Treatment of Lyme neuroborreliosis with plasmapheresis

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RitaA
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Treatment of Lyme neuroborreliosis with plasmapheresis

Post by RitaA » Tue 15 Sep 2015 8:48

http://www.ncbi.nlm.nih.gov/pubmed/26356494
J Clin Apher. 2015 Sep 10. doi: 10.1002/jca.21430. [Epub ahead of print]

Treatment of Lyme neuroborreliosis with plasmapheresis.

Çelik T1, Çelik Ü2, Kömür M1, Tolunay O3, Dönmezer Ç3, Yıldızdas D4.

Author information

1 Department of Pediatric Neurology, Adana Numune Research and Training Hospital, Adana, Turkey.
2 Department of Pediatric Infection, Adana Numune Research and Training Hospital, Adana, Turkey.
3 Department of Pediatrics, Adana Numune Research and Training Hospital, Adana, Turkey.
4 Department of Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey.

Abstract

Lyme disease is a rare tick-borne multisystemic infection caused by Borrelia burgdorferi. Different neurological conditions were reported in the disease. In this article, we present a 15-year-old patient hospitalized with ataxia who was diagnosed with Lyme neuroborreliosis. Intravenous immunoglobulin and ceftriaxone treatment was applied to the patient for 4 weeks. However, ataxia did not recover, upper and lower muscle weakness developed, and deep tendon reflexes diminished during follow-up. The patient was diagnosed with Guillain-Barre syndrome arising from B. burgdorferi. Second dose of intravenous immunoglobulin treatment was started for 5 days but the patient didn't recover. Therefore administration of plasmapheresis was decided. All symptoms relieved following the plasmapheresis. The effect of plasmapheresis in pediatric neuroborreliosis has not been documented before. This study highlights that plasmapheresis could be a useful alternative for pediatric neuroborreliosis cases. J. Clin. Apheresis, 2015. © 2015 Wiley Periodicals, Inc.

© 2015 Wiley Periodicals, Inc.

KEYWORDS:

Guillain-Barre; Lyme; child; plasmapheresis

PMID: 26356494 [PubMed - as supplied by publisher]
Something about the last sentence doesn't seem quite right. I wonder if the authors meant "adjunct" rather than "alternative" or if they left out the words "to IVIG where GBS symptoms are present"? Although I'm no expert, I strongly suspect that plasmapheresis alone (i.e. in the absence of antibiotics) would not be sufficient when treating neuroborreliosis.

X-member
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Re: Treatment of Lyme neuroborreliosis with plasmapheresis

Post by X-member » Wed 16 Sep 2015 15:47

Treatment of Lyme neuroborreliosis with plasmapheresis.

http://www.ncbi.nlm.nih.gov/m/pubmed/26356494/

A quote:
Intravenous immunoglobulin and ceftriaxone treatment was applied to the patient for 4 weeks.

RitaA
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Re: Treatment of Lyme neuroborreliosis with plasmapheresis

Post by RitaA » Wed 16 Sep 2015 18:11

X-member wrote:Treatment of Lyme neuroborreliosis with plasmapheresis.

http://www.ncbi.nlm.nih.gov/m/pubmed/26356494/

A quote:
Intravenous immunoglobulin and ceftriaxone treatment was applied to the patient for 4 weeks.
Yes, I noticed that -- which is why I posted that "alternative" doesn't seem like the best choice of words in the last sentence of the abstract. I'm guessing that the authors meant that plasmapheresis may be an alternative to IVIG in cases of Lyme neuroborreliosis where patients develop symptoms of GBS.

We'll have to wait until the full article is available to better understand why the patient was given IVIG in addition to antibiotics to begin with. Most people with Lyme neuroborreliosis are only prescribed antibiotics.

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Re: Treatment of Lyme neuroborreliosis with plasmapheresis

Post by X-member » Wed 16 Sep 2015 19:49

I think I understand what you say Rita. If they talk about some kind of "post-Lyme" (after the abx) then they can not say that plasmapheresis is a treatment for neuroborreliosis.

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LHCTom
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Re: Treatment of Lyme neuroborreliosis with plasmapheresis

Post by LHCTom » Thu 17 Sep 2015 1:22

Plasmapheresis is a technique with many variables. Its works by removing blood from a person and separating the red blood cells from the liquid plasma. Then the plasma is filtered and remixed with the red blood cells and returned to the human circulation system. Its used in a variety of illnesses to filter certain elements in the plasma which can include various hemoglobulins such as IgG, IgM, IgE etc.., lipoproteins, toxins of all sorts, cytokines, chemokines, bacteria, viruses etc.. The trick is designing filters that either remove a whole class by size, weight or charge or highly specific using monoclonal antibody binding filters. It can target very specific molecules by using monoclonal antibodies to bind and remove any target antigen or something like a specific auto-antibody. It can be used for hypercholesterimia to remove lower density lipoproteins. Its a technique with many opportunities.

It would be fabulous approach to looking for persistence ( much smarter than xenodiagnosis and much easier) by simply using monoclonal antibody filters to trap and remove only Borrelia that binds to the filter monoclonal antibodies. Similar systems were used to remove Ebola virus loads from patients while waiting for treatments to take over. The filters contained monoclonal antibodies that bound to the Ebola virus allowing it to be removed from circulating blood.

But as a treatment is has a very large downside. The plasma in the blood is < 1% of the fluid in the human body. Bacteria and viruses often leave the blood system and hide elsewhere. Its likley that persisting Borrelia appears in the blood far less often than elsewhere in the body. So it would be hopeless to think one could remove Borrelia adequately using this approach. But you could catch a few. The same is true of toxins and other molecules that can disrupt our systems. Some can be removed from the circulating plasma but over time, the toxins trapped in fat will return back into the circulation.

I would like to see it used with Borrelia monoclonal antibody filters to search for Borrelia as they move through the circulatory system. A typical session might be many hours so has the opportunity to search for Borrelia in the blood for many cycles of circulation. This is far better than a culture which only uses less than 10ml of blood versus the entire circulatory flow. The filtrate could then be easily tested with advanced PCR techniques such as the one developed by Ibis specifically for Borrelia detection and identification.

Just a thought.
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

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ChronicLyme19
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Re: Treatment of Lyme neuroborreliosis with plasmapheresis

Post by ChronicLyme19 » Wed 23 Sep 2015 2:51

LHCTom, I've wondered that myself. My mother had a very atypical form of GBS and was cured using plasmapheresis. I've often wondered if it cured her because it took out the antibodies, some other infection, or both.

It sounds like from the abstract that they went to plasmapheresis because the IVIG and antibiotics failed. I wonder how long they followed the person, and if they were still symptoms free a year later.
Half of what you are taught is incorrect, but which half? What if there's another half missing?

Pandora
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Re: Treatment of Lyme neuroborreliosis with plasmapheresis

Post by Pandora » Sat 26 Sep 2015 20:33

Saudi built the world's largest dialysis facility serving up to 800 a day for some reason......

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