The History of Lyme disease · June 5, 2004 Conference "MS vs. Lyme disease", Eindhoven 5 The...
Transcript of The History of Lyme disease · June 5, 2004 Conference "MS vs. Lyme disease", Eindhoven 5 The...
June 5, 2004 Conference "MS vs. Lyme disease", Eindhoven 1
The History of Lyme disease
by Robert Bolderdijk
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The History of Lyme disease
1883 German Alfred Buchwald first describes skin lesion
1902 Herxheimer gives ACA it’s name
1909 Arvid Afzelius first describes EM and links it to a tick bite
1909 Ricketts demonstrates that Rickettsia causes Rocky
Mountain spotted fever and is transmitted by ticks
1910 Austria W. Balban describes the EM rash caused by insect
bites
1911 Swiss Jean Louis Burckhardt describes lymphocytoma
1913 Austrian Benjamin Lipschütz describes ECM
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The History of Lyme disease
1920 Strandberg links lymphocytoma with tick bites
1922 Charles Garin and Charles Bujadoux report about EM and
meningoradiculoneuritis, later called Bannwarth’s syndrome
1930 Sven Hellerström connects ECM and meningitis
1936 German Askani suggests a tick bite is the cause of EM
1941 German Alfred Bannwarth describes the neurological
LD triad: - severe nerve pain
- cranial nerve palsy- meningitis
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The History of Lyme disease
1942 German R. Kahle reports of 6 of 7 ACA patients having
serum positive for syphilis
1946 Penicillin effective in ACA
1948 Carl Lennhoff finds spirochetes in EM biosy
1949 At Southern Medical Ass. In Ohio, Sven Hellerström
describes that a tick bite results in a rash and neurological
problems
1949 G. Schaltenbrand reports 8 cases of Bannwarth’s syndrome
1950 Low-dose I.V. penicillin effective in EM patients
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The History of Lyme disease
1951 Jarish-Herxheimer reaction seen in ACA patients
1952 T. Grüneberg thinks J-HR in ACA patients due to spirochetes
1954 J. Pascoud relates a tick bite to EM, lymphocytoma and
Bannwarth’s syndrome
1954 Hans Götz performs skin transplants of ACA
1956 EM description first time in US medical textbook
1960 V. Sedlacek sees correlation between EM and peak season
for Ixodes ticks bites
1965 W. Hauser suggests, ACA, EM, lymphocytoma is one entity
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The History of Lyme disease
1968 H.C. Hoff reports about a cluster of 300 ACA cases
1970 Rudolf Scrimenti, Wisconsin, reports the first EM in the US
1971 Richard Kelly develops a culture media for Borrelia which
causes relapsing fever
1973 Rudolf Ackermann reports on 47 patients with
meningoradiculitis and rediscovers the Bannwarth’s
syndrome
1974 Klaus Weber reports a case of EM and meningitis failed oral
penicillin treatment but cured with high dose of I.V.
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The History of Lyme disease
1975 Polly Murray contacts Yale University
Judith Mensch contacts Connecticut State Health Dept.
1975 David Snydman begins the investigation
Allen Steere rheumatologists is asked to lead the study
1976 W. Mast and W. Burrows describe 10 cases of EM and treat
with ABX
1977 Steere describes a new arthitis form in children and calls it
Lyme arthritis and treats it with aspirin
- short-term ABX failed- Steere thinks it’s a virus
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The History of Lyme disease
1981 Willy Burgdorfer et al. report on the discovery of spirochetes in Ixodus scapularisLater they are called after him Borrelia burgdorferi
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The History of Lyme disease
1982 Barry Marshall and Robin Warren discover the Helicobacter pylori
1982 Rudolf Ackermann finds spirochetes in Ixodus ricinus in Germany and treats successfully EM with ABX
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The History of Lyme disease
1983 Borrelia burgdorferi isolated from LD patients in Conn.
1983 R. Ackermann finds antibodies to Bb in patients with EM and
Bannwarth’s syndrome
1983 W. Burgdorfer predicts LD will be Nr.1 tick-borne disease
in US
1984 Ackermann finds negative antibody test in EM patients
1985 1ste case of maternal-fetal transmission
1988 The Lyme Disease Foundation is founded
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The History of Lyme disease
1991 Intracellular capability of Bb and survival in macrophages
1991 Intralaboratory comparison of test results for detection
of LD; of 516 laboratories only gave 45% accurate identified
serum samples
1992 Klempner demonstrates Bb invade skin fibroblasts and
survive ceftriaxone
1993 The Borrelia burgdorferi sensu lato group entails
- Borrelia burgdorferi s.s.- Borrelia garinii- Borrelia afzelii
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The History of Lyme disease
1993 Dr. L. Mattman presents her book
Cell Wall Deficient Forms: Stealth Pathogens
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The History of Lyme disease
1996 Vera Preac-Mursic proves different antibiotic responses
among Borrelia strains
She recommends dual ABX and longer than a few weeks
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The History of Lyme disease
1998 SmithKline-Beacham gets approval for their LYMErix vaccine
1998 L. Mattman presents the Gold Standard for spirochetal
infection, the Q-RiBb test
1999 The ILADS is founded
1999 Goossens tested 15 commercial immunotest-kits for
Borrelia: - sensitivity 38-92% for Elisa
- sensitivity 50% for Western Blot
2001 OspA vaccination induced arthritis in 4 cases
2001 Scientists find cyst form reconversion into motile
spirochetes
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The History of Lyme disease
2002 LYMErix vaccine withdrawn from market
2004 CBO guidelines for Lyme treatment published
2004 ILADS guidelines for Lyme treatment published
2004 June 5th, the 1rst ILADS conference in Holland
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Salmonella detection
Salmonella detection by motility on MSRV
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Salmonella detection
2nd World Congress Foodborne Infections and Intoxications
Berlin 26-30 May 1986
Rapid Salmonella Detection From Foods By Motility Enrichment.
J.M. De Smedt, R.F. Bolderdijk and H. Rappold.
Journal of AOAC International 1996 Mar-Apr;79(2):441-50
Salmonella detection in dried milk products by motility
enrichment on modified semisolid Rappaport-Vassiliadis medium.
Collaborative study: R.F. Bolderdijk and J.E. Milas.
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Lyme disease from a patients view
My Storyby Robert Bolderdijk
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My Story
1995Change from office work to physical labourComplaints: - Joint and muscle pain
- Low back pain- Numbness, tingling and cramps in hands- Leg, under feet pain, cramps in calves - Facial left side tingling- Excessive sweats- Fatigue- Short of breath
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My Story
1996Diagnosed with fibromyalgieSevere pain in the left calfDiagnosis: deep venous thrombosis DVT
1997December, pulmonary emboli due to recurrent DVT in legSource of DVT: lupus coagulant antibodies positiveAntiphopholipidesyndrom APS
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My Story
1999Helicobacter pylori infection Sent to rheumatologist in University Hospital #1Results: - No SLE
- APS primary- IgM for Lyme negative (IFA)- IgG for Lyme positive (IFA)- Erythrocyturie e.c.i- ALAT of 368 mg/L- Hypertension
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My Story
1999Diagnosis: - Complaints due to primary APS
- No Lyme because of negative IgMMedication: prednisone and atenolol
My Lyme disease awakening!!
1974 Hospital treated twice for EM
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My Story
From my medical records1974 Cardiological examination1976 Neurological conductivity examination1981 Nose-sinus operation
Neurological conductivity examination1981-today Regular low back pain, headache and numbness and
tingling in handsLyme disease can trigger APS
F.D. gave me 14 days Doxycycline 200mg/d
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My Story
2000Visit to Lyme specialist University Hospital #2Immunotestsresults: ELISA IgM negative
ELISA IgG negativeDiagnosis: no active Lyme disease
Visit to Lyme specialist University Hospital #3No tests doneDiagnosis: no active LymeComplaints between the ears
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My Story
2001Visit internist University Hospital #1Requested immunotests for ELISA and Western BlotResults: in house IFA, IgM negative and IgG positiveResults from RIVM: ELISA IgM negative
ELISA IgG borderlineWB IgG: 17kD+, 22kD(+), 34kD++, 41kD+
Remark: incomplete but very suspect IgG patternCould be an old extinguished response of two years after ECM Diagnosis: extinguished infection or may be Lyme!Treatment proposal: Doxycycline for 21 days
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My Story
2001Blood examination at Laboratoriumsmedizin in Köln (Germany) by Prof. Dr. Rudolf AckermannImmunotest with whole cell-lysates of 3 genospecies of BorreliaResults: ELISA IgM negative >200=pos.
ELISA IgG positive 920E >400=highWB IgG: p30, p34, p41
Visit to the 3rd Lyme specialistGerman results were wrong because of the standard deviationDiagnosis: no Lyme serological scar from old Lyme
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My Story
2003Blood examination at Laboratoriumsmedizin Köln GermanyResult: ELISA IgM negative
ELISA IgG positive 660EWB IgG: p20, p30, p34, p41
Diagnosis Prof Ackermann: active Lyme disease
Visit neurologist at local hospital with German resultsLumbar puncture for CSF examination
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My Story
Results:
Treatment proposal: 21 days of Rocephin I.V. Immunotiter before and 3 months after the treatment
Local hospital Laboratoriumsmedizin
Serum IgM negative Not done
IgG negative Not done
CSF Dubious for intrathecallyantibodies
Protein 269mg/l
Positive for intrathecallyantibodies
Not done
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My Story
2003September: start of I.V. treatmentImmunotestsresults:
January: immunotests at Laboratoriumsmedizin- IgG positive 840E- WB not done, at own costs- Conclusion: I.V. treatment had no effect
Local hospital Laboratoriumsmedizin
Serum IgM negativeIgG negative
WB not done
Not doneIgG positive 700E
WB IgG; p20, p34, p39p41, p83
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My Story
TodayComplaints not changed
- Joint and muscle pain- Tingling and cramps in hands- Cramps in calves- Leg en feet pain- Breast pain- Neck pain
- Facial tingling- Sweats- Pain at the bite- APS- Hypertension- Erythocyturie- Proteinurie (Dr. Kirmizis, Lyme
and MPGN)
2004 Next, starts treatment with FDDoxycycline 2 X 200mg/d for 8 weeksMethronidazole 2X500mg/d pulsed weekly
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Learnings
Clinical symptoms are not recognizedLyme disease diagnosed by: family doctor 6%
specialists 44%patient 33%
Doctors rely on the immunotests instead of clinical signs
Immunotests are insufficient sensitive and performance is poor38-92% sensitivity for Elisa50% sensitivity for Western Blot(Goossens)
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Learnings
Standard antibiotic treatment in chronic Lyme often inadequateCBO guidelines needs to be revisedAfter standard treatment the patient is left aloneGeneral opinion about Lyme disease needs adjustment
Lyme disease does not (immediately) killhowever,
it does take your life!!