Post-treatment Lyme disease syndrome (PTLDS) exists. Although many patients complain of post Lyme symptoms, doctors sometimes do not recognize this for what it is. Because the post Lyme complaints and symptoms are all related to a pathological late and slow inflammation, and treatment of these cases with palmitoylethanolamide (Peapure) have yielded positive results, here a detailed description of such a post lyme disease case.
Dose of PeaPure: 3 times 400 mg during at least 3 months in cases of post Lyme inflammation. This natural anti-inflammatory agent is available as a supplement via the internet and directly via a pharmacy in San Diego (USA). Palmitoylethanolamide is a body-own molecule and side effects have not been reported. It can be combined with any other supplement or prescription drug, PeaPure is not an antibiotic however, it does not kill the parasites, if an infection is still ongoing.
The cases of positive response on palmitoylethanolamide and its use have been described in German.
Post Lyme disease syndrome description
Two weeks after completing a course of antibiotics, e female Lyme patient began experiencing lower-extremity neuralgia as well as tingling in her hands. She described her pain as “electrical currents running down her legs.”
The patient visited her primary care provider, who started a second 30-day treatment of doxycycline (500 mg twice daily) and gabapentin (900 mg daily before bed).
The patient has been referred to a local physician who has extensive experience with Lyme Disease for continued management of her medical therapy.
At the time of the case report, a year later, this patient reports that her symptoms include chronic fatigue and intermittent arthralgia that has required a cane to mobilize at times. Her only medication is methylphenidate (36 mg daily) for fatigue.
Few of Lyme patients will have persistent arthritis after antibiotic therapy, and are classified as antibiotic-refractory Lyme arthritis. Synovial biopsy specimens reveal exaggerated proliferation of synovial tissue, which covers articular cartilage, causing cartilage destruction and permanent deformities.16,20 Arthritis of late Lyme Disease is similar to rheumatoid arthritis, with its characteristic pannus development and consequences.
Early LD and EM are treated with antibiotics on an outpatient basis. Doxycycline (100 mg twice daily by mouth), amoxicillin (500 mg twice a day by mouth), or cefuroxime (250 mg twice a day by mouth) for 10–14 days are equally efficacious.
Doxycycline is often the drug of choice, because it is also considered the treatment for the Gram-negative bacterium Anaplasma phagocytophilum, a potential tick-borne coinfection.29 Macrolides like azithro- mycin, clarithromycin, and erythromycin should not be selected, due to possible antibiotic resistance that has been identified.
Approximately 10%–20% of patients treated for LD with a recommended 2-week course of antibiotics will have linger- ing symptoms of fatigue, headache, musculoskeletal pain, and lethargy. Thirty-four percent of a population-based, retrospective cohort study in Massachusetts were found to have arthritis or recurrent arthralgia, neurocognitive impair- ment, and neuropathy or myelopathy, for a mean of 6 years following treatment for Lyme Disorder. Sixty-two percent of a cohort of 215 consecutively treated LD patients in Westchester County, New York were found to have arthralgia, arthritis, and cardiac or neurologic involvement for an average of 3.2 years after treatment. This complication is commonly known as post-treatment LD syndrome (PTLDS). However, in the absence of additional tests to rule out the eradication of the initial infections, others would argue that the more appropriate diagnosis is chronic LD.
Coinfections in Lyme disease
Coinfections are a troubling complication for patients with chronic LD. The reported prevalence of coinfections in the US ranges between 4% and 28%. In the US, coinfections can include Anaplasma phagocytophilum, which causes human granulocytic anaplasmosis, and babesiosis.
The risk for coinfections is increased, due to the ixodid tick being a vector for all three. Symptoms of a babesiosis infection include fatigue, malaise, weakness, fever (.38°C), myalgia, arthralgia, and anorexia. Severe babesiosis infections may progress to acute respiratory distress syndrome, disseminated intravascular coagulation, congestive heart failure, renal failure, myocardial infarction, splenic infarcts or splenic rupture, and death.
Records of 139 patients with babesiosis between 1982 and 1993 were analyzed, and nine patients (6.5%) died, 35 (25.2%) were admitted to the intensive care unit, and 35 (25.2%) required hospitalization for more than 14 days. Rashes in patients with babesiosis are often reflective of concurrent infection with Lyme Disease.
Following an antibiotic regimen twice the length and double the recommended treatment dose outlined by the Infectious Diseases Society of America (IDSA), patients can still experiences symptoms of fatigue and arthralgia consistent with PTLDS.
Dose of PeaPure for treatment of Post-treatment Lyme disease inflammatory symptoms
Dose recommendation: start with 1200 mg daily in 2 to 3 gifts (e.g. 2 capsules after breakfast and 1 capsule after diner).
PEA is a body own modulator, and not a painkiller such as NSAIDs and morphine. It does mostly need some weeks to slowly bring the body in balance on a number of biological levels, and reduce the ongoing Lyme inflammation. As PEA has a number of modulating effects, both on the short term as well as slowly increasing, there are patients experiencing quick pain and inflammation relief within some days. There are also patients who need more time (especially in chronic inflammation and pain situations, such as in Lyme). Therefore the recommendation is to test the efficacy of PEA during 3 months in cases of chronic symptoms due to post Lyme syndrome, before deciding on its efficacy.
James R Palmieri et al. Lyme disease: case report of persistent Lyme disease from pulaski County, Virginia, International Medical Case Reports Journal, december 4 2013
Further reading on post treatment Lyme disease syndrome:
Development of a foundation for a case definition of post-treatment Lyme disease syndrome.
Aucott JN, Crowder LA, Kortte KB.
Int J Infect Dis. 2013 Jun;17(6):e443-9. doi: 10.1016/j.ijid.2013.01.008. Epub 2013 Feb 23.
Correlates of Perceived Health-Related Quality of Life in Post-treatment Lyme Encephalopathy.
Chandra AM, Keilp JG, Fallon BA.
Psychosomatics. 2013 Nov-Dec;54(6):552-9. doi: 10.1016/j.psym.2013.04.003. Epub 2013 Jul 9.
Probable late lyme disease: a variant manifestation of untreated Borrelia burgdorferi infection.
Aucott JN, Seifter A, Rebman AW.
BMC Infect Dis. 2012 Aug 1;12:173.
Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here?
Aucott JN, Rebman AW, Crowder LA, Kortte KB.
Qual Life Res. 2013 Feb;22(1):75-84.