late stage lyme disease kenny l. de meirleir, internal medicine emeritus gewoon hoogleraar v.u.b....
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LATE STAGE LYME DISEASE
Kenny L. De Meirleir, internal medicine
• Emeritus Gewoon Hoogleraar V.U.B.•Clinical Professor of Pathology, University of Nevada, Reno, U.S.A.•Medical Director Himmunitas VZW (Brussels) & WPI, University of
Nevada, Reno, Nevada, U.S.A.
Chronic Fatigue Syndrome / M.E. (Fukuda & Canadian criteria)
+ 95 % Late Stage Lyme Disease
Lyme Stage III
+ 95 % Borrelia burgdorferi LTT
Lyme Stage III = Late Stage Lyme Disease• Multisystem disease with high morbidity• Incidence in Belgium: UNKNOWN
> 100.000 (up to 500.000) patients• Transmission:
1) Blood sucking arthropods (Ixodes Ricinus): ticks, insects, ...2) Sexual transmission between humans (new S.O.A.)3) Mother-fetus transmission4) Blood transfusion
• Co-infections:– Bartonella - Rickettsia– Babesia - Tularemia– Chlamydiae - Parvovirus B19– Mycoplasmae - Yersinia– Campylobacter
Borrelia species – gramnegative bacteria
• U.S.A.: Borrelia burgdorferi
• Europe:– Borrelia burgdorferi– Borrelia afzelii– Borrelia garinii– other
DIAGNOSTIC TESTS• Borrelia burgdorferi antibody tests (Elisa, C6 peptide,
Western Blot→ mostly negative in LSLD
• Borrelia PCR tests:– Low sensitivity in blood– High specificity when combined and confirmed by sequencing
(U.L.)• Borrelia burgdorferi LTT*:
– Indirect test– Valuable in LSLD
• LTT accepted by FDA in 2011
• Borrelia culture→ not widely used; still investigational
• Microscopic detection of Borrelia spirochetes:– Semen– Vaginal swap
• Early treatment (< 2 months): no chronic disease• Late treatment: outcome uncertain – many
develop “chronic diseases”: ME/CFS, ALS, MS, ...• Chronic microglial activation in LSLD – low grade
neuroinflammation• Markers blood:
– sCD14 (LPS)– PGE2– IL-8– Number of CD57+ lymphocytes in the blood– Other pro-inflammatory cytokines and chemokines
• No vaccine available
Bartonella – gramnegative bacteria• Bartonella henselae – cat scratch disease
Bartonella quintana – trench fever• 31 other species (8 subspecies are known to infect
humans)• Only commercial antibody tests for Bartonella henselae• PCR with sequencing (only in Belgium)• Culture of Bartonella – not approved by FDA yet for
clinical use• Infects endothelial cells in humans• Infect red blood cells – 3-4 Bartonella / millions red blood
cells• Cats = reservoir: 1.000.000 Bartonella / million red blood
cells
Symptoms Bartonella positive vs. Bartonella negative
SYMPTOMS Pearson Chi-Square
weight change 0,005
anxiety - which may include panic attacks 0,007
emotional labiality (mood swings) 0,005
frequent, unusual nightmares 0,002
difficulty moving your tongue to speak 0,024
alcohol intolerance 0,015
Rash of Herpes Simplex of Shingles 0,005
impotence 0,005
Bartonella & Borrelia 15/10/2011 - 15/10/2012
0%
10%
20%
30%
40%
50%
60%
70%
Belgium n=496
Netherlands n=159
Norway n=165
Denm ark Sweden
n=29
United Kingdom Ireland
n=21
Aus tralia n=15
Germ any Switzerland Luxem bourg
n=12
Spain Italy Portugal France
n=22
Bartonella positive
Borrelia positive
Bartonella positive& Borrelia positive
Box plots ( line in box is median and size box is interquartile range : 50 % of centrally located points)
Non-parametric Mann – Whitney test performed for two independent groups :
Conclusion : for all three variables : MW is significant with p-value < 0.0009,so all three increased medians for CFS group.
Regulation of T-cell immunity
Naïve T
cells
Naïve T
cells
TH1cellsTH1cells
TH2cellsTH2cells
TH17cellsTH17cells
Protection againstintracellular pathogens(viruses, bacteria)Excess: hypersensitivities
Protection againstextracellular pathogens(parasites, bacteria)Excess: allergies
Local immunity(mucosa, skin)Protection againstfungi, bacteriaExcess: autoimmunity, inflammation
IL-12
TGF- + IL-6
IL-4
IFN-
Borrelia: prevention
• Reservoir: Rodents / mammals mice / cats / deer ...new strategies to control tick-born diseases
• Early detection tick-born diseases – G.P. education
• Screening all pregnant women• Screening of blood – blood transfusion• Recognize Borrelia as a S.O.A.