Author: Monica Carugatti
New note from La Nación about Lyme in Argentina : “The Lyme enigma: is the disease that Justin Bieber and celebrities have in Argentina?”
Mrs Gabriela Navarra’s note for La Nación gives us a fairly adequate view of the Lyme disease situation in Argentina. I recognize that it was difficult to develop due to the different discourses of patients and health authorities. It is a politically correct publication that allows us, the patients, to replicate some of the concepts issued by representatives of the health authorities.
In this article on my blog I try to explain some of the reasons why I consider the arguments expressed to be controversial and imply taking a position in a debate, others to be empty and highly contradictory arguments, and others just an act intended to deny the existence of Lyme in Argentina.
In all the explanations and in the publication to which the article refers, and signed by some of the professionals interviewed, the objective seems to be more to dismiss the evidence of the existence of a disease with a Lyme clinic after the bite of a tick, and positive in specialized laboratories abroad, than to look for how this disease originated, its characteristics, ticks, vectors, bacterial culture, etc. Nothing is said about this.
Before continuing, I would like to introduce two observations that, in my opinion, help to understand the dissidences in general.
We learned with Covid-19 that science is not unequivocal. The constant presence of infectious disease doctors in the media put us in the position of questioning ourselves about concepts that we often did not know and that were not part of our usual terminology. So the decision of who is right, in the vast majority of cases, goes more through ideology and empathy than through scientific foundation and / or an adequate understanding of dissidence.
In recent decades, unfortunately, evidence-based medicine replaced MEDICINE. The concept has been used and abused. If doctors base their profession only “on the evidence”, they leave without considering most of the aspects that must be taken into account in the medical care of a patient. Evidence should not be confused with existence. Evidence-based medicine is undoubtedly a fundamental advance for medicine, “but it brings us closer to knowing through a keyhole.” To this we must add the frequent non-compliance with the many necessary conditions in a scientific investigation. But this is a discussion that exceeds this space.
“From the ANLIS Malbrán they indicate that “neither the tick —the vector— nor the bacterium are in Argentine territory and that there are no autochthonous cases of Lyme. ”
This statement is false:
“In Argentina there are borrelias close to those that cause Lyme in Europe and North America, but they are not the same. It is not known if they cause any disease in humans or animals, they are of unknown pathogenicity.” Santiago Nava (La Nación, November 26, 2021) * (1) * (2) * (3)
1. Ixodes Scapularis is not the only tick that transmits Borrelia Burgdorferi sl and it is also not the only tick that transmits Lyme Disease. I do not know if Ixodes Scapularis exists in Argentina, but I do know that Ixodes Pararicinus, at least, is in Argentina and does transmit Borrelia spp. agent that causes Lyme disease. So Borrelia Burgdorferi sl is not the only Borrelia that transmits Lyme Disease and/or Relapsing Fever.*(4) *(6)
The truth is that there are many strains of Borrelia that cause the disease, for example Borrelia Miyamotoi, Borrelia Garini, Borrelia Afzelii, etc. Others isolated and others without isolation. Amblyomma Cajennense transmits in Brazil a borrelia with a different morphology and that does not belong to the Borrelia Burgdorferi group, which has not been cultivated and which generates a disease called Baggio-Yoshinari or Brazilian Lyme that gives a very serious clinical picture very similar to Lyme. *(5) * (3)
2. The arguments given to us in the note by ANLIS and Dr. Nava indicate a lack of knowledge of the situation in the world, where new ticks carrying different strains of borrelia are constantly being found, generating similar clinical pictures and which are included in the diagnosis of Lyme disease. If we were rigorous with the denominations and only called Lyme disease the borreliosis caused by the borrelia isolated by Willy Burgdorfer, we should give another name to the borreliosis produced by Borrelia Garini, B. Afzeli, B. Miyamotoi, etc., which is not the case. is done or is done less and less.
3. Fundamentally, these arguments deny the reality that we patients with a Lyme Disease clinic have and that in addition to responding to antibiotics (specific and in sufficient quantity), they have positive laboratories by different techniques and that they have been stung in the national territory. .
4. The arguments in the note from ANLIS and Dr. Nava are perverse in intent and want to make the interviewer and the population believe that there is no Lyme in Argentina, using technical language from a place of power and knowledge, to confuse.
“Between 2014 and 2019, Malbrán analyzed 31 clinical samples with suspected autochthonous Lyme; some with positive results in tests carried out with methods not validated by the US FDA.” All were negative, “they indicated.” * (7)
I hope that this study is not the only one that concludes that there are no patients with autochthonous Lyme in Argentina, that the bacteria is not present and neither is the vector. The only thing that this Malbrán study says is that the Western Blot results in a US laboratory are negative. A conclusion cannot be drawn from this publication indicating that there is no indigenous Lyme in Argentina because the conditions are not met.
1. The diagnosis of Lyme is clinical. In mid -2019, the CDC issued a disclaimer where it rightly says that the double standard tests used for research (Elisa and Western blot) “are not suitable” for the diagnosis and treatment of patients, whose diagnosis must be be a clinician * (8) * (9) *(10)
“A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance.
A systematic meta-analysis of published data shows that the mean sensitivity of the test at two levels is only 35.4% in the acute stage and 64.5% in the convalescent stage, with an overall sensitivity of 59.5% . The unreliability of the two-tier test is compounded by the widespread misconception among health care providers and insurers that patients must test positive according to surveillance criteria to confirm they have a legitimate case. of Lyme disease. This action was taken after a Data Quality lawsuit for a complaint filed by the Patient-Centered Care Advocacy Group on May 20, 2019.
The CDC surveillance case definition included the presence of Erythema Migrans. However many patients never have the rash. (Between 30% and 70% of patients do not have MS, according to different investigations.)
2. On the other hand, these tests were performed after the first positive tests, by different laboratories, by different technicians, and nothing is said about the clinical picture of these patients. “Serologic tests…do not identify the presence or absence of BB, but instead detect the presence of an antibody response that can be attributed to exposure to this pathogen. Of the dozens of serologic tests available on the U.S. market, none are FDA-approved Rather, they are all FDA-approved, meaning the test compares favorably with other tests already in use and works at least as well as the others, but has not been clinically validated in studies None have shown clear performance superiority. The reliability of diagnostic tests depends on their accuracy and reproducibility. Precision is the ability of a test to detect disease when it is present and not detect disease when it is absent, and reproducibility is the ability of a test to give the same result for a sample on repeated testing. High-precision tests generate few false negatives and few false positives. Unfortunately, Lyme serology produces many false negatives and false positives. In addition, investigators have repeatedly shown that both Lyme Elisa and immunoblot tests have poor reproducibility.”*(11)
“Don’t forget that these are just tests that don’t show the presence of an infection. To show a Borrelia infection you need to isolate Borrelia Burgdorferi from joint biopsies and then try to culture.” – Armin Schwarzbach *(12)
*(1) Borrelia Burgdorferi in Argentina: scientific publications (part 1)
*(2) Borrelia Burgdorferi in Argentina: scientific publications (part 2)
*(3) Lyme in neighboring countries
*(4) Wild birds as host of Borrelia burgdorferi sensu lato in northwestern Argentina
*(5) Borrelia sp. phylogenetically different from Lyme disease- and relapsing fever-related Borrelia spp. in Amblyomma varanense from Python reticulatus
*(6) Microbiology in Clinical Practice (Second Edition), 1989 (Borrelia)
* (7) SUSPECTED LYME DISEASE IN ARGENTINA, STATUS.
* (8) CDC Information Correction Request
*(10) CDC agrees to add disclaimer to Lyme disease case definition
* (11) ILADS – Research and Literature: Controversies and Challenges
* (12) Complexities of modern laboratory techniques Dr. Armin Schwarzbach