Laurie's Blogs.
May 2019
Guest Blog - Lasering & Infections
A colleague asked me the following question:
Hey Laurie,
Do you have any experience lasering dogs with discitis? I have been looking for an article about discitis and laser and sadly there is nothing out there. I know it is ok to laser if there is an infection, however my concern is that because I do not understand what the laser does to infection cells and the infection was located within an enclosed space is there any risk of kick starting the infection.
Thanks heaps for your help 😊 x
I said that I thought it would be worth a try, but that we should submit this question to Peter Jenkins from Spectravet. Well, Peter did not disappoint!
Hey!
I was also unable to find any papers specifically relating to discitis and laser therapy/PBM, but there are a few papers (attached) on laser/PBM therapy of similar conditions, such as osteomylitis, and others demonstrating anti-bacterial/anti-fungal/pro-immune effects.
1: "...laser phototherapy with the appropriate irradiation parameters appears to be a promising adjunct and/or alternative technique to pharmacological agents in the treatment of osteomyelitis." https://www.ncbi.nlm.nih.gov/pubmed/21219239
1a (Letter to Editor re above): "...it is possible that the healing effect of 808-nm light on osteomyelitis induced in rats is not the result of S. aureus killing but through upregulating the immune system."
2 (only available in Russian): "It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process." https://www.ncbi.nlm.nih.gov/pubmed/26852503
3: An S. aureus infected wound healing study in diabetic rats demonstrated "...significant bacterial growth inhibition" with PBM. https://www.ncbi.nlm.nih.gov/pubmed/27579876
4: PBM can "...significantly reduce the pathogenicity of Candida albicans." https://www.ncbi.nlm.nih.gov/pubmed/24905928
Basically, any proliferative effects light may have upon infectives (as demonstrated in vitro) is at least partially offset, totally mitigated, or even reversed due to the stimulatory effects of light on the host immune response.
To maximise the immune response I'd suggest irradiating accessible lymph nodes in addition to the local treatment of the spine.
Hope this helps!
Cheers!
Peter
I thought this was brilliant as is, but he then sent more information based on a similar question from another colleague. The question was basically, ‘What does current research say regarding the safety of laser over areas of active infection?’
Here’s Peter’s reply to that!
Although photobiomodulation (a.k.a. laser therapy, LLLT, LPLI, cold laser, etc..) has been shown to have both inhibitory and proliferative effects upon bacteria and fungal infectives in vitro, in vivo the effects are almost always inhibitory and, thus, beneficial to the patient.
For example:
1. Nussbaum et al (2003) investigated the effect of LLLT at various irradiances and exposure times on E. coli, P.aeruginosa, and S. aureus in vitro, and found that "E. coli growth increased", "P. aeruginosa growth decreased", and that S. aureus was largely unaffected.
2. Lu et al (2016) found that "...mice treated via LPLI [low-power laser irradiation] exhibited a profoundly enhanced defense against infection with L. monocytogenes, and both the bacterial clearance ability and the survival rate of the mice were increased under LPLI treatment.", and that "LPLI treatment augments macrophage phagocytic activity and the host defense against infection".
3. Ranjbar and Takhtfooladi (2016) studied S. aureus infected wounds in diabetic rats concluded that "Photobiomodulation therapy may be useful in the management of wound infection through a significant bacterial growth inhibition and an acceleration of wound healing process.".
4. Kaya et al (2011) found that "...laser phototherapy with the appropriate irradiation parameters appears to be a promising adjunct and/or alternative technique to pharmacological agents in the treatment of [MRSA-induced] osteomyelitis.", and attributed the healing effect to the bactericidal effect of 808-nm diode on S. aureus, however...
4a. Lubart (2011) suggest that, instead, "the healing effect of 808-nm light on osteomyelitis induced in rats is not the result of S. aureus killing but through upregulating the immune system.". [NB. a similar pro-immune effect may also be the case in 3, above, and is also discussed in 4b, below]
4b. Trunova et all (2015) state, "It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process.".
5. Seyedmousavi et al (2014) concluded that, rather than posing a risk, laser PBM can "...significantly reduce the pathogenicity of Candida albicans" and, therefore, "...may be a promising novel treatment approach for superficial and mucocutaneous C. albicans infections.".
Basically, any proliferative effects light may have upon infectives (as demonstrated by Nussbaum, in vitro) is at least partially offset, totally mitigated, or even reversed, due to the stimulatory effects of light on e.g. the host immune response.
Regarding TB, Vlassov and Reze (2006) (6) reviewed the use of low level laser therapy (LLLT) as an adjunct to antituberculous drugs for treating tuberculosis. Although they concluded there was insufficient evidence at the time to support its widespread use and it "should only be used in randomized controlled trials until its value is evaluated", no adverse effects were attributed to the use of laser therapy in TB patients.
Cheers!
Peter
References:
1-nussbaum2003.pdf: Nussbaum, E. L., Lilge, L., & Mazzulli, T. (2003). Effects of Low-Level Laser Therapy (LLLT) of 810 nm upon in Vitro Growth of Bacteria: Relevance of Irradiance and Radiant Exposure. Journal of Clinical Laser Medicine Surgery, 21(5), 283–290. doi:10.1089/104454703322564497 https://www.ncbi.nlm.nih.gov/pubmed/14651796
2-lu2016.pdf: Lu, C., Fan, Z., & Xing, D. (2016). Photo-enhancement of macrophage phagocytic activity via Rac1-mediated signaling pathway: Implications for bacterial infection. The International Journal of Biochemistry & Cell Biology, 78, 206–216. doi:10.1016/j.biocel.2016.06.010 https://www.ncbi.nlm.nih.gov/pubmed/27345261
3-ranjbar2016.pdf: Ranjbar, R., & Takhtfooladi, M. A. (2016). The effects of photobiomodulation therapy on Staphylococcus aureus infected surgical wounds in diabetic rats. A microbiological, histopathological, and biomechanical study. Acta Cirurgica Brasileira, 31(8), 498–504. doi:10.1590/s0102-865020160080000001 https://www.ncbi.nlm.nih.gov/pubmed/27579876
4-kaya2011.pdf: Kaya, G. Ş., Kaya, M., Gürsan, N., Kireççi, E., Güngörmüş, M., & Balta, H. (2011). The Use of 808-nm Light Therapy to Treat Experimental Chronic Osteomyelitis Induced in Rats by Methicillin-Resistant Staphylococcus Aureus. Photomedicine and Laser Surgery, 29(6), 405–412. doi:10.1089/pho.2010.2807 https://www.ncbi.nlm.nih.gov/pubmed/21219239
4a-lubart2011.pdf: Lubart, R. (2011). A Possible Mechanism for Treating Staphylococcus aureus-Induced Chronic Osteomyelitis in Rats Using 808-nm Light. Photomedicine and Laser Surgery, 29(12), 789–790. doi:10.1089/pho.2011.9898 https://www.ncbi.nlm.nih.gov/pubmed/22107485
4b-trunova2015.pdf: Trunova OV, Mashkov AE, Khan MA, Prikuls VF, Nazarenko NN, Supova MV, Smirnova SN, Larionov KS (2015). The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis. Vopr Kurortol Fizioter Lech Fiz Kult. 2015 Sep-Oct;92(5):50-53. doi: 10.17116/kurort2015550-53. https://www.ncbi.nlm.nih.gov/pubmed/26852503
5-seyedmousavi2014.pdf: Seyedmousavi, S., Hashemi, S. J., Rezaie, S., Fateh, M., Djavid, G. E., Zibafar, E., … Ataie-Fashtami, L. (2014). Effects of Low-Level Laser Irradiation on the Pathogenicity of Candida albicans: In Vitro and in Vivo Study. Photomedicine and Laser Surgery, 32(6), 322–329. doi:10.1089/pho.2012.3387 https://www.ncbi.nlm.nih.gov/pubmed/24905928
6-vlassov2006.pdf: Vlassov, V. V., & Reze, A. G. (2006). Low level laser therapy for treating tuberculosis. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003490.pub2 https://www.ncbi.nlm.nih.gov/pubmed/16625582
And now you know!!! :)
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