€ TITLE:
Borrelia burgdorferi-seropositive chronic encephalomyelopathy: Lyme neuroborreliosis? An autopsied report.
AUTHORS:
Kobayashi K; Mizukoshi C; Aoki T; Muramori F; Hayashi M; Miyazu K; Koshino Y; Ohta M; Nakanishi I; Yamaguchi N
AUTHOR AFFILIATION:
Department of Neuropsychiatry, Kanazawa University School of Medicine, Japan.
SOURCE:
Dement Geriatr Cogn Disord 1997 Nov-Dec;8(6):384-90
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 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 characteristic pathological features in the present case. The cerebellar ataxia and subsequent mental deterioration are unusual clinical features of Lyme neuroborreliosis. Spirochete B. burgdorferi can cause focal inflammatory parenchymal change in the central nervous tissues and the present case may be an encephalitic form of Lyme neuroborreliosis.

€ TITLE:
Morphologic, immunohistochemical, and ultrastructural characterization of a distinctive renal lesion in dogs putatively associated with Borrelia burgdorferi infection: 49 cases (1987-1992).
AUTHORS:
Dambach DM; Smith CA; Lewis RM; Van Winkle TJ
AUTHOR AFFILIATION:
Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA.
SOURCE:
Vet Pathol 1997 Mar;34(2):85-96
"A distinctive renal lesion consisting of glomerulonephritis, diffuse tubular necrosis with regeneration, and interstitial inflammation was found in 49 biopsy/necropsy cases obtained from 1987 to 1992. This lesion is manifested clinically as a rapidly progressive glomerular disease that was uniformly fatal. ...Previous reports have associated this lesion with Borrelia burgdorferi exposure. All dogs in this study were from Lyme disease-endemic areas. Of 18 dogs serologically tested, all were positive for exposure. Silver stain examination of kidneys revealed rare spirochetes, suggesting that the presence of spirochetes in the kidney is apparently unrelated to lesion development. The role of vaccination in development of the renal lesion is undetermined. The association of this histologically and clinically unique lesion, Lyme nephritis, with Borrelia burgdorferi infection is significant because it is the only fatal form of canine Lyme borreliosis."

€ TITLE:
Inflammatory brain changes in Lyme borreliosis. A report on three patients and review of literature.
AUTHORS:
Oksi J; Kalimo H; Marttila RJ; Marjamaki M; Sonninen P; Nikoskelainen J; Viljanen MK
AUTHOR AFFILIATION:
Department of Internal Medicine, Turku University Central Hospital, Finland.
SOURCE:
Brain 1996 Dec;119 ( Pt 6):2143-54
"Despite a rapid increase in the number of patients with Lyme neuroborreliosis (LNB), its neuropathological aspects are poorly understood. The objective of this study was evaluation of neuropathological, microbiological, and magnetic resonance imaging (MRI) findings in three patients with the Borrelia burgdorferi infection and neurological disease from whom brain tissue specimens were available. Perivascular or vasculitic lymphocytic inflammation was detected in all specimens. Large areas of demyelination in periventricular white matter were detected histologically and by MRI in one patient. The disease had a fatal outcome in this patient. ..."

€ TITLE:
Ceftriaxone in the treatment of Lyme neuroborreliosis.
AUTHORS:
Rohacova H; Hancil J; Hulinska D; Mailer H; Havlik J
AUTHOR AFFILIATION:
Hospital of Infectious Diseases, Charles University, Prague, Czech Republic.
SOURCE:
Infection 1996 Jan-Feb;24(1):88-90
ABSTRACT:
In an open non-comparative clinical trial with the aim of evaluating the clinical efficacy and safety of a 14 day course of 2 g ceftriaxone once daily, 46 patients with neuroborreliosis were entered at the Infectious Diseases Teaching Hospital in Prague 8. In 39 patients the diagnosis was early Lyme neuroborreliosis. Seven patients suffered from late stage disease. Clinical results were 30% of patients cured at the end of treatment and 85% after 9 months in early stage disease. In late stage disease two patients out of seven were cured and four had improved after 12 months. One patient died because of cardiac infarction. In no patient had treatment to be discontinued because of adverse reactions to antibiotics.

€ TITLE:
The epidemiology of infectious myocarditis, lymphocytic myocarditis and dilated cardiomyopathy.
AUTHORS:
Friman G; Wesslen L; Fohlman J; Karjalainen J; Rolf C
AUTHOR AFFILIATION:
Department of Infectious Diseases and Clinical Microbiology, Uppsala University Hospital,
Sweden.
SOURCE:
Eur Heart J 1995 Dec;16 Suppl O:36-41
"Infectious myocarditis is a common condition which often passes unrecognized, and the true incidence is thus unknown. Lymphocytic myocarditis has been recorded in 1.06% of 12,747 unselected routine autopsies performed over a 10-year period. Dilated cardiomyopathy (DCM) has an estimated frequency of 7.5-10% per 100,000 inhabitants per year. ...Among newly identified bacteria, Borrelia burgdorferi infection is accompanied by cardiac involvement in 1-8% of cases, where myocarditis with conduction disturbances is the most prominent feature. ...Borrelia burgdorferi may occasionally be implicated in DCM. In this contribution we focus also on sudden unexpected death (SUD) in young athletes, since, in Sweden, an increased frequency of SUD has recently been observed in young orienteers and myocarditis was a common feature."

€ TITLE:
Early disseminated Lyme disease: cardiac manifestations.
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
Division of Rheumatology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, USA.
SOURCE:
Am J Med 1995 Apr 24;98(4A):25S-28S; discussion 28S-29S
"The cardiac features of Lyme disease usually occur within weeks to months of the infecting tick bite; the result may be disruption of the conduction system, leading to heart block and muscle dysfunction, causing a mild myopericarditis. Lyme carditis is usually mild, although permanent heart block and a few fatalities claimed to be due to Lyme carditis have been reported, the latter usually with poor documentation. ..."

€ TITLE:
Rapidly progressive frontal-type dementia associated with Lyme disease.
AUTHORS:
Waniek C; Prohovnik I; Kaufman MA; Dwork AJ
AUTHOR AFFILIATION:
New York State Psychiatric Institute, NY 10032, USA.
SOURCE:
J Neuropsychiatry Clin Neurosci 1995 Summer;7(3):345-7
ABSTRACT:
The authors report a case of fatal neuropsychiatric Lyme disease (LD) that was expressed clinically by progressive frontal lobe dementia and pathologically by severe subcortical degeneration. Antibiotic treatment resulted in transient improvement, but the patient relapsed after the antibiotics were discontinued. LD must be considered even in cases with purely psychiatric presentation, and prolonged antibiotic therapy may be necessary.

€ TITLE:
Lyme disease acquired in Europe and presenting in CONUS.
AUTHORS:
Welker RD; Narby GM; Legare EJ; Sweeney DM
AUTHOR AFFILIATION:
Cutler Army Community Hospital, Fort Devens, MA 01433.
SOURCE:
Mil Med 1993 Oct;158(10):684-5
ABSTRACT:
Lyme disease is recognized in many parts of the world, including large areas of North America, Europe, Asia and Australia. Diagnosis and treatment of the disease is essential to avoid the debilitating and potentially life-threatening long-term effects of the infection; however, many physicians may not be aware of the international scope of the disease. This is particularly important for military physicians whose patients may visit or live in endemic areas and whose activities may bring them in contact with the organism. We report here the case of a soldier with near-fatal Lyme carditis acquired in Europe and presenting in Massachusetts.

€ TITLE:
Borrelia burgdorferi myositis: report of eight patients.
AUTHORS:
Reimers CD; de Koning J; Neubert U; Preac-Mursic V; Koster JG; Muller-Felber W; Pongratz DE; Duray PH
AUTHOR AFFILIATION:
Friedrich-Baur-Institute, Clinic for Internal Medicine Innenstadt, Munich, Germany.
SOURCE:
J Neurol 1993 May;240(5):278-83
"Myositis is a rare manifestation of Lyme disease of unknown pathogenesis. This study describes the course of disease in eight patients with Lyme disease, aged 37-70 years, all of whom were suffering from histologically proven myositis. ...One patient died from cardiac arrest caused by myocarditis and Guillain-Barre syndrome."

€ TITLE:
Fatal encephalitis caused by concomitant infection with tick-borne encephalitis virus and Borrelia burgdorferi.
AUTHORS:
Oksi J; Viljanen MK; Kalimo H; Peltonen R; Marttia R; Salomaa P; Nikoskelainen J; Budka H; Halonen P
AUTHOR AFFILIATION:
Department of Medicine, Turku University Hospital, Finland.
SOURCE:
Clin Infect Dis 1993 Mar;16(3):392-6
ABSTRACT:
We describe a 38-year-old farmer from the southwestern archipelago of Finland where both tick-borne encephalitis (TBE) virus and Borrelia burgdorferi are endemic. He presented with fever and headache, developed severe meningoencephalitis in 3 days, and, after 1 month, died without regaining consciousness. High titers of IgG and IgM antibodies to TBE virus were present in both serum and CSF. Serology for Borrelia was negative. Autopsy revealed necrotizing encephalitis and myelitis with involvement of the dorsal root ganglion. With use of polymerase chain reaction tests, segments of two separate genes of B. burgdorferi were amplified from the patient's CSF. This case demonstrates that the possibility of dual infection should be considered for patients residing in geographic areas where Ixodes ticks may carry both the TBE virus and B. burgdorferi. We believe that the most severe damage in this case was caused by TBE virus rather than by B. burgdorferi. Nevertheless, the coinfection might have contributed to the fatal outcome that has not been previously observed in Finnish patients with TBE.

€ TITLE:
Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node [published erratum appears in Postgrad Med J 1990 Mar;66(773):258]
AUTHORS:
Cary NR; Fox B; Wright DJ; Cutler SJ; Shapiro LM; Grace AA
AUTHOR AFFILIATION:
Department of Histopathology, Charing Cross and Westminster School, London, UK.
SOURCE:
Postgrad Med J 1990 Feb;66(772):134-6
ABSTRACT:
A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia ('mesothelioma') of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required.

€ TITLE:
Lyme disease misdiagnosed as TMJ syndrome. A case report.
AUTHORS:
Lader E
SOURCE:
N Y State Dent J 1989 Nov;55(9):46, 48, 50-2
ABSTRACT:
Due to the high incidence of Lyme disease, the ease with which it can be misdiagnosed, and its potential for causing irreversible neurologic or cardiac complications and fatalities if left untreated, all patients living in known epidemic areas who manifest intractable facial pain, or what appears to be a case of temporomandibular joint syndrome that does not respond to therapy should be tested for Lyme Borelliosis. It should be remembered however, that not all patients with active Lyme disease produce antibodies, and it is thus imperative for the clinician to obtain a detailed patient history with a focused series of questions directed at the known presentations of the disease, with specific emphasis placed on the prior appearance of an ECM lesion.

€ TITLE:
Fatal adult respiratory distress syndrome in a patient with Lyme disease.
AUTHORS:
Kirsch M; Ruben FL; Steere AC; Duray PH; Norden CW; Winkelstein A
AUTHOR AFFILIATION:
Department of Medicine, Montefiore Hospital, University of Pittsburgh School of Medicine, PA 15213.
SOURCE:
JAMA 1988 May 13;259(18):2737-9
ABSTRACT:
A dry cough, fever, generalized maculopapular rash, and myositis developed in a 67-year-old woman; she also had markedly abnormal liver function test results. Serologic tests proved that she had an infection of recent onset with Borrelia burgdorferi, the agent that causes Lyme disease. During a two-month course of illness, her condition remained refractory to treatment with antibiotics, salicylates, and steroids. Ultimately, fatal adult respiratory distress syndrome developed; this was believed to be secondary to Lyme disease.

€ TITLE:
[Fatal meningoradiculoneuritis in Lyme disease (letter)]
AUTHORS:
Melet M; Gerard A; Voiriot P; Gayet S; May T; Hermann J; Dournon E; Dureux J; Canton P
SOURCE:
Presse Med 1986 Nov 22;15(41):2075
[No abstract available.]

€ TITLE:
Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis. Demonstration of spirochetes in the myocardium.
AUTHORS:
Marcus LC; Steere AC; Duray PH; Anderson AE; Mahoney EB
SOURCE:
Ann Intern Med 1985 Sep;103(3):374-6
ABSTRACT:
A 66-year-old man developed fever, chills, myalgias, three erythematous skin lesions, and transient left eyelid lag. Because of persistent fever, he was hospitalized 4 weeks after the onset of disease; a peripheral blood smear showed Babesia microti in 3% of his erythrocytes. Eighteen hours later, he died unexpectedly. Autopsy showed pancarditis with a diffuse lymphoplasmacytic infiltrate, and spirochetes were found in the myocardium. Antibody titers to both the Lyme disease spirochete Borrelia burgdorferi and Babesia microti were elevated. The finding of spirochetes in the myocardium and the elevated antibody titers to Borrelia burgdorferi suggest that the patient died from cardiac involvement of Lyme disease.

---

Fetal-death and Lyme disease

€ TITLE:
Fetal outcome in murine Lyme disease.
AUTHORS:
Silver RM; Yang L; Daynes RA; Branch DW; Salafia CM; Weis JJ
AUTHOR AFFILIATION:
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City 84132.
SOURCE:
Infect Immun 1995 Jan;63(1):66-72
"Lyme disease is an inflammatory syndrome caused by infection with Borrelia burgdorferi. Although this syndrome has important implications for human pregnancy, little is known about gestational infection with B. burgdorferi. ...Forty-six percent of acutely infected mice suffered at least one fetal death, compared with none of the control animals (P = 0.0002). ...These findings indicate an association between murine fetal death and acute infection with B. burgdorferi early in gestation but not with chronic infection. Our data suggest that fetal death is due to a maternal response to infection rather than fetal infection. These findings could provide an explanation for observations in humans in which sporadic cases of fetal death in women infected with B. burgdorferi during pregnancy have been reported, while previous infection has not been associated with fetal death."

€ 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.
SOURCE:
Pediatr Clin North Am 1992 Aug;39(4):669-90
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.

€ TITLE:
Gestational Lyme borreliosis. Implications for the fetus.
AUTHORS:
MacDonald AB
AUTHOR AFFILIATION:
Southampton Hospital, New York.
SOURCE:
Rheum Dis Clin North Am 1989 Nov;15(4):657-77
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, 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.

€ TITLE:
Stillbirth following maternal Lyme disease.
AUTHORS:
MacDonald AB; Benach JL; Burgdorfer W
SOURCE:
N Y State J Med 1987 Nov;87(11):615-6
[No abstract available.]

€ TITLE:
Human fetal borreliosis, toxemia of pregnancy, and fetal death.
AUTHORS:
MacDonald AB
SOURCE:
Zentralbl Bakteriol Mikrobiol Hyg [A] 1986 Dec;263(1-2):189-200
[No abstract available.]

€ TITLE:
Lyme disease during pregnancy.
AUTHORS:
Markowitz LE; Steere AC; Benach JL; Slade JD; Broome CV
SOURCE:
JAMA 1986 Jun 27;255(24):3394-6
ABSTRACT:
Lyme disease is an increasingly recognized tick-borne illness caused 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.

---

Non-supportive of fatal Lyme disease

€ TITLE:
Epidemiology of European Lyme borreliosis.
AUTHORS:
O'Connell S; Granstrom M; Gray JS; Stanek G
AUTHOR AFFILIATION:
PHLS Laboratory, Southampton University Hospital Trust, UK.
SOURCE:
Zentralbl Bakteriol 1998 Mar;287(3):229-40
"Lyme borreliosis occurs throughout Europe and is particularly prevalent in the east. In a small proportion of untreated cases serious sequelae may occur, but Lyme borreliosis alone does not cause death. ..."

€ TITLE:
Tick-borne infections. What starts as a tiny bite may have a serious outcome.
AUTHORS:
Middleton DB
AUTHOR AFFILIATION:
St Margaret Memorial Hospital, Pittsburgh, PA 15215.
SOURCE:
Postgrad Med 1994 Apr;95(5):131-9
ABSTRACT:
Tick-borne illnesses are being reported increasingly often. Unlike Lyme disease, which tends to be indolent, Rocky Mountain spotted fever and ehrlichiosis can kill and so must be recognized and treated promptly. These diseases require clinical diagnosis, because laboratory confirmation with antibody tests takes too long. Tetracycline hydrochloride, doxycycline (Doryx, Vibramycin), or chloramphenicol (Chloromycetin) treatment is effective. Other diseases (eg, babesiosis, tularemia) are encountered occasionally and can also be fatal but are treatable with antibiotics.
[Note: From Merriam-Webster/Medscape Medical Dictionary: indolent 1 : causing little or no pain, 2 a : growing or progressing slowly, b : slow to heal]

€ TITLE:
Lyme disease and pregnancy outcome: a prospective study of two thousand prenatal patients.
AUTHORS:
Strobino BA; Williams CL; Abid S; Chalson R; Spierling P
AUTHOR AFFILIATION:
Department of Pediatrics, New York Medical College, Valhalla 10595.
SOURCE:
Am J Obstet Gynecol 1993 Aug;169(2 Pt 1):367-74
ABSTRACT:
OBJECTIVE: The purpose of the study was to determine if prenatal exposure to Lyme disease was associated with an increased risk of adverse pregnancy outcome. STUDY DESIGN: Approximately 2000 Westchester County, New York, women completed questionnaires and had sera tested for antibody to Borrelia burgdorferi at their first prenatal visit and at delivery. Fetal death, birth weight, length of gestation at delivery, and congenital malformations were examined in relation to maternal Lyme disease exposure before and during pregnancy. RESULTS: Maternal Lyme disease or an increased risk of exposure to Lyme disease was not associated with fetal death, decreased birth weight, or length of gestation at delivery. Tick bites or Lyme disease around the time of conception was not associated with congenital malformations. Tick bites within 3 years preceding conception were significantly associated with congenital malformations, but this could have reflected reporting differences between exposed and unexposed women. CONCLUSIONS: Maternal exposure to Lyme disease before conception or during pregnancy is not associated with fetal death, prematurity, or congenital malformations taken as a whole. We have not ruled out the possibility that exposure to Lyme disease as defined by maternal history increases the risk of specific malformations or has an effect if it is not treated. We have insufficient numbers of women who were seropositive at their first prenatal visit to determine if this subgroup of exposed women are at a moderately increased risk of having a child with a congenital abnormality. The low frequency of seroconversion at delivery in this endemic area suggests that preventive measures are being taken by obstetricians and patients.

---

For more information about Lyme disease, see: Lots Of Links On Lyme Disease

Comments or questions concerning this page should be directed to Art Doherty.

Last updated on 13 December 1999 by
Art Doherty
Lompoc, California
doherty@utech.net

---

This page hosted by Get your own Free Home Page