Lyme stages and definitions

General or non-medical topics with information and discussion related to Lyme disease and other tick-borne diseases.
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Re: Lyme stages and definitions

Post by X-member » Wed 18 Jul 2012 16:31

The three phases (from the link in the previous post):

http://derma.akademos.de/pdfdown/akadem ... ea6887.pdf
Phase 1: local infection of the skin

In the first phase of infection, the pathogen is deposited in
the skin by means of a tick bite. Once in the skin it begins to
reproduce.The pathogen has a long generation time,
spanning 20 to 30 hours which is why it reproduces only
slowly. Only after a latency period, which normally covers
about ten days (even with reinfection it is at least seven
days), there is a cellular and humoral immune response. All
cutaneous manifestations of borreliosis, from erythema
migrans to acrodermatitis,present with bluish-red areas of
skin caused by the migration of lymphocytes and plasma
cells, i.e., the cellular immune response of the skin.
Depending on the intensity of the cellular immune response,
typical erythema migrans (EM) or borrelial lymphocytoma
(BL) develops.The latter can occur alone or in
combination with EM. In rare instances, there is also a concomitant
reaction of the subcutaneous fatty tissue in the
form of panniculitis.

Phase 2: generalization of disease

After the pathogen multiplies in the skin, it migrates peripherally
from the site of the bite and at some point enters
the blood or lymphatic vessels. Borrelial organisms are thus
carried in the bloodstream and the generalization phase,
the second stage of disease, begins. Clinically, this stage is
characterized by generalized flu-like symptoms,myalgia,
headache, (sometimes) fever, night sweats, and palpitations.
Initial organ manifestations (carditis, neuritis, ophthalmitis,
etc. can also occur).Afterward there is a severe
immune response and the pathogen count drops drastically.
Only in collagen can Borrelia successfully evade the
immune response.There they persist and can trigger later
disease episodes after a secondary latency period of a
variously long duration.

Phase 3: chronic phase

Clinically the third stage of disease is characterized by
neuropathy, arthralgia, and myalgia, which are accompanied
during disease episodes by generalized symptoms
(mainly night sweats, occasionally fever). In general,any
area of the body may be affected. Acrodermatitis chronica
atrophicans may develop on the skin, often after a prolonged
course of disease lasting several. It is first apparent
during an inflammatory stage, and then after a longer
period develops into »cigarette paper-like« atrophy. This is
almost always accompanied by neuropathy and osteopathy.
Occasionally there are also the pathognomonic fibroid
nodules containing a high number of pathogens.
In all stages of disease, the pathogen can be cultivated
from infected tissue which underscores the character of a
chronic bacterial infection analogous to syphilis. In no
phase of borrelial infection does spontaneous healing
occur. This also parallels syphilis. In the following we focus
on disease manifestations involving the skin.

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Re: Lyme stages and definitions

Post by X-member » Sun 30 Sep 2012 16:39

"Dr. Holtorf on Lyme Disease Diagnosis and Treatment - A Culmination of the Literature"

(By Kent Holtorf, MD* • ProHealth.com • June 1, 2011)

http://www.prohealth.com/library/showAr ... 1=EG060111

A quote:
Types of Lyme Disease
1. Early Lyme disease (“Stage I”)
... a. At or before the onset of symptoms
... b. Can be cured if treated properly

2. Disseminated Lyme (“Stage II”)
... a. Multiple major body systems affected
... b. More difficult to treat

3. Chronic Lyme Disease (“Stage III”)
... A. Ill for one or more years
... B. Serologic tests less reliable (seronegative)
... C. Treatment must be more aggressive and of longer duration

Chronic Lyme
1. Disease changes character
2. Involves immune suppression
3. Less likely to be sero-positive for Lyme
4. Development of alternate forms of Borrelia
5. More likely to be co-infected
6. Immune suppression and evasion
7. More difficult to treat
8. Protective niches

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Re: Lyme stages and definitions

Post by X-member » Sun 30 Sep 2012 16:45

Chronic Lyme borreliosis (in Europe).

http://www.borreliose-gesellschaft.de/T ... elines.pdf
2.2.4 Chronic stage
The time differentiation between the early and late stages is arbitrary. 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.

A members own ;) definition (s) you can find here (but also earlier in this thread):

http://www.lymeneteurope.org/forum/view ... =10#p30379

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Re: Lyme stages and definitions

Post by X-member » Sun 30 Sep 2012 17:00

Maybe some information/help can be found (especially for people and physicians from Europe) in the topic below:

"Neuroborreliosis is not the same thing as late Lyme disease"

http://www.lymeneteurope.org/forum/view ... 176#p31155

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inmacdonald
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Re: Lyme stages and definitions

Post by inmacdonald » Tue 2 Oct 2012 3:54

There is from the pathological point of view
a point on the continuum of tissue injury in the constellation of Lyme Borreliosis
where the tissue INJURY BECOMES IRREVERSIBLE and UN_HEALABLE.

A quick example if irreversible tissue injury which we can all agree upon is the DIALTED
CARDIOMYOPATHY OF STANEK, as defined in his New England Journal of Medicine article, and
subsequently ratified by other researchers.

Other examples of Irreversible Lyme borreliosis are the FATAL CASES, which are exemplified
by the case reports of Dr Paul Harrison Duray on Acute Respiratory Distress Syndrome in adult patients,
and Stillbirth due to transplacental transmission of Borrelia burgdorferi from mother to fetus,
as reported by me, Dr Jorge Benach, and Dr Willy Burgdorfer in the New York State Journal of Medicine
( indexed earlier on the LNE Site with supporting immunohistochemistry of Borrelia spirochetes in Autopsy
myocardium)

So for Irreversible and/or fatal cases of Lyme Borreliosis, why not invoke the number Stage 4?

Stage 1 is localized disease, Stage 2 is early disseminated disease NOT INVOLVING DEEP VISCERA,
Stage 3 is DISSEMINATED DISEASE which extends from the surface lining tissues but not involving Permanent irreversible Deep tissue Injury ( ie cartilage loss, Brain or neuronal cell loss), and Stage 4 would correspond to IRREVERSIBLE LYME RELATED TISSUE INJURY --
ie MYOCARDIAL CELL HYPERTROPHY, Permanent overwhelming LUNG INJURY [ARDS}, FETAL DEATH at TERM (Stilbirth), and PERMANENT IRREVERSIBLE BRAIN OR SPINAL CORD INJURY ( Multiple sclerosis-like injury, OR Dementia, AND AMYOTROPHY), Skin with ACA ( Irreversible tissue atrophy and or Fibrosis).

Clearly this system violates the IDSA Dogma that "Lyme is hard to catch and easy to treat"
But pathological case studies prove that some cases of Lyme borreliosis
RESULT IN PERMANENT IRREVERSIBLE TISSUE INJURY. These irreversible tissue injury cases
logically are more severe and advanced than Stage 3 disseminations to the Eye, FETUS, OR NERVOUS SYSTEM.

A classification system which acknowledges PERMANENT AND IRREVERSIBLE TISSUE INJURY
must levy a numerical score beyond Stage 3.

STAGE 4 DISEASE in lyme borreliosis is a logical breakpoint which calls attention to "sores which do not heal".

Untreated or Uncured disease relentlessly procedes to Irreversible tissue injury/ and or Death (fetal), in some cases.

Not every case of Lyme Borreliosis has a happy ending...

Respectfully submitted,
Alan B. MacDonald MD
October 1, 2012

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Spanky
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Re: Lyme stages and definitions

Post by Spanky » Tue 2 Oct 2012 15:11

"inmacdonald":
But pathological case studies prove that some cases of Lyme borreliosis
RESULT IN PERMANENT IRREVERSIBLE TISSUE INJURY.
I'll bet that you are just a ton of fun at parties.

Cobwebby
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Joined: Mon 29 Oct 2007 0:55

Re: Lyme stages and definitions

Post by Cobwebby » Tue 2 Oct 2012 15:42

Not every case of Lyme Borreliosis has a happy ending...

Respectfully submitted,
Alan B. MacDonald MD
October 1, 2012
I know I almost succumbed to the desperation of suicide.
The greater part of our happiness or misery
depends on our dispositions,
and not on our circumstances.
Martha Washington

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Re: Lyme stages and definitions

Post by X-member » Mon 8 Apr 2013 14:59

From EUCALB:

http://meduni09.edis.at/eucalb/cms_15/i ... &Itemid=38
Clinical Features

Infection can be subclinical (asymptomatic), or have a range of clinical presentations, depending on the tissues affected, the duration of infection, host factors such as the vulnerability of the immune system and immunogenetic factors which could predispose the patient to the development of certain complications. Clinical presentations can generally be divided into three stages but progress from an early to later stage is not inevitable, even if the infection is untreated. The three stages are named early localised LB, early disseminated LB and late (chronic) LB.

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Re: Lyme stages and definitions

Post by X-member » Fri 12 Dec 2014 23:05

Kronisk fästingburen borrelios (Chronic tick-borne borreliosis)
Professor Sven Bergström

http://www.medfak.umu.se/digitalAssets/ ... gstrom.pdf

A google translated quote:
What is Lyme disease then? The answer has to do with what is chronic and not chronic. We can speak of three steps: The first is a local infection around the tick bite, the next step is the bacteria more widespread in the body and it goes into the blood and to different types of tissues like the heart, nervous system and joints. The third step is what we can call a chronic or persistent illness - which is basically a rare condition, ie there are only a few patients that get chronic Lyme disease. If we treat with antibiotics during the first two phases will, in most cases, the infection disappear. But if you do not treat it can of course go through all three phases and be just chronic.

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Re: Lyme stages and definitions

Post by X-member » Fri 12 Dec 2014 23:23

More information from Sweden.

Laboratoriediagnostik av borreliainfektion (Folkhälsomyndigheten/SMI)

http://www.dagensmedicin.se/Global/Dage ... 101-28.pdf

A google 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 the cerebrospinal fluid (csv) and in the blood with a duration of six months.
BI = Borrelia infection

Chronic BI = stage 3

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