collecte section Bourgogne

un médecin traitant lyme se voit "mis à pied "

Wisconsin Lyme Doctor Gets Reprieve
Submitted by Fran Zell on Sun, 01/29/2012 - 9:10pm

It has the makings of a John LeCarré thriller:  A debilitating, potentially deadly, infectious disease carried by an insect the size of a poppy seed is spreading across the land. The medical establishment insists that everything is under control and that all these “sick” people are slackers or need psychiatric help. A few doctors—just a few—believe the people are really sick, and treat them according to guidelines not approved by insurance companies. One such doctor gets people in wheelchairs walking again, gives bedridden folks a new lease on life. Sick people flock to him from all over the land. He has saved many lives, and never harmed a patient. Yet one day his license is summarily suspended. There are not enough other doctors in the land to treat his many patients.
This is a story about that doctor and a state Medical Examining Board that has not always looked kindly on practitioners who treat “outside the box.” The disease is real. It’s called Lyme, and by some expert accounts, it’s an epidemic. The place is Wisconsin. But it could happen almost anywhere.

[Photos: Dr. Robert Waters in his Wisconsin Dells office; Lyme Patient John Blohm; Atty. Arthur Thexton at the November hearing for Dr. Hoffmann.]

Wisconsin Lyme doctor gets reprieve
By Fran Zell and Tom Boswell
John Blohm was a charter airplane pilot until a mysterious disease made it impossible for him to fly. Neurologists did meticulous work-ups and found nothing wrong, despite the fact that Blohm couldn’t hear or see right, suffered from exhaustion, extreme dizziness, bouts of fever and chills, tremors, and what he refers to as “lightning-bolt” zaps of pain.
“I spiraled downhill for years,” says Blohm. “The doctors referred me to psychiatrists and I began to think I was crazy.  A Mayo Clinic specialist accused me of malingering and said I should go back to work.”
After seven years, Blohm did some research and realized his symptoms were typical of Lyme disease, a tick-borne bacterial infection endemic to Wisconsin.  He remembered that years earlier – just before his symptoms began – he had been bitten by a tick in his suburban Beloit backyard.  He had tested negative for Lyme during the course of his illness but now he found a doctor who treated chronic Lyme disease at his small clinic in Waupaca. 
“Dr. Hoffmann was a godsend,” he says. “By the time I first saw him, I’d lost the use of one arm and could barely walk. The vertigo was unbearable. I was losing about five pounds a week.  He diagnosed me with Lyme based on my symptoms and history and started treating me with antibiotics. He brought me back from the edge.”
In mid-November, Blohm’s treatment ended abruptly.  His Lyme doctor — John Gregory Hoffmann — was summoned to Madison by the State’s Medical Examining Board. After a brief hearing, his medical license was suspended, effective immediately.
“The state says this has nothing to do with Lyme disease, but I think it’s a veiled attack,” asserted Blohm, who spearheaded a movement among fellow Lyme sufferers to challenge the Board’s decision.  “Dr. Hoffmann does not treat Lyme according to (standard) guidelines, and I think they’re trying to stop him.”
Arthur Thexton, the Division of Enforcement (DOE) prosecuting attorney who filed the complaint requesting summary suspension, would neither confirm nor deny Blohm’s suspicion. “If I want to keep my job, I can’t talk to the press,” he said.
On January 18 Hoffmann, his attorney, and the Medical Board reached an agreement whereby the suspension of Hoffmann’s license would be “stayed” subject to various terms and conditions. Hoffmann must work under supervision of a professional mentor, may not accept new patients, must complete a “robust self-study program,” and pass a Special Purpose Examination (SPEX), a test used by medical boards to re-examine a licensed or previously licensed physician’s basic medical knowledge.
“They’re saying I’m not up to standard with modern medical practice, that I practice out of the routine.” Hoffmann commented after his January Board appearance. “It’s not a complaint regarding patient care.”
Thexton reopened an old (1997) case on Hoffmann in 2007, for reasons that are not revealed in the case file. The old case related to a 1992 incident in which Hoffmann had been drinking while on call. The case was fully resolved in 2006.
Marina Andrews, who blogs about Lyme from Luck, Wisconsin, said the new case originated with a former patient who complained that Hoffman would not prescribe pain medication during an office visit. Thexton then asked for patient records, many of them Lyme files. “There was a public outcry at the time and Thexton was temporarily removed from the case,” Andrews said.
In 2008, the Board ruled that Hoffmann’s charts suggested possible “deficiencies in medical knowledge and practice standards” and referred him to the UW Medical Physician Assessment Center.  Last August, a report from UW said Hoffmann had “significant deficiencies” based on standardized testing and recommended more testing. Thexton called for suspension, contending there was an immediate need to protect the public from Hoffmann.
Maybe he didn’t study for the test, but he’s a fabulous doctor, said Hoffmann patient Jennifer Christie of De Pere.  “I had a severe situation recently. My kidneys were bleeding. I was in the ER three days in a row. Everyone at Bellin (Medical Center in Green Bay) missed it. I made one call to Doc and he immediately knew it was a drug interaction related to a med my primary provider put me on.”
“Dr. Hoffmann saved my life,” said Lyme patient Della Haugen, a former photojournalist for a Madison TV station, and one of two thousand people who wrote letters and signed a petition of support prior to the November hearing. “I saw lots of UW doctors and none of them could help me. I got so sick I had to stop working.”
A Milwaukee area public official who testified at the November hearing said Hoffmann’s Lyme treatment enabled her to leave her wheelchair. She told a reporter that since being bitten by a tick 14 years ago, she endured fainting spells, horrible neck and eye pain and numbness on one side of her body. “Then my legs wouldn’t support me. I was writing my will,” she said of the time before she started seeing Hoffmann.
Dr. Gene Musser, the Board member who made the motion to suspend Hoffmann’s license, said he could not discuss the case other than to note that the Board did not sanction Hoffmann because of his Lyme treatment practices.
But the fact remains that Lyme is a major medical controversy, to the point that Hoffmann was treating a disease — chronic Lyme — that the academic-medical establishment has long insisted does not exist.
“Is this an issue the state has with him because he’s operating outside of medical thought? I think it is,” said Dr. Robert Waters, who operates a medical clinic in the Dells. “They’re holding him responsible for something that happened 20 years ago. This doesn’t have anything to do with the sick people he treats. There’s no evidence he harmed anyone.
“The state has unlimited funds to continue a prosecution,” Waters said. “When a doctor runs out of money, his lawyers ask him to settle and stipulate and admit to certain things (he’s) done ‘wrong.’ The burden of proof is on the doctor, even when there are no complaints from patients.”
Waters said that the state, and Thexton in particular, have a pattern of coming down hard on alternative health care practitioners.  He himself was the center of a highly publicized investigation by Thexton that was dismissed as groundless, in 2003, shortly after Thexton was removed from the case. “It went on for six and a half years, cost me $50,000 in legal fees, untold stress, heartache and lost income,” he said.
Thexton and DOE attorney James Polewski investigated so many alternative practitioners at the time that some of those involved, including Watertown nurse Barbara Lemke, considered it a “vendetta.” Lemke was called before the Board for using an allergy elimination treatment called acupressure. She ultimately appealed her case and was exonerated. “But it cost me $26,000 (in attorney fees) to keep my license,” she said.
As a result of the experience, Lemke helped found the Wisconsin Association for Health Freedom. “We're currently trying to get a bill passed that would allow practitioners to use alternative therapies without fear of being prosecuted,” she said.
Waters was investigated for using a toxin-removing therapy called chelation for a controversial purpose — treating cardiovascular disease and circulatory disorders. Thexton publicly called it “quackery,” even though the National Institute for Health was conducting a major study on chelation in which Waters had been asked to participate.
Hoffmann follows treatment protocols for Lyme developed by the International Lyme and Associated Disease Society (ILADS), a small, but vocal medical group based in Washington, D.C.  ILADS contends that, if untreated or under-treated, Lyme bacteria remain in the body and the disease goes “chronic,” manifesting in a host of serious symptoms often misdiagnosed as fibromyalgia, chronic fatigue, rheumatoid arthritis, early Alzheimer’s, Parkinson’s, multiple sclerosis, Crohn’s disease, ALS and more.
Most doctors – and health insurers – debunk ILADS. They follow Lyme protocols mandated by the Infectious Disease Society of America (IDSA), which holds that Lyme bacteria are eradicated after a short course of antibiotics.
“If symptoms remain after that, they say it’s a somatic syndrome,” said Dr. Burton Waisbren Sr., a founding member of IDSA who disagrees with the group’s position on Lyme. The Milwaukee internist and infectious disease specialist asserts that chronic Lyme does exist, and that patients seriously ill with it have responded to long-term antibiotic therapy at his clinic. In his new book, Treatment of Chronic Lyme Disease (iUniverse, Inc.), Waisbren chronicles 51 recent cases (not all of them successful) that have led him to conclude that chronic Lyme is a national epidemic.
Recent statistics from the Centers for Disease Control (CDC) indicate that Wisconsin is fast becoming ground zero for Lyme disease. Reported incidences have increased more than five-fold since 2000, making Wisconsin the third hardest-hit state in the country. But there are only a handful of doctors in the Midwest who will treat Lyme outside of IDSA guidelines.
“I think for anyone in Wisconsin prescribing outside of standard protocols, there is always going to be the chance of an issue coming up,” said Kim Saxe, a naturopathic doctor who provides complementary services to many Lyme patients at her Brookfield wellness center.
Saxe said that insurance companies “are raising red flags” and reporting doctors for their prescribing methods. “It’s been an issue with Lyme doctors in other parts of the country who have lost their licenses,” she said. “It’s how the issue reaches medical boards. It is also why many Lyme doctors are choosing not to bill insurance.
“I know there were other claims made against Dr. Hoffmann,” she said, “but I find it a little challenging to believe (the case) was unrelated to his Lyme prescribing.”
Saxe said she knew little about Lyme until she contracted it herself about four years ago. She said that for two years she saw a lot of doctors and spent $20,000 out of pocket on tests that turned up nothing, despite her abdominal dysfunction and loss of muscle mass.
“No one thought of Lyme. Doctors told me I needed antidepressants and anxiety medication, but I knew something serious was going on.”
Eventually she ran her own Lyme test. “Lyme testing is horrible, she noted. “There are many false negatives.” But Saxe tested positive, then found a Milwaukee internist who treats Lyme outside of IDSA guidelines but does not publicize the fact for fear of losing his license.
“Lyme doctors are doing what they feel and know is right for patients, even though it is not the standard of care,” she said.
Waters went through ILADS training in 2009 and now also treats Lyme. He said he stopped taking Medicare, Medicaid, and private insurance years ago because he didn’t want to risk being investigated by the state for doing “what I know is right for patients.”  The complaint Thexton prosecuted him for originated with a doctor and Blue Cross Blue Shield.
State Senator Dale Schultz (R) supported Waters at the time and said he still does.
“I have a number of constituents who are his chelation patients and they are passionate about him,” he said. “That led me to be supportive too. Information came to light that the U.S. government was using chelation to take bad things out of the body. It seemed extremely unreasonable to me for the state to pick on someone for doing the same treatment.”
Blue Cross Blue Shield also initiated the complaint that precipitated a nine-year licensing battle that Dr. Eleazer Kadile, a Green Bay chelation practitioner, said cost him $500,000 in legal bills.
“It was purely politics,” alleges Kadile, who was ultimately cleared on charges relating to chelation. Thexton’s key witness in both chelation cases was a Massachusetts doctor with consulting ties to the insurance industry. He was largely discredited on the stand, though he billed the state for nearly $86,000.
Sheldon Wasserman, a Milwaukee physician on the Medical Examining Board, believes that some of the conflict over state regulation of alternative health care practitioners can be mitigated with a re-write of Chapter Med 10 of the Administrative Code, which covers unprofessional conduct of physicians. Wasserman, who served 14 years in the State Assembly (D), assumed the chair position on the Board in January.
“Rewriting of Chapter 10 will be one of my top priorities for the year,” Wasserman said. He feels there is an “emerging position” on the Board to develop rules that would allow physicians freedom to practice as long as there was “truly-given informed consent” on the part of patients. The code revision would “put a lot of burden on physicians” to inform patients that their treatment was not “the standard of care” and “basically create a buyer-beware type of situation.
“I think people have the right to decide what they want, and the right to do what they want with their own bodies, across the board,” commented Wasserman.
Waters addressed the issue of doctor-patient understanding several years ago, following the lead of alternative practitioners in other states. He turned his clinic into a private association, charging a nominal fee to patients who then sign a contract accepting services. It enables him to offer the treatments patients seek without interference from governmental bodies, he explained.
John Blohm, for one, said he knew what he was getting into when he started seeing Hoffmann. “He told me about the risks of long-term antibiotic treatment. But I also know it will kill me if I don’t do it. I made a very informed decision. I chose to follow ILADS guidelines.”
The fallout from Hoffmann’s license suspension has been huge, said Kristin Collins, a Pewaukee nurse whose two small children are Hoffmann’s patients.
“He has about 1,500 patients, said Collins, who volunteered at the Waupaca clinic for four days following the Board’s November decision to suspend Hoffmann’s license. “Dr. Hoffmann has his own unique way of treating. He took Medicare and Medicaid, and most other insurance. He never turned his back on anyone because of money. There aren’t enough other Lyme doctors in the state to take on these patients.
“Some people called the office, sobbing,” she said. “They had seen numerous doctors who ignored them. Doc believed them and helped them.”
The “interim” stipulation agreed to by Hoffmann and the Medical Board on January 18 represents a “pathway” to full re-instatement of the doctor’s license, according to Greg Gasper, spokesperson for Wisconsin’s new Department of Safety and Professional Services.
About a half-dozen of Hoffmann’s patients spoke at the meeting in support of him, despite the fact that his case was not listed on the public agenda.
“They (the Board) got the message,” Hoffmann commented.
 # # #
Photos of Atty. Arthur Thexton and Dr. Robert Waters by Tom Boswell. Photo of John Blohm by Laura Blohm.
About the writers: Fran Zell and Tom Boswell are freelance journalists residing in Evansville, Wisconsin. Zell has written extensively about Lyme disease, including stories in the Chicago Tribune and Milwaukee Magazine. She has written cover stories for Isthmus and the Chicago Reader. Tom Boswell is a writer and photographer who has had cover stories in the National Catholic Reporter, Shepherd Express and other publications. His photographs for an Isthmus cover story in December 1996, won a first place award from the Milwaukee Press Club.

les mycoplasmes dans la maladie de lyme chronique

Mycoplasma - Often Overlooked In Chronic Lyme Disease
by Scott Forsgren

Those of us with chronic Lyme disease are quite familiar with the names of the better known Lyme co-infections. Babesia, Bartonella, and Ehrlichia have become everyday words. As much as we would like to rid ourselves of these illness-producing pathogens, they have become a part of our daily struggle to regain a sense of health and wellness. Unfortunately, these are not the only co-infections seen in chronic Lyme disease. For some reason, Mycoplasma infections are not only lesser known by patients, but seemingly often overlooked by doctors as well. It is important for us, as patients, to educate ourselves on the topic of Mycoplasma and to ask our practitioners how we are being evaluated and treated for these infections.

In 1987, Dr. Garth Nicolson, PhD was a professor at the University of Texas at Houston when his wife, an instructor at Baylor College of Medicine, became seriously ill and nearly died. She was diagnosed with a Mycoplasma infection, treated, and later recovered. A few years later, their daughter, who had served in the Gulf War, returned from active duty quite ill. Not only was she sick, but the symptoms that she exhibited were very similar to those that Dr. Nicolson's wife had expressed years earlier.

At that point, Dr. Nicolson had the idea that his daughter's illness could be the result of an infection and started to investigate his theory further. As his work progressed, he looked at Brucella, Borrelia, Ehrlichia, and other chronic intracellular infections that have the potential to cause illness and present with overlapping signs and symptoms. In Gulf War veterans that were being evaluated, approximately 45% of those that were ill had Mycoplasma infection. It was found that the infection was a particular type of Mycoplasma, namely a peculiar species called Mycoplasma fermentans

Very little was known about this particular species of Mycoplasma at the time except that the Armed Forces Institute of Pathology and the Army had been doing research on the organism. Once this likely causative agent of Gulf War Illness (GWI) had been identified in about one-half of the GWI cases, Dr. Nicolson recommended that the Mycoplasma-infected Gulf War veterans be treated with Doxycycline. He then found himself the target of vicious attacks for making the connection between the illness and M. fermentans. Dr. Nicolson shared that "even talking about this organism was highly discouraged." In fact, until the Gulf War, the military's own medical school had been teaching about the dangers of M. fermentans for years.


Just years earlier in Texas, prisons emerged in which many of the inmates and guards came down with neurodegenerative conditions at rates that were far from ordinary. In Huntsville, where three large State prisons are found, there were about 70 cases of ALS, numerous cases of Multiple Sclerosis, and highly unexpected numbers of Rheumatoid Arthritis cases. At that time, the term "Mystery Disease" was used to identify the unusual illnesses that so many seemed to have acquired.
Dr. Nicolson started testing prison guards and their family members and found that very high numbers of these people were testing positive for Mycoplasma fermentans. Furthermore, this appeared to be a weaponized version of the organism called M. fermentans incognitus, a specific strain of Mycoplasma that had been altered to cause more severe symptoms, to be more virulent, and to be more survivable than the naturally occurring M. fermentans. Dr. Nicolson believed that biological weapons experiments had been carried out on inmates in the Texas prison system for years in which humans had been used as guinea pigs. 

As time progressed, these illnesses did not remain confined to the prisoners. Soon after the prisoners unknowingly became a part in these experiments, the prison guards became ill. Their illnesses gradually became those of their families. It was not long before these Mycoplasma-based illnesses became a broader part of the surrounding Huntsville, Texas landscape. 

The Texas prisoners that came down with Amyotrophic Lateral Sclerosis (ALS) later died. In the state of Texas, at the time, the state law dictated that all prisoners that died were later to be autopsied at University of Texas at Galveston. However, that was not what was happening to the prisoners who had died as a result of this horrific experimentation, according to Dr. Nicolson. Through one of his former students who at the time was responsible for the autopsy service at UT Galveston, Dr. Nicolson learned that none of the bodies had been sent there. Dr. Nicolson had discovered that at least six private autopsies a week were being performed on deceased prisoners at a US Army base. The bodies were then sent to a private crematory at a secret location in central Texas. Additionally, prisoner records were destroyed. All of this, according to Dr. Nicolson, violated state law. 

Though much of the evidence of this experimentation had been destroyed, a document was found in the basement of an Austin building that was viewed as the "smoking gun". The document indicated that the Texas Prison Board, Baylor College of Medicine, and the Department of Defense were all a part of the experiments involving the Texas prisoners - experiments that later resulted in the death of many of the inmates. According to Dr. Nicolson, some of the experiments used Mycoplasma while others utilized various "cocktails of microbial agents" such as Mycoplasma, Brucella, and DNA viruses such as Parvovirus B19. This project later became the topic of a book by Dr. Nicolson entitled Project Day Lily. 

Dr. Nicolson believes that Mycoplasma fermentans is a naturally occurring microbe. However, some of the strains that exist today have been weaponized. Dr. Nicolson's research found unusual genes in M. fermentans incognitus that were consistent with a weaponized form of the organism. Weaponzing of an organism is done in an attempt to make a germ more pathogenic, immunosuppressive, resistant to heat and dryness, and to increase its survival rate such that the germ could be used in various types of weapons. Genes which were part of the HIV-1 envelope gene were found in these Mycoplasma. This means that the infection may not give someone HIV, but that it may result in some of the debilitating symptoms of the HIV disease. Indicators of a weaponized organism were evident in the prison guards in Huntsville as well as in military personnel that were likely exposed to the infections both through military vaccinations as well as through weapons used in the Gulf War. 

The unfortunate reality according to Dr. Nicolson is that "once these things get out, you can't put the genie back in the bottle". Once these germs have been released, they are airborne infections that slowly penetrate into the population. In the case of Mycoplasma fermentans, Dr. Nicolson believes that this is exactly what happened. It may be this weaponized form of Mycoplasma that has led to the significant increases in neurodegenerative and autoimmune diseases over the last several years. Those patients with weaponized strains of these organisms are generally very sick. They may experience 60-75 signs and symptoms and are even at risk of their diseases becoming fatal. 

In looking at the source of infection in the Gulf War veterans who were contracting Mycoplasma, Dr. Nicolson suggests that vaccinations appear to be the most likely mechanism through which the veterans became infected. Many military personnel that later became ill were far from the battlefields or had received the vaccinations and were never deployed. However, biological weapons sprayers were known to have been deployed by the Iraqis in the Gulf War and were used to spray the sand in Iraq and Kuwait. Gerald Schumacher, a Special Forces colonel in charge of biological weapons detection, blew the whistle on this after he retired. During the Gulf War, his group was not allowed to deploy their biological weapons detectors which led to reports that no such weapons were detected or used. 

The Iraqis received a great deal of assistance on biological warfare from the United States during the Iran-Iraq Conflict. Both chemical and biologic weapons were given to them from the United States. After the Gulf War, rather than taking inventory of these weapons, they were blown up. Dr. Nicolson indicates that some of his patients have taken videos standing next to crates with Hazardous Materials tags from the United States. In the same videos, the crates are opened and weapons are clearly striped as having originated from the United States and being both chemical and biological weapons.

There were clear indicators that Iraq had offensive weapons in their arsenal. In Kuwait, many people had become quite ill. It was estimated that 25% of the population after the Gulf War had signs and symptoms which matched the symptoms of those infected with weaponized Mycoplasma. There were also a number of other chemical exposures and thus, there was never a clear indicator as to whether or not the Iraqi illnesses were caused by biologic or chemical agents.

When asking Dr. Nicolson how much he personally has been harassed for bringing much of this information to light, he shared that it has been "a horrific time". After Dr. Nicolson exposed the Huntsville prison experiments, the University of Texas educational system attempted to fire him from his tenured and highly respected position. Dr. Nicolson shared that a tremendous amount of pressure was put on the University of Texas system to "shut him up and close his laboratory". He was threatened on an almost daily basis with closing his lab as he continued to do his research on Mycoplasma. This became a major subject in the book Project Day Lily. Fortunately, for many of us struggling with chronic illnesses, Dr. Nicolson's experience and knowledge continue to be a benefit in that we understand so much more than we otherwise would about this formidable foe called Mycoplasma.


The signs and symptoms of Mycoplasma infection are highly variable and thus it is not uncommon for a diagnosis to be entirely missed. A partial list of symptoms includes chronic fatigue, joint pain, intermittent fevers, headaches, coughing, nausea, gastrointestinal problems, diarrhea, visual disturbances, memory loss, sleep disturbances, skin rashes, joint stiffness, depression, irritability, congestion, night sweats, loss of concentration, muscle spasms, nervousness, anxiety, chest pain, breathing irregularities, balance problems, light sensitivity, hair loss, problems with urination, congestive heart failure, blood pressure abnormalities, lymph node pain, chemical sensitivities, persistent coughing, eye pain, floaters in the eyes, and many others. On Dr. Nicolson's web site at, a full list of signs and symptoms and an illness survey form can be found. 

It doesn't take long to see that the symptoms of Mycoplasma infections are very similar to the symptoms of Borrelia infections in chronic Lyme disease. Dr. Nicolson has looked at some of the more common neurodegenerative diseases and the infections that are associated with each. Mycoplasma is commonly found in patients with ALS, Multiple Sclerosis, Autism, Chronic Fatigue Syndrome, Rheumatoid Arthritis, Chronic Asthma, Lyme disease, and many other chronic disease conditions.


Mycoplasma are pleomorphic bacteria which lack a cell wall and, as a result, many antibiotics are not effective against this type of bacteria. There are over 100 known species of Mycoplasma, but only a half dozen or so are known to be pathogenic in humans. The pathogenic species are intracellular and must enter cells to survive. Once they are inside the cells, they are not recognized by the immune system and it is difficult to mount an effective response. 

They stimulate reactive-oxygen species (ROS) which damage cell membranes. They release toxins into the body. Infected cells can be stimulated to undergo programmed cell death which may result in ALS or other severe neurological presentations. 90% of ALS patients evaluated were found to have Mycoplasma infections, whereas Mycoplasma was found in 100% of ALS patients with Gulf War Syndrome, almost all of which were weaponized M. fermentans incognitus.

They are thought of as "borderline anaerobes", meaning that they generally prefer low oxygen environments. Dr. Nicolson has found that airline employees are much more susceptible to these types of infections and that symptoms worsen with frequent long flights at low oxygen tension. Mycoplasma also have some characteristics of viruses.

Mycoplasma tend to be slow growing infections and they are usually transmitted slowly. Dr. Nicolson states that "Mycoplasma can be sexually transmitted, but the infection is usually passed through far less intimate contact. Mycoplasma can be obtained through fluid exchange, and it is easily transmitted through the air." In Gulf War veterans, the first person besides the veteran to become ill was the spouse and, later, other members of the household also became ill. Not everyone is equally susceptible to Mycoplasma infections, especially those with strong immune systems who can resist infection.

As already discussed, Mycoplasma fermentans produces numerous symptoms. Those infected are rarely found to be asymptomatic. In North America, M. pneumoniae is the most common Mycoplasma seen in various diseases. In Europe, M. hominis is far more prevalent and the incidence of M. fermentans is much lower than in North America. 
The potential genetic factors involved in Mycoplasma illnesses are not known. Those with immune deficiencies and other illnesses, such as cancers and degenerative diseases, are at far greater risk of infection.


In one study looking at Mycoplasma in patients with Chronic Fatigue Syndrome, Dr. Nicolson has observed some interesting patterns in his research. Generally, the majority of CFS patients have Mycoplasma infections. However, CFS patients infected with Borrelia burgdorferi, the punitive agent in Lyme disease, had an even higher overall Mycoplasma infection rate. As many as 75% of Lyme disease patients appear to have Mycoplasma infections, and yet Mycoplasma is often overlooked in the diagnosis and treatment of chronic Lyme disease, neurodegenerative diseases, and many other chronic illnesses lacking clear origins. 

Even more startling was the finding that of the patients infected with Borrelia, over 50% of the patients had the M. fermentans infection. Approximately 23% carried M. pneumoniae

Chronic Fatigue patients that did not test positive for Borrelia had much more of a mixture of various species of Mycoplasma. Only 28% of the group not co-infected with Lyme disease had the M. fermentans infection. In normal, healthy controls, only 1.7% were found to have M. fermentans and at a total Mycoplasma infection rate of 5% compared to the 75% group mentioned earlier. 

Dr. Nicolson notes that these findings are consistent with the fact that it is the Mycoplasma fermentans species that is more often isolated in ticks collected from the environment. The same tick that serves as the vector for Borrelia burgdorferi often also transmits M. fermentans simultaneously. Once a patient is multiply co-infected, the duration and severity of their illness both increase. 

In his experience, Dr. Nicolson has found that Mycoplasma is the number one Lyme coinfection. The rate of infection with Mycoplasma in patients with Lyme disease surpasses that of Bartonella (25-40%) slightly and that of Babesia (8-20%) significantly.

According to Dr. Nicolson, a healthy immune system can generally clear M. pneumoniae infections though will have a harder time eradicating M. fermentans on its own. Healthy people can often hold these infections in check - essentially having the infection but not expressing symptoms.


Dr. Nicolson noted that Mycoplasma infections in chronic Lyme disease are often overlooked by most doctors because they simply don't test for it. He states that those that do test for it find a much higher number of infected patients. Dr. Richard Horowitz, MD in New York finds a high incidence of M. fermentans, according to Dr. Nicolson. 

Sadly, however, even if patients are tested for Mycoplasma, a similar problem exists here as the one that almost all Lyme doctors and patients are aware of - namely that reliable tests do not exist. Dr. Nicolson notes that once a laboratory gets a reliable test in place, the laboratory is often shutdown. There are only a few labs left that test for Mycoplasma as a result.
In testing ticks for various microbial species, Dr. Nicolson has found a very high incidence of Mycoplasma fermentans. However, other Mycoplasma species have also been found such as M. pneumoniae and M. hominis. The incidence of these other species is far lower. "Far and away", it is the M. fermentans species that is seen in ticks, and this probably reflects the high incidence of M. fermentans coinfections in Lyme disease.

In terms of laboratory testing, Dr. Nicolson generally recommends Viral Immune Pathology, formerly known as RedLabs. He has found that the usefulness of any given lab in testing for Mycoplasma changes regularly. In the past, Dr. Nicolson used Medical Diagnostic Laboratories (MDL) for testing, but later he and other physicians found that the testing was no longer reliable. As a result, he no longer recommends MDL.

Dr. Nicolson finds that laboratories testing for Mycoplasma are highly scrutinized by federal agencies and that may affect the way the labs test and report this type of infection.


Thomas McPherson Brown, MD studied Mycoplasma at the Rockefeller Institute just before World War II. He was able to isolate bacteria from the joint fluid of a person with autoimmune arthritis and believed that the infection could have been the trigger for her disease. At the time, the organisms were too small to identify precisely, but it was later determined to be Mycoplasma

Even then, Dr. Brown believed that Mycoplasma was very common and not easy to eradicate. He suggested using tetracycline drugs as an effective treatment for the disease. He later found that Doxycycline and Minocycline were effective at dealing with Mycoplasma. Though he garnered praise from his patients, he was generally regarded by the medical community as misguided and a trouble-maker. He died in 1989 prior to being fully vindicated. Fortunately, his work was validated through an NIH-sponsored study called MIRA or "Minocycline in Rheumatoid Arthritis". 

Due to many of the characteristics of Mycoplasma, they may be responsible for the triggering of numerous autoimmune responses. As Mycoplasma replicate within cells and are eventually released, they capture antigens from the surface of the host cell and incorporate these antigens into their own membranes. This makes it almost impossible for the body to tell the difference between good and bad, between human and microbe, or between us and them. As a result, the immune system may begin to respond to these antigens now incorporated into the cell walls of the bacteria and create a condition of self-attack, or autoimmunity.

The microorganisms can produce mimicry antigens that mimic the natural host surface antigens and trigger an immune response to these antigens which may also result in autoimmune conditions through cross-reactivity. Additionally, Mycoplasma may cause cell death of host cells through a process known as apoptosis or programmed cell death.


Though various strains of Mycoplasma have their own unique characteristics and drug responses, treatment tends to be quite similar. The variations in the strains do not appear to be a factor in a successful treatment response.

Dr. Nicolson suggests that in-vitro differences have been found but that it is not possible to easily extrapolate these findings to an in-vivo environment. Various factors including drug targeting, drug clearance, and the ability for the drug to cross into various body compartments are important considerations in treatment that cannot be examined in-vitro. 

Dr. Nicolson believes that, like many other coinfections of Lyme disease, Mycoplasma cannot be fully eradicated, but that once infected, treatment becomes an ongoing "management approach". He notes that this is a commonly understood fact and that the same is true of other organisms such as Chlamydia and Borrelia. Mycoplasma have the ability to go into a quiescent phase in intracellular locations within the body. Once in these locations, neither antibiotics nor the immune system can effectively reach or kill the organisms.
Many people recover from Mycoplasma infections and are fine for years. They may later have an incident involving severe trauma or other significant life stressor and symptoms fully reappear within weeks to months.
Dr. Nicolson recommends that the physician adopt an initial 6-month course of treatment with no break followed by several 6-week on, 2-week off antibiotic cycles. Candidate antibiotics include: Doxycycline, Ciprofloxacin (Cipro), Azithromycin (Zithromax), Minocycline, or Clarithromycin (Biaxin). He notes that antibiotic combinations may be required if there is a limited response to single drug, and most patients require switching antibiotics at least once during their treatment. Some patients may find the addition of Flagyl to be a benefit to treatment.
In Gulf War patients, once effectively treated, the majority of patients recovered. For civilians, six months is the minimum recommended treatment length, and some patients require much longer treatment in order to recover.
Given that Mycoplasma have some characteristics of viruses, some physicians have suggested that Famvir or Ganciclovir may be added to the antibiotic therapy.

Herxheimer reactions do occur when treating Mycoplasma infections. To minimize this die-off effect where the patient generally feels much worse while on treatment, Dr. Nicolson advises using 50mg oral Benadryl taken 30 minutes before the antibiotics. He also finds that a strained blend of 1 whole lemon, 1 cup fruit juice, and 1 tablespoon of olive oil can be helpful.

Though Dr. Nicolson believes that antibiotics are the most effective approach to treating Mycoplasma infections, he has found some good natural options. In terms of natural approaches to treating Mycoplasma, Raintree Nutrition ( has created several products that may be quite helpful for patients. These include Raintree Myco, Raintree A-F, and Raintree Immune Support. 

Dr. Nicolson has seen evidence that Mycoplasma-specific transfer factors such as those from Chisholm Labs and others can be beneficial in some patients. He says that many natural options help in some patients, but that his experience has been that the antibiotic treatment results in the best outcomes. In many, recovery requires a push and pull between conventional and alternative treatments.

One of the hallmark signs of Mycoplasma infection is fatigue. The infections lead to oxidation in the body that leads to damage of the cell membranes. Oxidation accelerates the damage to the lipids in cell membranes which impacts mitochondrial function. This leads to less energy in the cell and ultimately to a fatiguing of the larger organism due to the fact that there is less energy to support necessary cellular functions. 

In patients where fatigue is due to cell membrane damage, Dr. Nicolson has found NT Factor® to be highly beneficial. NT Factor® replaces the damaged lipids and helps to restore mitochondrial function. Often, fatigue then resolves or is reduced.
Dr. Nicolson has found that oxidative therapies such as ozone can be helpful in the fight against Mycoplasma. However, he notes that this is generally palliative and does not produce the same results as the antibiotic therapy in the long-term. He finds that the oxidative therapies "are generally more cytostatic than cytotoxic". Hyperbaric oxygen may be helpful but similarly does not appear to be a highly effective treatment in the longer-term.

In other countries, IV drips with H2O2 (hydrogen peroxide) have been used with some benefit, but Dr. Nicolson notes that these therapies, while potentially effective, are highly dangerous and not advised.

In the realm of frequency medicine and Rife therapy, Dr. Nicolson believes that the frequencies that could be used to address Mycoplasma are too similar to normal cellular frequencies. Thus, he is not certain that Rife therapy is an effective way to approach the problem. 

In the nutritional realm, Dr. Nicolson finds that many patients with chronic infections are immunosuppressed and that proper nutrition is vital. He cautions against smoking and drinking. He suggests avoidance of sugars, trans-fats, and allergenic foods. He advises patients to increase their fruits, vegetables, and whole grains. Some dietary winners in supporting the immune system include cruciferous vegetables, soluble fiber-based foods such as prunes and bran, wheat germ, yogurt, fish, and whole grains. 

Patients are often depleted in key vitamins and minerals. Supplementation with B-Complex, Vitamin C, Vitamin E, and CoQ-10 are often beneficial. Minerals are often necessary. Dr. Nicolson notes, however, that many people have poor absorption and may require sublingual or injectable forms of these nutrients. Amino acids, flax seed, and fish oils can provide additional support, but the best nutrition for cell membranes is NT Factor®.

Many patients with chronic illnesses have a toxic body burden of heavy metals such as mercury, lead, cadmium, and aluminum. Hair, stool, and urine testing is available through labs like Doctor's Data ( and Genova Diagnostics ( Dr. Nicolson has seen reports of positive results with EDTA chelation suppositories from Detoxamin ( and oral chelators from Longevity Plus (

For patients using antibiotics, beneficial gut flora is often depressed. Supplementation with a high quality probiotic is important, but probiotics have to be taken two hours or longer after taking antibiotics. Natural immune support can be helpful in the form of whey proteins, transfer factors, or immune-support products such as Beyond Immuni-T from Longevity Plus.


Dr. Nicolson believes that biofilms are a factor in successfully treating Mycoplasma infections. In cases that are refractory to antibiotics, biofilms are likely a major factor. 

In men with chronic refractory prostatitis which is infection-based, one often cannot be treated effectively with antibiotics. However, when Detoxamin (EDTA) or other agents to address the biofilms are used, it then becomes possible to treat these infections with tetracyclines. Patients quickly show functional increases and decreases in pain other symptoms.


In chronic Lyme disease, it is often difficult to know which infections are actually responsible for the persistence of illness. However, in general terms, chronic intracellular infections that change the metabolism of cells and suppress mitochondrial and other functions will lead to patients remaining in a chronically ill state. Dr. Nicolson believes that these infections must be aggressively treated. "Similar to chronic Lyme disease, the current CDC or IDSA recommendations for short-term treatment of chronic infections are simply inadequate," he says.

Dr. Nicolson has found that there is a hierarchy of symptoms that resolve relatively quickly and those that resolve more slowly when treating Mycoplasma. Gut-associated phenomenon such as Irritable Bowel Syndrome (IBS) often resolve quickly. Other systemic signs and symptoms can resolve in an intermediate period of time from many weeks to many months. Symptoms associated with the central and peripheral nervous systems such as neuropathy and pain often resolve much more slowly. Skin sensitivity and burning sensations may take much longer to resolve. Mycoplasma infections do invade nerves, and nerve-related symptoms are among the more difficult to resolve.

Dr. Nicolson states "We keep seeing the suppression of information on Mycoplasma and similar intracellular bacterial infections. The world of Mycoplasma parallels the world of chronic Lyme disease in terms of the politics involved. Physicians are being persecuted by their medical boards as a result of bad information. It is important for us to do everything within our power to get rid of harmful, erroneous information about these diseases. Both Mycoplasma and Borrelia have been manipulated for biological weapons purposes and as a result, both are politically incorrect to discuss, work on, or do anything about. Until this changes, we won't see any real progress."

La maladie de Lyme comme toutes les spirochétoses n’est pas une maladie infectieuse immunisante

Maladies Infectieuses
Hôpital de la Croix Rousse
69004 Lyon
Exposé bref
9h00 Amphi 3

En France, la maladie de Lyme, zoonose transmise par la piqûre d’une tique du genre Ixodes,
est liée à une infection bactérienne par différentes espèces de Borrelia Burgdorferi sensu lato
(B. garinii, B. afzelii, B. Burgdorferi sensu stricto).
La primo-infection est exceptionnellement asymptomatique et se définit par l’érythème
migrant (EM). Non traitée, elle évolue vers le stade secondaire qui s’accompagne de
manifestations isolées ou associées, cutanées, articulaires, cardiaques, neuroméningées ou
oculaires. A la phase tertiaire, on retrouve des signes cutanés (acrodermite chronique
atrophiante), neurologiques, articulaires, musculaires et cardiaques.

Une primo-infection de l’adulte à B. burgdorferi se traite par 14 à 21 jours d’amoxicilline (3
g/jour), doxycycline (200 mg/jour), céfuroxime-axétil (500 mg x 2 fois/jour) ou 10 jours
d’azithromycine (500 mg/jour). Doxycycline est contre-indiquée chez l’enfant de moins de 8
ans et la femme enceinte.
Les molécules éligibles pour le traitement des phases secondaires ou tertiaires sont
amoxicilline, doxycycline et ceftriaxone (2 g/jour) pour une durée de 21 à 28 jours.
Dans certaine situation, une prolongation d’antibiothérapie peut-être proposée. Il n’est pas
recommandé d’assurer un suivi sérologique mais uniquement un suivi clinique.
La maladie de Lyme comme toutes les spirochétoses n’est pas une maladie infectieuse
immunisante. La protection mécanique repose sur le port de vêtements protecteurs longs et
fermés. Il faut retirer le plus vite possible la tique avec un tire-tique, désinfecter et surveiller la
zone de morsure. Une antibioprophylaxie systématique (dans les 72 heures après le
détachement de la tique) n’est pas recommandée mais discutée au par cas en cas
d’attachement de la tique depuis plus de 36 heures, en zone de forte endémie d’infection
des tiques (plus de 20%) et chez des patients immunodéprimés. Il n’y a pas de vaccin
disponible en France.
La morphée est le grand diagnostic différentiel de la maladie de Lyme et justifie d’une
biopsie de peau avec anatomie-pathologie et PCR Borrelia. Les infections à streptocoque et
staphylocoque sont plus connues après morsure par une tique que TIBOLA.
Les évolutions des écosystèmes imposent une surveillance attentive des zoonoses et tout
particulièrement de la maladie de Lyme.

 Borréliose de Lyme et autres borrélioses. E.Pilly, 2010 : 309- 12.
Borréliose de Lyme, recommandations françaises (2006) :
‐ Texte court :
‐ Texte long :
Maladie de Lyme, recommandations américaines (2006 et 2010):

autre site parlant de la borreliose

Bonjour a tous,

je suppose que ce sujet sera encore longtemps actuel...malheureusement!

Alors, je voulais apporter quelques infos concernant cette maladie...

En Allemagne, il n'y a malheureusement aucune place pour cette maladie dans le milieu medical! a tel point qu'il m'a fallut moi-meme expliquer au medecin la multitude de symptomes possibles de la borreliose. Cette maladie ne sera surement pas acceptée avant longtemps par le milieu medicale dans la mesure où ses symptomes sont dans presque tout les domaines, comme Parkinson, sclerose en plaque, Tremblement essentiel familiale, infarctus, tintement d'oreille, vertige, tout les problemes articulaires, et - le meilleur pour la fin! alzheimer... Et j'en passe plein dautres. En fait, accepter tout ces symptomes comme venant de la borreliose serait une catastrophe economique pour l'industrie pharmaceutique!
Pour les labo, c'est pire qu'en france : je n'en ai pas trouvé un qui soit competent dans le domaine et je me suis aussi tourné sur le labo de Viviane Schaller a strasbourg...

La seul chance que nous avons en Allemagne vient d'un ethnologue-chamane - Wolf-dieter Storl, qui ayant eu la borreliose, l'a etudiée avec des moyens a la fois medicaux, ethonologique et chamanique...
Une estimation allemande (parallele) dit qu'un allemand sur 7 aurait la borreliose! En effet, la borreliose n'est pas transmise par les tiques mais aussi par nous-meme! : par le sexe et par le sang. Comme pour le sida au debut, il n'y a pas de depistage de la borreliose pour les donneurs de sang! Donc a chaque transfusion, il y a risque de propagation!!!
Curieusement, beaucoup d'individus développent une défense naturelle qui oblige les borrelies a s'encapsuler, etat dans lequel elle sont intouchables et peuvent rester 9 mois...
Aucun antibiotique n'est donc efficace pour la meme simple raison qu'elles s'encapsulent aussitot...

Selon Storl, ces bacteries sont les championnes de la survie. Elles seraient une variation plus evoluée de la syphilis... Il a donc regardé ce que faisaient les chamanes amerindiens avec la syphillis : ils modifiaient le terrain de la personne de telle facon que les bacteries ne pouvaient plus y vivre!

En definitive - parce que je ne vais pas vous traduire le livre ici ;-) , il s'est gueri lui-meme par des frequentes sweat-lodges (les borrelies s'encapsulent au-dessus de 42°C) et une cure de cardere - plante qui modifie le terrain et le rend impropre aux borrelies...
Cette cure de cardere a l'avantage d'etre preventive dans le cas de piqure de tique. En effet, les borrelies se trouvent dans l'estomac de la tique et analyse le sang que suce la tique. Si ce sang leur convient, elles migrent vers l'hote pour l'infester. Ce processus dure au moins dix-neuf heures. (donc pas de panique si vous voyez une tique le soir apres avoir fait une ballade en foret!).

J'ai fait personnellement une cure de cardere de deux fois deux mois et une trentaine de sweat-lodges en un an et demi, mais les symptomes (surtout arthrite et tremblements des mains) demeurent... J'attends encore un peu pour aller ramasser des racines de cardere et me faire une nouvelle teinture-mere.
Alors pour finir, comment faire une teinture-mere de racine de cardere : le cardere se développe en deux phase : la 1ere année, il fait une rosette au sol et rassemble toute son energie dans la racine (un rhizome) afin de pouvoir faire sa fleur l'année suivante. Donc c'est a l'automne a l'etat de rosette qu'il faut la ramasser, quand elle est pleine d'energie! Ensuite, on la rape et en bourre au maximum un pot etanche que l'on rempli d'alcool a 70%. Apres un mois de maceration, on extrait la teinture-mere en pressant les racines dans un linge de coton.
Plus on presse fort, plus la teinture est concentrée. Il faut pas mal de cardere pour obtenir un kilo de racine mais cela depend ou elles poussent : ca peut aller du simple au decuple en poids!
Personnellement je l'ai prise a raison de 30 gouttes avant chaque repas...
J'imagine que l'ideal serait de faire une cure de plus de neuf mois pour etre certain que toutes sont mortes, mais je n'ai pas trouvé assez de carderes dans ma region!!!

voilà, j'espere que ca peut en aider certains...

sur un autre blog

La maladie de Lyme est véhiculée par les tiques. C'est une maladie peu connue, classée comme rare en France. En fait, elle n'est pas si rare que ça. Elle prend plusieurs formes et peu occasionner des troubles sévères. Il faudrait considérer la maladie de Lyme un peu comme la séropositivité et le sida, avec autant de sérieux. Malheureusement, par méconnaissance, beaucoup de médecins et même des hopitaux passent à coté pour leurs diagnostics. De très bon articles sont lisibles sur des sites spécialisés ou dans des actes de colloques.Cet article n'a pas pour objet d'inquiéter, mais d'apporter des éléments complémentaires aux informations déjà en circulation sur internet (par exemple sur

Si vous avez la maladie de Lyme (ou vous la suspectez), il y a des chances que votre foie soit fatigué. Vous devez alors l'épargner, en adaptant votre alimentation. Vous pouvez privilégier les légumes de saison, éviter l'alcool, le chocolat... ce qui vous alourdit lorsque vous mangez.
Par ailleurs, la maladie semble progresser surtout sur « terrain acide ». En fait, notre corps doit tendre vers un équilibre acido-basique, autour d'un ph de 7. Pour déterminer votre ph, des bandelettes sont en vente dans les magasins de diététique ou les pharmacies, avec des explications sur la façon de procéder et un code couleur pour déterminer votre ph. En gros, vous urinez et trempez la bandelette qui se colore (on privilégie la deuxième urine du matin, l'urine avant le repas de midi ou avant le repas du soir). Les tiques, comme els puces et les moustiques aiment les terrains acides, alors si vous agissez sur votre équilibre acido-basique, vous alliez préventif et curatif.
Pour gérer votre équilibre acido-basique, d'autant plus si vous avez Lyme, des changements de vie (stress, alimentation, repos...) risquent de s'imposer.
Un très bon livre de Christopher Vasey, « gérez votre équilibre acido-basique » aux éditions Jouvence est très clair et explicite.
Quelques petits trucs qui concernent Lyme:
Le dépistage: une analyse de sang classique ne suffit pas à déterminer si nous avons une forme ou une autre de maladie de Lyme. Il existe un laboratoire spécialisé dans les seules analyses fiables dans ce domaine, c'est le Laboratoire d'Analyse Médicales de Viviane SCHALLER, 16 rue Oberlin, 67000 STRASBOURG. Exigez de votre médecin une analyse dans ce laboratoire! Pour la sérologie de Lyme (test Elisa et Western Blot), vous ou votre médecin contacte le laboratoire qui envoie un kit pour le prélèvement de sang et toutes les instructions à suivre. Si votre médecin comprend que cette maladie n'est pas rare, il en commandera un carton (comme le font les médecins qui connaissent un peu cette maladie). En France, ce test est remboursé par la sécurité sociale.
Si vous habitez dans le sud de la France, comme moi, un docteur fait un travail formidable dans ce domaine, le Docteur DUGAUQUIER Sylvie à Saint Gaudens (
Préventif: Si vous avez la maladie de Lyme, sachez qu'elle se transmet par le sang et le placenta. Aussi, merci de ne pas donner votre sang pour transfusion, car il n'y a aucun dépistage actuellement (un peu comme le sida à ses débuts...). Si après transfusion un ami à vous a des symptômes concernant Lyme, bien qu'il n'aie pas été piqué par une tique, un dépistage peut s'avérer aidant.
Préventif: Vous pouvez préparer un mélange préventif d'huiles essentielles (pelargonium, eucalyptus citronné, girofle, romarin, citronnelle). Ce mélange, j'en met 10 à 20 % dans de l'alcool (70 à 90 °), je laisse macérer puis je pulvérise su mes vêtements lorsque je vais en nature.
Ce même mélange, dilué dans une huile de cuisine (olive ou tournesol), je me l'applique sur la peau aux chevilles et poignets.
Curatif: chacun doit trouver sa propre voie. Certains utilisent l'homéopathie, d'autres la médecine chinoise, d'autres la naturopathie, d'autres l'antibiothérapie... Voici quelques clés concernant l'homéopathie:
En Allemagne, un remède majeur contre Lyme est la teinture mère de cardère, assez facile à faire.
En France, ceux qui utilisent la forme homéopathique de la borelia doivent se la procurer en Belgique, car la souche française est issue d'un vaccin alors que la souche belge est issue directement de la borelia. Pour la commander, une petite adresse mail:
Curatif: les borelia n'aiment pas la chaleur de type sauna. Alors si vous avez un sauna ou un hammam à proximlité, il est peut-être temps de prendre un abonnement.
Curatif: La vitamine C naturelle (acérola, argouses, mûres, cynorhodon...) sont des alliés précieux.



L’association de symptômes appartenant à des catégories différentes
Une maladie de Lyme non reconnue ou insuffisamment traitée à la phase primaire, risque d’évoluer vers une phase secondaire avec souvent un retard ou une absence de diagnostic liés à la grande variété de ses symptômes cliniques. Il faut avoir deux objectifs :
- identifier et traiter précocement l’affection au stade primaire pour éviter le passage aux autres stades
- penser à suspecter devant certaines symptomatologies « multi-organes », la possibilité d’une maladie de Lyme à un stade évolué.
La maladie de Lyme, due à Borrelia burgdorferi, est transmise par une piqûre de tique. En France, l’incidence moyenne est de 9,4 /100 000 (12 à 15 000 nouveaux cas par an) et entre 86 et 200/100 000 en Alsace (6). « Ces chiffres sont sous estimés, estime le Pr Perronne, la maladie est souvent non diagnostiquée et la sensibilité de la sérologie est médiocre.»
La piqûre de tique passe inaperçue dans 69 % des cas. L’érythème migrant (EM), seul signe pathognomonique apparaissant 2 à 30 jours après la piqûre et disparaissant spontanément après quelques semaines, n’est présent que dans 70 à 80 % des cas. Et quand il est présent, il n’est pas toujours identifié ; soit que le patient ne consulte pas ou s’adresse seulement à la pharmacie, soit que EM n’est pas reconnu comme tel et étiqueté piqûre d’insecte, plaque d’allergie….
Aussi il importe de :
- éduquer ses patients à inspecter avec attention leurs corps après toute balade en forêt à la recherche de tique (sans oublier le cuir chevelu et les plis)
- enlever le plus tôt possible une tique, surveiller l’endroit pendant au moins 4 semaines et consulter dès l’apparition d’une rougeur (parfois d’un fébricule, de myalgies.) Pas d’antibiothérapie systématique sauf chez la femme enceinte (2).
- traiter toute personne présentant une lésion cutanée évocatrice d’EM (même sans notion de piqures) par une antibiothérapie suffisante (amoxicilline 3g/jour ou doxycycline 200mg/j pendant 2 à 3 semaines, sans attendre et sans faire de sérologie. (1). « Trop d’EM ne sont pas traités ou sont traités à des doses insuffisantes et/ou sur une durée trop courte, avec le risque de laisser la maladie de Lyme évoluer », déplore le Pr Perronne.
Non traitée au premier stade, la bactérie peut disséminer et être responsable de manifestations qui peuvent survenir quelques semaines à quelques mois plus tard. Ces symptômes possibles sont nombreux, divers, intermittents et extrêmement variables d’un sujet à l’autre. Aucun n’est spécifique, il peut s’agir de :
- asthénie intense, douleurs diffuses, parfois troubles de la mémoire et/ou de la concentration ;
- manifestations articulaires (arthralgies ou arthrites touchant une ou plusieurs articulations, les grosses surtout et le genou en particulier), musculaires ;
- manifestations neurologiques (céphalées, névralgies, radiculite souvent dans le territoire correspondant au lieu de la piqûre paralysie faciale à frigore, paresthésies, …), méningées ;
- manifestations cardiaques (tachycardie, extra-systoles, bradycardie,…), symptômes oculaires (conjonctivite, uvéite, troubles de la vision…),
- manifestations cutanées (morphée, rare lymphocytome cutané bénin) (4, 5).
Au stade tertiaire, qui évolue au fil des années si la maladie n’a pas été diagnostiquée et traitée, les mêmes catégories de symptômes deviennent chroniques, souvent permanents, parfois fluctuants.
« Par la diversité de ses symptômes et leur absence de spécificité, la maladie de Lyme peut simuler beaucoup de maladies notamment auto-immunes. Penser à l’éventualité d’une origine infectieuse devant une symptomatologie floue et diverse permet, si elle est confirmée, de guérir ces patients ».
-› L’association de symptômes appartenant à des catégories différentes doit faire évoquer une maladie de Lyme, en exemple : une névralgie et une anomalie du rythme cardiaque, ou des paresthésies avec une asthénie et une arthralgie du genou, ou des signes oculaires avec des algies diffuses…
-› Ces patients ont habituellement un fond de fatigue et de douleurs mal expliquées et migratrices de type fibromyalgie, quelques paresthésies.
-› L’apparition de troubles des performances intellectuelles chez quelqu’un de jeune qui subitement présente des difficultés à se concentrer, à raisonner, des oublis est très évocatrice.
Il faut enquêter : ces patients, ont-ils déjà été piqués par une tique, se souviennent-ils d’avoir eu une plaque cutanée ? « Le premier obstacle au diagnostic, c’est que seulement 31 % des malades atteints se souviennent de la piqûre de tique. Ainsi, toute symptomatologie cutanée, oculaire, neurologique, méningée, psychiatrique, musculaire, cardiaque, osseuse, algique, etc… doit faire prescrire une sérologie de la maladie de Lyme, a fortiori si aucun autre diagnostic précis n’a pu être établi. »
Les stades secondaires ou tertiaires sont traités par antibiotique (amoxicilline 3gr/j ou doxycycline 200 mg/j) pendant 3 à 4 semaines.
En cas de forte suspicion clinique de maladie de Lyme (absence d’autre étiologie aux symptômes), si la sérologie est négative, un traitement antibiotique peut être proposé qui dans ce cas, a valeur de test thérapeutique.
Dr Catherine Freydt (rédactrice, sous la direction scientifique du Pr Christian Perronne (Chef du service de Médecine Aiguë Spécialisée, CHU Raymond Poincaré, 104 boulevard Raymond-Poincaré. 92380 Garches).