Dig Deeper – Chronic Lyme Infection

Chronic tissue infection with Borrelia burgdorferi (Lyme disease spirochetes)

Abstract:

Borrelia burgdorferi, the tick-transmitted etiologic agent of Lyme borreliosis, can colonize and persist in multiple tissue sites despite vigorous host immune responses. The extracellular matrix appears to provide a protective niche for the spirochete. Recent studies in mice suggest that B. burgdorferi interacts in various ways with collagen and its associated molecules, exploiting molecular and structural features to establish microcolonial refugia. Better knowledge of the genetic and structural bases for these interactions of B. burgdorferi with the extracellular matrix will be required before an understanding of the persistence of B. burgdorferi in the tissues anddevelopment of chronic infections can be achieved.

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Human culture confirmed persistent Borrelia burgdorferi

Abstract:

The persistence of Borrelia burgdorferi in six patients is described. Borrelia burgdorferi has been cultivated from iris biopsy, skin biopsy, and cerebrospinal fluid also after antibiotic therapy for Lyme borreliosis. Lyme Serology: IgG antibodies to B. burgdorferi were positive, IgM negative in four patients; in two patients both IgM and IgG were negative. Antibiotic therapy may abrogate the antibody response to the infection as shown by our results. Patients may have subclinical or clinical disease without diagnostic antibody titers. Persistence of B. burgdorferi cannot be excluded when the serum is negative for antibodies against it.

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Survival strategies of Borrelia burgdorferi

Abstract:

To fight, flee or hide are the imperatives of long-term survival by an infectious microbe. Active immune suppression, induction of immune tolerance, phase and antigenic variation, intracellular seclusion, and incursion into immune privileged sites are examples of survival strategies of persistent pathogens. Here we critically review the supporting evidence for possible stratagems utilized by Borrelia burgdorferi, the spirochete that causes Lyme disease, to persist in the mammalian host.

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Chronic infection in post-Lyme disease syndrome

Abstract:

Chronic infection in -post-Lyme borreliosis syndrome- Cairns and Godwin provide strong evidence that patients with Lyme borreliosis may have persistent fatigue, musculoskeletal pain, and neurocognitive difficulties despite-adequate-antibiotic therapy. The authors state that -ongoing infection has not been excluded-in these patients with -post-Lyme borreliosis syndrome- Based on the evidence, we postulate that ongoing infection is the most likely explanation for chronic Lyme disease symptoms.

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Severity of persistent Lyme disease symptoms

Abstract:

Background: Persistent Lyme Disease Symptoms (PLDS) have included fatigue, headaches, poor concentration and memory, lightheadedness, joint pain, and mood disturbances. Evidence-based guidelines committees disagree over the severity of PLDS. The 2004 International Lyme and Associated Diseases Society (ILADS) concluded that PLDS are severe. The 2006 Infectious Disease Society of America (IDSA) guidelines committee concluded that PLDS are nothing more than the ‘‘aches and pains of daily living” and an ad hoc International Lyme group concluded that PLDS are ‘‘symptoms common in persons who have never had Lyme disease.”

Evaluation: There are 22 standardized instruments used to measure the severity of PLDS among the four published National Institutes of Health sponsored double-blind randomized placebo-controlled trials.

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Statistical analysis documents post-treatment Lyme disease symptoms

Abstract:

Background: This meta-analysis compares the prevalence of fatigue, musculoskeletal pain, and neurocognitive difficulties in patients who have had Lyme borreliosis (LB) and control subjects without LB. Five studies with 504 patients and 530 controls were included in the meta-analysis.

Results: The prevalence of symptoms was significantly higher in the LB patients, with P-values between 0.00001 and 0.007 for 8 of the 10 symptoms in the three categories listed above. The higher prevalence of certain neurocognitive symptoms but not others, in the same pattern as reported in the literature, is further confirmation of this syndrome. The pattern of symptoms appears to be different from that seen in fibromyalgia, depression, and chronic fatigue syndrome.

Conclusions: This meta-analysis provides strong evidence that some patients with LB have fatigue, musculoskeletal pain, and neurocognitive difficulties that may last for years despite antibiotic treatment.

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Chronic Lyme disease a persistent inflammatory infection

Abstract:

Seth Pincus (ASM News, November 2005, p. 529–535) provides a thought-provoking review of the potential role of infection in chronic inflammatory diseases. In terms of Lyme disease, he states that “the mechanism of disease is not fully understood and may involve both infectious and postinfectious processes.”

Unfortunately, most studies of chronic Lyme disease have focused on “postinfectious” causes of chronic inflammation. Recently, however, this antigenic cross-reactivity was shown to be “irrelevant” in chronic Lyme disease.

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Persistence of Borrelia burgdorferi in dogs post-antibiotic treatment

Abstract:

In specific-pathogen-free dogs experimentally infected with Borrelia burgdorferi by tick exposure, treatment with high doses of amoxicillin or doxycycline for 30 days diminished but failed to eliminate persistent infection. Although joint disease was prevented or cured in five of five amoxicillin- and five of six doxycycline-treated dogs, skin punch biopsies and multiple tissues from necropsy samples remained PCR positive and B. burgdorferi was isolated from one amoxicillin- and two doxycycline-treated dogs following antibiotic treatment.

In contrast, B. burgdorferi was isolated from six of six untreated infected control dogs and joint lesions were found in four of these six dogs. Serum antibody levels to B. burgdorferi in all dogs declined after antibiotic treatment. Negative antibody levels were reached in four of six doxycycline- and four of six amoxicillin-treated dogs. However, in dogs that were kept in isolation for 6 months after antibiotic treatment was discontinued, antibody levels began to rise again, presumably in response to proliferation of the surviving pool of spirochetes. Antibody levels in untreated infected control dogs remained high.

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Presence of Borrelia burgdorferi in mice post-antibiotic treatment

Abstract:

The effectiveness of antibiotic treatment was examined in a mouse model of Lyme borreliosis. Mice were treated with ceftriaxone or saline solution for 1 month, commencing during the early (3 weeks) or chronic (4 months) stages of infection with Borrelia burgdorferi. Tissues from mice were tested for infection by culture, PCR, xenodiagnosis, and transplantation of allografts at 1 and 3 months after completion of treatment.

In addition, tissues were examined for the presence of spirochetes by immunohistochemistry. In contrast to saline solution-treated mice, mice treated with antibiotic were consistently culture negative, but tissues from some of the mice remained PCR positive, and spirochetes could be visualized in collagen-rich tissues.

Furthermore, when some of the antibiotic-treated mice were fed on by Ixodes scapularis ticks (xenodiagnosis), spirochetes were acquired by the ticks, as determined based upon PCR results, and ticks from those cohorts transmitted spirochetes to naive SCID mice, which became PCR positive but culture negative. Results indicated that following antibiotic treatment, mice remained infected with nondividing but infectious spirochetes, particularly when antibiotic treatment was commenced during the chronic stage of infection.

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Reinfection versus relapse in Lyme disease

Abstract:

In the 15 October 2007 issue of Clinical Infectious Diseases, Nadelman and Wormser describe the “surprising” number of patients with “reinfection” following treatment of an initial episode of Lyme disease. The distinction between reinfection and relapse in these patients is based on the presence of a recurrent erythema migrans (EM) rash and successful completion of a standard 2–4-week course of appropriate antibiotics.

These parameters are insufficient to distinguish between the 2 clinical possibilities. Recurrent EM rashes have been noted in cases of persistent Lyme disease, and the Lyme spirochete Borrelia burgdorferi has been cultured from normal-appearing skin specimens after resolution of the EM rash.

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Chronic bacterial and viral infections

Abstract:

Often, patients with neurodegenerative or neurobehavioral diseases have chronic, neuropathic infections that could be important in disease inception, disease progression, or increasing the types or severities of signs and symptoms. Although controversial, the majority of patients with various neurodegenerative or neurobehavioral conditions, such as amyotrophic lateral sclerosis, multiple sclerosis, Alzheimers disease, Parkinsons disease, and autistic spectrum disorders, show evidence of central nervous system or systemic bacterial and viral infections.

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Persistent babesiosis

Abstract:

PERSISTENT PARASITEMIA AFTER ACUTE BABESIOSIS: When left untreated, silent babesial infection may persist for months or even years. Although treatment with clindamycin and quinine reduces the duration of parasitemia, infection may still persist and recrudesce and side effects are common. Improved treatments are needed.

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Mycoplasma infection and chronic Lyme disease.

Abstract:

Mycoplasma – Often Overlooked In Chronic Lyme Disease: Those of us with chronic Lyme disease are quite familiar with the names of the better known Lyme coinfections. 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 coinfections 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 ask our practitioners how we are being evaluated and treated for these infections.

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Relationships among Lyme disease, Chronic Fatigue Syndrome and Fibromyalgia

Abstract:

Editorial: Of considerable interest as well is the question whether patients who are diagnosed as having chronic fatigue syndrome or fibromyalgia might have Lyme disease as the underlying cause, given the overlap of symptoms. It would seem unlikely that most or all cases of these other disorders are due to Lyme disease, but, especially in Lyme-endemic areas, it would seem reasonable to evaluate patients who have chronic fatigue syndrome or fibromyalgia for the possibility that they have Lyme disease, using a combination of clinical criteria-including exposure history, laboratory tests, MRI of the brain-looking for white matter foci, brain SPECT scans, and treatment trials..

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Severity of Chronic Lyme Disease vs Other Diseases – Comparison

Abstract:

Overview. The Centers for Disease Control and Prevention (CDC) health-related quality of life (HRQoL) indicators are widely used in the general population to determine the burden of disease, identify health needs, and direct public health policy. These indicators also allow the burden of illness to be compared across different diseases. Although Lyme disease has recently been acknowledged as a major health threat in the USA with more than 300,000 new cases per year, no comprehensive assessment of the health burden of this tick-borne disease is available. This study assesses the health-related quality of life of patients with chronic Lyme disease (CLD) and compares the severity of CLD to other chronic conditions.

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Review of Immune System Evasion in Persistent Lyme Disease

Abstract:

Abstract: Is chronic illness in patients with Lyme disease caused by persistent infection? Three decades of basic and clinical research have yet to produce a definitive answer to this question. This review describes known and suspected mechanisms by which spirochetes of the Borrelia genus evade host immune defenses and survive antibiotic challenge. Accumulating evidence indicates that Lyme disease spirochetes are adapted to persist in immune competent hosts, and that they are able to remain infective despite aggressive antibiotic challenge. Advancing understanding of the survival mechanisms of the Lyme disease spirochete carry noteworthy implications for ongoing research and clinical practice.

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