Neuroborreliosis: the Guillain-Barré mimicker

Tyagi N, Maheswaran T, Wimalaratna S.

BMJ Case Reports, Online first, 2015 Jun 25. 

http://doi.org/10.1136/bcr-2014-209080

Summary

A 34-year-old woman presented to the medical admissions unit with progressive ascending weakness of her limbs and areflexia. Diagnosis of Guillain-Barré syndrome was suspected and she was started on intravenous immunoglobulins. 

Owing to a poor initial response, further exploratory history revealed travel to the New Forest and a possible tick bite; subsequent investigations confirmed positive serology for antibodies against Borrelia. The patient's weakness improved with intravenous ceftriaxone for neuroborreliosis, a manifestation of Lyme disease. 

With inpatient neurorehabilitation, she made good recovery and was able to mobilise with a stick from being completely bed bound 6 weeks after completion of her antibiotics. 

http://doi.org/10.1136/bcr-2014-209080

*Intestinal Pseudoobstruction Caused by Chronic Lyme Neuroborreliosis

Intestinal Pseudoobstruction Caused by Chronic Lyme 
Neuroborreliosis. A Case Report

David F Schefte and Tyge Nordentoft
/Journal of / /Neurogastroenterology and Motility/, 2015; 
21(3): 440-442.

http://dx.doi.org/10.5056/jnm14118

Abstract

Chronic intestinal pseudoobstruction is often classified as 
idiopathic. The condition is associated with poor quality of 
life and high morbidity, and treatment options are often 
unsatisfactory.

A case of chronic intestinal pseudoobstruction in a 
66-year-old woman, presenting with back and abdominal pain, 
urinary retention and severe constipation is described. The 
patient lived in an area in which Lyme disease is endemic 
and had been bitten by ixodes ticks. Intrathecal synthesis 
of anti-borrelia IgM and IgG and lymphocytosis in the 
cerebrospinal fluid was found, consistent with chronic Lyme 
neuroborreliosis since symptoms had lasted for more than six 
months.

The patient's gastrointestinal function recovered and the 
pain subsided significantly following treatment with 
antibiotics. Lyme neuroborreliosis (LNB) often results in 
palsy, but rarely affects the autonomic nervous system. 
Three patients have been described with intestinal 
pseudoobstruction due to acute LNB.

However, this is the first described case of intestinal 
pseudoobstruction due to chronic Lyme neuroborreliosis. LNB 
must be suspected in patients with intestinal 
pseudoobstruction, in particular in patients who have been 
bitten by an ixodes tick and in patients living in an 
endemic area.

http://dx.doi.org/10.5056/jnm14118

Dr. Richard Horowitz M.D. comments on UC Davis Lyme findings

FYI  Posted by Karla:

--------------------------------------

On his Facebook page, Dr. Horowitz explains why important new research from UC Davis may explain why many Lyme patients may continue to demonstrate a positive IgM profile and fail to develop a positive IgG profile. This is contrary to the current recommendations of the IDSA, the CDC, and the NYS DOH to physicians to ignore all positive B. burgdorferi IgM profiles after one month of illness.

Press Release- Lyme disease subverts immune system, prevents future protection: http://news.ucdavis.edu/search/news_detail.lasso?id=11254

Suppression of Long-Lived Humoral Immunity Following Borrelia burgdorferi Infection:   

 http://journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1004976

Dr. Horowitz facebook:
https://www.facebook.com/drrichardhorowitz 

Dr. Horowitz: "Borrelia burdorferi has developed one more strategy to evade the immune system. Nicole Baumgarth and her colleagues at the University of California, Davis, just published a groundbreaking study showing why some people living in endemic areas can continually be exposed to spirochetes and not clear the infection with an adequate immune response. According to the study done in mice, borrelia is able to rapidly invade the lymph nodes, and cause a destruction of the distinct architecture of the lymph node that helps it to function normally. "While B cells accumulated in large numbers and made some specific antibodies against B. burgdorferi, they did not form "germinal centers", structures that are needed for the generation of highly functional and long-lived antibody responses". Borrelia also subverted a B cell response (B cells produce antibodies to fight infection), and instead, caused T cell independence, leading to an IgM skewed profile (in our practice, we often see many more IgM positive Western blots in patients with chronic persistent Lyme, as opposed to IgG positive Western blots). These findings suggest that "B. burgdorferi hinders the immune system from generating a response that is fully functional and that can persist and protect after repeat infections", and suggests a novel evasion strategy for B. burgdorferi by subverting the quality of a strongly induced, potentially protective borrelia-specific antibody response."

More important information from Dr. Horowitz in the comments section of his Facebook post:

Dr. Richard Horowitz - I'm looking into pulsing antibiotics and persister drugs (like those used for TB and Hansen's disease) in Lyme. We are presently accumulating data, but some of the results have been very encouraging in resistant patients. I presented preliminary data last weekend at Omega. When the studies are completed, I will share them at the upcoming Lyme conference at Kripalu in December. http://kripalu.org/presenter/V0008603/richard_horowitz

Very interesting Lyme legality site

http://www.ohioactionlyme.org

Bob

Lyme disease subverts immune system, prevents future protection

July 2, 2015

http://news.ucdavis.edu/search/news_detail.lasso?id=11254

 

The bacteria that cause Lyme disease are able to trick an animal's immune system into not launching a full-blown immune response or developing lasting immunity to the disease, report researchers at the University of California, Davis.

The discovery may explain why some human patients remain vulnerable to repeat infections by the same strain of bacteria, especially in regions where Lyme disease is prevalent. It also suggests that blood tests may not be an effective method for detecting previous exposure to Lyme disease, by far the most common vector-borne disease in the United States and Europe. 

Findings from this mouse-based study are reported July 2 in the online scientific journal PLOS Pathogens, published by the Public Library of Science.

"We demonstrated that an animal infected with Borrelia burgdorferi, the corkscrew-shaped bacteria that cause Lyme disease, launches only a short-lived immune response, and that protective immunity against repeat infections quickly wanes," said Nicole Baumgarth, a professor in the School of Veterinary Medicine and an authority on immune response to infectious diseases at the UC Davis Center for Comparative Medicine.

"This study also suggests a possible mechanism responsible for the disappearance of antibodies following infection and subsequent treatment with antibiotics," she said.

The Borrelia burgdorferi bacteria are transmitted to humans and animals through bites from infected ticks. Symptoms of the disease include fever, headache, fatigue and a characteristic skin rash. If left untreated, the infection can spread to the joints, heart and nervous system. About 300,000 cases of Lyme disease are diagnosed annually in the United States.

The bacteria initially trigger a strong immune response in an infected animal, but findings from this study indicate that the bacteria soon cause structural abnormalities in "germinal centers" — sites in lymph nodes and other lymph tissues that are key to producing a long-term protective immune response.

For months after infection, those germinal centers fail to produce the specific cells — memory B cells and antibody-producing plasma cells — that are crucial for producing lasting immunity. In effect, the bacteria prevent the animal's immune system from forming a "memory" of the invading bacteria and launching a protective immune response against future infections.

The researchers found that following Borrelia burgdorferi infection, this process even prevented induction of strong immune responses to an influenza infection.

Funding for the study was provided by grants from National Institutes of Health and National Institute for Allergy and Infectious Diseases.

Additional information:

• Related: Study shows why dengue fever prevention efforts often fail
• Related: Lyme disease bacteria take cover in lymph nodes, study finds
• Related: Lingering bacteria don't indicate chronic Lyme disease

Media contact(s):

• Nicole Baumgarth, Center for Comparative Medicine, (530) 754-5813, nbaumgarth@ucdavis.edu
• Pat Bailey, UC Davis News Service, (530) 752-9843, pjbailey@ucdavis.edu

 

 

Carl Tuttle

Hudson, NH 03051

Website: New Hampshire Lyme Misdiagnosis

 

Petition: Calling for a Congressional investigation of the CDC, IDSA and ALDF

 

Letter to the Editor, The Lancet Infectious Diseases Published May 2012

 

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Blacklegged Tick Populations Have Expanded Via Migration, Penn Biologists Show

Lyme disease cases are on the rise, with diagnoses occurring in areas that were historically Lyme-free. Scientists attribute the spread to the fact that populations of blacklegged ticks, which carry the bacteria that causes the disease, now flourish in areas once thought to be devoid of ticks.

In a new study, biologists from the University of Pennsylvania, together with colleagues from the New York Department of Health and State University of New York at Albany, used genetic and phylogeographic analyses to determine the origin and recent migratory history of newly discovered tick populations in the Northeastern United States. Their findings indicate that the ticks moved into new areas from established populations, mainly through short-distance, local moves. The results shed light on patterns of disease spread and could have implications for strategies to control ticks in order to reduce disease.

Read the full story:

http://www.upenn.edu/pennnews/news/blacklegged-tick-populations-have-expanded-migration-penn-biologists-show

Bell's Palsy of the Gut?

Lyme can cause gastroparesis, loss of gag reflex, and many other gut problems! See "Bell's Palsy of the Gut" article at http://thehumansideoflyme.net/viewarticle.php?aid=62

Unusual long rash of bartonellosis

Thanks to Virginia Sherr, MD for her image.

RI Blood Center Lays Off 60 To Offset Cost Of New Babesiosis Test

Kristin Gourlay

The Rhode Island Blood Center will lay off 60 people by this fall. That's to help cover the cost of screening for a tick-borne disease that's on the rise in Rhode Island: babesiosis.

Babesiosis  causes flu-like symptoms in some, but it can be life-threatening for the elderly or people with weak immune systems. It spreads through tick bites and blood transfusions. It's become the top transfusion-transmitted disease in the country, and it's endemic in Rhode Island.

Read the source here: 

http://ripr.org/post/ri-blood-center-lays-60-offset-cost-new-babesiosis-test

Hear various speakers talk about tick-byte prevention

Listen and learn from speakers from the Cary Institute, Dutchess County Department of Health, Cornell University, SUNY Adirondack and Hudson Valley Lyme Disease Association.

--- NYS Senator Serino ---

Full Forum at:

http://www.nysenate.gov/video/2015/jul/01/senator-serino-hosts-community-lyme-disease-forum

Senator Serino Hosts Community Lyme Disease Forum | New York State Senate

With tick season in full swing, Senator Sue Serino brought critical information...directly to...

--- Hudson Valley News Network ---

http://hudsonvalleynewsnetwork.com/2015/07/01/senator-sue-serino-host-lyme-disease-forum/

 

--- NYS Assemblymember Didi Barrett---

https://www.facebook.com/pages/Didi-Barrett/311168413519?fref=ts

I joined the State Senate Task Force on Lyme and Tick-Borne Diseases at the first Community Forum ...

 

Some pictures follow

Presenters

Right to left Ben Elone with Ira,

Sen. Serino, Assemblymbr Barrett

Ira models permethrin impregnated

clothing, including gaiters