TIME public health

What You Should Know About Chronic Lyme Disease

Yolanda Foster on 'Watch What Happens Live'
Yolanda Foster on Watch What Happens Live on Dec. 23, 2014. Bravo—NBCU Photo Bank via Getty Images

Lyme disease affects about 300,000 people in the U.S. each year

Real Housewives of Beverly Hills star Yolanda Foster is making waves with her recent blog post about her struggle with chronic Lyme disease. Foster, who was diagnosed with Lyme in 2012, according to People.com, says she’s had severe mental impairment from her condition, writing, “I have lost the ability to read, write, or even watch TV, because I can’t process information or any stimulation for that matter.”

But don’t antibiotics cure Lyme disease and, if so, what exactly is chronic Lyme? Health has the scoop:

What is Lyme disease and how is it treated?

Lyme disease is a bacterial infection, caused by the bacteria Borrelia burgdorferi and transmitted by ticks. It hits more of us than we realize—the Centers for Disease Control and Prevention estimates that about 300,000 people are diagnosed with the disorder each year, about 10 times higher than the number actually reported to the CDC. Left untreated, it can cause symptoms such as headaches and neck stiffness, pain and swelling in joints, even neurological symptoms such as memory problems.

Lyme is diagnosed based on symptoms (including the distinctive “bull’s-eye rash“) and blood tests. Most people recover with a 21-day course of antibiotics, though if the disease has spread to your central nervous system, you may need a longer course (2-4 weeks) of intravenous antibiotics.

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Is there such a thing as chronic Lyme?

While in rare cases an infection can still persist, “when patients talk about chronic Lyme, they’re usually referring to what doctors term ‘post-treatment Lyme disease syndrome,’ where you still have a cluster of symptoms such as fatigue, trouble concentrating, and muscle and joint aches after treatment,” explains Brian Fallon, MD, MPH, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University Medical Center. The CDC says approximately 10 to 20% of Lyme disease patients will have lingering symptoms like these. While it’s not clear what causes it, “it could be damage done to the body by the bacteria itself, or it could even be neurotransmitter changes in the brain induced by the prior Lyme disease,” Dr. Fallon says.

How is post-Lyme syndrome treated?

The treatment is itself controversial, mainly because it’s virtually impossible to tell if symptoms remain due to a recurrent infection or if they’re due to residual damage from Lyme. “The current diagnostic tests just reveal whether someone has antibodies due to previous exposure to Lyme disease, so while they indicate if you’ve ever been infected, they don’t show whether or not you’re infected now,” explains Dr. Fallon.

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A small subgroup of doctors argue that the condition is caused by residual bacterial infection and should be treated with long-term antibiotic therapy for months or even years. (Indeed, animal studies do suggest that Lyme infection may persist in some cases, Dr. Fallon says.) However, groups such as the Infectious Diseases Society of America frown on this approach. “There’s no research to show that this type of treatment works—several studies have shown that people taking long-term antibiotic for Lyme disease to treat lingering symptoms fare the same as those who take placebo,” states Chris Ohl, MD, an infectious disease expert at Wake Forest Baptist Medical Center.

Dr. Fallon allows for another possibility: Lyme bacteria are “very slow growing, so if you go off antibiotics but find your symptoms return within two to three weeks, it’s highly unlikely that Lyme is the culprit,” he explains. “But if they return within a few months, or even a year, you may have a recurrent infection” and thus may need another (short) course of antibiotics.

If it’s not really Lyme, what causes those symptoms?

It could be another condition entirely—such as another tick-borne infection. “It may very well be that [a patient has] developed an autoimmune disease such as rheumatoid arthritis, which was triggered by the Lyme disease,” adds Dr. Fallon.

HEALTH.COM: 15 Surprising Facts About Rheumatoid Arthritis

“Most of the cases I’ve seen, we’ve done a thorough workup and eventually come up with an underlying condition like anemia, a thyroid condition, a viral infection like Epstein-Barr virus, or even hepatitis C,” says Michael Parry, MD, Thomas J. Bradsell Chair of Infectious Diseases at Stamford Hospital in Stamford, Connecticut.

If extensive testing reveals nothing, then most doctors recommend cautious monitoring and addressing the symptoms (for example, treating joint or muscle pain with either over-the-counter or prescription anti-inflammatory drugs). It’s also important to utilize therapies also used with conditions like chronic fatigue syndrome, including good sleep and exercise habits and, if needed, treatment for depression.

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This article originally appeared on Health.com.

TIME ebola

The Ebola Virus Is Mutating, Say Scientists

Guinea West Africa Ebola
A health care worker, right, takes the temperatures of school children for signs of the Ebola virus before they enter their school in the city of Conakry, Guinea, Monday, Jan. 19, 2015 Youssouf Bah—AP

The outbreak has so far claimed 8,795 lives across the affected West African region

Scientists at a French research institute say the Ebola virus has mutated and they are studying whether it may have become more contagious.

Researchers at the Institut Pasteur are analyzing hundreds of blood samples from Guinean Ebola patients in an effort to determine if the new variation poses a higher risk of transmission, according to the BBC.

“We’ve now seen several cases that don’t have any symptoms at all, asymptomatic cases,” said human geneticist Dr. Anavaj Sakuntabhai. “These people may be the people who can spread the virus better, but we still don’t know that yet. A virus can change itself to less deadly, but more contagious and that’s something we are afraid of.”

Although virus mutations are common, researchers are concerned that Ebola could eventually morph into an airborne disease if given enough time.

However, there is no evidence to suggest this has happened yet, and the virus is still spread only via direct contact with an infected person.

Institut Pasteur, which first pinpointed the current Ebola outbreak last March, is hoping that two vaccines they are developing will reach human trials by the end of the year.

Current figures indicate 8,795 of some 22,000 cases across Liberia, Guinea and Sierra Leone — around 40% — have been fatal.

[BBC]

TIME public health

Medical Pot May Have a Place for Very Ill Kids, Says Pediatric Group

Medical Marijuana
Colin Brynn—Getty Images

'The Academy recognizes some exceptions should be made for compassionate use'

In an update to its 2004 policy statement on marijuana legalization, the American Academy of Pediatrics (AAP) now says that in some cases, children with certain debilitating illnesses should be allowed derivatives of marijuana to ease their suffering.

The group of pediatricians announced the change in position today in a statement reaffirming its opposition to the legalization of marijuana. It now includes several exceptions for “compassionate use” in children dealing with debilitating or life-limiting conditions. Compounds found in pot, known as cannabinoids, have become a method of stopping seizures for children suffering from epilepsy.

“Given that some children who may benefit from cannabinoids cannot wait for a meticulous and lengthy research process, the Academy recognizes some exceptions should be made for compassionate use in children,” the organization said in a press release.

Read More: Pot Kids: Inside the Quasi-Legal, Science-Free World of Medical Marijuana for Children

The organization stopped short of explicitly endorsing the practice and called for further research into its effectiveness.

“While cannabinoids may have potential as a therapy for a number of medical conditions, dispensing marijuana raises concerns regarding purity, dosing and formulation, all of which are of heightened importance in children,” said policy statement co-author William P. Adelman in the press release.

The organization maintained its steadfast opposition to recreational marijuana use, arguing that allowing its use for adults is more likely to lead to increased use among teenagers.

“Just the campaigns to legalize marijuana can have the effect of persuading adolescents that marijuana is not dangerous, which can have a devastating impact on their lifelong health and development,” said Seth D. Ammerman, another author of the statement, in the release.

TIME animals

Millions of Genetically Modified Mosquitoes Could Be Released in Florida

Jason Garcia
Jason Garcia, a field inspector with the Florida Keys Mosquito Control District, tests a sprayer that could be used in the future to spray pesticides to control mosquitos in Key West, Fla., on Oct. 4, 2012 Wilfredo Lee—AP

"This is essentially using a mosquito as a drug to cure disease"

Scientists could release millions of genetically modified mosquitoes in the Florida Keys in an attempt to kill off insects that spread the diseases dengue and chikungunya — if their proposal wins regulatory approval.

The male mosquitoes, created by British biotech firm Oxitec, are engineered to keep their partners from producing offspring when they mate in the wild, the Sun Sentinel reports. The number of mosquitoes capable of spreading the diseases would be reduced if enough wild mosquitoes mate with the genetically modified population.

“This is essentially using a mosquito as a drug to cure disease,” Michael Doyle, executive director of the Florida Keys Mosquito Control District, told the Sun Sentinel.

Despite the benefits of reducing incidences of dengue and chikungunya, two viral diseases that cause a number of uncomfortable conditions, many are wary about releasing genetically modified organisms into the wild. More than 130,000 people have signed a Change.org petition opposing the release of the mosquitoes in the Florida Keys.

[Sun Sentinel]

TIME global health

What the Gates Foundation Has Achieved, 15 Years On

Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived
Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived Scott Olson; Getty Images

Jeffrey Kluger is Editor at Large for TIME.

Much has been done over the foundation's first decade and a half — with more still to do

There are a whole lot of things you may or may not get to do in the next 15 years, but a few of them you can take for granted: eating, for one. Having access to a bank, for another. And then there’s the simple business of not dying of a preventable or treatable disease. Good for you—and good for most of us in the developed world. But the developed world isn’t the whole story.

The bad—and familiar—news is that developing nations lag far behind in income, public health, food production, education and more. The much, much better news is that all of that is changing—and fast. The just-released Annual Letter from the Bill and Melinda Gates Foundation makes a good case for hoping there is still more to come.

The 2015 letter represents something of a threshold moment for the Foundation. It was in 2000 that the Gateses began their work and set themselves a very public 15-year deadline: show meaningful progress in narrowing the health, income and resource gap between the world’s privileged and underprivileged people, or be prepared to explain why not. So far, nobody—neither the Gates Foundation nor the numerous other global health groups like the World Health Organization and UNICEF—have much explaining to do.

The number of children under five who die each year worldwide has been nearly cut in half, from a high of nearly 13 million to 6.5 million today. Polio has been chased to the very brink of extinction, and elephantiasis, river blindness and Guinea worm are close behind. Drought-tolerant seeds are dramatically increasing agricultural yields; economies in the once-desperate countries in sub-Saharan Africa are now matching the developed world in rate of annual growth. Up to 70% of people across the developing world now have access to wireless service, making mobile banking possible—a luxury in the West but a necessity in places there is no other banking infrastructure.

The trick of course is that progress isn’t the same as success. The 13 million babies who were dying a year in the years before the Foundation began, for example, factored out to a horrific 35,000 every single day. Slashing that in half leaves you with 17,500—still an intolerable figure. For that reason and others, the Gateses are turning the 15-year chronometer back to zero, setting targets—and framing ways to achieve them—for 2030.

The most pressing concern involves those 17,500 kids. The overwhelming share of the recent reduction in mortality is due to better delivery of vaccines and treatments for diseases that are vastly less common or even nonexistent in much of the developed world—measles, pneumonia, malaria, cholera and other diarrheal ills. Those are still the cause of 60% of the remaining deaths. But the other 40%—or 2.6 million children—involve neonates, babies who die in the first 30 days of life and often on the very first day. The interventions in these cases can be remarkably simple.

“The baby must be kept warm immediately after birth, which too often doesn’t happen,” Melinda Gates told TIME. “This is basic skin-to-skin contact. Breast-feeding exclusively is the next big thing, as is basic cord care. The umbilical cord must be cut cleanly and kept clean to prevent infections.”

HIV may similarly be brought to heel, if not as easily as neonate mortality. A vaccine or a complete cure—one that would simply eliminate the virus from the body the way an antibiotic can eliminate a bacterium—remain the gold standards. But in much of the world, anti-retrovirals (ARVs) have served as what is known as a functional cure, allowing an infected person to live healthily and indefinitely while always carrying a bit of the pathogen. Gates looks forward to making ARVs more widely available, as well as to the development of other treatment protocols that we may not even be considering now.

“We’re already moving toward an HIV tipping point,” she says, “when the number of HIV-positive people in sub-Saharan Africa who are in treatment will exceed the number of people becoming newly infected.”

Food security is another achievable goal. Even as Africa remains heavily agrarian—70% of people in the sub-Saharan region are farmers compared to 2% in the U.S.—yields remain low. An acre of farmland here in America may produce 150 bushels of corn; in Africa it’s just 30. The problem is largely rooted in our increasingly unstable climate, with severe droughts burning out harvests or heavy rainstorms destroying them.

“Millions of people eat rice in Africa,” says Gates, “and rice has to be kept much wetter than other crops. At the equator it’s staying drier longer, but when the rains do come, they hit harder.”

In the case of rice and corn and all other crops, the answer is seeds engineered for the conditions in which they will have to grow, not for the more forgiving farmlands of the West. In Tanzania, site-specific seed corn has been made available and is already changing lives. “That seed,” one farmer told Gates when she visited in 2012, “made the difference between hunger and prosperity.”

Finally comes banking. Across Africa, only 37% of people are part of the formal banking system, but up to 90%, depending on the area, are part of the M-Pesa network—a mobile banking link accessible via cellphone. The Pesa part of the name is Swahili for money and the M is simply for mobile.

“Today too many people put their money in a cow or in jewelry,” Gates says. “But it’s impossible to take just a little of that money out. If someone gets sick or you have another emergency, you simply sell the cow.” Mobile banking changes all of that, making it much easier to save—and in a part of the world where even $1 set aside a day can mean economic security, that’s a very big deal.

Nothing about the past 15 years guarantees that the next 15 will see as much progress. The doctrine of low-hanging fruit means that in almost all enterprises, the early successes come easier. But 15 years is a smart timeframe. It’s far enough away that it creates room for different strategies to be tried and fail before one succeeds, but it’s close enough that you still can’t afford to waste the time you have. Wasting time, clearly, is not something the folks at the Gates Foundation have been doing so far, and they likely won’t in the 15 years to come either.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Infectious Disease

Five Workers at Disneyland Have Been Diagnosed With Measles

Disneyland in Anaheim, Calif.
Disneyland in Anaheim, Calif. H. Lorren Au Jr.—AP

Unvaccinated workers who came into contact with them have been asked to take paid leave

Five employees at Disneyland, California have been diagnosed with measles, bringing the total number of cases in the outbreak up to 53.

All workers who have come into contact with the five have been asked to show vaccination records or do a blood test, the Los Angeles Times reports.

Those who have not been vaccinated have been asked to go on paid leave until their health status can be confirmed.

Earlier this month, nine cases of measles were confirmed in two California-based theme parks, and in Utah from people who had visited the resorts between Dec. 17 and 20.

Since then, the disease has spread across three other states and to Mexico.

[LAT]

TIME Infectious Disease

Unlicensed Cambodian Medic Charged With Murder After Allegedly Spreading HIV

212 HIV cases were found in the community where he practiced

An unlicensed medic is being charged with murder after Cambodian medical authorities found 212 cases of HIV in the district where he had been treating patients, allegedly with contaminated equipment.

Yem Chrin treated poor patients and was believed to have healing powers, Reuters reports. However, he did not have a medical license and was allegedly delivering injections and blood transfusions using unclean equipment. Authorities tested 1,940 people in the northwestern province where Yem Chrin worked, and 212 tested positive for HIV. Some children as young as 6 years old tested positive for the virus, according to al-Jazeera.

Yem Chrin allegedly told police that he sometimes used the same syringe on two or three patients before disposing of it.

The World Health Organization and UNAIDS found that “the percentage of people that reported receiving an injection or intravenous infusion as part of their health treatment was significantly higher among the people who tested positive for HIV than the people who were HIV negative,” in the area in which Yem Chrin treated patients, Reuters reports.

The development is a setback in Cambodia’s largely successful efforts to eradicate the virus since it first spread through the country in the 1990s.

[Reuters]

TIME ebola

U.N. Official Says Ebola Can Be Beat in 2015

Red Cross workers carry away the body of a person suspected of dying from the Ebola virus, in the Monrovia, Liberia on Oct. 4, 2014.
Red Cross workers carry away the body of a person suspected of dying from the Ebola virus in Monrovia, Liberia on Oct. 4, 2014. Pascal Guyot—AFP/Getty Images

"We have a long and difficult way to go," U.N. health official says

A United Nations official said Friday that the Ebola outbreak can be stomped out in 2015 but that months of hard work remain to stop the virus that has killed almost 8,000 people.

“We have not come anywhere close to ending the crisis. We’ve done a lot in 90 days in a very successful response but we have a long and difficult way to go,” Anthony Banbury, head of the U.N. Mission for Ebola Emergency Response told reporters.

His comments were reported by Reuters.

Read more: The Ebola fighters are TIME’s 2014 Person of the Year

“It’s going to go on for not just weeks but some months more,” Banbury said. “But I believe we will do it in 2015 and we’re going to do it by working very closely not just with governments of the countries but the communities.”

U.N. Secretary-General Ban Ki Moon created the international body’s Ebola mission in September to ramp up the international response to the crisis. Banbury is the outgoing mission chief. He’ll be replaced by Ould Cheikh Ahmed on Saturday.

[Reuters]

TIME ebola

There Are 53 Drugs That Could Treat Ebola

University of Utah Researchers Work Toward Cure For Ebola Strains
A container holds a Peptide that contains a potential new drug candidates for testing against a part of Ebola that is vulnerable to drugs, at the University of Utah on Oct. 14, 2014 in Salt Lake City. George Frey—Getty Images

New research raises prospect of treatments to be found in already available drugs

Scientists have identified 53 existing drugs that could be effective in fighting Ebola, according to newly published research.

There is currently no vaccine or drug available to treat the disease, which is one of the primary reasons the virus has been able to infect 18,603 people so far, and kill 6,915. A vaccine is undergoing clinical trials in humans, but a drug to treat people who already have the disease is critically needed. The experimental drug ZMapp has been used on a handful of Ebola patients, but resources of it are exhausted and it has not undergone adequate testing.

Running against the clock, some groups of scientists have decided that one of the most efficient ways to go about tackling the task of developing and distributing an Ebola drug is by screening drug compounds already available to see if any of those compounds could be used to create an effective drug.

MORE: Scientists Explore 10,000 Compounds for an Ebola Drug

In a new study published in the Nature Press journal Emerging Microbes and Infections, researchers at the Icahn School of Medicine at Mount Sinai and the National Institutes of Health (NIH) said they’ve identified 53 promising drug compounds. The team used high speed technology to scan through a library of 2,816 U.S. Food and Drug Administration-approved compounds already used for other ailments. Their method, which uses a virus-like particle that contained Ebola proteins, was calibrated to identify drugs that could prevent Ebola from infecting human cells by 50%.

Among these 53 promising compounds are ones used in cancer drugs, antihistamines, antibiotics, and antidepressants.

The compounds will be tested in animals to see what effects they have on Ebola, as well as their side effects. If a drug is proven both safe and effective, the government may use it in Ebola zones.

As TIME reported in October, scientists at Emory University Hospital are taking a similar approach to their library of 10,000 drug compounds. They think it’s possible Ebola could be treated similarly to the the treatments they’ve developed for viruses like HIV and Hepatitis C.

TIME Disease

There’s a ‘Super Bacteria’ in Waters Where the 2016 Olympics Will Be Held

OLY-2016-RIO-SAILING-REGATTA
Athletes compete in the Men's Laser during the final day of Aquece Rio, the International Sailing Regatta 2014, the first test event for the Rio 2016 Olympic and Paralympic Games at Guanabara bay in Rio de Janeiro, Brazil, on August 9, 2014. Yasuyoshi Chiba—AFP/Getty Images

Newly discovered bacteria is resistant to much modern medicine

Scientists have discovered a hard-to-treat ‘super bacteria’ in the body of water where Olympic events are planned in 2016 in Brazil.

The bacteria, which contains a special enzyme that makes it highly resistant to medical treatment, was found in Rio de Janeiro’s Guanabara Bay, which will be the site of competitions in sailing and wind surfing, the Associated Press reports.

The Instituto Oswaldo Cruz, a Brazilian health institute, said it had not yet detected any infections from the contaminated water but that an infected person would need very strong antibiotics and possible hospitalization to fight off the bacteria. Infected people can spread the bacteria even if they don’t become sick, the institute said.

In Rio 70% of sewage goes untreated and flows into rivers, bays and beaches. Olympic planners have said they will reduce the amount of sewage flowing into Guanabara Bay by 80% in time for the Games.

[AP]

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