Pachner 2001: These data demonstrate that Lyme neuroborreliosis is a persistent infection, 
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 Pachner 2001: These data demonstrate that Lyme neuroborreliosis is a persistent infection,

1: Ann Neurol 2001 Sep;50(3):330-8 Related Articles, Books, LinkOut  

Central and peripheral nervous system infection, immunity, and inflammation in
the NHP model of Lyme borreliosis.

Pachner AR, Cadavid D, Shu G, Dail D, Pachner S, Hodzic E, Barthold SW.

Department of Neurosciences, UMDNJ-New Jersey Medical School, Newark 07103,

The relationship between chronic infection, antispirochetal immunity, and
inflammation is unknown in Lyme neuroborreliosis. In the nonhuman primate model
of Lyme neuroborreliosis, we measured spirochetal density in the nervous system
and other tissues by polymerase chain reaction and correlated these values to
anti-Borrelia burgdorferi antibody in the serum and cerebrospinal fluid, and to
inflammation in tissues. Despite substantial presence of Borrelia burgdorferi,
the causative agent of Lyme borreliosis, in the central nervous system, only
minor inflammation was present there, though skeletal and cardiac muscle, which
contained similar levels of spirochete, were highly inflamed. Anti-Borrelia
burgdoferi antibody was present in the cerebrospinal fluid but was not
selectively concentrated. All infected animals developed anti-Borrelia
burgdorferi antibody in the serum, but increased amplitude of antibody was not
predictive of higher levels of infection. These data demonstrate that Lyme
neuroborreliosis is a persistent infection, that spirochetal presence is a
necessary but not sufficient condition for inflammation, and that antibody
measured in serum may not predict the severity of infection.

PMID: 11558789 [PubMed - indexed for MEDLINE]

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Wed, 31 Mar 2004 12:08:52 GMT
 Pachner 2001: These data demonstrate that Lyme neuroborreliosis is a persistent infection,
It takes four - yes 4 - spirochetes to cause syphilis infection in a rabbit.
______________
"....The eye is
well known as an immunologically favored site and can serve as a persistent
locus of spirochetes that can keep a person infected, or can reinfect them when
antibiotics are stopped....."

"....Dr. Nick Harris, president of IGeneX ....While the Lyme spirochetes grow
to high densities in ticks.....in mammals
there is an extremely low density, probably less than one spirochete per
gram of tissue or {*filter*}...."

 California Lyme Disease Symposium  1994 -  reported by Jean Hubbard

  "Regarding the PCR, Dr. Burrascano believes it is a technique which
looks promising but has serious limitations.  One very important thing to
remember when considering antigen-capture tests in general, he stated, is
that 'the spirochetes of Lyme do not live in the liquid portions of the
body;  they are deep tissue infections'.  He stated that it is a very rare
occurence , especially in later Lyme, to find spirochetes in the spinal
fluid, in the urine or in the {*filter*}, and he feels that this is a big
limitation of the clinical usefulness of PCR testing which needs to be
studied further. "

"Dr. Nick Harris, president of IGeneX .......who spoke on laboratory
testing for Lyme disease, further emphasized the testing problem created by
low tissue densities of spirochetes, noting that serial sections of a
patient who had Lyme carditis revealed only one
spirochete................He stated that 'the PCR is a very sensitive tool,
but there are some pitfalls.  The laboratory has to recover at least one
organism, or the DNA from at least one organism.  A positive test says,
'yes, we've found the DNA of Borrelia.'  aA negative says 'that sample is
negative'......"

"While the Lyme spirochetes grow to high densities in ticks.....in mammals
there is an extremely low density, probably less than one spirochete per
gram of tissue or {*filter*}.  This fact plus the probable abitlity of the
spirochete to bind IgM antibody to itself are two reasons why it is so
difficult to test for the presence of Lyme disease."

This is information from 1994--
from:  California Lyme Disease Symposium--Lyme Disease Resource Center of
California pg. 18
Reported by Jean Hubbard

"Dr. Burrascano  also emphasized the complexity of Lyme disease, particularly
chronic disease, and he too recommended an article....by Kenneth Leigner in the
Journal of Clinical Microbiology, August 1993, 1961-1963 that deals with the
very basic questions that need to be addressed  in diagnosing and treating Lyme
disease:  the accuracy of the diagnostic tests, the accuracy of beliefs about
the existence of 'post-Lyme syndrome', and the accuracy of beliefs about
treatment duration.
"He observed that he has a practice of patients who are really 'end-stage,
chronic Lyme patients, and therefore my view of things is biased'.  He noted
that CNS symptoms can begin one day after EM and that experimental infection in
rodents shows that within 12 hours after their injection spirochetes can be
recovered from the CNS.  He noted that there are studies in humans showing that
' At the time of otherwise asymptomatic EM you can find evidence of infection
in the CNS...........Treatment for early Lyme disease has to be designed to
penetrate the CNS, even if it is an asymptomatic person with EM,' especially
since the CNS disease can then become latent for long periods of time, up to 14
years.  He sees patients who were not  treated early and who present sometimes
14 years later  with encephalopathy, headache, irritability, stroke, persistent
neurogenic Lyme.  'The  best correlation of this with other illnesses, of
course, is syphilis, and we all know about the Tuskegee study where syphilis
was purposely not treated to  to see what would happen.  Patients who are not
treated or who are given minimal treatment may go on to progress.  The bottom
line,' he says, 'is not just how does the patient feel next week, or does the
treatment make the patient feel well, or is the joint better. The better
question is: Is the whole person better?  How long do we follow these people?
For a month?  Three months?  Six months?  I basically recommend that until we
have more technology to tell whether the patient is infectious, they be
followed for life.'
"With regard to diagnosis, Dr. Burrascano emphasized that serologies are not
reliable, and that several groups have been able to culture Borrelia
burgdorferi spirochetes in the CSF of patients who had negative serologies both
on {*filter*} and CSF.  Lyme disease is not diagnosed with a {*filter*} test;  it is
diagnosed with the whole clinical picture, the background of the patient, the
exposures, the symptoms, the evolution of symptoms over time, ....taking the
whole picture into account.'
"He warned that in his opinion it is the patients who are much more ill who
remain seronegative or only weakly seropositive for years ......His experience
suggests that these patients also in general respond much more poorly to
therapy, and he is concerned that they are not studied at all by groups which
limit their patient poplulation to CDC-defined cases of Lyme disease, which
require seropositivity.
"Dr. Burrascano noted that there is controversy related to how long someone is
supposed to be treated.  Articles often state that treatment should consist of
two to three or sometimes four weeks of antibiotics, but he asserted that this
is an arbitrary time period, that...'Never in the entire history of this
illness has there ever been a single study that has proven by any scientific
method whatsoever that x number of weeks was enough to kill the spirochete.  If
you look at  the the science of this, there are many studies of failures of
four weeks or less of treatment, proven by positive antigen capture and culture
and so forth.'  He said that this is particularly true for late stage Lyme.  He
stated that if treatment is stopped when patients are still sick, they are
still going to be sick, and that the hard part for the clinician to decide is
when the patient is over the active infection.  ' There is no test for a cure,
' he said, 'and there probably will not be one, because of the nature of the
beast.
So what you have to try to do is discover, from close work with the patient,
what the symptoms are that are indicative of an ongoing, active infection, as
opposed to some permanent damage or autoimmune phenomena that may or may not be
occurring .'  For example,'some ongoing low grade fevers or night sweats, with
the low-grade fevers often occurring in the late afternoon at about 4 o'clock,
are a sign if you exclude other sources of fever.  Patients who have migratory
polyarthritis or polyarthralgia, when it's in the elbow for two weeks and then
it moves to the knee and it moves to the wrist, something is moving around in
there, and that is a sign of ongoing infection.'  Dr. Burrascano finds that if
patients have such signs, and treatment is stopped, 'either they are never
going to go completely back to normal, or they will relapse fully after they
have been treated, and this is what makes the treatment of Lyme so difficult.'
Some patients in his practice, he observed, have had Lyme disease for over five
years, undiagnosed and untreated, and have had one month of amoxicillin and
were absolutely fine, and in five to ten years of followup never have been sick
again.  On the other hand, other patients in his practice have been on
antibiotics for more than three years and have been found by objective cultures
or by electron microscopy to harbor living spirochetes.
"Dr. Burrascano discussed some of the means by which the spirochete might
resist both detection and antibiotic therapy.  These include dormancy or
latency, residence within intracellular structures, residence within certain
organisms  of the body which are resistant to both immunologic defenses and
antibiotics, and the ability of the spirochete, as described by Dr. Dorward, to
coat itself  with a gel-like substance including immunoglobulins which may well
insulate it from detection by the immune system and from the effects of
antibiotic {*filter*}.
"With respect to dormancy/latency, he reported a study done in 1991 by McDonald
which cultured spirochetes from EM lesions and found that, in the same medium
and using the same techniques. some spirochetes grew for a month or two, some
spirochetes did not appear to grow until several more months went by, and one
culture lay dormant for over 10 months before it started to regrow.  This
correlates with observations on latent periods and relapses in human
symptomatology, and Dr. Burascanno noted that if the laboratory findings hold
true in human systems, this is very important in as much as antibiotic therapy
kills spirochetes only in their growth phase.
"With respect to intracellular residence, he noted that several different
scientists have found the spirochetes inside the cells of the body, inside
fibroblasts and inside macrophages.  If spirochetes actually take up residence
in these intracellular structures for more than a transient  passing through,
he observed, then they will be resistant to {*filter*} like cephalosporins, which
don't penetrate cells.  He also reported that in New Jersey a well-known
opthalmologist is the field of Lyme disease has shown electron micrographs of
spirochetes that have been cultured from the inside of the eyes.  The eye is
well known as an immunologically favored site and can serve as a persistent
locus of spirochetes that can keep a person infected, or can reinfect them when
antibiotics are stopped....."

posted:

".... These data demonstrate that Lyme
neuroborreliosis is a persistent infection, that spirochetal presence is a
necessary but not sufficient condition for inflammation, and that antibody
measured in serum may not predict the severity of infection......"

1: Ann Neurol 2001 Sep;50(3):330-8 Related Articles, Books, LinkOut  

Central and peripheral nervous system infection, ...

read more »



Thu, 01 Apr 2004 07:11:20 GMT
 
 [ 2 post ] 

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