Lyme Borreliosis Diagnostic Accuracy Serological Tests Systematic Review
International Cutaaneous Borreliosis and Molecular ...
Transcript of International Cutaaneous Borreliosis and Molecular ...
Textbooks , clinical experience
Three Tick bite sitesEach withoutErythema or painor Itching at the sites
PatientRemovedIxodesScalularisNymphformFromThis tickbite site
Tick HypostomeIn Human SkinBlue box
ClassicalSpiralFormsOfBorreliaBurgdorferi [ L ]AndMultipleSmaller“blebs”Or Liposomes {Circles}OfBorreliaBurgdorferiOn anElectronMicroscopeGrid
Specimen submitted by::Alan B. MacDonald,MD Year 1988Electron Microscopy by:S. F. Hayes, Electron Microscopist,Rocky Mountain Laboratory, Hamilton,MT Note: No DNA
wasDetectedwithinThese Blebsin 1988
In Year 1989::Dr. Claude Garon PhDet al, detected BorreliaDNA molecules inBlebs of B.burgdorferi
Possible“Transfection”by LiposomesOf BorreliaBurgdorferiScenario--------As aConsequenceOf PenetrationOf the NucleusOf the humanCell byLiposomes“Blebs”OfBorreliaBurgdorferi
Skin of Trunk
ClassicalSite andClassicalGrossappearanceSoft parts ofLOBE of EAR
Comment:(ABM)This case couldBe easilyMisdiagnosed as“relapsingPolychondritis”Because theSoft parts of theLobe of the EarAre Spared.Incredible case!!Unusual for EarInvolvementIn BL!!!
MultifocalBorreliaLymphocytoma
Nose
Scalp
Lip
Classical grossFindings forBorreliaLymphocytoma
“Special site Skin”These sites includeEarlobeAreolaEyelidGenitalPeriumbilical
Could this beconfusedWith a smallErythemaMigrans???Size 2.5 cmx1.1 cm
What would yourCDC ConsultantDiagnose?
Monotypic:: Sharp Borders,rubbery, Stable
Oligotropic :: Gradual Increasein Size
Spreads along Lymphatics
Miliary form:: MULTILPLE PinPoint lesions LYMPHATICSpread
6 MonthsDurationEar lobe
CartilageNotInvolvedSkin ofHelixRegionQuiescent
Skin of:
ElbowHandArmLegPlantar skin
Plantar SkinWith ProminentDiseaseNOTE:Very few diseasesInflict INJURYOn thePalmar SkinOf Plantar Skin______________Can you name anotherDisease whichInvolvesPalmar/Plantar??
Paper thinEpidermis[Epidermalatrophy]Is ahallmarkOf ACA
Mainly FibroticStageWith scatteredPERSISTENTInflammatoryFocithroughoutThe lesion
ACA DenseInflammatoryStageLittle to NoFibrosis in thisStage
Revolutionized the Microscopist’s ability to find borrelia in the Skin
Focus Floating Microscopy ::Demonstrates Red staining Borrelia – single and in Groups
ParaproteinemiaN= 5 cases
PlasmacytomaN= 2 cases
World Total NumberOf NXG cases
N=80
FACE >>Trunk>extremitiesAlso in:
Myocardium, Liver, Lungs
Paraproteins :: specificityBIND to LIPOPORTEINs
PCR [ with B31 PCR primers:: Always negative in NXGNO PCR ever done withPrimers for BB sl Group ofBorreliae
Southern ErythemaMigransCollectionEdwin Masters MDCape GirardeauMissouri
Can You TellMissouri typeErythema Migrans
From
Erythema MigransNew York type?????
Southern Erythema MigransFrom Dr Edwin Masters’ patients residing inCape Girardeau, Missouri
Can you tellErythema MigransMissouri Type
From
Erythema migransNew York Type??
CDC Map : National LymeDisease Cases
RED> Yellow>Green
BLUE = VIRTUALLY NOSIGNIFICANT LYME
A true Case – of LYME Disease in a Resident of aSouthern State in the USAA Reportable Case - -To your State Department of HealthA Statistical point on the USA Map –CDCA disease which Merits – TREATMENT WITHANTIBIOTICS
Not a True Case of Lyme diseaseSouthern State in the USA AND
the Medical Justification to Treat with Antibiotics
Northern State in the USAAmblyomma Americanum [Lone Star] Tick vectorNot a Reportable Case—Not a Statistical point on the USA MAP –CDCA disease which may encounter fiery DEBATE about
In Vitro biofilm formation by Bb Proven by Dr Eva Sapi et al, inPLOS ONE article epublished October 24, 2012
Tick Midgut :: Ixodes Scapularis, “a Carpet of Spirochetes”
Human Skin :: FFM Positive cases from Dr. Klaus Eisendle and Dr. Bernhard Zelger
Mouse Skin:: Dr.Linda Bockenstedt:: Yale :: Experimental Lyme arthritis model in Mice
Video Lectures on Biofilm Science by the late Dr. WilliamCosterton, are gratefully received.Conversations with Mr. Richard Longman, are gratefully Received
A “carpet” of Spiral formAnd interspersedCystic [round body]Forms in acommunity..{sessile}..Attached to tickMidgut epithelial cells
Amorphous “Globs” of BorreliaIn Deep Mouse DermisIn Chronic ExperimentallyinducedLyme Arthritis
Are these so called “Globs”Actually biofilm Colonies inThe Deep dermis Near theArthritic Mouse Joint??A Community of Specialized[NonSpiral]Borrelia with interspersedRound Body forms in themouse Dermis
Specilaized Non-SpiralBorrelia , includingRound body forms,Granular forms,In the dermisForming many Colony-Communities in theMouse Dermis—Highly resemblingbiofilm Communities,Because of their highDensity, and lack ofSpiral Borrelia forms
Spiral Borrelia forms around the Edges of a biofilmCommnity. The specialized borrelia forms [granularforms] dominate the central regions of the Biofilm.Planktonic forms=Spiral :: Specialized formsareINSIDE the Community
So called “Amorphous Glob”of borrelia burgdorferi
Pure culture of ATCC 35210 [B31 strain] ofBorrelia burgdorferi :: In vitro Biofilm
In VIVO borrelia biofilmsNot Yet Accepted in a Peer reviewed Journal –YetBut the Image evidence from microscopyIn various articles already publishedDescribing Biofilm-like-communities in Tick, Mouse,HumanIs Very VERY CloseTo the Biofilm Profiles – Now Proven –in PLOS ONE (Sapi,E, etal , Oct24 2102 IN VITRO models
Number of legitimate kinds of Borrelia Skin DiseasesNumber of Strains of Borrelia burgdorferi SS and SL species infectivefor ManNumber of Tick strains – as COMPETENT to TRANSMITNumber of Continents with Borreliosis as a Public Health problemNumber of Molecular dimensions to borreliosis in mammalian hostsNumber of ”invisible” manifestations [Blebs] [Liposomes of borrelia]Number of Extracutaneous legitimate manifestations of BorreliosisNumber of diverse forms that the borrelia spirochete can take andremain viableNumber of biofilm models {In Vitro, In TickO, In Mouse0, In humanO}Liposomes of borrelia as a model for Transfection of Borrelia DNA toHuman cells
and the LIPOSOME model for activation of the Cellular immuneresponse
with “AUTO IMMUNE” diseasesACA dense Fibrosis/dense inflammation to explain now idiopathic
fatal Fibrosing Diseases ( Retroperitoneal Fibrosis, Mediastinalfibrosis}The “Expanding Clinical Spectrum of Duray” –Lead, Follow, or Get outof the Way!!
Sir Dr. William Costerton PhD ,Dr. Paul Harrison Duray, MD
The Commentaries and the Opinions [which sometimes go beyond the territoryOf Current Peer Reviewed published Manuscripts]DO NOT NECESSARILY REFLECT THE BELIEFS OF THE ABOVE CAPTIONEDEXPERTs. All Controversial Issues contained within this work are the SOLERESPONSIBILITY of Alan B. MacDonald, MD, FCAP,FASCP Date October 29,2012And are protected by Copyright, All rights Reserved
Dr. Willy Burgdorfer , PhD , MD (hon.), Dr. Alan G. Barbour , MD, Dr. Tom G. SchwanPhD. , Dr. Dan Corwin PhD, Mr. S. F. Hayes , Dr. Scott Samuels PhD, Dr. Justin Radolf,MD., Dr. Linda Bockenstedt MD,., Dr. Bernard W. Berger MD, Dr. Klaus Eisendle MD,PhD , Dr. Med. S. A. Buchner, MD[Basil], Dr. Med. Klaus Weber MD , Dr. Med. EvaAsbrink , Dr. Med. Anders Hovmark, MD, Dr. Med. Elisabeth Aberer, MD, Dr. Med.Dieter Haussler, MD, Dr. Med. M. Leverkus, MD, Dr. Med Th. Hardmeier, MD , Dr.Oystein Brorson, MD, Dr. S.H. Brorson, MD ,Dr. Peter Krause, MD. Dr. Bernhard Zelger ,MD , MSC.. .Dr. Edwin Masters MD, Dr. Steven Norris PhD, Dr. Tao Lin MD PhD, Dr.Maria Esteve-Galant ,PhD , Dr. Guadalupe Gordillo-Perez MD, PhD, Dr. YoshinariNatalino ,MD, Dr. Peter Mayle MD, Dr. Eva Sapi PhD, Dr. Kordula Elbl PhD, Dr. ArminSchwartzbach MD, Dr. Marcia Herman Giddens PhD, Dr. Kerry Clark, PhD ,Dr. Steven Phillips,MD, Mrs. Elizabeth Schmitz,Mr. Richard Longman , Ms. Elena CookSaul Steinberg and New York Magazine,