DOCSLIB.ORG

What Is Lyme Disease?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
What Is Lyme Disease? The threat of Lyme disease Dr Roger Evans Consultant Clinical Scientist National Lyme Borreliosis Testing Laboratory What is Lyme disease? • Also known as Lyme borreliosis • An infection caused by Borrelia burgdorferi sensu lato, a gram negative spirochaete bacterium • Transmitted through the bite of an infected tick (Ixodes ricinus in the UK) – a tick needs to be attached to the skin for around 24 hours to transmit Borrelia sp. to a person. • Recognised clinical presentations: early localized, early disseminated and late Lyme disease • There are large gaps in our clinical understanding of Lyme disease, particularly for ‘Post Treatment Lyme Disease Syndrome ‘ Picture credit: James Gathany Ixodes ricinus (tick) ecology/ life cycle Adapted from Manelli et al. 2011 Laboratory samples and cases of LB in Scotland 1996 to 2016 500 7000 450 6000 400 350 5000 300 4000 250 3000 200 Number of cases Number of samples 150 2000 100 1000 50 0 0 Cases Seroneg EM Year Samples GP study (2010-2012) • Three GP practices in NHS Highland region: Nairn, Culloden, Fort William • Number of laboratory cases compared to number of cases treated for Lyme disease without testing • About 2 x number of cases diagnosed by GP without lab testing compared to those that were tested • 2010-2011 • 1440 blood donors • Screened by EIA • EIA positive or equivocal samples confirmed by immunoblot (IB) • 60/1440 (4.2%) IB positive Munro et al (2015) Transfusion Medicine. Letter to the Editor doi: 10.1111/tme.12197 What does it cost? • Netherlands study (2010) – 5 health outcomes: tick bite + no infection, tick bite + asymptomatic infection, erythema migrans (EM), late Lyme borreliosis (LB), Post Treatment Lyme Disease Syndrome (PTLDS) – Annual cost of 19.3M euros for population of 16.6M – 1748 Disability Adjusted Life Years Van den Wijngaard et al 2017 ‘The cost of Lyme borreliosis’ Eur J Public Health 27(3): 538-547 • USA study (2015) – Retrospective study 2006-2010 – Medical health claims data for 52 795 LD cases <65y compared to 264 000 controls with no LD exposure – $2 968 per person more for LD – Total cost in USA is $712M to $1.3B each year Adrion E et al 2015. Health care costs, utilization and patterns of care following Lyme disease. PLoS ONE 10(2): e0116767. doi:10.137/journal.pone.0116767 Patient case: NLBTL tests • June 2012 presented with lethargy, joint pain, tick bite • EIA negative, No evidence of Borrelia burgdorferi infection • March 2016 presented with chronic fatigue, cyclical illness, muscle pain • EIA negative, No evidence of Borrelia burgdorferi infection • September 2017 presented with fatigue, neurological symptoms after tick bite 2012 • EIA negative, No evidence of Borrelia burgdorferi infection Patient case: private tests • Report back from German private laboratory • February 2017 for comment – Lymphocyte transformation test positive • Results indicate current cellular activity against ‘Borrelia burgdorferi’ – Borrelia IgG serospot: negative – Borrelia IgM serospot: negative • Indicates no humoral immune response against Borrelia burgdorferi – Also tested for Ehrlichia, Bartonella, Babesia, Chlamydia pneumoniae, Mycoplasma pneumoniae, Yersinia, EBV, HSV 1/2, CMV, VZV, Coxsackie virus A7, B1 and HHV6 Lymphocyte transformation test (LTT) • Information presented about the LTT • Reflecting the current T-cellular activity of Lyme disease: Indication for a currently active Borrelia burgdorferi infection in cases of furthermore positive EliSpot after the end of therapies • T-Cell-Spot/IGRA has been approved by the FDA in May 2011 for M. tuberculosis: "… A positive result suggests that an infection is likely, a negative result suggests that an infection is unlikely…” “…Results can be available within 24 hours…” Meeting the ISO 15189 standard? • ‘Having acquired a broad range of expertise, Dr. Schwarzbach recognized the problem of insensitivities and lacking standardization with regard to Borrelia burgdorferi antibody ELISA and immunoblot tests. He accomplished this by comparing these test results with the patients’ typical symptoms for Lyme disease.’ Indirect threats of Lyme disease • Scientific method is being ignored; tests introduced with no, little or poor evidence base • Patients are paying large sums of monies for tests which may not be beneficial – harmful? • Patients may be mis-diagnosed and have inappropriate management What are we doing? • National Lyme disease sub group – Strategic planning and coordinate activity to reduce morbidity of Lyme disease in Scotland – Educational resources • Reference laboratory – Currently applying for reference lab status – Provide better epidemiological data in humans and ticks and improve research into different tests eg. LTT Questions? .
Load more

Recommended publications
  • Compendium of Measures to Control Chlamydia Psittaci Infection Among
    Compendium of Measures to Control Chlamydia psittaci Infection Among Humans (Psittacosis) and Pet Birds (Avian Chlamydiosis), 2017 Author(s): Gary Balsamo, DVM, MPH&TMCo-chair Angela M. Maxted, DVM, MS, PhD, Dipl ACVPM Joanne W. Midla, VMD, MPH, Dipl ACVPM Julia M. Murphy, DVM, MS, Dipl ACVPMCo-chair Ron Wohrle, DVM Thomas M. Edling, DVM, MSpVM, MPH (Pet Industry Joint Advisory Council) Pilar H. Fish, DVM (American Association of Zoo Veterinarians) Keven Flammer, DVM, Dipl ABVP (Avian) (Association of Avian Veterinarians) Denise Hyde, PharmD, RP Preeta K. Kutty, MD, MPH Miwako Kobayashi, MD, MPH Bettina Helm, DVM, MPH Brit Oiulfstad, DVM, MPH (Council of State and Territorial Epidemiologists) Branson W. Ritchie, DVM, MS, PhD, Dipl ABVP, Dipl ECZM (Avian) Mary Grace Stobierski, DVM, MPH, Dipl ACVPM (American Veterinary Medical Association Council on Public Health and Regulatory Veterinary Medicine) Karen Ehnert, and DVM, MPVM, Dipl ACVPM (American Veterinary Medical Association Council on Public Health and Regulatory Veterinary Medicine) Thomas N. Tully JrDVM, MS, Dipl ABVP (Avian), Dipl ECZM (Avian) (Association of Avian Veterinarians) Source: Journal of Avian Medicine and Surgery, 31(3):262-282. Published By: Association of Avian Veterinarians https://doi.org/10.1647/217-265 URL: http://www.bioone.org/doi/full/10.1647/217-265 BioOne (www.bioone.org) is a nonprofit, online aggregation of core research in the biological, ecological, and environmental sciences. BioOne provides a sustainable online platform for over 170 journals and books published by nonprofit societies, associations, museums, institutions, and presses. Your use of this PDF, the BioOne Web site, and all posted and associated content indicates your acceptance of BioOne’s Terms of Use, available at www.bioone.org/page/terms_of_use.
    [Show full text]
  • Chlamydia Trachomatis and Chlamydia Pneumoniae Interaction with the Host: Latest Advances and Future Prospective
    microorganisms Review Chlamydia trachomatis and Chlamydia pneumoniae Interaction with the Host: Latest Advances and Future Prospective Marisa Di Pietro 1,* , Simone Filardo 1 , Silvio Romano 2 and Rosa Sessa 1 1 Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome “Sapienza”, 00185 Rome, Italy; simone.fi[email protected] (S.F.); [email protected] (R.S.) 2 Cardiology, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; [email protected] * Correspondence: [email protected] Received: 15 April 2019; Accepted: 14 May 2019; Published: 16 May 2019 Abstract: Research in Chlamydia trachomatis and Chlamydia pneumoniae has gained new traction due to recent advances in molecular biology, namely the widespread use of the metagenomic analysis and the development of a stable genomic transformation system, resulting in a better understanding of Chlamydia pathogenesis. C. trachomatis, the leading cause of bacterial sexually transmitted diseases, is responsible of cervicitis and urethritis, and C. pneumoniae, a widespread respiratory pathogen, has long been associated with several chronic inflammatory diseases with great impact on public health. The present review summarizes the current evidence regarding the complex interplay between C. trachomatis and host defense factors in the genital micro-environment as well as the key findings in chronic inflammatory diseases associated to C. pneumoniae. Keywords: Chlamydia trachomatis; Chlamydia pneumoniae; host-pathogen interaction 1. Introduction Currently, there is a renewed research interest in Chlamydiae that cause a broad spectrum of pathologies of varying severity in human, mainly Chlamydia trachomatis and Chlamydia pneumoniae [1,2]. Advances in molecular biology and, in particular, the recent advent of metagenomic analysis as well as the development of a stable genomic transformation system in Chlamydiae have significantly contributed to expanding our understanding of Chlamydia pathogenesis [3–5].
    [Show full text]
  • Chlamydia Pneumoniae Is Present in the Dental Plaque of Periodontitis
    University of the Pacific Scholarly Commons Dugoni School of Dentistry Faculty Articles Arthur A. Dugoni School of Dentistry 3-11-2019 Chlamydia pneumoniae is present in the dental plaque of periodontitis patients and stimulates an inflammatory response in gingival epithelial cells Cássio Luiz Coutinho Almeida-da-Silva Tamer Alpagot Ye Zhu Sonho Sierra Lee Brian P Roberts See next page for additional authors Follow this and additional works at: https://scholarlycommons.pacific.edu/dugoni-facarticles Part of the Dentistry Commons Recommended Citation Almeida-da-Silva, C., Alpagot, T., Zhu, Y., Lee, S., Roberts, B., Hung, S., Tang, N., & Ojcius, D. (2019). Chlamydia pneumoniae is present in the dental plaque of periodontitis patients and stimulates an inflammatory response in gingival epithelial cells. Microbial Cell, 6(4), 197–208. DOI: 10.15698/mic2019.04.674 https://scholarlycommons.pacific.edu/dugoni-facarticles/459 This Article is brought to you for free and open access by the Arthur A. Dugoni School of Dentistry at Scholarly Commons. It has been accepted for inclusion in Dugoni School of Dentistry Faculty Articles by an authorized administrator of Scholarly Commons. For more information, please contact [email protected]. Authors Cássio Luiz Coutinho Almeida-da-Silva, Tamer Alpagot, Ye Zhu, Sonho Sierra Lee, Brian P Roberts, Shu- Chen Hung, Norina Tang, and David M Ojcius This article is available at Scholarly Commons: https://scholarlycommons.pacific.edu/dugoni-facarticles/459 Research Article www.microbialcell.com Chlamydia pneumoniae is present in the dental plaque of periodontitis patients and stimulates an inflammatory response in gingival epithelial cells Cássio Luiz Coutinho Almeida-da-Silva1, Tamer Alpagot2, Ye Zhu1, Sonho Sierra Lee3,4, Brian P.
    [Show full text]
  • CHLAMYDIOSIS (Psittacosis, Ornithosis)
    EAZWV Transmissible Disease Fact Sheet Sheet No. 77 CHLAMYDIOSIS (Psittacosis, ornithosis) ANIMAL TRANS- CLINICAL FATAL TREATMENT PREVENTION GROUP MISSION SIGNS DISEASE ? & CONTROL AFFECTED Birds Aerogenous by Very species Especially the Antibiotics, Depending on Amphibians secretions and dependent: Chlamydophila especially strain. Reptiles excretions, Anorexia psittaci is tetracycline Mammals Dust of Apathy ZOONOSIS. and In houses People feathers and Dispnoe Other strains doxycycline. Maximum of faeces, Diarrhoea relative host For hygiene in Oral, Cachexy specific. substitution keeping and Direct Conjunctivitis electrolytes at feeding. horizontal, Rhinorrhea Yes: persisting Vertical, Nervous especially in diarrhoea. in zoos By parasites symptoms young animals avoid stress, (but not on the Reduced and animals, quarantine, surface) hatching rates which are blood screening, Increased new- damaged in any serology, born mortality kind. However, take swabs many animals (throat, cloaca, are carrier conjunctiva), without clinical IFT, PCR. symptoms. Fact sheet compiled by Last update Werner Tschirch, Veterinary Department, March 2002 Hoyerswerda, Germany Fact sheet reviewed by E. F. Kaleta, Institution for Poultry Diseases, Justus-Liebig-University Gießen, Germany G. M. Dorrestein, Dept. Pathology, Utrecht University, The Netherlands Susceptible animal groups In case of Chlamydophila psittaci: birds of every age; up to now proved in 376 species of birds of 29 birds orders, including 133 species of parrots; probably all of the about 9000 species of birds are susceptible for the infection; for the outbreak of the disease, additional factors are necessary; very often latent infection in captive as well as free-living birds. Other susceptible groups are amphibians, reptiles, many domestic and wild mammals as well as humans. The other Chlamydia sp.
    [Show full text]
  • The Presence of Porphyromonas Gingivalis, Chlamydia Pneumonia
    Journal of Research in Medical and Dental Sciences 2018, Volume 6, Issue 3, Page No: 1-6 Copyright CC BY-NC-ND 4.0 Available Online at: www.jrmds.in eISSN No. 2347-2367: pISSN No. 2347-2545 The Presence of Porphyromonas Gingivalis , Chlamydia Pneumonia , Helicobacter Pylori , Mycoplasma Pneumonia and Enterobacter Hormaechei DNA in the Atherosclerotic Plaques Saeed Shirgir Abibiglou 1, 2, Hossein Bannazadeh Baghi 1, 2, Mohammad Yousef Memar 2, 3, Nasser Safaei 4, Rezayat Parvizi 4, Mansur Banani 5, Naser Alizadeh 1,2 , Reza Ghotaslou 1, 2* 1Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran 2Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 3Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran 4Department of Cardiothoracic Surgery, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 5Department of Parasite and Fungal diseases, Razi Institute, Iran DOI: 10.5455/jrmds.2018631 ABSTRACT Cardiovascular disease is the most common illness in the developed and developing countries. Atherosclerosis is a cardiovascular inflammatory disease, which causes tissue destruction and fibrosis in the long run. On the other hand, atherosclerosis is a very common disease and is a multifactorial process. A potential role of some infectious agents has been suggested in the pathogenesis of atherosclerosis. This study aimed to determine the presence of Porphyromonas gingivalis, Chlamydia pneumonia, Helicobacter pylori, Mycoplasma pneumonia and Enterobacter hormaechei DNA in coronary artery atherosclerotic plaques by PCR analysis and the study of association between the presence of bacterial DNA and atherosclerosis, clinical, and demographic features of patients. Twenty-eight patients with atherosclerotic diseases who had undergone coronary artery bypass grafting surgery were included.
    [Show full text]
  • Detection of Chlamydia Pneumoniae and Other Organisms of The
    As presented at the Clinical Virology Symposium, Clearwater, Florida, 2001. Detection of Chlamydia pneumoniae and Other Organisms of the Chlamydiaceae Family by Strand Displacement Amplification on the BD ProbeTec™ ET System* SHA-SHA WANG, DAVID WOLFE AND TOBIN HELLYER BD Diagnostics • 7 Loveton Circle • Sparks, MD 21152, USA ABSTRACT Three species in the Chlamydiaceae family: Chlamydophila INTRODUCTION pneumoniae (formerly Chlamydia pneumoniae), Chlamydia Three species in the family Chlamydiaceae: Chlamydophila pneumoniae (formerly Chlamydia pneumoniae), Chlamydia trachomatis and Chlamydophila psittaci (formerly Chlamydia trachomatis and Chlamydophila psittaci (formerly Chlamydia psittaci) cause disease in humans including respiratory psittaci) cause human disease including trachoma, respiratory infection (pneumonia), and sexually transmitted infections of infection (pneumonia), trachoma, and sexually transmitted the reproductive organs such as urethritis, cervicitis, pelvic infections of the reproductive organs. Pneumonia can be inflammatory disease, and epididymitis. Pneumonia can be caused by C. pneumoniae and C. psittaci (psittacosis) in adults, and by caused by C. pneumoniae and C. psittaci (psittacosis) in adults, C. trachomatis in newborn infants. There is also evidence linking and by C. trachomatis in newborn infants. C. pneumoniae C. pneumoniae with atherosclerotic vascular disease and several species within the Chlamydiaceae are known to cause disease in has also been associated with chronic diseases such as animals. There is, therefore, a significant clinical need to detect all atherosclerosis and asthma. Currently, commercially available the pathogens or potential pathogens within the Chlamydiaceae family in a wide range of sample types. molecular methods are only directed towards the detection Traditional methods for laboratory diagnosis of of C. trachomatis in urine or on genital swabs and no such Chlamydiaceae infection include culture and serology.
    [Show full text]
  • My Story About My Journey
    My Story • Name: Ingeborg Kuiper • Age: • My address is: • My postal address is: [same as above] • You can contact me on: • I want my story to be public. About my journey I acquired Lyme-like illness at home, in QLD. It started when I hugged my dog. Hours later, I was scratching at an itch in my neck. When I looked closer, I noticed it was a small tick. I started to get sick several days later. I was born in the Netherlands (ie outside of Australia) and had also travelled to Europe about 8 months before getting sick. While this means my case of Lyme disease is difficult to prove as being acquired in Australia, it is extremely unlikely that I acquired Lyme while in Europe. This is because I had been living in Australia for 15 years with no health problems and the recent trip to Europe was in the middle of winter, when ticks are inactive. Also, I am not aware of having been bitten by any ticks while in Europe, while I know I was bitten by a tick in Australia a few weeks before getting sick. Type of Bite: tick bite. I was relatively lucky, because I was able to get an accurate diagnosis within months of getting sick. This was as a result of sending blood samples overseas. I have since met many people with Lyme who took years to find out why they were sick; and these people tend to take a very long time to recover, even with effective treatment from overseas.
    [Show full text]
  • Bluediver Comprehensive Solution for Quick and Accurate Analysis of Infectious Diseases
    BlueDiver Comprehensive solution for quick and accurate analysis of infectious diseases Automatic system for immunoblot FOLLOW US processing and evaluation BIOVENDOR.GROUP BlueDiver Simple, smart and small sized device for complete automation of the immunoblot method. Unique Features and Advantages Space-saving Easy to use and short hands on time small sized and compact instrument without a need for simply insert the test strips, disposable reagent extra devices cartridges, patient samples and then follow the instructions on the touchscreen No risk of contamination no pumps, inlet hoses, handling with liquid reagents, High reliability “dead” volumes; disposable cartridges are ready to use compatibility of strips and reagents automatically checked using the integrated barcode reader High flexibility it is possible to analyze up to 24 various strips at the Extremely short analysis time same time - compatibility of the whole product range through innovative patented process of D-tek and TestLine intended for automation Technical parameters Dimensions (W x H x D) 51.5 x 29.8 x 28.9 cm Weight 16 kg Controlling touchscreen Sample capacity 1–24 Input voltage 24 V Power 40 W Communication USB 2.0 connector type interface: A use only with USB flash drive – Closed system - preprogramed analysis protocol – Integrated barcode and 2D code reader Protocol Summary – Inserting holders with strips and reagents into the instrument – Automatic batch and expiry control using the integrated barcode reader – Samples pipetting – Automated incubation and washing – Strips drying incubation with conjugate substrate sample 30 min 20 min 10 min 0:00:00 1:14:00 wash wash wash wash 1 min 3 × 2 min 3 × 2 min 2 min Immunoblot Software Scanner combined with intuitive and user-friendly evaluation software that allows results to be transferred to LIS.
    [Show full text]
  • Papers Multiplex Polymerase Chain Reaction for the Simultaneous
    J Clin Pathol 1999;52:257-263 257 Papers Multiplex polymerase chain reaction for the simultaneous detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia psittaci in respiratory samples C Y W Tong, C Donnelly, G Harvey, M Sillis Abstract Mycoplasma and chlamydia are major causes Aims-To develop a multiplex polymerase of community acquired atypical pneumonia.1-3 chain reaction (PCR) for the simultaneous Mycoplasma pneumoniae activity occurs in the detection of Mycoplasma pneumoniae, United Kingdom in predictable four yearly Chlamydia pneumoniae, and Chlamydia cycle. So far, outbreaks have been documented psittaci in respiratory samples. during 1983, 1987, 1991, and 1995.4 Methods-Oligonucleotide primers for Chlamydia pneumoniae is rare in children the amplification of the DNA of these under five but becomes more common with three organisms were optimised for use in increasing age,6 with an adult seroprevalence combination in the same reaction. PCR of up to 40-70%.] Chlamydia psittaci, a zoono- products were detected by hybridisation sis acquired from avian exposure, is less com- with pooled internal probes using an mon than Mycoplasma pneumoniae and enzyme linked immunosorbent assay. Chlamydia pneumoniae, but is still an impor- Those with positive signals were further tant pathogen in the United Kingdom, with differentiated using species specific reported outbreaks involving contact with probes. Quality of DNA extraction and psittacine birds' and poultry,9 causing severe PCR inhibition were controlled by ampli- systemic illness in addition to pneumonia. fication ofa human mitochondrial gene. A Culture of these organisms is difficult and time panel of 53 respiratory samples with consuming.1' " Differentiation between M p- known results was evaluated blindly.
    [Show full text]
  • Chlamydia (Chlamydophila) Pneumoniae in Animals: a Review
    Vet. Med. – Czech, 49, 2004 (4): 129–134 Review Article Chlamydia (Chlamydophila) pneumoniae in animals: a review L. P�������, J. C������� Veterinary Research Institute, Brno, Czech Republic ABSTRACT: An important discovery in the last couple of years is that humans are not the only natural hosts with which C. pneumoniae is the primary cause for the disease. Successively, the C. pneumoniae strain was isolated from horses, koala bears affected by ocular and genital infection, Australian and African frogs, from a Tanzanian cha- meleon, a green sea turtle living in the Cayman Islands, an iguana, puff adders and a Burmese python. All of the animals in which the C. pneumoniae was confirmed, were suffering from some form of illness that is also typical in humans when affected by this chlamydial species. All strains also showed a high similarity with the human C. pneumoniae strain (up to 100%). Keywords: epizootology of chlamydia; free-ranging animals; laboratory and domestic animals Chlamydia (Chlamydophila) pneumoniae (C. pneu- The transmission of C. pecorum to humans has not moniae) is a primary pathogen with humans. The occurred or has not been proved yet. present state of knowledge indicates that it plays According to a newly proposed classification the most important role in human pathology out of (Evere� and Andersen, 1997; Evere� et al., 1999) all chlamydia species. It is the most frequent cause the family Chlamydiaceae is divided into two gen- of respiratory infections. It is also one of the agents era: Chlamydia (includes the species C. trachomatis, in the pathological processes in other organs (joint C.
    [Show full text]
  • Genital Chlamydia Trachomatis Infections and Associated Conditions Treatment Guidelines, 1985
    APPENDIX Genital Chlamydia trachomatis Infections and Associated Conditions Treatment Guidelines, 1985 u.s. Department of Health and Human Services, Public Health Service, Division of Sexually Transmitted Diseases, Center for Prevention Services, Centers for Disease Control, Atlanta, Georgia 30333. Excerpted from Morbidity and Mortality Weekly Report 34(supp 4): 77S-107S, 1985. These guidelines for treatment of sexually transmitted diseases (STD) were established after careful deliberation by a group of experts and staff of the Centers for Disease Control (CDC). Commentary received after dissemination of preliminary documents to a large group of physicians was also considered. Certain aspects of these guidelines represent the best judgment of experts. These guide­ lines should not be construed as rules, but rather as a source of guidance within the United States. This is particularly true for topics that are controversial or based on limited data. Expert Committee members: MF Rein, MD, School of Medicine, University of Virginia; V Caine, MD, Bellflower Clinic, Indianapolis; JH Grossman III, MD, PhD, George Washington University School of Medicine; LT Gutman, MD, Duke University Medical Center; HH Handsfield, MD, Seattle King County Department of Public Health and University of Washington School of Medicine; KK Holmes, MD, PhD, University of Washington School of Medicine, Seattle; JP Luby, MD, University of Texas Southwestern Medical School, Dallas; Z McGee, MD, University of Utah School of Medicine; RC Reichman, MD, University of Rochester
    [Show full text]
  • Chronic Lyme Disease and Co-Infections: Differential Diagnosis
    Send Orders of Reprints at [email protected] 158 The Open Neurology Journal, 2012, 6, (Suppl 1-M10) 158-178 Open Access Chronic Lyme Disease and Co-infections: Differential Diagnosis Walter Berghoff* Practice of Internal Medicine, Rheinbach, 53359, Germany Abstract: In Lyme disease concurrent infections frequently occur. The clinical and pathological impact of co-infections was first recognized in the 1990th, i.e. approximately ten years after the discovery of Lyme disease. Their pathological synergism can exacerbate Lyme disease or induce similar disease manifestations. Co-infecting agents can be transmitted together with Borrelia burgdorferi by tick bite resulting in multiple infections but a fraction of co-infections occur inde- pendently of tick bite. Clinically relevant co-infections are caused by Bartonella species, Yersinia enterocolitica, Chlamy- dophila pneumoniae, Chlamydia trachomatis, and Mycoplasma pneumoniae. In contrast to the USA, human granulocytic anaplasmosis (HGA) and babesiosis are not of major importance in Europe. Infections caused by these pathogens in pa- tients not infected by Borrelia burgdorferi can result in clinical symptoms similar to those occurring in Lyme disease. This applies particularly to infections caused by Bartonella henselae, Yersinia enterocolitica, and Mycoplasma pneumo- niae. Chlamydia trachomatis primarily causes polyarthritis. Chlamydophila pneumoniae not only causes arthritis but also affects the nervous system and the heart, which renders the differential diagnosis difficult. The diagnosis is even more complex when co-infections occur in association with Lyme disease. Treatment recommendations are based on individual expert opinions. In antibiotic therapy, the use of third generation cephalosporins should only be considered in cases of Lyme disease. The same applies to carbapenems, which however are used occasionally in infections caused by Yersinia enterocolitica.
    [Show full text]