jwissmille

"..........Since Lyme disease is a clinical diagnosis, research must continue
to
improve diagnostic...."

Title:
Chronic Lyme Disease: An Evolving Syndrome
Authors:
Luft BJ
Conference:
9th Annual International Scientific Conference on Lyme
Disease & Other
Tick-Borne Disorders, Westin Copley Plaza Hotel, Boston,
MA, April
19-20, 1996
Presenter:
Benjamin J. Luft, M.D.
Professor, Chair (acting)
Department of Medicine
State University of New York at Stony Brook


Abstract:
Lyme disease, initially described as an arthritic disease, has unfolded
over the past 15 years
as a multistage, multisymptom disease of great complexity and
variability. Several key factors
are involved in the development of Lyme disease; the spirochetal agent,
the tick and the host.
The spirochete shows strain heterogeneity with at least three major
genospecies: Borrelia
burgdorferi, B. garinii and B. afzelii. Different genospecies appear to
be associated with
distinct clinical manifestations. Multiple strains of B. burgdorferi can
infect the same tick and
human infection can include single or multiple spirochete strains. In
the case of the ticks,
environmental factors such as temperature, humidity and source of blood
meal may alter the
major outer surface proteins (Osp) of the spirochete within the tick
vector. This can affect the
spirochete infectivity. Ticks can be co-infected with multiple
organisms, including Babesia and
Ehrlichia species. The immune response plays a definite role in the
infectivity and pathogenesis
of B. burgdorferi. Osp A, a major outer surface protein with relative
molecular mass of
31,000, stimulates B cells and cytokine production. Humans with chronic
arthritis are more
likely to show an immune response to Osp A.

Chronic Lyme disease has become an increasing concern for health care
providers.
Retrospective studies confirm that a proportion of patients treated for
Lyme disease
experience prolonged post treatment problems. Persistent complaints are
generally
non-specific and include arthralgias, myalgias, cognitive difficulties,
fatigue, malaise, dizziness,
stiff neck and photophobia. Chronic Lyme disease patients may be
seropositive or
seronegative with or without a documented history of Lyme disease.

Since Lyme disease is a clinical diagnosis, research must continue to
improve diagnostic
assays using recombinant proteins which are more sensitive and specific
than the whole
organism sonicate used for both ELISA and Western blots. Possible
biological markers of
chronic Lyme disease, such as positive Borrelial antigen, Borrelial DNA
and pleocytosis in
the CSF or synovial fluid, need to be assessed and validated.
Elimination of biological
markers in combination with sensitive indices of neuropsychological
symptoms will be useful
for the evaluation of treatment modalities.

Unique ID: 96LDF023