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Lyme on The Brain - Lecture Note - References Reference Categories: August 30, 2010 General Lyme Disease …………………. 2 Lyme Tests ……………………………………. 9 Lyme Arthritis/Myalgia/Lupus ……… 19 Dermatological Lyme, EM, ACA …… 23 Ophthalmic Lyme …………………………. 26 Persistent Infection ………………………. 27 Cardiovascular ………………………………. 32 Antibiotic Therapy ………………………… 34 Alternative Therapies …………………… 41 Neurological Lyme ………………………… 44 Borrelia burgdorferi-seropositive Chronic encephalomyelopathy: Lyme neuroborreliosis? An Autopsied report…..………………………..54 Epidemiology and Prevention……….. 56 Microbiology …………………………………..67 Veterinary Lyme …………………………….76 Other Tick-Borne Illnesses …………… 78 Books……………………………………………… 79 Coping With Chronic Illness…………...80 Non-Lyme References ………………….. 82 Pregnancy and Lyme ……………………. 88 Multiple Sclerosis & Neurological invasion by Borrelia. ……………………. 100 Further Reading on neuroborreliosis/MS..105 Antimyelin antibodies in Lyme………105 Ceftriaxone Compared with Doxycycline for the Treatment of Acute Disseminated Lyme Disease 106 1 General Lyme Disease Topics Abstracts too numerous to list (2-3 thousand) most recently are the abstracts from the 1996, VII International Congress on Lyme Borreliosis, June 16-21, held in San Francisco, and the 1996 LDF International Lyme Borreliosis, and Tick-Borne Disease Conference held in Boston, Massachusetts. Asch ES, Bujak DI, Weiss M. Lyme disease: An infectious and post infectious syndrome. J Rheumatol 1994;21:454-61 Baltimore RS, Shapiro ED. Lyme Disease. Pediatrics in Review. May 1994;15(5):167-174 Bleiweiss John D. M.D. When to suspect Lyme disease. Lecture handout LDF Conference 1993 Bryerson AD. Clinical pathology of the Jarisch-Herxheimer reaction. J of Infect Dis 1976;133:696-705 Burgdorfer W. First decade of Lyme Borreliosis. Infection, July/August 1991;19(4) Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunvaldt E, Davis JP. Lyme Disease - a tick borne spirochetosis ? Science 1982;216: 1317-1319 Burgdorfer W. Discovery of the Lyme disease spirochete: A historical review. Inter J Microbiol Hyg, Series A, 1986;7-9 Burrascano JJ. Diagnostic Hints and Treatment Guidelines for Lyme Disease. 1995; 10th Edition handout from the 9th LDF Scientific Lyme Disease Conference. Held in Boston April 21-22 1996. Burrascano JJ. Diagnostic Hints and Treatment Guidelines for Lyme Disease. 1995; 11th Edition handout, from the 10th LDF Scientific Lyme Disease Conference. Held in Bethesda, MD/ NIH April 1997. Burrascano JJ. Diagnostic Hints and Treatment Guidelines for Lyme Disease. 1997; Conn’s Current Therapy . Cavert, Kathy. Psychosocial Issues of Lyme disease. Lyme Disease Update 1995 2 Cimmino MA, Azzolini A, Tobia F, Pesce CM. Spirochetes in the spleen of a patient with chronic Lyme disease. American J Clin Pathol 1989;91(1):95-97 Clark JR, Carlson RD, Sasaki CT. Facial Paralysis in Lyme disease. Laryngoscope 1985;95:1341-1345 * Coyle BS, Et al. The Public Health Impact of Lyme Disease in Maryland. J Infect Dis, 1996;173:1260-1262 Dattwyler RJ. Lyme borreliosis: An Overview of the Clinical Manifestations. Laboratory Medicine 1990;21:290-292 Dattwyler RJ, Luft BJ. Immunodiagnosis of Lyme Borreliosis. Rheumatic Disease Clinics of North America, November 1989;15(4):727-734 Dinerman H, Steere AC. Lyme Disease associated with fibromyalgia. Ann Intern Med 1992;117:281-285 Duffy J, Schoen RT, Sigal LH,. 1991 Update on Lyme Disease. Patient Care. 1991;June 15):24-51 Eppes SC, Klein JD, Caputo GM, Rose CD. Physician beliefs, attitudes, and approaches toward Lyme disease in an endemic area. Clinical Pediatrics, March 1994:130-134 Fallon BA, Nields JA, Burrascano JJ, et al. The Neuropsychiatric Manifestations of Lyme Borreliosis. American J of Psych, November 1994 and Psychiatric Quarterly, Spring 1992;63(1):95-117 Feder HM, Gerber MA, Krause PJ, Ryan R. Early Lyme Disease: A FluLike Illness Without Erythema Migrans. Pediatrics, February 1993;91(2):456-459 Feder HM, Hunt MS. Pitfalls in the Diagnosis and Treatment of Lyme Disease. JAMA 1995;274(1):66-68 Felsenfeld Oscar MS M.D. , Borrelia-strains, Vectors, Human and Animal Diseases, 1971 Warren Green Inc. 10 South Brentwood Blvd, St. Louis MO 63105, Library of Congress # 72-127355 Friedland JG, Warrell DA. The Jarisch-Herxheimer reaction in Leptospirosis: a possible pathogenesis and review. REV Infect Dis. 1991; 13:207-210 3 Gerber MA, Shapiro ED. Diagnosis of Lyme disease in children. J Pediatrics 1992;121(1):157-62 Goellner MH, Agger WA, Burgess JH, Durray PH. Hepatitis due to recurrent Lyme Disease. Ann Intern Med 1988;108:707-708 Golightly MG. Laboratory considerations in the diagnosis and management of Lyme Borreliosis. [Review Article with 51 references] Amer J Clin Pathol 1993;99(2):168-74 Hahlberg P, Granlund H, Nyman D. Panelius J, and Sappälä I. Treatment of Late Lyme Borreliosis. Infection 1994;29:255-261 Hamilton DR. Lyme disease the hidden pandemic. Post Graduate Medicine 1989;85:303-314 Herxheimer K, Krause E. Vebereine bei syphitischen Vorkommende Quecksilberreaktion. Deutch Med Wochenschr. 1902;28:895-897 * How to diagnose and treat Lyme disease in children. Infectious Diseases and Immunization committee, Canada Pediatric Society-Review Article 12 references. Canada Med Assoc J 1992;147(2):169-78 Kindree Diane. How to diagnose and treat Lyme disease in children [Letter and Commentary] Canada Med Assoc J. January 15, 1993;148(2):132 Huppertz H-I. Childhood Lyme Borreliosis. Neurology 1988;38:863-867 Johnson RC, Schmid GP, Hyde AG, Steigerwalt AG, Brenner DJ. Borrelia burgdorferi species the etiologic agent of Lyme Disease. Int J Sys Bacteriology 34:496;97 Kantor FS. Disarming Lyme Disease. Scientific American. September 1994:34-39 Kaslow RA. Current Perspectives on Lyme Borreliosis. JAMA, March 11, 1992;267(10):1364-1367 and 1381-1383 Kirsch M, Ruben FL, Steere AC, Durray PH et al. Fatal Adult respiratory Distress Syndrome in a patient with Lyme disease. JAMA 1988;259:2737-2739 4 Leff Robert D, Akre Steven P. Late Stage Lyme Borreliosis in Children. Southern Med Journal 1989;82(8):954-956 Lissman BA, et al. Spirochete-associated Lyme Arthritis in a Dog. Amer Vet Assc 1984;185:219-20 J MacDonald, Alan B. Gestational Lyme Borreliosis. Rheum Dis Clin North America 1989;15(4(:657-672 MacDonald, Alan B, Gestational Lyme Borreliosis and a Rationale for a Prospective study of Sudden Infant Death Syndrome (SIDS). 1989; Rheumatic Disease Clinic of North America 1989;15(4):657-677 MacDonald AB, Benach JL, Burgdorfer W. Stillbirth Following Maternal Lyme Disease. New York State Journal of Med 1987 MacDonald AB, Berger BW, Schwan TG. Clinical implications of delayed growth of the Lyme disease spirochete, Borrelia burgdorferi. Acta Tropica 1991;48:89-94 Massarotti EM, Luger SW, Rahn DW et al. Treatment of Early Lyme Disease. American J Med 1992;92:396-403 Masters EJ, Donnell D, Fobbs M. Missouri Lyme disease: 1989-1992. J Spiro and Tick-borne Dis 1994;1(1):12-17 Michigan Department of Health Letters and response to correspondence. Mitchell Paul D. Ph.D. Lyme Borreliosis: A persisting diagnostic dilemma. Clin Microbiol Newsletter, April 15, 1993;15(8):57-64 Moulton Chris. Lyme Disease: New facts only add to diagnostic frustrations. Adv for Med Lab Professionals July 29, 1991:18-19 Mulberg AK, Linz C, et al. Identification of nonsteroidal drug induced gastrodoudenal injury in children with juvenile rheumatoid arthritis. Journal of Pediatrics 1993;122:647-649 Nadleman RB et al. The clinical spectrum of early Lyme borreliosis in patients with culture-confirmed erythema migrans. Amer J Med, May 1996;100:502-508 NIH State of the Art Conference. Diagnosis and Treatment of Lyme Disease. Cin Courier August, 1991;9:1-8 5 NIH Gears up to test a hotly disputed theory. Science, October 1995;270(13):228-229 Nields JA, Kveton JF. Tullio Phenomena and Seronegative Lyme Disease. Lancet. 1991;338:128-129 Norcross Karen. Injustice Based on Misunderstanding. September 6, 1994 Masters Thesis Treatment Ostrov BE, Athreya DJ. Lyme Disease-difficulties in diagnosis and management. Pediatric Clinics of North America, June 1991;38(3): 535-553 Pfister HW, Einhapl K, Preac-Mursi V, Wilske B, Schierz G. The spirochetal etiology of lymphocytic meningoradiculitis of Bannwarth’s Syndrome. J Neurol 1984;231:141-144 Pfister HW, Wilske B, Weber K. Lyme Borreliosis: Basic science and clinical aspects. Lancet, April 23, 1994;343(8904):1013-1016 Pfluger K-H, Reimers et al. Lyme-borreliosis and possible association with HLA antigens. Tissue Antigens. 1989;33:375-381 * Pietrucha, Dorothy M. Many Difficult Problems for Children with Lyme. Lyme Times, Newsletter of the Lyme Disease Resource Center – Summer 1992 Pietrucha, Dorothy M. M.D. Neurologic Manifestations of Lyme Disease in Children. Lecture Handout 1-908-922-0337 FAX 908-922-1631 Pediatric Neurology, 3318 Route 33, Neptune New Jersey, 07753 Pietrucha, D. IV Treatment and follow-up for children with neurologic Lyme disease. Lyme Times-Lyme Disease Resource Center 1991; 2(2):30-31 Plotkin SA, Georges P. Treatment of Lyme Borreliosis in children. Pediatrics July 1991; 88:176-79 Putkonen T, Salo OP, Mustakaillio KK. Febrile Jarisch-Herxheimer reaction in different phases of primary and secondary syphilis. British Journal of Venereal Diseases 1966; 42:181-184 Rahn DW. Lyme Disease: Clinical manifestations, diagnosis, and treatment. Sem Arthritis and Rheum 1991;20(4):201-218 6 Rahn DW, Malawista SE. Lyme disease: Recommendations for diagnosis and treatment. Annals of Internal Med 1991;114:472-482 Rahn DW. Lyme Disease: Where’s the bug? [Letter} New Engl J Med, 1994;330(4):282-3 Scrimenti RJ et al. Lyme disease redux: The legacy of Sven Hellerstrom. Wis Med J January 1993;92(1):20-21 Scott JD. How to diagnose Lyme disease in children. [Letter] Canada Med Assoc J, January 15, 1993;148(2)132 Shadick NA M.D. MPH, Phillips CB, Logigian EL, Steere AC, Kaplan RF, Beradi VP, Durray PH, Larson MG, Wright EA, Ginsburg KS, Katz JN, Liang MW. The Long Term Outcomes of Lyme Disease (A population based retrospective cohort study) American College of Physicians 1994: Ann Intern Med 1994;121:560-567 Shrestha M, Grodzicki RL, Steere AC. Diagnosing Early Lyme Disease. American J Med 1985;78:235-240 Sigal Leonard H. Editorial: Lyme disease: Primum Non Nocere. J Infect Dis 1995;171:423-424 Address responses to: Leonard H. Sigal MD, 1 Robert Wood Johnson Place, MEB 484, New Brunswick, NJ 08903-0019 Sigal LH. Lyme disease: don’t let disguises fool you. Intern Med, June 1992;13:24-33 Sigal LH. Lyme disease: Immunologic manifestations and possible immunologic mechanisms. Seminars in Arthritis and Rheum 1989;18:151-67 Sigal LH, Lyme disease in New Jersey: A practical guide for clinicians. Princeton NJ: Academy of Med New Jersey 1993 Sigal LH. Severe complications of Lyme disease; recognition and management. Management of the critically ill patient with rheumatic or immunologic illness. In Mandell BF. Edition New York: Marcel Decker;1993 Sigal LH. Summary of the first 100 patients seen at a Lyme disease referral center. American J Med 1990;88:577-581 7 Sigal LH, Schutzer S. Possible autoimmune mechanisms in Lyme disease. Molecular and Immunologic approaches to Lyme disease. Cold Spring Harbor Press, Plainview, NY Sigal Leonard H. MD. The Lyme Disease Ccontroversy. Arch Internal Med, July 26,1996;156:1493-1500 Steere AC. Seronegative Lyme Disease JAMA 1993;270(11):1369 Steere AC, Levin RE, Molloy PJ et al. Treatment of Lyme Arthritis. Arthritis and Rheum 1994;37(6):878-888 Steere AC, Bartenhagen NH, Craft JE et al. The Early Clinical Manifestations of Lyme Disease. Ann Intern Med 1983;99:76-82 Steere AC, Grodzicki RL, Kornblatt AN et al. The spirochetal etiology of Lyme disease. New Eng J Med 1983;308:733-744 Steere AC. Distinguishing Lyme Disease from Its Look-A likes. Emergency Medicine, August 1992;15:28-44 Steere AC, Malawista AC. Cases of Lyme Disease in the United States: locations correlated to the distribution of Ixodes dammini. Ann Internal Med 1979;91:730-733 Steere AC. Lyme Disease. New England J Med 1989;321:586-596. Steere AC, Taylor E, McHugh GL, Logigian EL. The Overdiagnosis of Lyme Disease. JAMA, April 14, 1993;269(14):1812-1816 Sullivan, David Ph.D President of American Lifeline Inc. Makers of Florajen-acidophilus/bifida capsules. 1-800-257-5433 (Supplied various peer review studies and unpublished data on acidophilus and bifida supplementation. NIH, Diagnosis and Treatment of Lyme Disease. NIH State of the Art Conference, August 1991;9(5) Wisconsin Department of Health. “A Clinician’s Guide to Lyme Disease”. January 1989 Ziska MH, Donta ST, Demarest FC. Physician Preferences in the Diagnosis and Treatment of Lyme Disease in the United States. Infection, 1996;24(2):182-186 8 Lyme/Laboratory Tests (ELISA: Enzyme-Linked Immunosorbent Serum Assay) 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 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 Barbour AG. Laboratory Aspects of Lyme borreliosis. Clin Microbiol Rev 1988;1:399-414 Cameron DJ. False Positive. [Letter/Commentary on Arch Internal Med 1991;151(9):1837-40] Arch Internal Med 1992;152(6):1331 Coyle PK. Borrelia burgdorferi specific antigen-antibody complexes in the CSF of 78 % of seronegative Lyme patients with early EM rashes. Fifth International Conference on Lyme Borreliosis, Arlington, VA, June 1992 and LDF Conference Atlantic City 1993.* Coyle PK, Schutzer SE, Belman AL, Krupp LB, Golightly MG. Cerebrospinal fluid immune complexes in patients exposed to Borrelia burgdorferi: Detection of Borrelia-specific and non-specific complexes. Annal of Neurology, 1990;28:6:739-744 Coyle PK, Deng Z, Schutzer SE, Belman AL, Benach J, Krupp LB, Luft B. Detection of Borrelia burgdorferi antigens in the cerebrospinal fluid. Neurology 1993;43:1093-1097 Craft JE, Grodzicki RL, Steere AC. Antibody response in Lyme Disease: an evaluation of diagnostic tests. J Infect Dis 1988 158:754-60 Craft JE, Fisher DK, et al. Antigens of Borrelia burgdorferi recognized during Lyme disease, Appearance of a new immunoglobulin M response 9 and expansion of the IgG response late in the illness. J Clin Invest 1986;78:934-939 Dattwyler RJ, Volkman DJ et al. Seronegative Lyme Disease. New Eng J of Med 1988;319:1441-1446 Fawcett PT, Gibney KM et al. Adsorption with a soluble E. coli antigen fraction improves the specificity of ELISA tests for Lyme Disease. J Rheumatology 1991;18(5):705-708 Fawcett PT, O’Brien AE, Doughty RA. An Adsorption Procedure to Increase the Specificity of Enzyme-Linked Immunosorbent Assays for Lyme disease without Decreasing Sensitivity. Arthritis and Rheum 1989;32(0):1-6 Feaga, Wendy P. D.V.M. Self dosing of the Borrelia dog Vaccine by Veterinarians. Poster Presentation LDF Lyme Research Symposia, Stamford CT, 1993* Fung BP, McHugh GL, Leong JM et al. Humoral Immune Response to Outer Surface Protein C in Lyme Disease: Role of the Immunoglobulin M Response in the Serodiagnosis of Early Infection. Infection and Immunity, August 1994;62(8):3213-3221 Golightly MG. Laboratory considerations in the diagnosis and management of Lyme Borreliosis. [Review Article with 51 references] Amer J Clin Pathol 1993;99(2):168-74 Hansen K, Hinderson P, Pederson NS. Measurement of antibodies to Borrelia burgdorferi flagellum improves serodiagnosis in Lyme disease. J Clin Microbiol 1988;26:338-346 Karch H, Huppertz H-I, Bohme M, et al. Demonstration of Borrelia burgdorferi DNA in Urine Samples from healthy humans whose sera contain B. burgdorferi-specific antibodies. J Clin Microbiol September 1994;32(9):2312-2314 Hansen, Klaus. Serodiagnosis of erythema Migrans and Acrodermatitis Chronica Atrophicans by Borrelia burgdorferi flagellum ELISA. J Clin Microbiol, March 1989;27(3):545-551 Harris, Nick S. Ph.D. Overview of the Lyme Urine Antigen Test (LUAT). IgX 1-800-832-3200 Palo Alto, CA, IGenix Newsletter 1992;2(1) 10 Harris Nick S. Ph.D., Kalberg G, Leung SS, Scott JS, Meier K. Detection of Borrelia burgdorferi antigen in urine from Lyme Disease patients. Abstract V International Conference on Lyme Borreliosis. Arlington VA, May 1992 Hedberg CW, Osterholm MT, MacDonald KL, White KE. An interlaboratory study of antibody to Borrelia burgdorferi. J Infect Dis 1987;155:1325-27 Johnson BJB, Robbins KE, Bailey RE, et al. Serodiagnosis of Lyme Disease: Accuracy of a Two-Step Approach Using a Flagella-Based ELISA and Immunoblotting. J Infect Dis 1996;174:346-53 Kaiser R, Lucking CH. Intrathecal Synthesis of Specific Antibodies in Neuroborreliosis. J Neurological Sciences, 1993;118:64-72 Lane RS, Lennette ET, Madigan JE. Interlaboratory and Intralaboratory Comparisons of Indirect Immunofluorescence Assays for Serodiagnosis of Lyme Disease. J Clin Microbiol 1990;28(8):1774-1779 Magnarelli LA. Quality of Lyme disease tests. JAMA 1989;262: 3464-3465 Magnarelli LA, Anderson JF. Enzyme-Linked Immunosorbent Assays for the Detection of Class-Specific Immunoglobulins to Borrelia burgdorferi. American J of Epidemiology, April 1988;127(4)818-825 Magnarelli LA, Anderson JF, Johnson RC et al. Comparison of Different Strains of Borrelia burgdorferi Sensu Lato Used as Antigens in ELISA. J Clin Micro, May 1994;32(5):1154-1158 Magnarelli LA. Serologic Diagnosis of Lyme Disease. Annals New York Academy of Sciences, 1988;539:154-161 Magnarelli LA, Anderson JF, Johnson RC. Cross Reactivity in Serological Tests for Lyme Disease and other Spirochetal Infections. J Infectious Diseases, July 1987;156(1):133-138 Magnarelli LA, Meegan JM, Anderson JF, Chappell JF et al. Comparison of indirect fluorescent antibody test with an ELISA for serological studies of Lyme disease. * 11 Mitchell PD, Reed KD, et al. Comparison of four immunoserologic assays for detection of antibodies to Borrelia burgdorferi in patients with culture positive erythema migrans. J Clin Microbiol 1994;32(8):1958-1962 Russell H, Sampson JS, Schmid GP, Wilkonson HW, Plikaytis B. Enzyme-linked immunosorbent assay for Lyme disease. J Infect Dis 1984;149:465-470 Schwartz BS, Goldstein MD, Rebeiro JMC, Schulze TL. Antibody testing in Lyme disease: A comparison of results in four different laboratories. JAMA. 1989;262:3431-3434 Sczepanski A, Benach JL. Lyme Borreliosis: Host response to Borrelia burgdorferi. Microbiol Review 1991;55:21 Telford SR, Kantor FS, Lobet Y, Barthold SW, Spielman A, Flavell RA, Fikrig E. Efficacy of Human Lyme disease Vaccine formulations in a Mouse Model. J Infect Dis 1995;171:1368-1370 Weiss NL, Phillips MR, Sadock VA, Sigal LH, et al. False positive seroactivity to Borrelia burgdorferi in Rheumatic disease: The value of immunoblotting. Autoimmunity 1994 * Weyand CM, Gorozny JJ. Immune responses to Borellia burgdorferi in patients with reactive Lyme arthritis. Arthritis Rheum. 1989;32: 1057-1064 Williams CL, et al. Lyme disease: Pregnancy and congenital malformations: A cord blood serosurvey. Abstract IV International Conference on Lyme Borreliosis, Stockholm, Sweden 1990 * Zalneraitis EL Gerber MA. Prevalence of clinically significant neurological disorders attributable to congenital Lyme Borreliosis. Abstract IV International Conference on Lyme Borreliosis, Stockholm Sweden,1990* Zoller L, Haude M, Hassler D et al. Spontaneous and post-treatment antibody kinetics in late Lyme Borreliosis. Serodiagnosis Immunother Infect Dis 1989;3:345-353 Zoschke DC. Is it Lyme disease? How to interpret results of laboratory testing. Postgrad Med, 1992;91(7):46-55 12 (Western Blot) Craft JE, Fischer DK, Shimamoto GT et al. Antigens of Borrelia burgdorferi recognized during Lyme Disease. J Clinical Investigation. October 1986;78(4):934-939 Dattwyler RJ, Luft BJ. Immunodiagnosis of Lyme Borreliosis. Rheumatic Disease Clinics of North America, November 1989;15(4):727-734 Dressler F, Whalen JA, Reinhardt BN. Western Blotting in the Serodiagnosis of Lyme Disease. J Infect Dis. February 1993;167: 392-400 Dressler F. Lyme Borreliosis in European Children and Adolescents. Clinical and Experimental Rheumatology. September-October 1994;12(supplement 10):S49-S54 Engstrom SM, Sshoop E, Johnson RC. Immunoblot Interpretation Criteria for the Serodiagnosis of Early Lyme Disease. J of Clin Micro, 1995 Minnesota Dept of Health Diagnosis Committee Handout. Hilton E, Tramontano A, DeVoti J, Sood SK. Temporal Study of Immunoglobulin M Seroreactivity to Borrelia burgdorferi in Patients Treated for Lyme Borreliosis. J Clin Microbiol 1997; Vol35, No 3:774-776 Jain VK, Hilton E, et al. Immunoglobulin M Immunoblot for Diagnosis of Borrelia burgdorferi Infection in Patients with Acute Facial Palsy. J Clin Micro Biol, August,1996;34(8):2033-35 Karlsson M. Western Immunoblot and Flagellum Enzyme-Linked Immunosorbent Assay for Serodiagnosis of Lyme Borreliosis. J Clin Micro, Sept 1990;28(9):2148-2150 Ma B, Christen B, Leung D et al. Serodiagnosis of Lyme Borreliosis by Western Immunoblot: Reactivity of various significant antibodies against Borrelia burgdorferi. J Clin Micro. 1992;30(2):370-376 Norman GL, et al. Serodiagnosis of Lyme Borreliosis by Borrelia burgdorferi sensu stricto, and B Garinii, and B. afzelii Western Blots (Immunoblots). J Clin Microbiol, 1996;34(7):1732-1738 13 Simpson, WJ, Schrumpf ME, Schwan TG. Reactivity of Human Lyme Borreliosis Sera with a 39-Kilodalton Antigen Specific to Borrelia burgdorferi. J Clin Microbiol 1990;28(6):1329-1331 Technical Report: ImmunoWell Borrelia burgdorferi Test, ImmunoWell P39 Test, and ImmunuDOT Borrelia (Lyme) Test Lecture Handout LDF Conference Atlantic City NJ, 1993, pp. 1-49 ABSTRACT # 1254 Western Blot and False Negatives in Children: 1995 Rheumatology Symposia Abstract #1254 Dr. Paul Fawcett et al. These data show that under the old Western Blot reporting criteria used by our lab, 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 Dearborne, Michigan, criteria only 20 were now considered positive. That means 46 children of the 66 total who originally presented with a known tick bite and bull's-eye rash and were all symptomatic, would probably be considered NEGATIVE by the newly proposed Western Blot reporting criteria. That’s a diagnostic success rate of only 31% even in cases of clearly defined tick-bite and rash. Undertaking a new Reporting Criteria before it was tested in human field trials, should be reconsidered. 66 Children with bull’s-eye rash New NIH Criteria Old W. Blot Criteria 100 % positive 31 % positive The verbatim conclusion of the researchers was: The proposed Western Blot Reporting Criteria are grossly inadequate, because it excluded 69% of the infected children.• 14 (Reprinted from "Complexities of Lyme Disease: A microbiology Primer: by Tom Grier, Pedagogue Press 1995 ) (Antigen Detection) Baranton G, Postic D, Saint-Girons I, et al. Delineation of Borrelia burgdorferi Sensu Stricto, Borrelia garinii sp. nov., and Group VS461 Associated with Lyme Borreliosis. International J Sys Bacteriology. July 1992;42(3):378-383 Coyle PK, Deng Z, Schutzer SE, Belman AL, Benach J, Krupp LB, Luft B. Detection of Borrelia burgdorferi antigens in cerebrospinal fluid. Neurology. June 1993;43(6):1093-8 Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ et al. Seronegative Lyme disease: dissociation of the specific T- and B-lymphocyte response to Borrelia burgdorferi. New Engl J Med. 1988;319:1441-1446 Dressler F, Yoshinari NH, Steere AC. The T-cell proliferation assay in the diagnosis of Lyme disease. Ann Intern Med. 1991;115:533-539 Dorward DW, Schwan TG, Garon CF. Immune Capture and Detection of Borrelia burgdorferi Antigens in Urine, blood, or tissues from Infected Ticks, Mice, Dogs, and Humans. J Clin Micro. June 1991;29(6):11621170 Dressler F, Yoshinari NH, Steere AC. The T-cell proliferation assay in the diagnosis of Lyme disease. Ann Intern Med. 1991;115:533-539 Klempner MS, Noring R, Steere AC, Schwan TG. Antibodies to a 39 kDa antigen of Borrelia burgdorferi are a specific marker of late but not early Lyme disease. Abstract Fifth International Conference on Lyme Borreliosis, Arlington, VA, May 30-June 2, 1992* Rasiah C et al Use of hybrid protein consisting of the variable region of the Borrelia burgdorferi flagellin and part of the 83-kDa protein as antigen for serodiagnosis of Lyme Disease. J Clin Microbiol 1994;32(4):1011-1017 Schutzer SE, Coyle PK, Belman AL, Golightly MG, Drulle J. Sequestration of antibody to Borrelia burgdorferi in immune complexes in seronegative Lyme disease. Lancet. 1990;335:312-315 15 Simpson WJ, Burgdorfer W, et al. Antibody to 39-kilodalton Borrelia burgdorferi Antigen (P39) as a marker for infection in experimentally and naturally infected animals. J Clin Microbiol 1991;29(2):236 Simpson WJ, Schrumpt ME, Schwan TG. Reactivity of Human Lyme Borreliosis Sera with a 39 - Kilodalton antigen specific to Borrelia burgdorferi. J Clin Micro Biol 1990;28:1329-1331 (Culture) Asbrink E, Hovmark A. Successful cultivation of spirochetes from the skin lesions of patients with erythema migrans, Afzelius and Acrodermatitis Chronica Atrophicans. Acta Pathol Microbiol Immunol Scand, 1985;sect B, 93:161-163 * Barbour AG. Isolation and cultivation of Lyme disease spirochetes. Yale J Biol Med 1984;57:521-525 Benach JL, Bosler EM, Hanrahan JP, Coleman JL, Habicht GS, Bast TF et al. Spirochetes isolated from the blood of two Lyme disease patients. New Eng J Med. 1983;308:740-742 Berger BW, Johnson RC, Kodner C, et al. Cultivation of Borrelia burgdorferi from the blood of two patients with erythema migrans lesions lacking extracutaneous signs and symptoms of Lyme Disease. J American Acad Derm. January 1994;30(1):48-51* Berger BW, Johnson RC, Kodner C et al. Cultivation of Borrelia burgdorferi from erythema migrans lesions, and perilesional skin. J Clin Microbiol, February 1992;30(2):359-361 Callister SM, Schell RF, Case KL, et al. Characterization of the Borreliacidal Antibody Response to Borrelia burgdorferi in Humans: A serodiagnostic test.[The Gunderson Lyme Test] J Infect Dis 1993;167:158-164 Cogswell FB, Bantar C, et al. Host DNA Can Interfere with the Detection of Borrelia burgdorferi in Skin Biopsy Specimens by PCR. J Clin Microbiol, April 1996;34(4):980-982 Gunderson Lyme Test: The Most Frequently asked Questions. LaCosta Clinical Laboratory 5919 Farnsworth CT. Carlsbad, CA, 92008, 1-800522-5070, Newsletter 1 volume 1 1993 16 Petney TN, et al. Comparison of urinary bladder and ear biopsy samples for determining prevalence of Borrelia burgdorferi in rodents in central Europe. J Clin Microbiol, 1996;34(5):1310-1312 Pfister HW, Preac-Mursic V, Wilske B, et al. Latent Lyme Neuroborrelliosis: Presence of B. burgdorferi in the CSF without concurrent inflammatory signs. Neurology 1989;39:1118-1120 Nadleman et al. Isolation of Borrelia burgdorferi from the blood of seven patients with Lyme disease. Amer J Med 1990;88:21-26 Rafto et al. Biopsy confirmed CNS Lyme disease. AJNR 11, May-June 1990:482-84 Schmidli J, Hunziker T, Moesli P, et al. Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme Borreliosis. J Infect Dis, October 1988;158(4):905-906 Syndman DR, Schenkein DP, Berardi VP, et al. Borrelia burgdorferi in Joint Fluid in Chronic Lyme Arthritis. Annals of Internal Medicine, 1986;104:798-800 Thomfor JW, Conrad PA, Telford SR et al. Cultivation and Phylogenetic Characterization of a Newly Recognized Human Pathogenic Protozoan Babesia microti. J Infect Dis. 1994;169:1050-1056 PCR - Polymerase Chain Reaction: DNA amplification Bradley JF, Johnson RC, Goodman JL. The persistence of Spirochetal Nucleic Acids in Active Lyme Arthritis. Annals of Internal Medicine, March 1994;120(6):487-489 Busch U, et al. Three species of Borrelia burgdorferi sensu lato (B. burgdorferi sensu stricto, B afzelii, and B. garinii) identified from cerebrospinal fluid isolates by pulsed-field gel electrophoresis and PCR. J Clin Microbiol, May 1996;34(5):1072-78 Cogswell FB et al. Host DNA can interfere with detection of Borrelia burgdorferi in skin biopsy specimens by PCR. J Clin Microbiol 1996;34(4):980-982 17 Drulle, John M.D. The pitfalls of Laboratory Tests. Lecture Handout LDF Conference Atlantic City, NJ, 1993 Kalish RA, Leong JM, Steere AC. Association of treatment resistant chronic Lyme arthritis with HLA-DR4 and antibody reactivity to OSP-A and OSP-B of Borrelia burgdorferi. Infect Immunol 1993;61:2774-9 Keller TL, Halperin JJ, Whitman M. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of neuroborreliosis patients. Neurology 1992;43:32-42 Jaulhac B, Chary-Valckenaere I, et al. Detection of Borrelia burgdorferi by DNA amplification in synovial tissue from samples from patients with Lyme arthritis. Arthritis and Rheum, May 1996;39(5):736-745 Malawista SE, Barthold SW, Persing DH. Fate of Borrelia burgdorferi DNA in tissues of infected mice after antibiotic treatment. J Infect Dis. 1994;170:1312-16 Nocton JJ, Dressler F, Rutledge BJ, et al. Detection of Borrelia burgdorferi DNA by PCR in Synovial Fluid from Patients with Lyme Arthritis. New Eng J Med. January 27, 1994;330(4):229-234 Persing DH, et al. Multi-target detection of B. burgdorferi associated sequences in synovial fluid of patients with arthritis. Arthritis rheum 1990;33:S36 Persing DH, Ruteledge BJ, Rys PN, et al. Target Imbalance: Disparity of Borrelia burgdorferi Genetic Material in Synovial Fluid from Lyme Arthritis Patients. J Infect Dis, November 4, 1993;169:668-672 Priem S, Rittig MG, et al. An optimized PCR leads to rapid and highly sensitive detection of Borrelia burgdoferi in patients with Lyme Borreliosis. J Clin Microbiol 1997; Vol35, No3:685-690 Rosa PA, Schwan TG. A specific and sensitive assay for the Lyme disease spirochete Borrelia burgdorferi using the polymerase chain reaction test. J Infect Dis 1989;160:1018-29 Schmidt B, et al. Detection of Borrelia burgdorferi-specific DNA, in urine specimens from patients with erythema migrans before and after antibiotic therapy. J Clin Microbiol, 1996;34(6):1359-63 18 Lyme Arthritis, Myalgia, and Lupus Appel MJ, Allan S, Jacobson RH, Lauderdale TL, Chang YF et al. Experimental Lyme disease in dogs produces arthritis and persistent infection. J Infect Dis, March 1993;167(3):651-4 Beck G, Benach JL, Habicht GS. Isolation of interleukin-1 from the joint fluids of patients with Lyme disease. J Rheumatol. 1989;16:800-806 Bradley JF, Johnson RC, Goodman JL. The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann Internal Med.1994;120:487-9 Bredveld FC, Trentham DE. Suppression of collagen and adjuvant arthritis by a tetracycline. Arthritis and Rheumatism 1988;31(Supplement 1):R3 Bujak DI, Sabbeth B, Weinstein A. Persistent fatigue and arthralgia following Lyme disease. (abstract) V International Conference On Lyme Borreliosis. Arlington, VA May 1992* Dinerman H, Steere AC. Fibromyalgia associated with Lyme disease. Association with neurologic involvement and lack of response to antibiotic therapy. Arthritis Rheum 1990;33:S136 also abstract from the 1992 Fifth International Lyme research conference in Arlington VA Fatehnejad S, Fikrig M, Rahn DW, et al. Parvovirus arthritis, and underdiagnosed illness, mistaken for Lyme disease, an overdiagnosed illness. Arthritis Rheum 1990;33:S142 Fraser DD, Kong LI, & Miller FW. Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyosistis. Clin and Exp Rheum 1992;10:387-390 Futrell N, Schultz LR, Milikan C. Central nervous system disease in patients with systemic lupus erythematosus. Neurology 1992;42: 1649-1657 Georgilis K, Peacocke M, and Klempner MS. Fibroblasts protect the Lyme Disease spirochete, Borrelia burgdorferi from ceftriaxone in vitro. J. Infect Dis 1992;166:440-444 Hardin JA, Steere AC, Malawista SE. Immune complexes and the evolution of Lyme Arthritis: Dissemination and localization of abnormal Clq binding activity. New Eng J Med 1979;301:1358-1363 19 Hsu V, Patella SJ, Sigal LH. Chronic Lyme Disease as the Incorrect diagnosis of fibromyalgia. Arthritis and Rheum. 1993;36:1493-1500 Jaulhac B, Chary-Valckenaere I, et al. Detection of Borrelia burgdorferi by DNA amplification in synovial tissue from samples from patients with Lyme arthritis. Arthritis and Rheum, May 1996;39(5):736-745 Johnston YE, Durray PH, Steere AC, Kashgarian M, Buza J, Malawista SE, Askenase PW. Spirochetes Found in Synovial Microangiopathic Lesions. American J Pathol. January 1985;118:26-34 Johnston YE, Durray PH, Steere AC, et al. Lyme Arthritis: Spirochetes found in the synovial microangiopathic lesions. American J Pathol 1985:118:26-34 Kalish RA. Lyme Disease. Infectious Arthritis. May 1993;19(2):399-425 Kalish RA, Leong JM, Steere AC. Association of treatment resistant chronic Lyme arthritis with HLA-DR4 and antibody reactivity to OspA and OspB of Borrelia burgdorferi. Infect Immunol. 1993 Kalish Robert A. Evidence for a Deleterious Immune Response to the OSP proteins of Borrelia burgdorferi in Chronic Lyme Arthritis. Abstract # 147 Biology Section, V International Conference on Lyme Borreliosis, Arlington VA 1992 * Kinigadner U, Mur E, et al. Borrelia burgdorferi infection as a possible cause of HLA-B27 negative sacroilitis J Rheumtol. 1991;18:484-485 Kuper BC, Failla S. LUPUS American J Nursing November 1994 pp26-32 Lavoie Paul E. Borrelia burgdorferi in the blood of three (SLE) and chronic Lyme patients. Abstract and Lecture handout St. Paul - Lyme Disease Coalition of MN Lyme Borreliosis research Symposium. Minneapolis MN * Lightfoot RW, Luft BJ, Rahn DW, Steere AC, Sigal LH, Zoschke DC, Gardner P, Britton MC, Kaufman RL. Empiric Parenteral Antibiotic Treatment of Patients with Fibromyalgia and Fatigue and a Positive Serologic Result for Lyme Disease. Amer College of Physicians September 1993;119(6):503-509 20 MacDonald KL, et al. A case controlled study to assess possible triggers and cofactors in Chronic fatigue syndrome. Amer J Med. 1996;100: 548-554 Manicourt DH et al. Levels of circulating tumor necrosis factor alpha and interlukin-6 in patients with rheumatoid arthritis. Arthritis Rheum 1993;36(4):490-499 Martin JC, Harvey J, Dixey J. Chest pain in patients with rheumatoid arthritis. [Case reports/discussion] Arthritis and Rheum, April 1996;39(4):152-153 Mayo DR, Vance DW Jr. Parvovirus B19 as the cause of a syndrome resembling Lyme arthritis in adults. (Letter) New Engl J Med. 1991;324:419 Miller A, Stanton RP, Eppes SC. Acute Arthritis of the hip of a child infected with the Lyme spirochete. Clin Orthop, January 1993;286: 212-214 Mouritsen LC, et al. PCR Detection of Lyme Disease: correlation with clinical manifestations, and serologic responses. Amer J Clin Pathol 1996;105:647-654 Nocton JJ, Dressler F, Ruteledge BJ, et al, Detection of Bb DNA by PCR in synovial fluid from patients with Lyme arthritis. New Engl J Med, Jan 27, 1994;330(4):229-234 Oksi J, Marjamaki M, et al. Persistence of Borrelial DNA and Antibodies in Lyme Arthritis Originally diagnosed as Juvenile Rheumatoid Arthritis (JRA). Dept Med Microbiol Turku University Finland. FAX +358-212330008 Abstract 1995 Rheumatology conference Texas.* Pfluger KH, Reimers CD, Neubert U. Erythema Migran Borreliosis: and HLA-associated disease? Ann NY Acad Sci 1988;539:414-416 Pfister HW, et al. Letter Reinfection with Borrelia burgdorferi. Lancet October 1986:984-985 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;17:355-359 21 Rees DHE, Axford JS. Rheumatic Diseases: Lyme Arthritis. Annals of Rheumatic Diseases, 1994;53:553-556 Roux-Lombard P. et al. Soluble tumor necrosis factor receptors in human inflammatory synovial fluids. Arthritis Rheum 1993;36(4):485488 Ruberti G, Egovich AB, Steere AC. Molecular analysis of the role of the HLA class II genes DRB1, DQA1, DQB1 in susceptibility to Lyme arthritis. Hum Imunol. 1991;31:20-27 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 Sigal LH. Treatment resistant Rheumatic Diseases. Rheum Dis Clin North America 1994 resistant Lyme disease. Treatment Sigal LH, Steere AC, et al. Proliferative response of mononuclear cells in Lyme disease; Concentration Borrelia burgdorferi reactive cells in synovial fluid. Arthritis and Rheum 1986;29:761-769 Sigal LH, Patella SJ. Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia. Pediatrics 1992;90:523-528 Snydman DR, et al. Borrelia burgdorferi in joint fluid in Chronic Lyme Arthritis. Annals Internal Med. 1986;104:789-800 Steere AC. Pathogenesis of Lyme arthritis: Implications for rheumatic disease. Ann NY Acad Sci 1989;539:87-92 Steere AC, Gibofsky A, Patarroyo ME, Winchester RJ, Hardin JA, Malawista SE. Chronic Lyme Arthritis: clinical and immunogenetic differences between Lyme Arthritis and Rheumatoid Arthritis. Ann Intern Med. 1979;90:896-901 Steere AC, Levin RE, Molloy PJ et al. Treatment of Lyme Arthritis. Arthritis and Rheum 1994;37(6):878-888 Steere AC, Schoen RT, Taylor E. The Clinical Evolution of Lyme Arthritis. Ann Intern Med. 1987;107:725-31 Steere AC, Dwyer E, Winchester R, Association of chronic Lyme arthritis with HLA-DR4 and HLS-DR2 alleles. New Eng J Med. 1990;323:21-223 22 Szer IS, Taylor E, Steere AC. The Long term Course of Lyme Arthritis in Children. New Engl J Med 1991;325(3):159-63 Trentham DE, Orav JE, et al. Effects of Oral administration of Type-II Collagen on Rheumatoid Arthritis. Science September 24, 1993;261:1227-1230 Vancheeswaran R, Black C, et al. Childhood-onset Scleroderma, Arthritis and Rheumatism, 1996;39(6):1041-49 Weyand CM, Gorozny JJ. Immune responses to Borrelia burgdorferi in patients with reactive Lyme arthritis. Arthritis Rheum. 1989;32:10571064 Wokke JHJ, van Doorn PA, Brand A, et al. Association of HLA-DR2 antigen with serum IgG antibodies against Borrelia burgdorferi in Bannwarth’s Syndrome. J Neurol. 1988;238:415-417 Dermatological Lyme, ACA, and Bull’s-Eye Rashes Asbrink E, Hovmark A. Successful cultivation of spirochetes from the skin lesions of patients with erythema migrans, Afzelius and Acrodermatitis Chronica Atrophicans. Acta Pathol Microbiol Immunol Scand, 1985;sect B, 93:161-163 * Berger, Bernar W. Dermatological Manifestations of Lyme disease. Review of Infectious Diseases 1989;11(Supplement 6): S1475-1481 Berger BW, Johnson RC, Schwann TG. Clinical and microbiologic findings in six patients with erythema migrans of Lyme disease. Amer J Acad Dermatol 1989;21:1188-91 Chancellor MB, McGinnis DE, Shenot PJ, et al. Urinary dysfunction in Lyme disease. Journal of Urology, 1993;149(1):26-30 Czub, Durray PH, Thomas RE, Schwan TG. Cystitis induced by infection with the Lyme disease spirochete, Borrelia burgdorferi, in mice. Amer J Pathol, 1992;141(5):1173-9 Feder HM, Hunt MS. Pitfalls in the Diagnosis and Treatment of Lyme Disease. JAMA 1995;274(1):66-68 23 Feder HM, Gerber MA, Krause PJ, Ryan R. Early Lyme Disease: A FluLike Illness Without Erythema Migrans. Pediatrics, February 1993;91(2):456-459 Fraser DD, Kong LI, & Miller FW. Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyosistis. Clin and Exp Rheum. 1992;10:387-390 Georgilis K, Peacocke M, and Klempner MS. Fibroblasts protect the Lyme Disease spirochete, Borrelia burgdorferi from ceftriaxone in vitro. J. Infect Dis. 1992;166:440-444 Hansen K, Asbrink E. Serodiagnosis of Erythema Migrans and Acrodermatitis Chronica Atrophicans by the Borrelia burgdorferi Flagellum Enzyme-Linked Immunosorbent Assay. J Clin Microbiol. March 1989;27(3):545-551 Katzel JH, Ritter RI. Lyme Disease without Erythema Migrans: Five case studies. Abstract #55C, V International conference on Lyme Borreliosis. Arlington, VA, May 1992 * Kaufman LD, Gruber BL, Phillips ME Benach JL. Late Cutaneous Lyme disease: Acrodermatitis Chronica Atrophicans. American Journal of Medicine 1989;86:828-830 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 Ma Y, Sturrock A, Weiss JJ. Intracellular localization of Borrelia burgdorferi within human endothelial cells. Infect Immunol 1991;59:671-8 Marsch WC et al. Cutaneous fibrosis induced by Borrelia burgdorferi. Br J Dermatol 1993;128(6):674-8 Meyers SA, Sexton DJ. Dermatological Manifestations of ArthropodBorne Diseases. Infectious Disease Clinics of North America. September 1994;8(3):701-713 Moter S, Hofmann H et al. Detection of Borrelia burgdorferi Sensu Lato in Lesional skin of Patients with Erythema Migrans and Acrodermatitis 24 Chronica Atrophicans by osp-A- specific PCR. J Clin Microbiol December 1994;32(12):2980-2988 Ohlenbusch A, Matuschka FR, Richter D, et al. Etiology of the Acrodermatitis Chronica Atrophicans Lesion in Lyme Disease. J Infect Dis 1996;174:421-3 Schned ES, Williams DN. Special concerns in Lyme disease: Seropositivity with vague symptoms and development of fibrositis. Postgrad Med 1992;91(7):65-70 Shih CM, et al. Delayed dissemination of Lyme disease spirochetes from the site of deposition in the skin of mice. J Infect Dis 1992;166(4): 827-31 Stern HS, et al. Progressive hemifacial atrophy associated with Lyme disease. Plastic Reconstructive Surgery 1992;90(3):479-83 Steere AC, Malawist, SE, Hardin JA, et al. Erythema Chronica Migrans and Lyme Arthritis: The enlarging spectrum. Annals Intern Med 86:685695 Viljanen MK, Oksi J et al. Cultivation of Borrelia burgdorferi from the blood and a subcutaneous lesion of a patient with relapsing febrile nodular nonsupportive panniculitis. [Letter] J Infect Dis 1992;165(3):596-7 Ophthalmic Lyme Disease Bergloff J, Gasser R, Feigl B. Ophthalmic Manifestations in Lyme Borreliosis. J Clin Neuro-ophthalmology 1994;;14(1):15-20 25 Karma A, Seppala I, Mikkila H, et al. Diagnosis and Clinical Characteristics of Ocular Lyme Borreliosis. American J Ophthalmology 1995;119:127-135 Kornmehl EW, Lesser RL, Jaros P, Rocco E, Steere AC. Bilateral Keratitis in Lyme Disease. Ophthalmology 1989;96(8):1194-1202 Lesser Rl, Kornmehl EW, Pachner AR et al. Neuro-Ophthalmologic manifestations of Lyme disease. Ophthalmology 1990;97(6):699-706 Preac-Music V, Pfister HW, Spiegel H, et al. First isolation of Borrelia burgdorferi from an iris biopsy. J Clin Neuro-ophthalmology 1993;13:155-161 Rodriguez M, Siva A, et al. Optic Neuritis: A population based study in Olmsted County Minnesota. Neurology 1995;45:244-250 Steere AC, Durray PH, Danny JH et al. Unilateral Blindness Caused by Infection with the Lyme Disease Spirochete Borrelia burgdorferi. Annals of Internal Med, 1986;103:382-384 Suttorp-Schulten MS, Luyendijk L, VanDam AP, et al. Birdshot chorioretinopathy and Lyme Borreliosis. Amer J Ophthalmol 1993;115(2):149-53 Winward KE, Lawson-Smith J, et al. Ocular Lyme Borreliosis. American Journal of Ophthalmology 1989;108:651-657 Winterkorn, Jaqueline. Lyme Disease: Neurologic and Ophthalmic Manifestations. Survey of Ophthalmology 1990;35(3):191-203 Persistent Infection Appel MJ, Allan S, Jacobson RH, Lauderdale TL, Chang YF et al. Experimental Lyme disease in dogs produces arthritis and persistent infection. J Infect Dis, March 1993;167(3):651-4 26 Asch ES, Bujak DI, Weiss M, Peterson MGE, & Weinstein A. Lyme Disease: An Infectious and Postinfectious Syndrome. J. of Rheum 1994;21:454-461. Barthold SW, et al. Chronic Lyme Borreliosis in the laboratory mouse. Amer J Pathol 1993;143(3):959-71 Bradley JF, Johnson RC, Goodman JL. The persistence of spirochetal nucleic acids in active Lyme arthritis. Ann Internal Med 1994;120:487-9 Cameron, Daniel. The efficacy of three antibiotics in elderly Lyme borreliosis patients: Forty patients over the age of 70 are followed for 13 months. Abstract 1993 LDF VI Annual Conference On Lyme Borreliosis, Atlantic City, NJ 1993 * Cimmino MA, Azzolini A, Tobia F, Pesce CM. Spirochetes in the spleen of a patient with chronic Lyme disease. Amer J Clin Pathol 1989;91:95-7 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 * Diringer MN, Halperin JJ, Dattwyler RJ. Lyme meningoencephalitis: A report of a severe, penicillin resistant Borrelia encephalitis responding to cefotaxime. Arthritis and Rheum 1987;30:705-708 Drulle John MD. Persisting Lyme disease: Chronic infection or immune phenomena? Lecture Handout 1992 * Dumler JS, Bakken JS. Human Granulocytic Ehrlichiosis in Wisconsin and Minnesota: a frequent infection with the potential for persistence. J Infect Dis, 1996;173:1027-30 Feder HM Jr., et al. The persistence of serum antibodies to Borrelia burgdorferi in patients treated for Lyme disease. Clin Infect Dis 1992;15(5):788-93 Fried Martin 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* 27 Fraser DD, Kong LI, & Miller FW. Molecular detection of persistent Borrelia burgdorferi in a man with dermatomyosistis. Clin and Exp Rheum 1992;10:387-390 Georgilis K, Peacocke M, and Klempner MS. Fibroblasts protect the Lyme Disease spirochete, Borrelia burgdorferi from ceftriaxone in vitro. J. Infect Dis 1992;166:440-444 Hassler D, Riedel K, Zorn J, and Preac-Mursic V. Pulsed high dosed cefotaxime therapy in refractory Lyme Borreliosis (Letter to Editor) Lancet 1991;338:193 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 * 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 Keller TL, Halperin JJ, Whitman M. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of neuroborreliosis patients. Neurology 1992;43:32-42 Kersten A, Poitschek C, Rauch S, and Aberer E. Effects of penicillin, ceftriaxone, and doxycycline on morphology of Borrelia burgdorferi. Antimicrobial Agents and Chemotherapy 1995 May;39 (5):1127-1133 Kezler K, and Tilton RC. Persistent PCR Positivity in a patient being treated for Lyme disease. J. of Spirochetal and Tick-Borne Diseases 1995;2(3):57-58 Klade H, Aberer E. Late complaints after Erythema Migrans. J Spirochetal and Tick-Borne Dis 1994;1(2):52-56 Klempner MS, Noring R, Rogers RA. Invasion of human skin fibroblasts by the Lyme disease spirochete, Borrelia burgdorferi. J Infect Dis 1993;167:1074-81 Kostis G, Peacocke M, Klempner MS. Fibroblasts protect the Lyme disease spirochete, Borrelia burgdorferi, from Ceftriaxone in vitro. J Infect Dis 1992;166:440-444 28 Lavoie Paul 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.* Lavoie Paul 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 Lawrence C, Lipton RB, Lowy FD, and Coyle PK. Seronegative Chronic Relapsing Neuroborreliosis. European Neurology. 1995;35(2):113-117 Liegner KB. Lyme Disease: A persistent problem. A Guest editorial JAMA 31(8):1961-63 Liegner KB. Lyme disease: The sensible pursuit of answers (Commentary). J. Clin Microbiol 1993;31:1961-1963 Liegner KB. Spectrum of antibiotic-responsive meningoencephalmyelitides: A fatal case of CMEM. Poster presentation 1992 LDF Lyme Conference, Stamford, CT April 1992 * Liegner Kenneth 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 * Liegner, Kenneth B. Chronic Lyme disease: A costly dilemma. Abstract # P012M, Fifth International Lyme Borreliosis Research Symposia, Arlington, VA 1992 * 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 Luft BJ, Steinman CR, Neimark HC, Muralidhar B, Rush T, Finkel MF, Kunkel M, and Dattwyler RJ. Invasion of the CNS by Bb in acute disseminated infection. JAMA 1992;267:1364-1367 29 Ma Y, Sturrock A, and Weis JJ. Intracellular localization of Borrelia burgdorferi within human endothelial cells. Infect Immun 1991;59: 671-678 Mahmoud AAF. The challenge of intracellular pathogens (Editorial). New Engl J. Med 1992;326:761-2 MacDonald AB, Berger BW, Schwan TG. Clinical implications of delayed growth of the Lyme borreliosis spirochete. Acta Tropica 1991;48:89-94 Masters EJ, Lynxwiler P, Rawlings J. Spirochetemia after continuous high dose oral amoxicillin therapy. Infect Dis Clin Practice 1994;3:207-208 Montgomery RR, Malawista SE. Degradation of Borrelia burgdorferi within mouse macrophages: an ultrastructural study. Abstract # P037M Fifth International Lyme disease research symposia, Arlington VA 1992.* Montgomery RR, Nathanson MH, and Malawista SE. The fate of Bb within endothelial cells. Infect Immun 1991;59:671-678 Natole J, Shindeling MM. The disabling effects of chronic Lyme disease. Lecture handout, St. Mary’s Medical Center, Saginaw Michigan. 1993 Nocton JJ, Dressler F, Ruteledge BJ, et al, Detection of Bb DNA by PCR in synovial fluid from patients with Lyme arthritis. New Engl J Med, Jan 27, 1994;330(4):229-234 Pal GS, Baker JT, Wright DJM. Penicillin resistant Borrelia encephalitis responding to cefotaxime. Lancet I (1988) 50-51 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 Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann A, and Prokop J. 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Neurology 1993;43:403407 Borrelia burgdorferi-seropositive chronic encephalomyelopathy: Lyme neuroborreliosis? An autopsied report. Kobayashi K, Mizukoshi C, Aoki T, Muramori F, Hayashi M, Miyazu K, Koshino Y, Ohta M, Nakanishi I, Yamaguchi N. Department of Neuropsychiatry, Kanazawa University School of Medicine, Japan. Abstract A 36-year-old Japanese woman presented with progressive cerebellar signs and mental deterioration of subacute course after her return from the USA. Her serum antibody to spirochete Borrelia burgdorferi was significantly 54 elevated. A necropsy 4 years after her initial neurological signs revealed multifocal inflammatory change in the cerebral cortex, thalamus, superior colliculus, dentate nucleus, inferior olivary nucleus and spinal cord. The lesions showed spongiform change, neuronal cell loss, astrocytosis and proliferation of activated microglial cells. The internal capsule was partially vacuolated and the spinal cord, notably at the thoracic level, was demyelinated and cavitated in the lateral funiculus. Microglial cells aggregated within and around the spongiform lesions and microglial nodules were present in the medulla oblongata. Use of Warthin-Starry stain demonstrated silver, impregnated organisms strongly suggesting B. burgdorferi in the central nervous tissues. The dentate nucleus and inferior olivary nucleus showed the most advanced lesions with profound fibrillary gliosis. Occlusive vascular change was relatively mild, and fibrous thickening of the leptomeninges with lymphocyte infiltrates was localized in the basal midbrain. The ataxic symptoms were due to the dentate and olivary nucleus lesions and mental deterioration was attributable to the cortical and thalamic lesions. Spongiform change, neuronal cell loss, and microglial activation are 55 characteristic pathological features in the present case. 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Sequence homology between spirochete flagellin and human myelin basic protein. [Letter] Immunology Today, July 1992;13(7):279-80 Wheeler CM, Garcia-Monco JC, Benach JL, Golightly MG, Habicht GS, Steere AC. Nonprotein antigens of Borrelia burgdorferi. J Infect Dis. 1993;167:665-74 Whitmire WK, Garon CF. Specific and nonspecific responses of murine B cells to membrane blebs of Borrelia burgdorferi. Infectious Immunology 1993;61:1460-1467 Wilske B. Preac-Mursic, et al. An OSP-A serotyping system for Borrelia burgdorferi based on reactivity with monoclonal antibodies and OSO-A sequence analysis. J Clin Microbiol 1993;31:340-50 Wormser, Gary P. A Vaccine Against Lyme Disease ? [Letter] Annals of Internal Med 1995;123(8):627-8 Young EJ, Weingarten NM, Baughn RE, Duncan WC. Studies on the pathogenesis of the Jarisch-Herxheimer reaction: development of an animal model, and evidence for a role of a classical endotoxin. J Infect Dis 1982: 146:606-615 Veterinary Lyme Azuma Y, et al. Neurological abnormalities in two dogs with suspected Lyme disease. Microbiol Immunol 1993;37(4):325-9 76 Barker IK, et al. The groundhog tick Ixodes cookei: a potential vector of Lyme Borreliosis. J Wildl Dis 1993;29(3):416-22 Browning A, et al. Lameness associated Borrelia burgdorferi infection in a horse. Vet Rec 1993;132(24):610-11 Bukowski JA. Lyme Disease: A tick-borne threat to people and pets. Vet Med, April 1988 pp346-358 Burgess EC. Experimentally induced infection of cats with Borrelia burgdorferi. Amer J Vet Res 1992;53(9):1507-11 Burgess EC, et al. Borrelia burgdorferi infection in dairy cows, rodents, and birds from four Wisconsin Dairy farms. Vet Microbiol 1993;35(12):61-77 Bushmich Sandra L. D.V.M. Lyme Borreliosis in domestic Animals. Journal of Spirochetal and Tick-Borne Diseases 1994;1(1):24-28 Cohen ND, et al. Seroprevelence of antibodies to Borrelia burgdorferi in a population of horses in Central Texas. J Amer Vet Med Assc 1993;201(7):1030-4 Falco RC, et al. The distribution of canine exposure of Borrelia burgdorferi in a Lyme-Disease endemic area. Amer J. Public Health 1993;83(9):1305-10 Feaga WP. Viewpoints on Borreliosis. [Letter/Comment] J Amer Vet Assc 1993;202(6):840-1 Fikrig EF, Barthhold SW, Chen M, et al. Lyme Borreliosis in Transgenic Mice Tolerant to OSPA from Borrelia burgdorferi 25015. JID 1997; 175:1000-1003 Gibson MD, et al. Borrelia burgdorferi infection of cats. [Letter] J Amer Vet Med Assc 1993;202(11):1786 Gordus AG, et al. Isolation of Borrelia burgdorferi from the blood of the bushy-tailed rat in California. J Wildl Dis 1993;29(3):478-80 Greene RT. Questions push for vaccination against Borrelia burgdorferi infection. [Letter] J Amer Vet Med Assc 1992;201(10):1491 77 Gustafson JM, et al. Intrauterine transmission of Borrelia burgdorferi in dogs. Amer J Vet Res 1993;54(6):882-90 Isogai H, et al. Seroepidemiological survey for antibody to Borrelia burgdorferi in cows. 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Box 1822 Cordova, TN 38018-1822 Arthritis foundation, Self-Help Manual for Patients With Arthritis. 1980, Arthritis Foundation 3400 Peachtree Road, NE, Atlanta, Georgia 30326 Barbour, Alan, Lyme Disease Benzania Diana. Protect Yourself from Lyme Disease, 1989 The New York Medical Guide to Prevention and Treatment. Dell Publishing, Bantam Doubleday Dell Publishing Group Inc., 666 Fifth Ave, New York, NY 10103 Brock, Thomas, Biology of Microorganisms Prentice-Hall Pub. 1974 79 Coyle Patricia K. M.D. Ph.D. Lyme Disease. Mosby Yearbook 1993 ISBN # 1-55664-365-9 Vanderhoof-Forschner, Karen, Everything You Need To Know About Lyme Disease, Wiley Press 1997 ISBN - 0-471-16061-X Weitraub, Pamela: Cure Unknown Coping With Chronic Illness DeKruif, Paul : Life Among the Doctors. pp140-168 Feaga, Wendy P. D.V.M. Handbook on Lyme Disease Ellicott City, MD June 1991 Felsenfeld Oscar MS M.D. , Borrelia-strains, vectors, Human and Animal Diseases, 1971 Warren Green Inc. 10 South Brentwood Blvd, St. Louis MO 63105 Library of Congress # 72-127355 Gilliam, Bret. Decompression Management: Decompression and Hyperbaric Oxygen Overview. Watersport Publishing, 1995 pp124-211 Grahm, Judy. Multiple Sclerosis: A Self-Help Guide to its Management 248 Pages, Healing Arts Press, Rochester Vermont, ISBN # 0-89281242-7, 1989 Hanner, Linda. Of Power & Love & Sound Mind: Six Years with undiagnosed Lyme Disease. 1989 Kashan Publishing P.O. Box 307, Delano, MN 55328 Hanner Linda, Witek J MD, Clift RB Ph.D. When You’re Sick and Don’t Know Why? Coping with your undiagnosed illness. 1991 DCI Publishing P.O. Box 47945. Minneapolis, MN, 55447-9727 Heltzel Jo Ann Ph. D. Learning About Lyme Disease. 1991 Hyperbaric Oxygen: The uses of oxygen under pressure. Emergency Medicine, March 15, 1986 Jarvis, DeForest C M.D. , Arthritis and Folk Medicine, 145 pages Fawcett Crest 1960 80 Lang Denise. Coping With Lyme Disease. A practical guide to dealing with diagnosis and treatment. Henry Holt and Company Inc, 115 West 18th St. New York, NY, 10011 Lieberman, Jacob Ph.D. Light: Medicine of the Future. 252 pages, Bear & company Publishing, Santa Fe, New Mexico, 1991 Mancuso, Thomas F. M.D. M.P.H. Help for the Working Wounded. 221 pages, International Association of Machinists and Aerospace Workers 1976 Mattman, Lida H Ph.D. Cell wall Deficient Forms: Stealth Pathogens. 2nd Edition, CRC Press, ISBN # 0-8493-4405-0, CRC Press Inc., 2000 Corporate Blvd. N.W. Boca Rattan Florida. 33431 Mermin, Lora. Lyme Disease 1991 - Patient/Physician perspectives from the US and Canada. 1991 Lyme Disease Education Project P.O. Box 55412, Madison WI 53705 Merck Manual, 19th Edition Murray, Polly. The Widening Circle: The Woman Who First Suspected JRA Was Somehow a Contagious Entity- A Lyme Disease Pioneer Tells Her Story. St. Martin’s Press, 321 pages $ 23.95 Payer, Lynne. Disease Mongers: How Doctors, Drug Companies and Insurers are Making You Feel Sick. New York: John Wiley & Sons 1992 PDR - Physician’s Desk Reference Prescription Drug Reference Book Vol. 49, 1995 Profile of an Antibiotic - The History of cephalosporins. Eli Lilly 1966 Robbin’s , Patholological Basis of Disease pp. 378-384, pp. 611-12, pp. 1183-84, pp. 1495-1496 Rose, Steve Ph.D. The Chemistry of Life. Pelican Publishing 1970 Schutzer, Steve M.D. Lyme Disease: Molecular and Immunologic Approaches. Series 6 Current Communications in Molecular and Cell Biology, Cold Spring Harbor Press, 329 pages, 1992 81 Silverstein Alvin, Silverstein Virginia, Silverstein Robert. Lyme Disease the Great Imitator. How to Prevent it, and cure it ! 1990 Avstar Publishing Corp, P.O. Box 537 Lebanon NJ, 08833 Stokes, JH M.D. Syphilology Hot Bath Therapy. U.S. Department of Health and Human Services, Understanding the Immune System, NIH Publication by Lydia Woods Schindler # 90-529, 1990 Willex, Robert D M.D. New Cures For Almost Every Disease. 122 pages Health and Longevity Press 1995 Ziff, Sam and Michael D.D.S. Dentistry Without Mercury. 77 pages BioProbe Inc., Orlando, FL 1993 Non-Lyme References AIDS -People With AIDS Buying Groups NY, 212-532-0280, SanFrancisco, 415-626-2316 American Lifeline Inc - Makers of Florajen-3 and other pro-biotic acidophilus products. Dave Sullivan CEO 1-800-257-5433 , 103 South 2nd St, Madison, WI, 53704 Supplied over three dozen articles on the beneficial effects of probiotic supplementation of the human diet. Baskin, Yvonne. The Immune response in AIDS and an AIDS vaccine. Discover Magazine, December, 1991, pp16-17 Bauer Helmut J. Multiple sclerosis in early childhood. 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A chronic illness characterized by fatigue, neurologic and immunologic disorders, and active human Herpes virus type-6 infection. Annal of Internal Med 1992;116:103-113 Caldwell, Mark. The Immune challenge. Discover Magazine, December 1991, pp56-61 Camu W, Cadilhac J, Billiard M. Conjugal ALS: A report on two couples from southern France. Sexually Transmitted Lou Gehrig’s disease? Neurology 1994;44:547-48 Carrette S. Cardiopulmonary Manifestations of Systemic Lupus Erythematosus (SLE). Rheum Dis Clin North Amer. 1988;14:135-147 Chambra RS, Brion LP, Castro M, et al. Comparison of maternal sera, cord blood, and neonatal sera for detecting presumptive congenital syphilis: Relationship with maternal treatment. Pediatrics 1993;91: 88-91 Christensen, Damaris. Another Look at the TB vaccine. A World Health Organization Proposal. June 18, 1994 Lecture handout CDC Cohn ZA, Kaplan G. Hansen’s Disease, cell mediated immunity and recombinant lymphokines. J Infect Dis 1991;163:1195-1200 Cotton DB, Mordechai H, Janusz C et al. Central Nervous System Effects of Magnesium Sulfate on N-Methyl D-Aspartate-induced seizures. Amer J Obstet Gynecol 1993;168(3):974-978 Davis LE, Schmidt JW. Clinical significance of cerebrospinal fluid tests for neurosyphilis. Annals of Neurology 1989;25:50-55 83 Dinarello CA, Wolf SM. The Role of Interlukin-1 in Disease. New Engl J Med. 1993;328(2):109-113 Electromagnetic Field Generator Operations Guide: Magnetic Research Protocols pp. 1-12, William H. Philpott M.D. Chairman, Bio-Electro Magnetic Institute, Independent research Institutional Review Board. 17171 SE 29th St. Choctaw, OK, 73020, 405-390-3009, Guide to Home Built Radio Frequency Generators FAACTS - Facts on AIDS Compounds and Treatments, 5337 College Ave. Suite 517, Oakland CA, 94618, 414-548-9654 Fibromyalgia Syndrome (FMS) A Patients Guide, Fibromyalgia Network 5700 Stockdale Hwy #100, Bakersfield, CA 93309 Fitzsimmions N, Berry DR, Inhibition of Candida albicans by Lactobaccilus acidophilus: evidence of involvement of a peroxidase system. Microbiology 1994;80(323):125-33 Fuller C, Hartley B. Systemic Lupus Erythematosus in Adolescents. J Ped Nursing. 1991;6:251-257 Futrell N, Schultz LR, Millikan C. Central Nervous System Disease in patients with systemic lupus erythematosus. Neurology 1992;42: 1649-1657 Gjestland T. The Oslo study of untreated syphilis: an epidemiologic investigation of the natural course of syphilitic infection based upon a restudy of the Boeck-Bruusgard material. Acta Derm Venerol 1955;35(suppl 34):1-368 Goldenberg DL. Fibromyalgia Syndrome: An emerging but controversial condition. JAMA 1987;257:2782-2787 Gomplels MM, Spickett GP. Chronic Fatigue, arthralgia, and malaise. Rheumatology 1996 Goodkin, Donald E. Interferon beta-1b: Drug profile of the first MS drug. Lancet 1994;344:1057-1060 Gorensek MJ. Chronic Fatigue and Depression in the Ambulatory Patient. Primary Care, June 1991;18(2):397-418 84 Gorman, Christine. Are some people immune to AIDS? Time Magazine March 22, 1993 Grossniklaus HE. The Cat Scratch Disease-Bacillary Angiomatosis puzzle. Editorial Lecture Handout` Hatch DL, Goldman LR. Reduced severity of eosinophilia-myalgia syndrome associated with the consumption of vitamin-containing supplements before illness. Arch Intern Med 1993;153:2368-2373 Healing Alternatives Foundation, 1748 Market St. , SanFrancisco, CA, 94102, 415-626-2316 Hiller SL et al. The normal vaginal flora, H202-producing lactobaccilli, and bacterial vaginosis in pregnant woman. Clin Infect Dis 1993;16(supplement 4): S273-81 Holmes GP, Kaplan JE, Gantz NM et al. Chronic Fatigue Syndrome: a working case definition. Intern Med 1988;108:387-9 Hook EW, Marra CM. Aquired Syphilis in Adults. New Engl J Med 1992;326:1060-1069 ICA-Interstitial Cystitis Association. Informational pamphlet on Interstitial Cystitis and Bladder Dysfunction. P.O. Box 1553 Madison Square Garden, New York, NY, 10159, (212) 979-6057 Johnson HM, Bazer FW, Szente BE, Jarpe MA. How Interferons Fight Diseases. Scientific American, May 1994 Jorizzo JL, McNeely MC, Baughn RE, Solomon AR, et al. Role of circulating immune complexes in human secondary syphilis. J Infect Dis. 1986;153:1014-1022 Komaroff AL, Buchwald D. Symptoms and signs of Chronic Fatigue Syndrome. Rev Infect Dis 1991;13(Suppl 1):S8-S11 Kuper BC, Failla S. Shedding New Light On Lupus. AJN, November 1994:26-32 Lavoie PE, Kong L, Hogrefe W. Borrelia burgdorferi DNA in the blood of three SLE patients. Abstract presented at the 1993 Lyme Disease Symposium in Minneapolis, October 1993* 85 Link J, Soderstrom M, et al. Organ-specific autoantigens induce interferon - gamma and interlukin-4 mRNA expression in mononuclear cells in multiple sclerosis and myasthenia gravis. Neurology 1994;44:728-734 Lukehart SA, Hook EW, Baker-Zander SA et al. Invasion of the Central Nervous System by Treponema pallidum: Implications for diagnosis and treatment. Annals Internal Med 1988;109:855-862 MacDonald KL, et al. A case controlled study to assess possible triggers and cofactors in Chronic fatigue syndrome. Amer J Med. 1996;100:548554 Malone JL, Wallace M, et al. Syphilis and Neurosyphilis in a human immunodeficiency virus type-1 seropositive population: Evidence for frequent serologic relapse after therapy. Amer J Med 1995;99:55-63 Medical Letter - Interferon Beta-1A For Relapsing Multiple Sclerosis: July 19, 1996;Vol 38(Issue 979):63-66 Multiple Sclerosis Society, 733 Third Ave, New York, NY, 10017-32881800-LEARN MS or 212-986-3240 FAX- 212-986-7981, John M. Whitaker M.D. Annual research Progress Reports 1991-1995. Honey Bee Venom Research (HBV) - News # RMP 10-95, January 27,1995 - 1-800-fightMS Murray DM. The Clinical Significance of Infection by Heliobacter pylori ? Clin Micro Biol 1993;15(5):33-40 Musher, Daniel M. Syphilis, Neurosyphilis, and AIDS J Infect Dis 1991;163:1201-1206 Musher DM, Hamill RJ, Hamill RJ, Baughn RE. Effect of Human Immunodeficiency Virus (HIV) Infection on the course of Syphilis and on the Response to Treatment. Annals of Internal Med 1990;113:872-881 Nell EE. Comparative sensitivity of treponemes of syphilis, yaws, and bejal to penicilin in vitro, with observations on factors affecting its treponemicidal action. Am J Syphilis. 1956;38:92-106 Neri A, Rabinerson D. Bacterial vagonosis: Drugs vs alternative treatment. OB-Gyn Survey December 1994;49(12):809-13 86 Prokopowicz D, Bobrowska E, et al. Prevalence of Antibodies against Tick-borne Encephalitis (TBEV) among residents of North-Eastern Poland. Scand J Infect Dis, 1995;27:15-16 Quagliarello V, Scheid MW. Bacterial Meningitis: Pathogenisis, Pathophysiology, and Progress. New Engl J Med. 1992;327(12):864-871 Reilly PA, Littlejohn GO. Fibromyalgia and chronic fatigue syndrome: Curr Opin Rheumatol 1990;2:282-290 Richarson, Sarah. The Brain-Boosting Sex Hormone: Estrogen is more than a sex hormone. It boosts the brain power of rats and one day it may boost the hopes of Alzheimer’s patients. Discover Magazine, April 1994 pp. 30-31 Rodriguez M, Lennon VA. Immunoglobulins promote remyelination in the central nervous system. Ann Neurol 1990;27:12-17 Sadovnick AD, Ebers GC, Dyment DA, Risch NJ. Evidence for a genetic basis of Multiple Sclerosis. Lancet, June 1996;347:1728-1730 Sczepanski A, Benach JL. Lyme Borreliosis: Host response to Borrelia burgdorferi. Microbiol Rev 1991;55:21-34 Schinedling MM, Natole J. Neuropsychiatric Lyme Borreliosis and Syphilis: Is there a parallel? St. Mary’s Medical Center, Saginaw, MI Lecture handout. Sharief MK, Ciardi M, Thompson EJ. Blood Brain Barrier Damage in Patients with Bacterial Meningitis Association with Tumor Necrosis Factor-alpha but not Interlukin 1ß. J Infect Dis 1992;166:350-8 Sigurdardottir B, Bjornsson OM, et al. Acute Bacterial Meningitis in Adults. Arch Intern Med 1997; 157:425-430 Steinberg AD, Klinman DM. Pathogenesis of Systemic Lupus Erythematosus. Rheum Dis Clin North Amer. 1988;14:25-41 Stoddard GJ, Wallace RH. How to evaluate study methodology in published clinical research: Are published conclusions valid? A study of bias, statistics, controls, and study design. Journal of Intravenous Nursing 1993;16(2):110-116 87 Stoll BJ, Lee FK, et al. Clinical and Serological Evaluation of Neonates for Congenital Syphilis: A Continuing Diagnostic Dilemma. J Infect Dis 1993;167:1093-1099 Symons, Hugh. Bifidobacteria. World Newsletter Danone #3, January 1994:1-5 Telford SR, Dawson JE, et al. Perpetuation of the agent of Human Granulocytic Ehrlichiosis in a deer tick-rodent cycle. Microbiology June, 1996;93:6209-6214 Thomas PK,. Clinical aspects of PNS regeneration. Waxman SG, ed. Advances in Neurology. New York Raven Press; 1988;47:9-49 Tuberculosis: Discover Magazine December 1992 pp 62-64 Van Der Valk PGM, Kraai EJ, VanVoorst Vader PC, Haaxma-Reiche H, Snijder JAM. Penicillin concentrations in cerebrospinal fluid (CSF) during repository treatment regiman for syphilis. Genitourin Med 1988;64:223225 Warrell DA, Pope HM, Parry EHO, Perine PL, Bryerson AD. Cardiorepiratory disturbances associated with infective relapsing fever in man: Studies of Ethiopian Louse-borne Relapsing Fever. Clinical Science, 1970;39:123-145 Wenzel, Richard P, M.D. A New Hantavirus in North America. New Engl J Med 1994;330(14):1004-5 Whitney Hunter. Medicine OMNI February 1994 Wilke William S. MD. FIBROMYALGIA: Recognizing and addressing the multiple interrelated factors. Postgraduate Medicine, 1996;100(1): 153-170 Winters HA, Notar FV, Bromberg K et al. Gastric Syphilis: five recent cases and a review of the literature. Ann Intern Med 1992;116:314-319 Wright, Karen. Dead bones do tell tales: PCR and immunoassay of fossil bones reveal syphilis in a bear 11,500 years old, and rheumatoid arthritis in humans 5000 years old, in the new world. Discover Magazine, November 1991. 88 Zhang Y, Burger d, Saruhan G, Jeannet M, Steck AJ. The T-lymphocyte response against myelin-associated glyco protein and myelin basic protein in patients with multiple sclerosis. Neurology 1993;43:403-407 Pregnancy and Lyme TITLE: Lyme borreliosis as a cause of facial palsy during pregnancy. AUTHORS: Grandsaerd MG; Meulenbroeks AA AUTHOR AFFILIATION: Department of Otorhinolaryngology, Rijnstate hospital Wagnerlaan 55 6815 AD, Arnhem, The Netherlands ABSTRACT: The medical history of a pregnant woman in whom the initial pattern of complaints suggested hyperemesis gravidarum is described. After about 18 days the patient developed left facial palsy. Repeated tests eventually confirmed the diagnosis of neuroborreliosis. The problems concerning diagnostics, therapy and the possible complications of Lyme borreliosis during gestation are described. NLM PUBMED CIT. ID: 10817889 NLM CIT. ID: No Cit. ID Assigned SOURCE: Eur J Obstet Gynecol Reprod Biol 2000 Jul 1;91(1):99-101 TITLE: Maternal Lyme disease and congenital malformations: a cord blood serosurvey in endemic and control areas. AUTHORS : Williams CL; Strobino B; Weinstein A; Spierling P; Medici F AUTHOR AFFILIATION: 89 Child Health Center, American Health Foundation, Valhalla, New York 10595, USA. ABSTRACT: This report describes a cohort study of over 5000 infants and their mothers who participated in a cord blood serosurvey designed to examine the relationship between maternal exposure to Lyme disease and adverse pregnancy outcome. Based on serology and reported clinical history, mothers of infants in an endemic hospital cohort are 5 to 20 times more likely to have been exposed to B. burgdorferi as compared with mothers of infants in a control hospital cohort. The incidence of total congenital malformations was not significantly different in the endemic cohort compared with the control cohort, but the rate of cardiac malformations was significantly higher in the endemic cohort [odds ratio (OR) 2.40; 95% confidence interval (CI) 1.25, 4.59] and the frequencies of certain minor malformations (haemangiomas, polydactyly, and hydrocele), were significantly increased in the control group. Demographic variations could only account for differences in the frequency of polydactyly. Within the endemic cohort, there were no differences in the rate of major or minor malformations or mean birthweight by category of possible maternal exposure to Lyme disease or cord blood serology. The disparity between observations at the population and individual levels requires further investigation. The absence of association at the individual level in the endemic area could be because of the small number of women who were actually exposed either in terms of serology or clinical history. The reason for the findings at the population level is not known but could be because of artifact or population differences. NLM PUBMED CIT. ID: 7479280 NLM CIT. ID: 96061203 SOURCE: 90 Paediatr Perinat Epidemiol 1995 Jul;9(3):320-30 TITLE: [Manifestation of Lyme arthritis in the puerperal period] VERNACULAR TITLE: Manifestation einer Lyme-Arthritis im Wochenbett AUTHORS: Bussen S; Steck T AUTHOR AFFILIATION: Universitatsfrauenklinik Wurzburg. ABSTRACT: Lyme disease, a tick-transmitted spirochetal illness caused by Borrelia burgdorferi, usually begins with a characteristic erythema chronicum migrans accompanied by flu-like symptoms. This phase may later be followed by meningitis, neuritis, carditis or arthritis. Congenital abnormalities due to maternal infection during pregnancy have been described. We report on a case of a 36-year old V gravida III para. After a normal pregnancy and a Cesarean section the patient developed postpartal an acute Lyme arthritis. NLM PUBMED CIT. ID: 7975802 NLM CIT. ID: 95066274 SOURCE: Z Geburtshilfe Perinatol 1994 Aug;198(4):150-2 TITLE: Congenital infections and the nervous system. AUTHORS: Bale JF Jr; Murph JR AUTHOR AFFILIATION: Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa. 91 ABSTRACT: Despite vaccines, new antimicrobials, and improved hygienic practices, congenital infections remain an important cause of death and long-term neurologic morbidity among infants world-wide. Important agents include Toxoplasma gondii, cytomegalovirus, Treponema pallidum, herpes simplex virus types 1 and 2, and rubella virus. In addition, several other agents, such as the varicella zoster virus, human parvovirus B19, and Borrelia burgdorferi, can potentially infect the fetus and cause adverse fetal outcomes. This article provides an overview of these infectious disorders and outlines current strategies for acute treatment and long-term management. NLM PUBMED CIT. ID: 1321971 NLM CIT. ID: 92342460 SOURCE: Pediatr Clin North Am 1992 Aug;39(4):669-90 TITLE: [Borrelia infections from a dermatological viewpoint] VERNACULAR TITLE: Borrelieninfektion aus dermatologischer Sicht. AUTHORS: Vocks E; Engst R; Borelli S AUTHOR AFFILIATION: Dermatologische Klinik und Poliklinik Technischen Universitat Munchen. ABSTRACT: Erythema migrans (EM), Borrelia lymphocytoma (BL) and acrodermatitis chronica atrophicans (ACA) are the established dermatological manifestations of borrelia infection, a complex multiorganic disease. Analogous to syphilis Borrelia infection can be classified by three 92 stages, at which stage I (localized infection) and II (disseminated infection) are manifestations of early infection and stage III (persistent infection) a symptom of late infection. At all stages skin manifestations can be present, the above mentioned as stage-marker as well as other non-specific polymorphous skin lesions which sometimes appear at stage II. Because of its frequent (60-80%) occurrence in all borrelia infections EM has a pathognomonic importance for borrelia infection. In diagnosis serology is currently the only practical laboratory aid. False negative and false positive results must be considered. Treatment of choice is ceftriaxone, penicillin G (or amoxycillin) or tetracycline. Prophylactic antibiotic therapy for tick bites is not recommended. Congenital borrelia infections seem to be unusual, but it is likely that they can occur and cause different adverse fetal outcome or abortion. NLM PUBMED CIT. ID: 1922122 NLM CIT. ID: 92017931 SOURCE: Monatsschr Kinderheilkd 1991 Jul;139(7):425-8 TITLE: Lyme disease during pregnancy. AUTHORS: Schutzer SE; Janniger CK; Schwartz RA AUTHOR AFFILIATION: Department of Allergy and Immunology, New Jersey Medical School, Newark 07103-2714. ABSTRACT Lyme disease, caused by infection with Borrelia burgdorferi, 93 can affect those exposed to a vector tick. Pregnant women are no exception, and such infection places the fetus at risk. It is particularly important to recognize the disease early so that effective therapy may be instituted. Although the present patient had a favorable outcome, not all do. Clinical diagnosis is especially important since conventional laboratory tests may be inadequate or require lengthy periods of time before a positive result occurs. The dermatologic sign of Lyme disease, erythema migrans, although occurring in only 50 percent of cases, is likely to be the most important diagnostic sign. NLM PUBMED CIT. ID: 2070648 NLM CIT. ID: 91300895 SOURCE: Cutis 1991 Apr;47(4):267-8 TITLE: Gestational Lyme borreliosis. Implications for the fetus. AUTHORS: MacDonald AB AUTHOR AFFILIATION: Southampton Hospital, New York. ABSTRACT: Great diversity of clinical expression of signs and symptoms of gestational Lyme borreliosis parallels the diversity of prenatal syphilis. It is documented that transplacental transmission of the spirochete from mother to fetus is possible. Further research is necessary to investigate possible teratogenic effects that might occur if the spirochete reaches the fetus during the period of organogenesis. Autopsy and clinical studies have associated gestational Lyme borreliosis with various medical problems including fetal death, 94 hydrocephalus, cardiovascular anomalies, neonatal respiratory distress, hyperbilirubinemia, intrauterine growth retardation, cortical blindness, sudden infant death syndrome, and maternal toxemia of pregnancy. Whether any or all of these associations are coincidentally or causally related remains to be clarified by further investigation. It is my expectation that the spectrum of gestational Lyme borreliosis will expand into many of the clinical domains of prenatal syphilis. NLM PUBMED CIT. ID: 2685924 NLM CIT. ID: 90069113 SOURCE: Rheum Dis Clin North Am 1989 Nov;15(4):657-77 TITLE: [Clinical aspects of Borrelia burgdorferi infections] VERNACULAR TITLE: Klinische Aspekte der Borrelia-burgdorferi-Infektionen. AUTHORS: Neubert U AUTHOR AFFILIATION: Dermatologische Klinik der Ludwig-Maximilians-Universitat Munchen. ABSTRACT: Skin lesions due to Borrelia burgdorferi-like erythema migrans, lymphadenosis cutis benigna, and acrodermatitis chronica atrophicans are hall-marks of a systemic infection, which tends to a chronically relapsing course. Even if the skin lesions are missing, or disappear spontaneously, the infection may persist and affect other organs. 95 This presumption is supported by the outcome of a long-term follow-up study on seropositive forest workers. In association with meningopolyneuritis (Garin-Bujadoux-Bannwarth disease) and acrodermatitis chronica atrophicans - myositis and fasciitis have been recently reported as further possible manifestations of Borrelia burgdorferi infection. Borrelial infection during pregnancy should promptly be treated with antibiotics in high dosages, in order to prevent maternalfetal transmission of borrelial organisms resulting in stillbirth or congenital defects of the newborn. NLM PUBMED CIT. ID: 2678790 NLM CIT. ID: 90021654 SOURCE: Z Hautkr 1989 Aug 15;64(8):649-52, 655-6 TITLE: Infants born to mothers with antibodies against Borrelia burgdorferi at delivery. AUTHORS: Nadal D; Hunziker UA; Bucher HU; Hitzig WH; Duc G AUTHOR AFFILIATION: Abteilungen fur Infektionskrankheiten und Immunologie der Universitat, Zurich, Switzerland. ABSTRACT: A serological survey over a 1-year period of 1416 mothers at delivery and their 1434 offspring for the presence of anti-Borrelia burgdorferi antibodies revealed a prevalence of 0.85%. Clinically active Lyme disease during pregnancy was found in 1 of these 12 women with elevated titres and the child was born with a ventricular septal defect. Of six affected children, two had hyperbilirubinaemia, one muscular hypotonia, one was underweight for gestational age, 96 one was macrocephalic, and one had supraventricular extrasystoles. Anomalous findings could not be attributed to B. burgdorferi due to a lack of serological evidence of intrauterine infection. Our data do not imply the need for serological screening in pregnancy, however, the importance of recognition and treatment of Lyme disease in pregnancy is emphasized. NLM PUBMED CIT. ID: 2920747 NLM CIT. ID: 89153177 SOURCE: Eur J Pediatr 1989 Feb;148(5):426-7 TITLE: Lyme Borrelia positive serology associated with spontaneous abortion in an endemic Italian area. AUTHORS: Carlomagno G; Luksa V; Candussi G; Rizzi GM; Trevisan G AUTHOR AFFILIATION: Dept. of Obstetrics and Gynecology, University of Trieste School of Medicine. ABSTRACT: Lyme borreliosis acquired during pregnancy may be associated with stillbirth and fetal malformations. This paper reports preliminary results of a study intended to evaluate the frequency of Borrelia burgdorferi infection associated with spontaneous abortion in an endemic Italian area. NLM PUBMED CIT. ID: 3252658 NLM CIT. ID: 89300130 SOURCE: Acta Eur Fertil 1988 Sep-Oct;19(5):279-81 97 TITLE: [Multiple neurologic manifestations of Borrelia burgdorferi infection] VERNACULAR TITLE: Les multiples manifestations neurologiques des infections a Borrelia burgdorferi. AUTHORS: Dupuis MJ AUTHOR AFFILIATION: Clinique St-Pierre, Ottignies, Belgique. ABSTRACT: The neurological spectrum of Borrelia burgdorferi infections is still enlarging. We review epidemiological, pathological and serological data of Lyme disease. The course of the disease is divided in three stages: stage 1 during the first month is characterised by erythema chronicum migrans and associated manifestations; stage 2 includes not only the classical European meningoradiculitis but also less specific neurological symptoms: isolated lymphocytic meningitis with an acute or even relapsing course, apparently idiopathic facial palsy, neuritis of other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign, peripheral nerve involvement, acute transverse myelitis, severe encephalitis, myositis. During stage 3, three to five months or longer after the onset of the disease, chronic arthritis, acrodermatitis chronica atrophicans and various neurological symptoms can be observed: chronic neuropathy with mainly sensory or motor signs, recurrent strokes due to cerebral angiopathy and progressive encephalomyelitis; 98 this third stage the central nervous system involvement is characterised by slowly progressive or fluctuating course during months or years, ataxic or spastic gait disorder, bladder disturbances, cranial nerve dysfunction including optic atrophy and hypoacusia, dysarthria, focal and diffuse encephalopathy. This chronic central nervous system disease can mimic multiple sclerosis, anorexia nervosa, psychic disorders or subacute presenile dementia. It is often associated with pleiocytosis, abnormal EEG and evoked potentials, sometimes multifocal and mainly periventricular white matter lesions visualised by CT or MRI, and as a rule high antibody titers against Borrelia burgdorferi. High doses of penicillin can halt the disease, sometimes induce spectacular regression of symptoms or sometimes be inefficient; ceftriaxone could be a more powerful therapy. Similarities between syphilis and Borreliosis are multiple: both of these spirochetes contain plasmids, can be transmitted through the placenta and progress for many years through successive stages, with multiorgan symptoms, including parenchymatous and vascular lesions of the central nervous system. Borrelia burgdorferi is the new great imitator. NLM PUBMED CIT. ID: 3070690 NLM CIT. ID: 89186273 SOURCE: Rev Neurol (Paris) 1988;144(12):765-75 TITLE: Lyme disease during pregnancy. AUTHORS: Markowitz LE; Steere AC; Benach JL; Slade JD; Broome CV ABSTRACT: Lyme disease is an increasingly recognized tick-borne illness caused 99 by a spirochete, Borrelia burgdorferi. Because the etiologic agent of Lyme disease is a spirochete, there has been concern about the effect of maternal Lyme disease on pregnancy outcome. We reviewed cases of Lyme disease in pregnant women who were identified before knowledge of the pregnancy outcomes. Nineteen cases were identified with onset between 1976 and 1984. Eight of the women were affected during the first trimester, seven during the second trimester, and two during the third trimester; in two, the trimester of onset was unknown. Thirteen received appropriate antibiotic therapy for Lyme disease. Of the 19 pregnancies, five had adverse outcomes, including syndactyly, cortical blindness, intrauterine fetal death, prematurity, and rash in the newborn. Adverse outcomes occurred in cases with infection during each of the trimesters. Although B burgdorferi could not be implicated directly in any of the adverse outcomes, the frequency of such outcomes warrants further surveillance and studies of pregnant women with Lyme disease. NLM PUBMED CIT. ID: 2423719 NLM CIT. ID: 86227939 SOURCE: JAMA 1986 Jun 27;255(24):3394-6 Additional References pertaining to Multiple Sclerosis and Neurological invasion by Borrelia 1. MRI Reveals Pathology in Neuro Lyme Disease. "Diagnostic ImagingMRI Insights". 2. "Biopsy-confirmed CNS Lyme Disease: MR Appearance at l.5T" American Journal of Neuroradiology-11:482-484. 100 3. Allen Steere, MD. et al. "The Long Term Course of Lyme Arthritis in Children" The New England Journal of Medicine. Vo. 325No. 4, Jly 18, 1991. 4. Stephen L. Schechter, MD. "Lyme Disease Associated with Optic Neuropathy" The American Journal of Medicine. July 1986. v. 81, 143-145 5. H. Kohler, Dept. Clinical Neurology and Neurophysiology, University of Freiburg, West Germany. "Letter to the Editor". Borrelia encephalomyelitis." The Lancet. July 5, 1986, p35. 6. "Kyke Award: GD-DTPA-Enhanced MR Imaging of Experimental Bacterial Meningitis: Evaluation and Comparison with CT. American Journal of Neuroradiology. 9:1045-1050; Nov./Dec. 1988. 7. Derek Gay et al. "Multiple Sclerosis Associated with Sinusitis: Casecontrolled study in General Practive. [Ed. note: Recent research in showing 99% Lyme patients have active sinusitis as presenting symptoms which often go undetected {unpublished results from personal research on symptomatology}]. The Lancet. Saturday 12 April 1986. 815-819. 8. Eric L. Logigian, MD; Allen Steere, MS et al. "Chronic Neurologic Manifestations of Lyme Disease. "The New England Journal of Medicine" 323:21;1438-1444, 1990. 9. Derek Gay , "Hypothesis" Is Mutiple Sclerosis caused by an Oral Spirochete? The Lancet. July 12. 1986. pp. 75-77. 10. Fernandez et al. "Lyme Disease of the CNS: MR Imaging: Findings in 14 cases. American Journal of Neuroradiology. 11; May/Jyne, 1990. 11. John Halpersin, MD et al. "Immunologic Reactivity Against Borrelia burgdorferi In Patients with Motor Neuron Disease." Archives of Neurology 47:586-594. May 1990. 12. Will Kohlhepp. et al. "Extrapyramidal Features in Central Lyme Borreliosis." European Neurology. 29:150-155, 1989. 13. Joh J. Halpersin, MD "Lyme Neuroborreliosis." Laborabory Medicine. 21:5; May 1990. 101 14. Louis Reik, Jr., MD et al. "Demyelinating Encephalopathy in Lyme Disease. Neurology. 46:790-795, July, 1989. 16. Presentation to Rocky Mountain Lab by Kenneth Liegner, MD from Armonk, New York, re: growing evidence for link between Lyme and MS. Missoulian Newspaper. Wed August 15, 1990. Gred Lakes. Hamilton, Montana, Rocky Mountain Lab; NIH facility where Dr. Willy Burgdorfer discovered the spirochetal etiology of Lyme disease. 17. R. Ackerman, E. Gollmer and B. Rehse-Kupper. "Progressive Borrelial Encephalomyelitis": The Chronic Neurologic Manifestations of Erythema Chronicum Migrans (ECM) Disease." Lyme Times Newsletter. April, 1993, p. 48 Phyllis Mervine, Editor. Reprint of German publication called Deutsche Medizinische Wochenschrift 110. 1995. Translated by Ron Ferris, Calgary, Alberta, Canada. Reprinted with persmission. English title, "Untreated neuroborreliosis progresses over years to cause serious MS-like encephalomyelitis." 18. J.H.J. Wokke, MD:,.van Gign, MD; A. Elderson, MD; and G. Stanek, MD. "Chronic Forms of Borrelia burgdorferi infection of the nervous system," Neurology 37:1031-1034: 1987. 19. Michael B. chancellor, MD; David E. McGinnis. Patrick J. Shenot, MS et al. Dept. Urology, Jefferson Medical College. Thomas Jefferson University, PA 19107. "lette" The Lancet. Vol 339: May 16, 1992 p.1237-1238. 20. Keffreu A. Nelson, MD; Mitchel, D. Wolf, MD; William T.c. Yuh, MD et al. "Cranial nerve involvement with Lyme borreliosis demonstrated by magnetic resonance imaging". Neurology. 42:671-673. March 1992. 21. P.K. Coyle,MD; Z.Deng, MS; S.E. Schutzer, MD; A.L. Gelman,MD et al. "Detection of Borrelia buergdoferi antigens in cerebrospinal fluid." Neurology. 43:1093-1097, 1993. 22. Saul Rosen, PhD, MD, Section Editor. "Current Perspectives on Lyme Borreliosis". Journal American medical Association. 276;10, March 11, 1992. "Gran Rounds at the Clinical Center of the National Institute of Health.". 23 Ackerman, R, MD; Rehse-Kupper, B. MD, "Chronic Neurologic manifestations of erythema chronicum migrans borreliosis". Annals NY 102 Academy of Science. 539-16-23. 24. Matuschka, Fr. and Spielman, A. The emergence of Lyme disease in a changing encironment in North American and Central Europe". Experimental and Applied Acarology. 2: 1986; 1337-1353. 25. JJ Halpersin, MD; Raymond Dattwyler, MD et al. "Lyme Disease: Cause of a Treatable Peripheral Neuropathy." Neurology. 37; No 11; 1700-06; 1987. 26. Belman, A.L.; Coyle, Patricia K.; Nachman, S. and Roche, C. "Brain MRI abnormalities in children infected by Borrelia burgdorferi." Neurology. 41 (Suppl 1) Item 73 P: March 1991. 27. Vincent Marshal, DVM, "Multiple Sclerosis is a chronic central nervous system infection by a spirochetal agent." Medical Hypothesis. 25:89-92, 1988. 28 A. Kirk E. winward, MD; J. Lawton Smith, MD et al. "Ocular Lyme Borreliosis." [Ed. note: eye diseases found in MS patients called "pars planitis" and uveitis, scotomas, disk edema, optic neuritis and neuropathy, blurred vision etc. are implicated in this article as Lyme disease eye phenomenon as well]. "A similar association with pars planitis has been reported in multiple sclerosis [18] because a demyelinating syndrome nearly indistinguishable from multiple sclerosis may also occur in Lyme disease, it is possible that Lyme borreliosis, pars planitis, and demyelinating disease may, in some cases, share a common pathogenic mechanism." p. 656. American Journal of Ophthalmology 108:651-657, 1989. 30. A. Berger, B.C., and Leopold, I.H. "The incidence of uveitis in mutiple sclerosis." American Journal of Ophthalmology. 62-540., 1966. 31.DuPuis, MJ , Multiple neurologic manifestations of Borrelia burgdorferi infection , Reviews in Neurology (Paris), 1988;144(12):765775. [Article in French, English abstract available on Medline] Exerpt: The central nervous system involvement is characterised by slowly progressive or fluctuating course during month or years, 103 ataxic or spastic gait disorder, bladder disturbances, cranial nerve sydrunction including optic atrophy and hypoacusia, dysarthria, focal and diffuse encephalopathy. This chronic central nervous system disease can mimic multiple sclerosis psychic disorders or subacute presentile dementia. It is often associated with pelocytosis, abnormal EEG and evoked potentials, sometimes multifocal and mainly periventricular white matter lesions visualized by CT or MRI...... Similarities between syphilis and Borreliosis are multiple: both of these spirochetes contain plasmids, can be transmitted through the placenta and progress for many years through successive stages, with multiorgan symptoms, including parencymetous and vascular lesions of the central nervous system. Borrelia burgdorferi is the new great imitator...and can cause acute transverse myelitis, severe encephalitis, myositis, chronic neuropathy, recurrent strokes, meningoradiculitis, lyphocytic meningitis with an acute or even relapsing course, apparently idiopathic facial palsy, neuritis of other cranial nerves, polyneuritis cranialis, Argyll-Robertson sign, and so on. 32. Baig S., Osson T, Hojeberg G, Link H., Dept. of Neurology, Karolinska Institute, Hugginge Unversity Hospital, Stockholm, Sweden, Cells secreting antibodies to myelin basic protein in cerebrospinal fluid of patients with Lyme neuroborreliosis. Neurology 1991; April, 41(4): 581-587. 33. Lyme borreliosis neuropathy. A Case report Am J. Phys. Medicine 104 and Rehabilitation, 1996 Jul;75(4):314-316. 34. Coyle, PK, Dept. of Neurology, School of Medicine, State University of New York, Stony Brook, Neurologic complications of Lyme disease. Rheumatologic Discussion Clinical North American, 1993, Nov;19(4) 993-1009. _____________________, Nervenar zt. 1990 Apr;61(4):248-9. German. Further Reading on Neuroborreliosis/MS Lawrence C, Lipton RB, Lowy FD, Coyle PK, Seronegative chronic relapsing neuroborreliosis. Eur Neurol 995;35(2):113-7. Garcia-Monco JC, Seidman RJ, Benach JL, Experimental immunization with Borrelia burgdorferi induces development of antibodies to gangliosides.Infect Immun 1995 Oct;63(10):4130-7 (Full text) Mattman L, Spirochaeta Myelophthora in Multiple Sclerosis, in: Cell Wall Deficient Forms: Stealth Pathogens, 2nd Edition, CRC Press, Boca Raton, Boston, London, New York, Washington D.C., 1993 Antimyelin antibodies in Lyme Epidemiol Mikrobiol Imunol 2002 Apr;51(2):60-5 [Article in Czech] Ryskova O, Vyslouzil L, Honegr K, Lesna J, Horacek J, Skrabkova Z. Ustav klinicke mikrobiologie, UK Praha, LF Hradec Kralove. [email protected] The method of enzyme immunoassay (ELISA) was used for detection of 105 antibodies against the basic protein myelin (antimyelin antibodies) for a group of serum samples (n 36) with positive anti-borrelia immunoglobulins IgG and IgM (ELISA-Borrelia afzelii) and their immune complexes (ELISA-PEG). Antimyelin antibodies (ELISA-Doxa Kit-Myelin Basic Protein Antibodies) were assessed in 31% (n 11) of examined serum samples of patients with the working diagnosis of Lyme borreliosis. Statistical analysis (p 0.07) confirmed a more frequent incidence of antimyelin antibodies in younger female subjects (age 31 years) as compared with a group of sera (n 25) where the authors did not record the formation of immunoglobulins against the basic myelin protein (age 51 years). Neither the value of titres nor the frequency of detected anti-borrelia IgG and IgM and immune complexes differed significantly in the two groups. From the assembled results ensues that in the course of Lyme borreliosis, in chronic affection of organs an autoimmune reaction may develop where the basic myelin protein is damaged (demyelinizatio) and subsequently antimyelin antibodies are formed. PMID: 11987581 [PubMed - in process] The study that allowed insurance companies to substitute doxycycline for IV Rocephin. But choosing Lyme patients with no symptoms other than a rash, and then a follow up of patients for only two weeks hardly is good science. But on August 1, 1997, over two dozen Minnesota patients were cut off from IV meds despite a patient protection bill. Ceftriaxone Compared with Doxycycline for the Treatment of Acute Disseminated Lyme Disease Raymond J. Dattwyler, M.D., Benjamin J. Luft, M.D., Mark J. Kunkel, M.D., Michael F. Finkel, M.D., Gary P. Wormser, M.D., Thomas J. Rush, M.D., Edgar Grunwaldt, M.D., William A. Agger, M.D., Michael Franklin, 106 M.D., Donald Oswald, Louise Cockey, and Dionigi Maladorno, M.D. N Engl J Med 1997; 337:289-295, July 31, 1997 Abstract Article References Citing Articles (24) BACKGROUND Localized Lyme disease, manifested by erythema migrans, is usually treated with oral doxycycline or amoxicillin. Whether acute disseminated Borrelia burgdorferi infection should be treated differently from localized infection is unknown. Full Text of Background... METHODS We conducted a prospective, open-label, randomized, multicenter study comparing parenteral ceftriaxone (2 g once daily for 14 days) with oral doxycycline (100 mg twice daily for 21 days) in patients with acute disseminated B. burgdorferi infection but without meningitis. The erythema migrans skin lesion was required for study entry, and disseminated disease had to be indicated by either multiple erythema migrans lesions or objective evidence of organ involvement. Full Text of Methods... RESULTS Of 140 patients enrolled, 133 had multiple erythema migrans lesions. Both treatments were highly effective. Rates of clinical cure at the last evaluation were similar among the patients treated with ceftriaxone (85 percent) and those treated with doxycycline (88 percent); treatment was considered to have failed in only one patient in each group. Among patients whose infections were cured, 18 of 67 patients in the ceftriaxone group (27 percent) reported one or more residual symptoms 107 at the last follow-up visit, as did 10 of 71 patients in the doxycycline group (14 percent, P > 0.05). Mild arthralgia was the most common persistent symptom. Both regimens were well tolerated; only four patients (6 percent) in each group withdrew because of adverse events. Full Text of Results... CONCLUSIONS In patients with acute disseminated Lyme disease but without meningitis, oral doxycycline and parenterally administered ceftriaxone were equally effective in preventing the late manifestations of disease. Full Text of Discussion... Read the Full Article... SOURCE INFORMATION From the Department of Medicine, State University of New York, Stony Brook (R.J.D., B.J.L.); the Department of Infectious Diseases, Danbury Hospital, Danbury, Conn. (M.J.K.); the Middelfort Clinic, Eau Claire, Wis. (M.F.F.); New York Medical College, Valhalla (G.P.W.); Briarcliff Manor, N.Y. (T.J.R.); Greensport, N.Y. (E.G.); La Crosse, Wis. (W.A.A.); Willow Grove, Pa. (M.F.); and Hoffmann–La Roche, Nutley, N.J. (D.O., L.C., D.M.). Lecture DVD Available; details on next page. 108 Lecture DVD Available A live lecture DVD is available from MIBDEC of Tom Grier giving the first of several lectures called “Lyme On The Brain”. It was recorded live in Superior, Wisconsin on September 14, 2009, and sponsored by the Wisconsin Public Health Nurses. Lyme On The Brain DVD 2 hours long with Questions and Answers and has special features including a preview of the Minnesota Lyme Patient Documentary and the presentation slides without narration. $ 19.95 + $ 2.99 P&S = $ 22.94 total Send to: MIBDEC 902 Grandview Ave Duluth MN 55812 Checks payable to MIBDEC for tax deductible contribution. Bulk quantities, please e-mail [email protected] 109