Complexities of Lyme disease article references

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Complications of Lyme Disease: Morbidity and Mortality

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64- Sharief MK, Ciardi M, EJ. Blood Brain Barrier Damage in

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** Cleveland CP, Dennler PS, Durray PH. Recurrence of Lyme disease

presenting as a chest wall mass: Borrelia burgdorferi was present

despite five months of IV ceftriaxone 2g, and three months of oral

cefixime 400 mg BID. Poster presentation LDF International

Conference on Lyme Disease research, Stamford, CT, April 1992 *

67- Diringer MN, Halperin JJ, Dattwyler RJ. Lyme meningoencephalitis:

A report of a severe, penicillin resistant Borrelia encephalitis

responding to cefotaxime.

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68- Drulle MD. Persisting Lyme disease: Chronic infection or

immune phenomena? Lecture Handout 1992 *

69- Fried D, Durray P. Gastrointestinal Disease in Children

with Persistent Lyme Disease: Spirochetes isolated from the G.I.

tract despite antibiotic therapy. 1996 LDF Lyme Conference Boston,

MA, Abstract*

70- Haupl TH, Krause A, Bittig M. Persistence of Borrelia burgdorferi

in chronic Lyme Disease: altered immune regulation or evasion into

immunologically privileged sites? Abstract 149 Fifth International

Conference on Lyme Borreliosis, Arlington, VA, 1992 *

71- Haupl T, Hahn G, Rittig M, Krause A, Schoerner C, Schonnherr U,

Kalden JR and Burmester GR: Persistence of Borrelia burgdorferi in

ligamentous tissue from a patient with chronic Lyme Borreliosis.

Arthritis and Rheum 1993;36:1621-1626

72- Lavoie E. Failure of published antibiotic regimens in Lyme

borreliosis : Observations on prolonged oral therapy. Abstract

presented at the 1990 Lyme Borreliosis International Conference in

Sweden.*

73-Lavoie E MD. Protocol from Rakel's: Explains persistence of

infection despite " standard " courses of antibiotics. Lyme Times-Lyme

Disease Resource Center 1992;2(2): 25-27 Reprinted from Conn's

Current Therapy 1991

74- Lawrence C, Lipton RB, Lowy FD, and Coyle PK. Seronegative

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75- Liegner KB. Spectrum of antibiotic-responsive

meningoencephalmyelitides: A fatal case of CMEM. Poster presentation

1992 LDF Lyme Conference, Stamford, CT April 1992 *

76- Liegner B MD. Chronic persistent infection and chronic

persistent denial of chronic persistent infection in Lyme Disease. A

position paper presented at the 6th Annual International Conference

on Lyme Disease and other tick-borne illnesses, Atlantic City, NJ,

May 5-6, 1993 *

77- Liegner, B. Chronic Lyme disease: A costly dilemma.

Abstract # P012M, Fifth International Lyme Borreliosis Research

Symposia, Arlington, VA 1992 *

78- Liegner KB, Shapiro JR, Ramsey D, Halperin AJ, Hogrefe W, and

Kong L. Recurrent erythema migrans despite extended antibiotic

treatment with minocycline in a patient with persisting Borrelia

burgdorferi infection. J. American Acad Dermatol 1993;28:312-314

79- Ma Y, Sturrock A, and Weis JJ. Intracellular localization of

Borrelia burgdorferi within human endothelial cells. Infect Immun

1991;59:671-678

80- Mahmoud AAF. The challenge of intracellular pathogens

(Editorial). New Engl J. Med 1992;326:761-2

81- Masters EJ, Lynxwiler P, Rawlings J. Spirochetemia after

continuous high dose oral amoxicillin therapy. Infect Dis Clin

Practice 1994;3:207-208

82- Pal GS, Baker JT, DJM. Penicillin resistant Borrelia

encephalitis responding to cefotaxime. Lancet I (1988) 50-51

83- Preac-Mursic V, Wilske B, Schierz G, et al. Repeated isolation of

spirochetes from the cerebrospinal fluid of a patient with

meningoradiculitis Bannwarth' Syndrome.

Eur J Clin Microbiol 1984;3:564-565

84- Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann

A, and Prokop J. Survival of Borrelia burgdorferi in antibiotically

treated patients with Lyme Borreliosis Infection 1989;17:335-339

85- Schmidli J, Hunzicker T, Moesli P, et al, Cultivation of Bb from

joint fluid three months after treatment of facial palsy due to Lyme

Borreliosis. J Infect Dis 1988;158:905-906

86- Stanek G, Klein J, Bittner R, Glogar D. Isolation of Borrelia

burgdorferi from the myocardium of a patient with long-standing

cardiomyopathy.

New Engl J Med 1990;322:249-252

87- Wokke JHJ, vanGijn J, Eldersom A, Stanek G. Chronic forms of

Borrelia burgdorferi infection of the central nervous system.

Neurology 1987;37:1031-1034

88- Abstract # 1154 by Dr. Pamela E. sey et al 1995

Rheumatology Symposia, This study suggests that Bb binds to a

variety of tissues, and has a specific affinity to many tissue types.

These specific affinities seem to be mediated by sialic acid, and

glycosaminoglycans. Further specific enzymes that dissolve these

compounds resulted in the inability of the bacteria to remain

attached to tissues in vitro.

89- Neuroboreliosis: In the journal, ls of Neurology Vol. 38, No

4, 1995 There was a brief article by Dr. Pachner MD,

Delaney BS, and Tim O'Neill DVM, Ph.D.

The conclusion of the article was simple and concise: " These

data suggest that Lyme neuroboreliosis represents persistent

infection with B. burgdorferi. " The study used nonhuman primates as a

model for human neuroboreliosis, and used a special PCR technique to

detect the presence of Borrelia DNA within specific structures of the

brains of five rhesus monkeys. The monkeys were injected with strain

N40Br of Borrelia burgdorferi, and later autopsied for analysis.

Accuracy of the Western Blot Using the New Suggested Criteria

90- Western Blot and False Negatives in Children: 1995

Rheumatology Symposia Abstract # 1254 Dr. Fawcett et al. This

abstract showed that under the old criteria, all of 66 pediatric

patients with a history of a tick bite and, Bull's Eye rash who were

symptomatic, were accepted as positive under the old Western Blot

interpretation. Under the newly proposed criteria only 20 were now

considered positive. That means 46 children who were all symptomatic,

would probably be denied treatment! That's a success rate of only 31

%.

66 Children with Bull's Eye rash Old W. Blot Criteria 100

% positive

New NIH

Criteria 31% positive

The number of false positives under both criteria was ZERO %

* Note: A misconception about Western Blots is that they have as many

false positives as false negatives. This is not true. False positives

are rare.

The conclusion of the researchers was: " the proposed Western Blot

Reporting Criteria are grossly inadequate, because it excluded 69% of

the infected children. "

91- Abstract # D612- E.L. Logigian - SPECT Scans in LD and reversible

Cerebral Hypoperfusion in Lyme Encephalopathy. SPECT scans in

patients with Lyme encephalopathy showed decreased blood flow in the

frontal sub-cortical and cortical regions of the brain. After IV

Rocephin there was partial improvement, but not total reversal.

Abstract #626 - Linger, SPECT Scans in Lyme Patients: SPECT

scans revealed significant perfusion problems in Chronic Neurologic

Lyme Patients, and may offer clinicians another tool to help assess

brain function, and neuropathies.

92- Abstract # D647 - P.K. Coyle et al, North American Meningitis.

Conclusion: North American Meningitis does not produce the marked

inflammatory and immune changes reported in European cases. Lyme

Meningitis can occur despite early oral antibiotics.

93- Abstract # D654 - J. Nowakowski, et al. Culture-Confirmed

Treatment Failures of Cephalexin Therapy for Erythema Migrans. Two of

six patients biopsied had culture confirmed Borrelia burgdorferi

infections despite up to 21 days of cephalexin (500 mg TID)

antibiotic treatment.

94- Abstract # D655 - Nowakowski, et al, Culture-confirmed infection

and reinfection with Borrelia burgdorferi. A patient despite

antibiotic therapy had a recurring Erythema Migrans rash on three

separate occasions. On each occasion it was biopsied, and revealed

the active presence of Borrelia burgdorferi on two separate occasions

indicating reinfection had occurred.

95- Abstract # D657 - J. Cimperman, F. Strle, et al, Repeated

Isolation of Borrelia burgdorferi from the CSF of two patients

treated for Lyme neuroborreliosis. Patient 1, was a twenty year old

woman who presented with meningitis but was sero-negative for

Borrelia burgdorferi. Subsequently six weeks later, Bb was cultured

from her CSF and she was treated with IV Rocephin 2 grams a day for

14 days. Three months later the symptoms returned and Bb was once

again isolated from the CSF. Patient 2 was a 51 year old female who

developed an EM rash after tick bite. Within two months she had

severe neurological symptoms, her serology was negative. She was

denied treatment until her CSF was culture positive nine months post

tick bite. She was treated with 2 grams of Rocephin for 14 days. Two

months post antibiotic treatment Bb was once again cultured from her

CSF. In both these cases the patients had negative antibodies, but

were culture positive, suggesting that the antibody tests are not

reliable predictors of neurological Lyme Disease. Also standard

treatment regimens are insufficient when infection of the CNS is

established, and Bb can survive in the brain despite Intra venous

antibiotic treatment.

96- Abstract # D658 - F. Strle et al. Reinfection with Borrelia

burgdorferi in endemic areas. Conclusion: Even despite high antibody

titers as seen in ACA patients, 7 % of 2273 patients with previous

Lyme disease, became reinfected and present with an EM rash and late

symptoms after a recent tick bite.

97- Pachner AR, Itano A. Borrelia burgdorferi infection of the brain:

Characterization of the organism and response to antibiotics and

immune sera in the mouse model. Neurology 1990;40:1535-1540

98- Bakken LL, Callister SM, Wand PJ, Schell RF. Interlaboratory

Comparison of Test Results for the Detection of Lyme Disease by 516

Participants in the Wisconsin State Lab of Hygiene/College of

American Pathologists Proficiency Testing Progrm. J Clin Microbiol

1997; Vol 35, No 3:537-543

99- Bakken LL, Case KL, Callister SM et al. Performance of 45

Laboratories participating in a proficiency testing program for Lyme

disease serology. JAMA 1992;268:891-895

Abstract # 1256 by K.K. McCartney et al : This study showed that the

using the newly proposed Western Blot criteria resulted in 60 % false

negative results in children with both E.M. Rash, and Bell's Palsy.

A total of 23 patients with both a bull's-eye Rash and Bell's Palsy

were tested using the new criteria for Western Blot as proposed by

the NIH committee. Only nine of the 23 patients were considered

positive with the new criteria. This means six out of every ten Lyme

Patients would be a false negative. This means flipping a coin is

actually more accurate by a healthy margin of 10%.

Abstract # D601/D618 - Y.Li et al. Neurborreliosis associated with

Guillian-Barre' Syndrome. - Report of two patients in China who were

previously diagnosed with Guillian-Barre' Syndrome who tested

positive for Bb.Their symptoms responded to antibiotic treatment.

This means they may have been misdiagnosed, or GBS is triggered by a

spirochetal infection.

Abstract: # D644 - P.K. Coyle, Rapid Dissemination of Bb from the

skin to the CNS. Conclusion: Bb can rapidly seed the CNS from the

entry site in the skin, even prior to the formation of a rash.

Therefore the traditional staging of Lyme disease based on symptoms,

as either early or late stage may be a poor indicator of actual

dissemination of the spirochete.

Abstract #D646 - P.K. Coyle, et al, Multiple Sclerosis vs. Lyme

disease a diagnostic dilemma. Forty-seven patients were identified as

possible MS patients. Many had brain lesions on their MRIs,

consistent with MS 61%. CSF was constant with MS in 46 % of the

patients. The final breakdown of the 47 patients was: 21 MS, 15 LD, 7

had findings constant with both LD and MS. Thirteen patients

responded to antibiotics but only those who had CSF findings

consistent with LD.

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