Lyme disease followed by Primary Progressive Aphasia type dementia - New England Journal of Medicine

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inmacdonald
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Lyme disease followed by Primary Progressive Aphasia type dementia - New England Journal of Medicine

Post by inmacdonald » Sat 4 Mar 2017 17:17

Infectious Dementias of the Borrelia Type:

FTD - PPA Variant ..Primary Progressive Aphasia,
Semantic Variant, due to TAR DNA Binding protein 43 {TDP 43},
Associated with Fronto-Temporal lobular degeneration, ( Type C)
is a Tau-opathy dementia . [FTD]

FTD was linked in a case study from Columbia Presbyterian Medical Center in which
aphasia was not a conspicuous finding.
A new paradigm was Dr. Dwork' s identification of a borrelia spirochete in the
autopsy brain of his FrontoTemporal dementia patient.
Can you identify the very important citation of Dr.Dwork’s case report..
in the New England Journal of Medicine ClinicoPathologic Conference references section?
Well, No .. because the authors and editors did not perform a literature search … with the
Keywords “ FrontoTemporal + Dementia + Lyme”.
Can you identify Dr. R. Blanc's important peer reviewed paper on
Borrelia Dementia in the discussion section?
Well, no, because the Authors and Editors did not perform a literature search ..
with the Key words.." Dementia and Borrelia"

There is no reason to Fail to Include :
Dr. Andrew Dwork’s year 1995 publication and Dr. F. Blanc year 2013 article ( below)
from the discussion section in this NEJM CPC. Were Dr. Robert E Scully MD
Professor of Pathology and Obstetrics and Gynecology, Harvard Medical School , ( Retired )...
still a NEJM Editor, these peer reviewed published reports would have, no doubt, have compelled
at the very least, the addition of possible Late Neuro-Borreliosis with dementia
in the differential diagnosis section of this Clinicopathological Conference. ( See : Blanc, F et al,
Journal of Alzheimer's Disease , Borrelia Dementia)

In this New England Journal of Medicine Clinicopathological Conference -
Fig 5 g shows an "alleged" TDP 43 "dystrophic "neurite" " which is accompanied by other
alleged neurites which are TDP 43 positive ( immunoreactive) , in panel 5D.
I cannot interpret the CPC Image 5F- but it appears to show
excessive brain cortical Hematoxylin-ophilic staining
which is inconsistent with stated neuronal "cell loss" (plural)

In my view, FrontoTemporal Dementia , of all types is always
strongly linked to LNB dementias.
Panel 5E looks like ..either a plump spirochete profile or possibly..
a small larval nematodal profile (if the TDP stain is allowed to include reactivities for Borrelia (sl). or
nematode parasites.

The clinical history is very contributory to a proper and to an adequate understanding of the
neuropathology in this Clinico-Pathologic Conference case study from the Massachusetts General Hospital.

Neuropathology of dementias is now re-written in 21st century peer reviewed manuscripts
which use sophisticated immunohistochemistries to subclassify FrontoTemporal Dementias.
especially in the realms of well documented infectious dementias.

FTD was linked in a case study from Columbia Presbyterian Medical Center in which
aphasia was not a conspicuous finding.
A new paradigm was Dr. Dwork' s identification of a borrelia spirochete in the
autopsy brain of his FrontoTemporal dementia patient.
Can you identify the very important citation of Dr.Dwork’s case report..
in the New England Journal of Medicine Clinicopathological Conference references section?
Well, No .. because the authors and editors did not perform a literature search … with the
Keywords “ FrontoTemporal + Dementia + Lyme”.
Can you identify Dr. R. Blanc's important peer reviewed paper on
Borrelia Dementia in the discussion section?
Well, no, because the Authors and Editors did not perform a literature search ..
with the Key words.." Dementia and Borrelia"

There is no reason to Fail to Include :
Dr. Andrew Dwork’s year 1995 publication and Dr. F. Blanc year 2014 article ( below)
from the discussion section in this NEJM CPC. Were Dr. Robert E Scully MD
Professor of Pathology and Obstetrics and Gynecology, Harvard Medical School , ( Retired )...
still a NEJM Editor, these peer reviewed published reports would have, no doubt, have compelled
at the very least, the addition of possible Late Neuro-Borreliosis with dementia
in the differential diagnosis section of this Clinicopathological Conference. ( See : Blanc, F et al,
Journal of Alzheimer's Disease , year 2014, reference below)

In this New England Journal of Medicine Clinicopathological Conference -
Fig 5 g shows an "alleged" TDP 43 "dystrophic "neurite" " which is accompanied by other
alleged neurites which are TDP 43 positive ( immunoreactive) , in panel 5D.
I cannot fully interpret the CPC Image 5F without access to the glass slide of brain tissue
- but it appears to show excessive brain cortical Hematoxylin-ophilic staining
which is inconsistent with stated neuronal "cell loss" (plural).
Panel 5E looks like ..either a plump spirochete profile or possibly..
a small larval nematodal profile (if the TDP stain is allowed to include reactivities for Borrelia (sl). or
nematode parasites.
In my view, FrontoTemporal Dementia , of all types is always
strongly linked to other proven Lyme NeuroBorreliosis dementias.

The patient's clinical history in this case study,
is very contributory to a proper and to an adequate understanding of the
neuropathology in this Clinico-Pathologic Conference case study from the Massachusetts General Hospital.
Lyme Disease was diagnosed and Treated with antibiotics in this woman
a decade before her demise. The time scale of Lyme Infection and the development of
dementia ( Fronto Temporal Lobular Degeneration with Primary Progressive Aphasia) as a tertiary manifestation of persistent Lyme disease in the brain of this woman perfectly
recapitulates the clinical histories of other patients with Late Lyme Dementias.


Respectfully,
Alan B. MacDonald, MD, FCAP
March 4, 2017

References:

New England Journal of Medicine: Jan 12, 2017
376 (2): 158-167
Case 1-2017 A 70 year old woman with gradually
Progressive Loss of Language”

Waniek C, Prohovnik I, Kaufman MA, Dwork AJ.
Lyme disease presenting as frontotemporal dementia.
J Neuropsych Clin Neurosci 1995

Blanc, F., Philippi, N., Cretin, B., Kleitz, C., Berly, L., Jung, B.,
Kremer, S., Namer, I.J., Sellal, F., Jaulhac, B. and de Seze, J., 2014.
Lyme neuroborreliosis and dementia. Journal of Alzheimer's Disease, 41(4), pp.1087-1093.

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