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Understanding Late-Stage Lyme Disease & Co-Infections: Diagnosis, Treatment, and Prevention

Learn about late-stage Lyme disease, symptoms, diagnostic tests, and treatment options. Explore co-infections like Bartonella and strategies for Lyme prevention.

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Understanding Late-Stage Lyme Disease & Co-Infections: Diagnosis, Treatment, and Prevention

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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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