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LATE STAGE LYME DISEASE

LATE STAGE LYME DISEASE. Kenny L. De Meirleir, internal medicine Emeritus Gewoon Hoogleraar V.U.B. Clinical Professor of Pathology, University of Nevada, Reno, U.S.A. Medical Director Himmunitas VZW (Brussels) & WPI, University of Nevada, Reno, Nevada, U.S.A.

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LATE STAGE LYME DISEASE

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  1. LATE STAGE LYME DISEASE Kenny L. De Meirleir, internal medicine Emeritus Gewoon Hoogleraar V.U.B. Clinical Professor of Pathology, University of Nevada, Reno, U.S.A. Medical Director Himmunitas VZW (Brussels) & WPI, University of Nevada, Reno, Nevada, U.S.A.

  2. Chronic Fatigue Syndrome / M.E. (Fukuda & Canadian criteria)  + 95 % Late Stage Lyme Disease Lyme Stage III + 95 % Borrelia burgdorferi LTT 

  3. Lyme Stage III = Late Stage Lyme Disease • Multisystem disease with high morbidity • Incidence in Belgium: UNKNOWN > 100.000 (up to 500.000) patients • Transmission: • Blood sucking arthropods (Ixodes Ricinus): ticks, insects, ... • Sexual transmission between humans (new S.O.A.) • Mother-fetus transmission • Blood transfusion • Co-infections: • Bartonella - Rickettsia • Babesia - Tularemia • Chlamydiae - Parvovirus B19 • Mycoplasmae - Yersinia • Campylobacter

  4. Borrelia species – gramnegative bacteria • U.S.A.: Borrelia burgdorferi • Europe: • Borrelia burgdorferi • Borrelia afzelii • Borrelia garinii • other

  5. DIAGNOSTIC TESTS • Borrelia burgdorferi antibody tests (Elisa, C6 peptide, Western Blot → mostly negative in LSLD • Borrelia PCR tests: • Low sensitivity in blood • High specificity when combined and confirmed by sequencing (U.L.) • Borrelia burgdorferi LTT*: • Indirect test • Valuable in LSLD • LTT accepted by FDA in 2011 • Borrelia culture → not widely used; still investigational • Microscopic detection of Borrelia spirochetes: • Semen • Vaginal swap

  6. Early treatment (< 2 months): no chronic disease • Late treatment: outcome uncertain – many develop “chronic diseases”: ME/CFS, ALS, MS, ... • Chronic microglial activation in LSLD – low grade neuroinflammation • Markers blood: • sCD14 (LPS) • PGE2 • IL-8 • Number of CD57+ lymphocytes in the blood • Other pro-inflammatory cytokines and chemokines • No vaccine available

  7. Bartonella – gramnegative bacteria • Bartonella henselae – cat scratch disease Bartonella quintana – trench fever • 31 other species (8 subspecies are known to infect humans) • Only commercial antibody tests for Bartonella henselae • PCR with sequencing (only in Belgium) • Culture of Bartonella – not approved by FDA yet for clinical use • Infects endothelial cells in humans • Infect red blood cells – 3-4 Bartonella / millions red blood cells • Cats = reservoir: 1.000.000 Bartonella / million red blood cells

  8. Symptoms Bartonella positive vs. Bartonella negative

  9. Box plots ( line in box is median and size box is interquartile range : 50 % of centrally located points)

  10. Non-parametric Mann – Whitney test performed for two independent groups : Conclusion : for all three variables : MW is significant with p-value < 0.0009, so all three increased medians for CFS group.

  11. Regulation ofT-cell immunity TH1 cells Protection against intracellular pathogens (viruses, bacteria) Excess: hypersensitivities IL-12 IFN-g Naïve T cells TH2 cells Protection against extracellular pathogens (parasites, bacteria) Excess: allergies IL-4 TGF-b + IL-6 TH17 cells Local immunity (mucosa, skin) Protection against fungi, bacteria Excess: autoimmunity, inflammation

  12. Borrelia: prevention • Reservoir: Rodents / mammals mice / cats / deer ... new strategies to control tick-born diseases • Early detection tick-born diseases – G.P. education • Screening all pregnant women • Screening of blood – blood transfusion • Recognize Borrelia as a S.O.A.

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