Lyme and coinfections and pregnancy

[Yvonne]

Gestational Lyme borreliosis. Implications for the fetus.

http://www.molecularalzheimer.org/files ... d_1989.pdf

[Yvonne]

Detection of borreliae in the placenta of two patients with erythema migrans

J. Hercogováa, J. ivnýa and D. Janovskáa

D. Hulínská1

a Charles University Prague Czech Republic
1 Institute of National Health Prague Czech Republic

Available online 20 March 2000.


Abstract
Objective: To study a possible intrauterine Borrelia infection in 31 women treated for erythema migrans (EM).

Results: 29 pts. delivered healthy children. In one pt. who delivered a healthy child the remains of Borrelia antigens were detected by MoAb against OspA (H 5332) in the ultrathin sections of the placenta. Two pts. had abnormal outcomes: In the first one, an intrauterine fetal death was found out in 15th week and Borrelia-like organism was detected in ultrathin sections of the decidua, incl. positive staining with MoAb H 9724 against flagellin. Abortus in the second pt. was induced for malformations, but Borrelia evidence was unsuccessful.

Conclusions: Borrelia-like organism detected in the placenta of pt. with EM started in the 1st trimester could influence the fetus and cause abortion. However, Borrelia antigens detected in the placenta of pt. with EM started in the 2nd trimester have not influenced the fetus and a healthy child was delivered in term. Further studies on Lyme borreliosis during pregnancy are to be done.

http://www.ingentaconnect.com/content/e ... 1/art96100

[Yvonne]

LYME DISEASE AND PREGNANCY
It is well known that B. burgdorferi can cross the placenta and infect the fetus. In addition, breast milk from
infected mothers has been shown to harbor spirochetes that can be detected by PCR and grown in culture.
The Lyme Disease Foundation in Hartford, CT had kept a pregnancy registry for eleven years beginning in
the late 1980s. They found that if patients were maintained on adequate doses of antibiotic therapy during
gestation, then no babies were born with Lyme. My own experience over the last twenty years agrees with
this.
The options for treating the mother include oral, intramuscular, and intravenous therapy as outlined above. It
is vital that peak and trough antibiotic levels be measured if possible at the start of gestation and at least oncemore during treatment.

During pregnancy, symptoms generally are mild as the hormonal changes seem to mask many symptoms.
However, post-partum, mothers have a rough time, with a sudden return of all their Lyme symptoms including profound fatigue. Post partum depression can be particularly severe. I always advise help in the home for at least the first month, so adequate rest and time for needed treatments are assured.
I also advise against breast feeding for obvious reasons as mentioned above.

http://www.ilads.org/files/burrascano_0905.pdf

[Yvonne]

Detection of Borrelia burgdorferi DNA by polymerase chain reaction in the urine and breast milk of patients with Lyme borreliosis

Bruno L. Schmidt1, , E. Aberer2, C. Stockenhuber1, H. Klade3, F. Breier3 and A. Luger1

1 From the Ludwig Boltzmann Institute for Dermato-Venerological Serodiagnosis, University of Vienna, Vienna, Austria
2 the Department of Dermatology, Division of Immunology, Allergy, and Infectious Diseases, University of Vienna, Vienna, Austria
3 the Division of General Dermatology, University of Vienna, Vienna, Austria

Received 24 October 1994; accepted 17 February 1995. ; Available online 20 January 2000.

Abstract
Current laboratory diagnosis of Lyme borreliosis relies on tests for the detection of antibodies to Borrelia burgdorferi with known limitations. By using a simple extraction procedure for urine samples, B. burgdorferi DNA was amplified by a nested PCR with primers that target the specific part of the flagellin gene. To control possible inhibition of the enzyme (polymerase), a special assay using the same primers was developed. We examined 403 urine samples from 185 patients with skin manifestations of Lyme borreliosis. Before treatment, B. burgdorferi DNA was detected in 88 of 97 patients with Lyme borreliosis. After treatment, all but seven patients became nonreactive. Six of these seven persons suffered from intermittent migratory arthralgias or myalgias, and one from acrodermatitis chronica atrophicans. Two of 49 control patients with various dermatologic disorders and none out of 22 presumably healthy persons were reactive in the PCR. In addition to urine, breast milk from two lactating women with erythema migrans was tested and also found reactive. Borrelia burgdorferi DNA can be detected with high sensitivity (91%) by a nested PCR in urine of patients with Lyme borreliosis. In addition, this test can be a reliable marker for the efficacy of treatment.

http://www.sciencedirect.com/science?_o ... 3471bf2acd

[Yvonne]

Wien Klin Wochenschr. 1999 Dec 10;111(22-23):933-40. Links

Erythema migrans in pregnancy.

Maraspin V, Cimperman J, Lotric-Furlan S, Pleterski-Rigler D, Strle F.
Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia.

From 1990 through to 1997, 105 pregnant women with typical EM were investigated at the Lyme Borreliosis Outpatients' Clinic of the Department of Infectious Diseases at the University Medical Centre in Ljubljana, Slovenia. Twenty-five (23.8%) patients acquired borrelial infection during the first trimester of pregnancy; eight (7.6%) of them had noticed the skin lesion before they became pregnant. In 43 (40.6%) patients the EM appeared in the second trimester, and in 37 (35%) patients in the third trimester of pregnancy. Two (1.9%) patients received phenoxymethyl penicillin (1 million IU t.i.d.), three (2.9%) benzyl penicillin (10 million IU b.i.d.), and 100 (95.2%) ceftriaxone (2 g daily). All patients were treated for 14 days except three (2.9%) in whom the treatment with ceftriaxone was discontinued because of mild side effects. The outcome of disease was good in all 105 patients. Ninety-three (88.6%) out of 105 patients had normal pregnancies; the infants were delivered at term, were clinically healthy, and subsequently had a normal psychomotor development. In the remaining 12 (11.4%) patients an adverse outcome was observed. Two (1.9%) pregnancies ended with an abortion (one missed abortion at 9 weeks, one spontaneous abortion at 10 weeks), and six (5.7%) with preterm birth. One of the preterm babies had cardiac abnormalities and two died shortly after birth. Four (3.8%) babies born at term were found to have congenital anomalies; one had syndactyly at birth and three had urologic abnormalities which were registered at the age of 5, 7, and 10 months, respectively. A causal association with borrelial infection was not proven in any infant. For at least some unfavourable outcomes a plausible explanation not associated with Lyme borreliosis was found.

PMID: 10666804

[Yvonne]

Immune Responses


IgM:

This is the earliest of the antibodies to appear in response to an infection. It is produced in quantity. It is six times larger than the IgG antibody. Because of its size, this immunoglobulin does not cross the placenta. Since it cannot enter the fetus from the mother, any newborn that starts to make IgM antibodies against Lyme disease must be infected. However, a fetus exposed to Borrelia burgdorferi early in the pregnancy may never make an antibody response to the Lyme bacteria because the baby's immune system doesn't recognize it as foreign.


The second antibody we make after the IgM is the IgG antibody. This antibody takes four to eight weeks to form, and is gone in less than twelve months. It peaks at about six weeks. This antibody crosses the placenta, so an infected mother can pass this antibody to her child. An IgG antibody titer in a newborn does not have to mean active infection. It does mean the mother has had exposure, and the child must be carefully monitored for signs of the disease.

http://www.canlyme.com/labtests.html

[Yvonne]

Congenital Lyme disease

- Infants can be infected with Borrelia transplacentally in any stage of pregnancy and/or via mother’s breast milk.
- The co-infections: Babesia, Bartonella,Mycoplasma and perhaps even theEhrlichias may be transmitted
transplacentally to the developing fetus

Gestational Borreliosis can be associated
with repeated miscarriages, fetal death in
utero, fetal death at term (stillbirths),
hydrocephalus, cardiovascular anomalies,
intrauterine growth retardation, neonatal
respiratory distress, “sepsis” and death,
neonatal hyperbilirubinemia, cortical
blindness, sudden infant death syndrome
and maternal toxemia of pregnancy.

- Borrelia spirochetes have been found at
autopsy in fetal brain, liver, adrenal
glands, spleen, bone marrow, heart and placenta

-None of the infected tissues showed any sign of inflammation

-Maternal antibiotic treatment during pregnancy does not guarantee that the
fetus will be free of infection

-Mothers with Lyme disease should be treated throughout pregnancy

Infants either infected congenitally or from breast
milk can have

- Floppiness with poor muscle tone
- Irritability
-Frequent fevers and illness early in life
- Joint sensitivities and body pain
-Skin sensitivity
- Gastro esophageal reflux
- Developmental delays
- Learning disabilities and psychiatric problems
- Small windpipes (tracheomalacia)
- Eye problems (cataracts)
-Heart defects
-Infants infected with breast milk as well as infants
bitten very early in life will have many of the same
symptoms as congenitally infected babies
- Infected infants often show a loss or decline in
previously acquired developmental milestones
and become slower at learning new skills

http://www.lymepa.org/html/dr__ann_f__c ... 20_17.html

[Yvonne]

Human granulocytic ehrlichiosis co-incident with Lyme borreliosis in pregnant woman--a case study

[Article in Polish]

Brzostek T.

Oddzial Obserwacyjno-Zakazny Zespolu Opieki Zdrowotnej w Debicy.

A case of 25 years old woman, living in an endemic area for Lyme borreliosis was examined. In 29 th week of pregnancy thrombocytopenia, fever and fatigue were observed, in the last 7 weeks erythema migrans was present. The woman was not treated by that time. The infant presented thrombocytopenia in the first few weeks of life. 3 months after delivery erythema migrans disseminata was observed, by that time Lyme borreliosis and HGE were serologically confirmed. It was not confirmed that the infection was transferred to the infant, but it is possible that thrombocytopenia was caused by the infection with A. phagocytophila.

Publication Types:
Case Reports

PMID: 15517809

[Yvonne]

Pediatr Pathol. 1991 Nov-Dec;11(6):827-38.Links

Nonsyphilitic spirochetosis in second-trimester fetuses.

Abramowsky C, Beyer-Patterson P, Cortinas E.
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235.

Four female fetuses (17-23 weeks) spontaneously aborted by young women (15-19 years old) showed spirochetal microorganisms predominantly in the intestinal lumen and mucosa and to a much lesser extent in other organs. Fetal tissues showed a brisk lymphocytic-plasmacytic response in intestinal mucosa, lungs, and meninges in some cases. In all instances the placenta had chorioamnionitis and severe chronic villitis, with villous vasculitis in some. One fetus had a concomitant cytomegalovirus infection. The observed lesions were reminiscent of Treponema pallidum infections; however, the spirochetes were morphologically different by light and ultrastructural microscopy from T. pallidum and did not react with a silver-enhanced, gold-labeled anti-T. pallidum antibody. In addition, serologic tests for syphilis of the women before or after the abortions were nonreactive. On the basis of clinical pathologic considerations as well as the absence of immunostaining, it is possible also to rule out infections caused by Lyme and relapsing fever Borrelia, Leptospira, and Campylobacter. The spirochetes' prominent tropism for the intestinal tract raises the possibility of a congenital infection with gastrointestinal spirochetal species described in recent years. The placental findings suggest an ascending transamniotic infection, with initial colonization of the intestinal tract and systemic dissemination of the organisms in the fetus and placental villi.

PMID: 1775399

[Yvonne]

Teratogen Update: Lyme Disease

ABSTRACT We reviewed the world literature
concerning the reproductive effects of Lyme disease
(LD). Borrelia burgdorferi, which is the etiology of LD, is
a spirochete and, as such, may share the potential for
causing fetal infection, which may occur in the setting
of maternal spirochetemia. Information concerning the
effects of gestational LD derives from case reports
and series, epidemiologic studies, and experimental
animal models. Although provocative, these studies fail
to define a characteristic teratogenic effect. However,
skin and cardiac involvement have predominated in
some reports. Pregnancy wastage has been suggested
primarily by animal studies. Gestational LD appears
to be associated with a low risk of adverse
pregnancy outcome, particularly with appropriated antibiotic
therapy. Suggestions for management of clinical
situations are presented.
Teratology 64:276–281,2001. © 2001 Wiley-Liss, Inc.

http://www.teratology.org/updates/64pg276.pdf