Please see the following email thread to Dr. Paul Auwaerter who has been involved in the "racketeering scheme" to deny chronic Lyme disease.

The next Zoom meeting for the New Hampshire Lyme Study Commission (HB490) is scheduled for Jan 11, 2020 at 9:00AM with Dr. Sam Donta presenting to the group. Dr. Sam Donta, (now retired) past member of the Tick-Borne Disease Working Group spent a career studying Lyme disease at BU School of Medicine. Dr. Donta diagnosed all Tuttle family members with chronic Lyme and NONE of us met the CDC’s strict criteria for positive Western blot. Had we not met Dr. Donta none of us would have been treated.

The meeting is open to the public: http://www.gencourt.state.nh.us/statstudcomm/details.aspx?id=1515&rbl=1&txtbillnumber=hb490

Inquiry to Dr. Paul Auwaerter, vice chair of the IDSA Foundation:

---------- Original Message ----------

From: 'CARL TUTTLE' <runagain@comcast.net>
To: Paul Auwaerter <pauwaert@jhmi.edu>
Cc: Members of the Commission
Date: 01/03/2021 11:16 AM
Subject: Inquiry from the New Hampshire Lyme Study Commission (HB490)

Jan 3, 2020

The IDSA Foundation
1300 Wilson Boulevard Suite 300
Arlington, VA 22209
Attn:  Paul Auwaerter, vice chair of the IDSA Foundation

Dear Dr. Auwaerter,

Since we last communicated per the email thread below, I have been appointed by Governor Chris Sununu to the Lyme Study Commission resulting from House Bill 490. The focus of our commission is the discussion of testing protocols.

During our last Zoom meeting the Chair of our commission brought up the recently revised IDSA Lyme Treatment Guideline.

Since you were president of the IDSA in 2018 I thought you might be able to answer a question relating to these guidelines.

There is a growing body of evidence through direct detection methods (not available to the average Lyme patient) and autopsy reports that we have been dealing with an antibiotic resistant/tolerant superbug.

For your review below, please see my June 2020 letter to the editor published in the BMJ which calls attention to just a handful of these “treatment failure” references; there are actually hundreds of publications. (see attachment)

Letter to the editor of the BMJ:

Lyme borreliosis: diagnosis and management
https://www.bmj.com/content/369/bmj.m1041/rapid-responses

The only FDA approved test for Lyme disease is the two-tiered antibody test; Elisa followed by a Western blot (only if the Elisa is positive). The Western blot is used to rule out a false positive Elisa but there is no means to rule out the false negative.  “If false results are to be feared, it is the false negative result which holds the greatest peril for the patient.” -Dr. Alan MacDonald, Pathologist

Lyme serology as you know cannot be used to gauge treatment failure or success which makes it the ideal tool for concealing persistent infection.

Question:

Why are there no references to treatment failure in your newly revised IDSA Lyme Treatment Guideline?

A response to this inquiry is requested.

Kindly hit Reply-All as all members of this study commission have been carbon copied.

Respectfully submitted,

Carl Tuttle
Hudson, NH

Attachment: Over 700 peer reviewed articles that support the evidence of persistence of Lyme and other tick-borne diseases. It is organized into different categories—general, psychiatric, dementia, autism and congenital transmission.
https://www.ilads.org/wp-content/uploads/2018/07/CLDList-ILADS.pdf

 

Response from Dr Auwaerter:

 

---------- Original Message ----------

From: Paul Auwaerter <pauwaert@jhmi.edu>
To: 'CARL TUTTLE' <runagain@comcast.net>
Date: 01/05/2021 7:55 AM
Subject: RE: Inquiry from the New Hampshire Lyme Study Commission (HB490)

Dear Mr. Tuttle

If objective evidence of treatment failure occurs after the initial therapy, a repeat course is advised (e.g., late Lyme arthritis) in the 2020 Guideline.  Microbiologically-confirmed (viable organisms) cases of B. burgdorferi infection after treatment are very rare.

As far as I know, B. burgdorferi has never been shown with wild-type isolates to have resistance to penicillin products or doxycycline.  This is likely the case as the reservoir is the mouse who is not exposed to antibiotics.  It could also be due to the spirochetes' nature (e.g., syphilis has never had penicillin resistance emerge).

Regarding your other issues, the evidence used in the Guideline was rated according to the GRADE methodology used advocated by the Institute of Medicine (now the National Academy of Medicine) and requires evidence beyond case reports for clinical decision-making.

Sincerely,

Paul Auwaerter

Paul G. Auwaerter, MD
Sherrilyn and Ken Fisher Professor of Medicine
Clinical Director, Division of Infectious Diseases
Johns Hopkins University School of Medicine
Baltimore, Maryland USA

Assistant: Stephanie Knight
Email: sknigh22@jhmi.edu
T: 443-287-4800
F: 410-502-7029

My reply to Dr. Auwaerter:

 

---------- Original Message ----------

From: 'CARL TUTTLE' <runagain@comcast.net>
To: Paul Auwaerter <pauwaert@jhmi.edu>
Cc: Members of the Commission
Date: 01/05/2021 10:55 AM
Subject: RE: Inquiry from the New Hampshire Lyme Study Commission (HB490)

Dr. Auwaerter,

Thank you for taking the time to respond to my inquiry.

I respectfully disagree with a number of your statements:

Statement#1

“Microbiologically-confirmed (viable organisms) cases of B. burgdorferi infection after treatment are very rare.”  -Paul G. Auwaerter, MD

1. Culture evidence of Lyme disease in antibiotic treated patients living in the Southeast.
https://danielcameronmd.com/culture-evidence-of-lyme-disease-in-antibiotic-treated-patients-living-in-the-southeast/

Rudenko and colleagues reported culture confirmation of chronic Lyme disease in 24 patients in North Carolina, Florida, and Georgia. All had undergone previous antibiotic treatment

2. The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963883/

Autopsy tissue sections of the brain, heart, kidney, and liver were analyzed by histological and immunohistochemical methods (IHC), confocal microscopy, fluorescent in situ hybridization (FISH), polymerase chain reaction (PCR), and whole-genome sequencing (WGS)/metagenomics. We found significant pathological changes, including borrelial spirochetal clusters, in all of the organs using IHC combined with confocal microscopy.

3. Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease
http://www.mdpi.com/2227-9032/6/2/33

“This pilot study recently identified chronic Lyme disease in twelve patients from Canada. All of these patients were culture positive for infection (genital secretions, skin and blood) even after multiple years on antibiotics so there was no relief from current antimicrobials. Some of these patients had taken as many as eleven different types of antibiotics.”

4. DNA sequencing diagnosis of off-season spirochetemia with low bacterial density in Borrelia burgdorferi and Borrelia miyamotoi infections.
https://www.ncbi.nlm.nih.gov/pubmed/24968274

Faulty/misleading antibody tests landed a sixteen-year-old male in a psychiatric ward when his lab results did not meet the CDC’s strict criteria for positive results. His Western blot had only four of the required five IgG bands. Subsequent DNA sequencing identified a spirochetemia in this patient’s blood so his psychiatric issues were a result of neurologic Lyme disease misdiagnosed by antiquated/misleading serology. This patient was previously treated with antibiotics.

5. Granulomatous hepatitis associated with chronic Borrelia burgdorferi infection: a case report
http://www.labome.org/research/Granulomatous-hepatitis-associated-with-chronic-Borrelia-burgdorferi-infection-a-case-report.html

The patient had active, systemic Borrelia burgdorferi infection and consequent Lyme hepatitis, despite antibiotic therapy. Spirochetes were identified as Borrelia burgdorferi by molecular testing with specific DNA probes.

6. Seronegative Chronic Relapsing Neuroborreliosis.
https://www.ncbi.nlm.nih.gov/pubmed/7796837

We report an unusual patient with evidence of Borrelia burgdorferi infection who experienced repeated neurologic relapses despite aggressive antibiotic therapy. Each course of therapy was associated with a Jarisch-Herxheimer-like reaction. Although the patient never had detectable free antibodies to B. burgdorferi in serum or spinal fluid, the CSF was positive on multiple occasions for complexed anti-B. burgdorferi antibodies, B. burgdorferi nucleic acids and free antigen.

Statement#2

"As far as I know, B. burgdorferi has never been shown with wild-type isolates to have resistance to penicillin products or doxycycline.  This is likely the case as the reservoir is the mouse who is not exposed to antibiotics.  It could also be due to the spirochetes' nature (e.g., syphilis has never had penicillin resistance emerge)."   -Paul G. Auwaerter, MD

 

1. Treatment of late Lyme borreliosis with cefoperazone and sulbactam
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(95)90496-4.pdf
March 4, 1995

There have been reports that intravenous penicillin and/or cephalosporins may fail in up to 40% of patients with late Lyme disease. (1,2) The mechanism underlying this sometimes poor response to antibiotic treatment has not been elucidated. Similar therapeutic failure is seen in patients with late syphilis, another spirochaetal infection caused by Treponema pallidum. According to Stapleton et al, (3) resistance to penicillin, certain cephalosporins, and erythromycin can be accounted for by plasmid DNA seen in certain strains of T pallidum. (4) Tazobactam has been shown (5) to affect penicillin-binding proteins and to inhibit growth of Borrelia burgdorferi in the presence of penicillin in vitro. We report a patient with late Lyme disease refractory to intravenous treatment with penicillin and cephalosporins, in whom combined treatment with a cephalosporin plus sulbactam was beneficial.

2. Cases of Lyme Borreliosis Resistant to Conventional Treatment: Improved Symptoms with Cephalosporin plus Specific β-Lactamase Inhibition
https://www.liebertpub.com/doi/10.1089/mdr.1995.1.341

(Also from 1995)

We present four cases of verified late  Lyme borreliosis with persistent symptoms and positive serology despite repeated courses of high-dose intravenous penicillin G and/or cephalosporins (including cefoperazone). The patients were now treated with cefoperazone 2 g plus sulbactam 1 g bid iv for 14 days. At the end of treatment, patients were symptom free and have remained so for the following 12 months. By then, IgG against  Borrelia burgdorferi had decreased. It is concluded that the addition of β-lactamase inhibitors to intravenous treatment could be beneficial in Lyme disease refractory to conventional treatment.

3. Metamorphoses of Lyme disease spirochetes: phenomenon of Borrelia persisters
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521364/

Here is a report of culture positive after antibiotics. The reason is that borrelia have ‘persister’ forms, round body forms, cell wall deficient forms, biofilm forms that are dormant, or protective, and not susceptible to antibiotics. They stay in this state but can convert back to normal forms when the coast is clear i.e., when antibiotic treatment stops. 

___________________________________________

Dr. Auwaerter,

Most likely you did not read my letter to the editor published in the BMJ as the majority of the references above were extracted from that publication.

Hundreds of thousands of Lyme patients, if not millions worldwide are left to fend for themselves when the one-size-fits-all IDSA treatment guideline fails all while you and your colleagues are in denial of persistent infection (Chronic Lyme disease) after extensive antibiotic treatment.

It certainly appears that you are caught up in this "racketeering scheme" to deny chronic Lyme.

You may want to review the following link:

THE HIPPOCRATIC OATH: MODERN VERSION
https://www.pbs.org/wgbh/nova/doctors/oath_modern.html

Carl Tuttle

Hudson, NH

Cc: All members of the New Hampshire Lyme Disease Study Commission.