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Lyme Disease

A minority of children diagnosed with Lyme disease recall a preceding tick bite
Nigrovic LE, Neville DN, Balamuth F, Bennett JE, Levas MN, Garro AC; for Pedi Lyme Net. A minority of children diagnosed with Lyme disease recall a preceding tick bite. Ticks Tick Borne Dis. 2019 Apr;10(3):694-696. doi: 10.1016/j.ttbdis.2019.02.015. Epub 2019 Feb 26. PMID: 30853264.

Out of 1770 children evaluated in the emergency department for Lyme disease, 362 (20.5%) were diagnosed with the condition. Among those with a documented tick bite history, only a small percentage (18.5%, 95% confidence interval 14.6-23.0%) of Lyme disease cases were associated with a recognized tick bite. Therefore, the absence of a tick bite history does not reliably rule out Lyme disease.

C-Reactive Protein Response in Patients With Post-Treatment Lyme Disease Symptoms Versus Those With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Melanie Uhde, Alyssa Indart, Brian A Fallon, Gary P Wormser, Adriana R Marques, Suzanne D Vernon, Armin Alaedini, C-Reactive Protein Response in Patients With Post-Treatment Lyme Disease Symptoms Versus Those With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Clinical Infectious Diseases, Volume 67, Issue 8, 15 October 2018, Pages 1309–1310, https://doi.org/10.1093/cid/ciy299

The data suggest the presence of different inflammatory mechanisms in ME/CFS compared to PTLDS. This difference may stem from the potentially more diverse causes of ME/CFS symptoms compared to PTLDS. The lack of a significantly elevated CRP response in ME/CFS, despite indications of activation in other inflammatory pathways, requires further investigation.

Borrelia burgdorferi adhere to blood vessels in the dura mater and are associated with increased meningeal T cells during murine disseminated borreliosis

li Divan, Timothy Casselli, S. Anand Narayanan, Sanjib Mukherjee, David C. Zawieja, John A. Watt, Catherine A. Brissette, M. Karen Newell-Rogers, Published: May 3, 2018. https://doi.org/10.1371/journal.pone.0196893

Traditionally, mice haven’t shown neuroborreliosis, mirroring human symptoms, but this study achieved colonization of the central nervous system in mice. Using two strains of B. burgdorferi, researchers infected mice through the skin, consistently detecting spirochetes in the brain membranes 75 days post-infection. Live spirochetes were present, adhering to blood vessels, indicating long-term infection. The presence of CD3+ T cells suggested an immune response. These findings provide new avenues for studying neuroborreliosis and may offer insights into potential treatments for patients.

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.