Posts found in:
Lyme Disease

Expression of C-Reactive Protein and Serum Amyloid A in Early to Late Manifestations of Lyme Disease
Uhde M, Ajamian M, Li X, Wormser GP, Marques A, Alaedini A. Expression of C-Reactive Protein and Serum Amyloid A in Early to Late Manifestations of Lyme Disease. Clin Infect Dis. 2016 Dec 1;63(11):1399-1404. doi: 10.1093/cid/ciw599. Epub 2016 Sep 1. PMID: 27585799; PMCID: PMC5106611.

The immune response to invasive microbes involves two main components: the innate and adaptive response. C-reactive protein (CRP) and serum amyloid A (SAA) are proteins elevated during inflammation. In Lyme disease, CRP is elevated in early stages with erythema migrans but normal in neurological symptoms and arthritis. However, post-treatment Lyme disease syndrome (PTLDS) shows higher CRP, indicating persistent inflammation. SAA is elevated only in patients with erythema migrans. These findings suggest that lingering symptoms post-antibiotic therapy in Lyme disease are associated with elevated CRP, warranting further study on long-term inflammatory processes.

Correlates of Perceived Health-Related Quality of Life in Post-Treatment Lyme Encephalopathy
Chandra AM, Keilp JG, Fallon BA. Correlates of perceived health-related quality of life in post-treatment Lyme encephalopathy. Psychosomatics. 2013 Nov-Dec;54(6):552-9. doi: 10.1016/j.psym.2013.04.003. Epub 2013 Jul 9. PMID: 23845316; PMCID: PMC5507690.

A significant portion of Lyme disease-treated patients experiences persistent symptoms for months or even years, including pain, fatigue, and neurocognitive issues, collectively referred to as post-treatment Lyme disease syndrome. Determining whether ongoing infection is present remains challenging with current technology, raising an open question. Alternatively, a post-infectious immune-mediated process could be responsible for sustained symptoms.

As fatigue and depression significantly impact the reported decline in both physical and mental functioning in patients with PTLDS, clinicians should thoroughly evaluate these symptoms. It is advisable to consider addressing these issues when selecting treatment interventions. Subsequent controlled studies should investigate the efficacy of such approaches for patients dealing with PTLDS.

Increased IFNα Activity and Differential Antibody Response in Patients with a History of Lyme Disease and Persistent Cognitive Deficits
Jacek E, Fallon BA, Chandra A, Crow MK, Wormser GP, Alaedini A. Increased IFNα activity and differential antibody response in patients with a history of Lyme disease and persistent cognitive deficits. J Neuroimmunol. 2013 Feb 15;255(1-2):85-91. doi: 10.1016/j.jneuroim.2012.10.011. Epub 2012 Nov 8. PMID: 23141748; PMCID: PMC3557545.
The increase in IFNα activity is suggestive of a mechanism contributing to the ongoing neuropsychiatric symptoms.
Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview

Rhee H, Cameron D. Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview. Int J Gen Med. 2012;5:163-174
https://doi.org/10.2147/IJGM.S24212

B. burgdorferi and GAβHS are very different microorganisms that evade the immune system and invade a wide variety of tissues, including the central nervous system (CNS). Lyme and PANS can have periods of active disease and periods of remission. Both infections cause physical, neurological, and cognitive symptoms.

The neuropsychiatric manifestations of Lyme borreliosis
Fallon BA, Nields JA, Burrascano JJ, Liegner K, DelBene D, Liebowitz MR. The neuropsychiatric manifestations of Lyme borreliosis. Psychiatr Q. 1992 Spring;63(1):95-117. doi: 10.1007/BF01064684. PMID: 1438607.
  • Lyme disease is a growing tick-borne illness affecting multiple systems.
  • While its neurological effects are well documented, its psychiatric symptoms are less recognized. This paper reviews Lyme’s neuropsychiatric impact and key research.
  • It also explores common psychiatric symptoms, patient challenges, and clinical guidance.
Borrelia burgdorferi in the nervous system: the new “great imitator”

Pachner AR. Borrelia burgdorferi in the nervous system: the new “great imitator”. Ann N Y Acad Sci. 1988;539:56-64. doi: 10.1111/j.1749-6632.1988.tb31838.x. PMID: 3190104.

Patient Vignette – Bicycle Boy
The patient was bitten by a tic. Weeks later he presented with neuropsychiatric symptoms. Was given IV antibiotics and all symptoms resolved.

  • Lyme disease shares key similarities with syphilis: spirochetal etiology, extended tissue survival, staged clinical manifestations, and antibiotic susceptibility. Lessons from syphilis, particularly regarding spirochetal brain disease mimicking other neurological conditions, apply to Lyme disease.
  • Clinicians should consider Lyme disease early due to its effective response to antibiotics.
  • Lyme meningitis in the second stage is recognizable, but milder cases often go undiagnosed.
  • Progression to third-stage disease, as in Lyme arthritis, may occur, highlighting the importance of serologic tests.
  • Serology is crucial for diagnosing later stages of Lyme disease, paralleling the situation in neurosyphilis where cultures and antigen tests are less useful.
  • Antibody titers vary in different manifestations, with Lyme arthritis and acrodermatitis atrophicans showing high titers.
  • Recognition challenges exist for CNS Lyme disease without prior stages, emphasizing the significance of serological diagnosis in later stages.
Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19
Shutikova AL, Leonova GN, Popov AF, Shchelkanov MY. Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19. Klin Lab Diagn. 2021 Nov 29;66(11):689-694. English. doi: 10.51620/0869-2084-2021-66-11-689-694. PMID: 34882355.
  • The study investigated the coexistence of pathogens in a patient, focusing on the relationship between laboratory diagnostics and clinical manifestations during SARS-CoV-2 infection in a case of chronic encephalitis-borreliosis.
  • Blood samples collected over a year revealed Lyme disease diagnosed through IgG antibodies to Borrelia, with joint pain and erythema migrans. Subsequently, the patient contracted SARS-CoV-2 during a Lyme disease exacerbation.
  • Treatment improved the underlying disease but led to TBEV activation, possibly due to immune system focus on SARS-CoV-2. Despite TBEV activation, clinical manifestations were absent, suggesting weak virulence. Etiotropic treatment suppressing borreliosis led to TBEV activation, highlighting the dominance of B. burgdorferi in tick-borne infections.