Chronic Lyme Article from 1987...?

[velvetmagnetta]

While I was researching a new finding on a recent MRI I had, I came across this article from all the way back to 1987!

Chronic central nervous system involvement in Lyme borreliosis
Kohler J, Kern U, Kasper J, Rhese-Küpper B, Thoden U. Chronic central nervous system involvement in Lyme borreliosis. Neurology. Jun 1988;38(6):863-7
http://www.ncbi.nlm.nih.gov/pubmed/3587624

Abstract

Three European patients had chronic active forms of Borrelia burgdorferi infection of the nervous system, with high titers of antibodies to this spirochete in serum and CSF. Two patients had meningitis for 3 to 4 years, with remissions in one and slowly progressive symptoms in the other. Both had CT lucencies in the basal ganglia. The third patient had lumbosacral plexus neuropathy for 1 year. All three patients responded to intravenous penicillin treatment.

Unfortunately, I cannot read it because it is behind a paywall. I would be very interested to know to what extent it has been known that Lyme can be a chronic infection. It is unclear if this article concluded the encephalitis is from an ongoing infection or the after-effects of one. It certainly looks like they are talking about a chronic, ongoing, relapsing infection!

If a chronic form of neuroborreliosis has been known to exist for so long, why are we all still debating this? These IDSA "doctors'" are making less and less sense the more I learn about Lyme disease...

[X-member]

Chronic (Lyme) neuroborreliosis = late (Lyme) neuroborreliosis.

Edit to add:

Chronic or Late Lyme Neuroborreliosis: Analysis of Evidence Compared to Chronic or Late Neurosyphilis

A quote:

Importantly, the existence of late Lyme disease is approved by all official guidelines in the U.S., Canada and Europe. The terms “late” and “chronic” Lyme disease, as in syphilis, are synonymous and define tertiary Lyme disease. The use of “chronic” Lyme disease as a different entity is inaccurate and confusing.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551238/

[Lorima]

Here are a couple more:
http://www.ncbi.nlm.nih.gov/m/pubmed/6316826/

http://www.ncbi.nlm.nih.gov/m/pubmed/21 ... 26/related

Chronic neurologic manifestations of Lyme disease.

Authors
Logigian EL1, Kaplan RF, Steere AC.
Author information
1Department of Neurology, Tufts University School of Medicine, Boston, MA 02111.
Journal
N Engl J Med. 1990 Nov 22;323(21):1438-44.
Affiliation
Comment in
N Engl J Med. 1991 Apr 18;324(16):1137.

Abstract
BACKGROUND AND METHODS: Lyme disease, caused by the tick-borne spirochete Borrelia burgdorferi, is associated with a wide variety of neurologic manifestations. To define further the chronic neurologic abnormalities of Lyme disease, we studied 27 patients (age range, 25 to 72 years) with previous signs of Lyme disease, current evidence of immunity to B. burgdorferi, and chronic neurologic symptoms with no other identifiable cause. Eight of the patients had been followed prospectively for 8 to 12 years after the onset of infection.

RESULTS: Of the 27 patients, 24 (89 percent) had a mild encephalopathy that began 1 month to 14 years after the onset of the disease and was characterized by memory loss, mood changes, or sleep disturbance. Of the 24 patients, 14 had memory impairment on neuropsychological tests, and 18 had increased cerebrospinal fluid protein levels, evidence of intrathecal production of antibody to B. burgdorferi, or both. Nineteen of the 27 patients (70 percent) had polyneuropathy with radicular pain or distal paresthesias; all but two of these patients also had encephalopathy. In 16 patients electrophysiologic testing showed an axonal polyneuropathy. One patient had leukoencephalitis with asymmetric spastic diplegia, periventricular white-matter lesions, and intrathecal production of antibody to B. burgdorferi. Among the 27 patients, associated symptoms included fatigue (74 percent), headache (48 percent), arthritis (37 percent), and hearing loss (15 percent). At the time of examination, chronic neurologic abnormalities had been present from 3 months to 14 years, usually with little progression. Six months after a two-week course of intravenous ceftriaxone (2 g daily), 17 patients (63 percent) had improvement, 6 (22 percent) had improvement but then relapsed, and 4 (15 percent) had no change in their condition.

CONCLUSIONS: Months to years after the initial infection with B. burgdorferi, patients with Lyme disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis. These chronic neurologic abnormalities usually improve with antibiotic therapy.

PMID 2172819 [PubMed - indexed for MEDLINE]

VM, have you read Cure Unknown? Weintraub did a great job of meticulously collecting and laying out the history of the science and politics of the disease. It's very well referenced, making it easy to verify for oneself.

[X-member]

Sweden:

A translated quote:

Chronic BI occur not only as ACA and chronic arthritis, but also as late (chronic) NB with persistent symptoms and objective signs of infection in cerebrospinal fluid (csv) and in blood with a duration of six months.

BI = borrelia infection, ACA = acrodermatitis, NB = neuroborreliosis.

http://www.folkhalsomyndigheten.se/page ... 101-28.pdf

Norway:

A translated quote:

Chronic Lyme borreliosis

Ongoing infection with Borrelia bacterium that has lasted more than 6 months.

http://nevro.legehandboka.no/sykdommer- ... 41458.html

Germany:

Two quotes:

The term “chronic Lyme borreliosis” is equivalent to Stage III.

Disease manifestations of Lyme borreliosis which occur more than 6 months after the start of infection are designated in this Guideline as late manifestations or as chronic.

http://www.borreliose-gesellschaft.de/T ... elines.pdf

US:

A quote:

Late or chronic Lyme disease refers to manifestations that occur months to years after the initial infection, sometimes after a period of latency. Signs and symptoms of chronic Lyme disease are primarily rheumatologic and neurologic. Acrodermatitis chronica atrophicans, the cutaneous feature of late-stage Lyme disease, is found almost exclusively in European patients.

http://emedicine.medscape.com/article/330178-clinical

Edit to add:

IDSA:

A quote:

Late Lyme Disease

http://www.idsociety.org/uploadedfiles/ ... isease.pdf

[Martian]

It is unclear if this article concluded the encephalitis is from an ongoing infection or the after-effects of one. It certainly looks like they are talking about a chronic, ongoing, relapsing infection!

I think that the article refers to late stages of Lyme disease, with patients who were not treated for Lyme disease yet, and one can say that the patients had a chronic ongoing infection.

Note that the term "chronic Lyme" has two meanings:

1. a synonym for "late Lyme", which has been used since the 1980s.

2. a name for symptoms caused by a persistent Borrelia infection, which persists despite supposedly adequate antibiotic treatments. Even years of antibiotics supposedly fail to eradicate the infection in thousands of patients.

Meaning 2 seems to be invented by the "llmds" and Lyme activists/patients somewhere during the 1990s. That's when the Babylonian confusion of tongues started regarding "chronic Lyme disease".

[X-member]

Chronic Lyme borreliosis = late active Lyme disease (no matter if an insufficient treatment has been given or not).

ILADS (Burrascanos) definition:

A quote:

A very important issue is the definition of “Chronic Lyme Disease”. Based on my clinical data and the latest
published information, I offer the following definition. To be said to have chronic LB, these three criteria must be present:

1. Illness present for at least one year (this is approximately when immune breakdown attains clinically
significant levels).
2. Have persistent major neurologic involvement (such as encephalitis/encephalopathy, meningitis, etc.)
or active arthritic manifestations (active synovitis)*.
3. Still have active infection with B. burgdorferi (Bb), regardless of prior antibiotic therapy (if any).

http://www.borrelia-tbe.se/media/burrguide200810.pdf

* Or ACA!

[duncan]

Yeah, vm, Martian's qualifier for his second meaning is cute but not based in any substantiated reality of which I am familiar.

I'd be curious as what he means by "Lyme activists/patients", too. I interpret that as individuals who have not forgotten to listen to patients, that understand and acknowledge the politics at play in the Lyme community, and are able to sift faux science from fact - but perhaps he means something else.

[X-member]

I agree with Martian, some people don't use the correct definition of "chronic Lyme".

[hv808ct]

Chronic Lyme Article from 1987...?
Post by velvetmagnetta » Thu 19 Mar 2015 3:26

While I was researching a new finding on a recent MRI I had, I came across this article from all the way back to 1987!
“Chronic central nervous system involvement in Lyme borreliosis”
It certainly looks like they are talking about a chronic, ongoing, relapsing infection!
If a chronic form of neuroborreliosis has been known to exist for so long, why are we all still debating this? These IDSA "doctors'" are making less and less sense the more I learn about Lyme disease.

It pays to read the entire article.

It’s not about “chronic” LD; it’s about 3 cases of “untreated” LD. Similar to a natural history case report provided by Schoen a couple of years ago (http://www.nature.com/nrrheum/journal/v ... 0.209.html).

Regarding the 1987 article, it reports 3 untreated cases that were eventually diagnosed and treated.
The first case occurred during 3/82—6/85 and was treated with 2wk of iv pen.
The 2nd case occurred during 9/83--3/86 and was treated with 2wk of iv pen.
The 3rd case occurred during 8/83--1/84. Overt ACA was treated with 4wk of oral pen. Subsequent complications occurred between 3/85--5/85 and were resolved with iv pen.

A nice reminder that untreated borreliosis—even untreated for years—can be resolved with a bit of penicillin.

[duncan]

Can be resolved with a little penicillin sometimes.

Sometimes.

Though, the longer it goes untreated, say in one's brain, the more challenging securing a cure may grow. I'm pretty sure even the IDSA Guidelines concede that point.