United States.
Experts have been unable to agree for decades on whether a case definition called chronic Lyme disease exists. Encore, some Lyme victims, même après avoir pris le traitement standard des antibiotiques, continue to suffer from long-term and often serious health problems for years after they first contract the disease. Does chronic Lyme disease exist, or is the condition which some patients experience an autoimmune or nervous system response triggered by the infection, or indeed is it a bit of both? These are some of the major questions researchers are trying to figure out as they take on the enormous challenges of identifying better Lyme diagnostic tools and treatment plans for what is becoming a growing global public health crisis.
Aujourd'hui, dans La recherche globale pour l'éducation, I take a look at tick-borne illnesses in Finland. I am joined by Docent Jarmo Oksi, Finland’s leading researcher in the field of Lyme disease, who is based at the University of Turku in Finland. En outre, I welcome Markku Kuusi, Chief Medical Officer from Finland’s National Institute for Health and Welfare.
What is the annual incidence of Lyme disease in Finland and in Europe at large?
Jarmo: Laboratory reports on Lyme Borreliosis cases (based on positive serology) have doubled in 10 years and are now about 1,500. The estimated number of Lyme Borreliosis infection cases is about four times this number — i.e. estimated incidence in Finland is 5,000-6,000 annually (population 5.5 million), qui est d'environ 100 à 100,000 inhabitants per year. However there are areas in the Southwestern Archipelago with incidence of 1000 à 100,000 inhabitants per year.
Markku: Based on the National Infectious Disease Register, the incidence of Lyme disease in Finland has been about 30/100,000 during the past few years. In terms of the annual incidence in other Nordic countries, in Norway it has been about 6/100,000 and in Denmark, 1 – 2/100,000. It is hard to believe that there is such a difference in actual incidence, so that is why I believe the diagnostic criteria are truly different. The weakness of the Finnish surveillance system is that we don’t collect any clinical information on patients, we only get notifications from laboratories; so it is difficult to say whether the symptoms of our cases really are compatible with Lyme Borreliosis.
Would you comment on the annual incidence of any of the other tick-borne illnesses which are endemic in Finland in addition to Lyme.
Markku: Tick-borne Encephalitis (TBE) is another important tick-borne disease in Finland. The incidence has been particularly high on Aland Island and therefore TBE vaccination is included in the national immunization program. Before the vaccination program, the annual incidence was up to 100/100,000 population. Now it has decreased substantially. It seems that in other parts of Finland (apart from Aland Island), the incidence is increasing, and therefore other areas may also be included in the immunization program in the near future (par exemple, the Archipelago around the city of Turku).
Croyez-vous que la maladie de Lyme chronique existe ou que ce est un abus de langage pour d'autres maladies provoquées par la maladie de Lyme?
Markku: Ceci est une question difficile. I think it is clear that some patients have a prolonged course of the disease which may last several months. The most experienced clinicians in Finland think that a continuing Borrelia infection is possible if the patient has not received adequate treatment for the illness, resulting in disseminated infection. Even after adequate treatment, some patients have symptoms due to immunological mechanisms, but it is very hard to say whether these symptoms are related to Borrelia infection or to some other causes.
Si vous croyez dans la maladie de Lyme chronique, ce sont, selon vous les moyens les plus efficaces pour le traiter?
Jarmo: If you mean chronic infection, I think that this entity after standard antibiotic therapy is very very seldom (I see about one case in five years). Cependant, if detected –e.g. with cultivation or PCR (the most specific way to detect), the treatment I give is individual antibiotic treatment — maybe double the length compared to the initial treatment.
What do you believe is the most effective way to treat symptoms triggered by the infection, e.g. chronic auto-immune reaction?
Jarmo: During the first months I wait for gradual improvement. If there is no improvement after six to 12 mois, I then start low-dose corticosteroid treatment for a certain subset of patients. Some other subsets may get help from, par exemple, amitriptyline, which raises the threshold for pain sensation.
Quels sont les tests actuellement à la disposition du grand public, other than the Western Blot test, croyez-vous fournir un meilleur degré de certitude?
Jarmo: PCR (et la culture) are useful in some situations (culture only in research settings), but even PCR is not sensitive enough to detect all cases — e.g. in CSF (cerebrospinal fluid) of neuroborreliosis cases. Besides Western Blots, ELISA tests based on C6 peptide are generally good as confirmatory tests.
Are you aware of any other promising tests in development?
Markku: L'année dernière, a Finnish group reviewed the diagnostic tests in our country. It is my understanding that right now there are not unfortunately any new reliable tests available. So we shall have to wait awhile for them.
To what research do you believe scientists around the world must give priority in order to overcome the challenges the public faces with finding a cure for Lyme disease?
Markku: I think it is important to better understand the mechanism behind the sequelae of acute borreliosis. Donc, we need more research on the immunology of the disease. En d'autres termes, how does the bacteria actually cause joint symptoms or neurologic symptoms. I think this will help us to develop better diagnostic tests and hopefully better drugs. I believe antibiotics are not the only solution.
Quel est l'objet de votre recherche et comment fonctionne-t-il lié aux défis de l'identification et le traitement de la maladie de Lyme et les maladies déclenchées par Lyme?
Jarmo: We are currently enrolling patients into a study on neuroborreliosis: comparison of IV Ceftriaxone for three weeks vs. oral Doximycin for four weeks. Hopefully this study (with control CSF specimens) and long follow-ups of patients also will give us new knowledge on markers of how to identify patients with reactive symptomatology triggered by Lyme neuroborreliosis.
How can technology help us find a cure for Lyme disease faster?
Markku: This is not really a field in which I am knowledgeable, but I believe that better molecular and immunological methods may give possibilities for new diagnostics and for the development of new drugs. What I really hope is that there will be better and more specific laboratory tests for Lyme Borreliosis in the future. I think that one of the key issues is to harmonize the laboratory methods so that we can get a better understanding of the epidemiology of Lyme disease in Finland.
For more information about Lyme and Tick-Borne Diseases, and Prevention and Protection, aller à http://www.TBDAlliance.org.
Photographs courtesy of CDC, National Institute for Health and Welfare Finland, and Docent Jarmo Oksi.
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Dans La Recherche globale pour l'éducation, joindre à moi et leaders d'opinion de renommée mondiale dont Sir Michael Barber (Royaume-Uni), Dr. Michael Bloquer (États-Unis), Dr. Leon Botstein (États-Unis), Professeur Clay Christensen (États-Unis), Dr. Linda Darling-Hammond (États-Unis), Dr. Madhav Chavan (Inde), Le professeur Michael Fullan (Canada), Professeur Howard Gardner (États-Unis), Professeur Andy Hargreaves (États-Unis), Professeur Yvonne Hellman (Pays-Bas), Professeur Kristin Helstad (Norvège), Jean Hendrickson (États-Unis), Professeur Rose Hipkins (Nouvelle-Zélande), Professeur Cornelia Hoogland (Canada), Honorable Jeff Johnson (Canada), Mme. Chantal Kaufmann (Belgique), Dr. Eija Kauppinen (Finlande), Le secrétaire d'Etat Tapio Kosunen (Finlande), Professor Dominique Lafontaine (Belgique), Professeur Hugh Lauder (Royaume-Uni), Professeur Ben Levin (Canada), Seigneur Ken Macdonald (Royaume-Uni), Professeur Barry McGaw (Australie), Shiv Nadar (Inde), Professeur R. Natarajan (Inde), Dr. PAK NG (Singapour), Dr. Denise Pape (États-Unis), Sridhar Rajagopalan (Inde), Dr. Diane Ravitch (États-Unis), Richard Wilson Riley (États-Unis), Sir Ken Robinson (Royaume-Uni), Professeur Pasi Sahlberg (Finlande), Andreas Schleicher (PISA, OCDE), Dr. Anthony Seldon (Royaume-Uni), Dr. David Shaffer (États-Unis), Dr. Kirsten immersive, (Norvège), Chancelier Stephen Spahn (États-Unis), Yves Thézé (Lycee Francais U.S.), Professeur Charles Ungerleider (Canada), Professeur Tony Wagner (États-Unis), Sir David Watson (Royaume-Uni), Professeur Dylan Wiliam (Royaume-Uni), Dr. Mark Wormald (Royaume-Uni), Professeur Theo Wubbels (Pays-Bas), Professeur Michael Young (Royaume-Uni), et le professeur Zhang Minxuan (Chine) alors qu'ils explorent les grandes questions d'éducation de l'image que toutes les nations doivent faire face aujourd'hui. La recherche globale pour l'éducation communautaire page
C. M. Rubin est l'auteur de deux séries en ligne largement lecture pour lequel elle a reçu une 2011 Upton Sinclair prix, “La recherche globale pour l'éducation” et “Comment allons-nous savoir?” Elle est également l'auteur de trois livres à succès, Y compris The Real Alice au pays des merveilles.
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