Borelioza stiintifica

Foarte des am intalnit pe internet in dezbaterile „exista lyme cronic sau nu?” intrebarea asta legata de „pe ce te bazezi?„. Sigur, in momentul in care ai primit intrebarea asta inseamna ca s-a deschis deja o punte de dialog. Trist ar fi fost sa se nege total si direct fara o documentatie initiala. Cam asa cum fac o buna parte din infectionistii din Romania.

Articolul acesta nu e scris de mine ci e rezultatul cautarilor pline de rabdare dupa parerea mea a unui misterios utilizator de facebook pe numele lui de scena „Studiu Lyme„. Eh, domnul sau doamna Studiu Lyme publica pe pagina lui/ei de facebook nenumarate linkuri catre diverse studii stiintifice utile pacientilor, mai ales medicilor si cel mai mult „scepticilor” care vor dovezi. Ei bine acolo se gasesc multe materiale stiintifice. Trebuie sa vrei doar sa le citesti si sa le gandesti.

Sigur, fiecare studiu pro-lyme cronic e urmat de un studiu care desfiinteaza teoria respectiva insa chiar si asa, trebuiesc considerate ambele variante. Cel putin asa ar fi etic…

Cum pe facebook sunt deja sute de astfel de linkuri, l-am rugat pe Studiu Lyme sa faca o mica sinteza a linkurilor pentru a putea fi pusa si aici pe blog (si in orice loc unde se cer „dovezi”). Personal n-am trecut prin toate materialele pe care Studiu Lyme le pune pe facebook, sunt multe, sunt stufoase si necesita timp. Daca as fi avut disponibile cele 9 ore de munca, poate as fi avut acel timp asa ca imi ramane doar sa sper ca cei care sunt platiti sa se documenteze in sensul asta, adica medicii, chiar o vor face.

p.s: oarecum in afara subiectului, salut aparitia unui nou blog in blogosfera borelioasa romaneasca: Eu, borelia si viata mea ducand astfel la 11 numarul blogurilor in care se vorbeste (si) despre boala Lyme (cel putin cele despre care stiu eu):

Asadar, Maestre, muzica!

Seronegativitate in Lyme : (inca din 1990 , se cunoaste aceasta situatie
http://www.sciencedirect.com/science/article/pii/0140673690906066

Seronegativitate si tratament lung in Lyme cronic (1997 )
http://cid.oxfordjournals.org/content/25/Supplement_1/S52.full.pdf+html

Although these patients had clinically active disease, none had diagnostic levels of antibodies to B. burgdorferi on either a standard enzyme-linked immunosorbent assay or immunofluorescence assay. On Western blot analysis, the level of immunoglobulin reactivity against B. burgdorferi in serum from these patients was no greater than that in serum from normal controls.

http://www.nejm.org/doi/pdf/10.1056/NEJM198812013192203

Necesitatea disocierii anticorpilor din complexele autoimune :
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC265679/pdf/jcm00020-0013.pdf

Caz clinic 2002
http://www.springerlink.com/content/a9xd2qb6bmk006jk/

http://www.sciencedirect.com/science/article/pii/019096229370043S

Caz clinic seronegativ :2007
http://www.springerlink.com/content/f7p2661361750gr4/

Studiu pe asimptomatici :
http://jid.oxfordjournals.org/content/163/2/305.short

Only 1 (2.2%) developed clinical Lyme borreliosis, Among all participants, the 6-month incidence of clinical Lyme borreliosis was 0.8% (6/755) but was much higher (8.1%) for asymptomatic seroconversion (45/558). In conclusion, positive Lyme serology was common in Swiss orienteers, but clinical disease occurred infrequently.

http://www.springerlink.com/content/d6h6d768l1jat752/

1996 -exprimare procentuala a seronegativitatii :
http://www.springerlink.com/content/j51754812078p4l7/

2003
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2133.2001.04034.x/abstract;jsessionid=ACD9EBB34301519F517CBE7D878666F2.d03t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false

De citit cu atentie :
http://www.lymecryme.com/lyme%20disease%20the%20clinical%20sectrum%20of%20abx%20responsive%20meningoencep.pdf

Anticorpii se formeaza greu :
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC296331/

Diferentele intre laboratoare : de aceea de multe ori ,exista rezultate diferite , iar procentul de seronegativitate nu este cel presupus.
http://archinte.jamanetwork.com/article.aspx?articleid=613111

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstractBuch&ArtikelNr=117104&ProduktNr=234269

Raspunsul imun poate da problemele in Lyme
http://www.sciencedirect.com/science/article/pii/S0165572897001185

PCR pozitiv si serologie negativa
http://ukpmc.ac.uk/abstract/MED/8623775
There was serological evidence of Lyme borreliosis in 75% of the cases
http://www.springerlink.com/content/uwenxgllqajrab77/

Asta este important , si nou , 2008 , cititi cu atentie :
http://www.nejm.org/doi/full/10.1056/NEJMc073063

Un studiu de caz , in care seropozitivitatea apare la doi ani de la declansarea infectiei si tratamentul dureaza un an . Sunt multe situatii in care titrul de anticorpi fluctueaza ca o diagrama sinusoida , si daca se face serologia cand nu este „pe val ” atunci testele pot fi negative :
http://jama.jamanetwork.com/article.aspx?articleid=195237

Ltt-ul important in seronegativitate :
http://www.sciencedirect.com/science/article/pii/S0732889306002136

Both acute and chronic borreliosis can be seropositive or seronegative. As shown by II and ELA, these patients had a moderate humoral response, high titers of the specific antibodies being a rare finding.
http://ukpmc.ac.uk/abstract/MED/8571255

Necesitatea testarii coinfectiilor :
http://jcm.asm.org/content/34/3/724.short

Un articol larg in care se recunoaste nesiguranta serologica in diagnostic:
http://www.neuro-lyme.com/Neurophsychiatric_Lyme.html

Opinia ILADS si bibliografia lor care le sustine punctul de vedere:
http://www.ilads.org/files/position2.pdf

In coinfectii se pare ca una dintre boli are prevalenta :
http://cid.oxfordjournals.org/content/16/3/392.short

Sensibilitate si specificitate :
http://download.springer.com/static/pdf/365/art%253A10.1007%252FBF00579624.pdf?auth66=1351537799_c076fcdffeb21966a708e6428c5d7653&ext=.pdf

Possible European rules, all closely related, were formulated from these bands, although there was no single rule that gave high levels of sensitivity and specificity for all the laboratories.
http://jcm.asm.org/content/38/6/2097.short

Probleme neurologice care au disparut dupa curse repetate de antibiotice :
Another was a 40-year-old man presenting with epileptic
seizures and MRI-detected multifocal lesions, which
disappeared after repeated courses of antibiotics. We
conclude that cerebral lymphocytic vasculitis and multifocal
encephalitis may be associated with B. burgdorferi infection.
The presence of B. burgdorferi DNA in tissue samples
from areas with inflammatory clianges indicates that direct
invasion ofB. burgdorferi may be the pathogenetic mechanism
for focal encephalitis in LNB.

http://owndoc.com/pdf/curing-lyme-lesions.pdf

Of the 35 of 83 (42%) patients who were positive for OspA antigen in their CSF, 15 (43%) were antigen positive despite being antibody-negative in CSF. Seven of these 15 (47%) had otherwise normal routine CSF analyses. Six of these 15 (40%) patients met strict CDC surveillance criteria for Lyme disease; four (27%) patients had serocon-version coincident with new neurologic problems; and three (20%) with characteristic syndromes for Lyme disease were seronegative, but had complexed antibody to B burgdorferi. The final two patients (13%) were seropositive and had unexplained neurologic problems not characteristic of Lyme disease.
http://www.neurology.org/content/45/11/2010.short

Trebuie sa intelegi ca , studiile TREBUIE facute pe pacienti care dovedesc boala , adica sunt pozitivi in teste . De aici si controversa. Daca sunt utilizati cei care nu dovedesc serologic boala, se ridica intrebarea , de unde stii ca este Lyme? Asa ca seronegativitatea nu poate fi probata totdeauna.

2005
http://jcm.asm.org/content/43/10/5080.short

Asta este ca o barfa :
http://www.bmj.com/content/335/7628/1008.1#T1

Coinfectari:
http://cid.oxfordjournals.org/content/34/9/1184.short

http://www.jabfm.org/content/22/2/219.abstract

http://cvi.asm.org/content/14/11/1420.abstract

http://jid.oxfordjournals.org/content/193/6/901.full.pdf+html

http://pediatrics.aappublications.org/content/112/3/e252.full.pdf+html

http://cid.oxfordjournals.org/content/33/5/676.short

http://iai.asm.org/content/69/5/3359.short

http://www.jimmunol.org/content/184/9/5085.abstract

http://www.ajtmh.org/content/75/6/1090.abstract

Seronegativitate in coinfectii:
http://www.ann-clinmicrob.com/content/4/1/15

http://www.cell.com/trends/parasitology//retrieve/pii/S147149221000019X?_returnURL=http://linkinghub.elsevier.com/retrieve/pii/S147149221000019X?showall=true

http://www.nejm.org/doi/full/10.1056/NEJM199110103251517

http://www.expert-reviews.com/doi/abs/10.1586/14737159.4.4.559?journalCode=erm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034327/

http://www.ncbi.nlm.nih.gov/pubmed/17713310

Babesioza :
http://ukpmc.ac.uk/abstract/MED/8607592

http://onlinelibrary.wiley.com/doi/10.1046/j.1537-2995.1988.28188127955.x/abstract

http://www.sciencedirect.com/science/article/pii/S1438422107000161

http://jcm.asm.org/content/40/7/2431.short

Concluzii:
– nu am gasit studii facute pe infectii simultane , cum se intampla in realitate , pentru ca un pacient cu Lyme nu are numai Lyme . Multi pacienti am infectii simultane si atunci imunitatea este suprasolicitata si titrul de anticorpi nu este reprezentativ pentru nici o boala.
Toate ghidurile sunt pe infectie unica , nu pe combinate . Nici studiile nu sunt pe combinate .
In acelasi timp , in privinta seronegativitatii , nu pot fi studii ci doar raportari de caz. Orice studiu trebuie facut pe subiecti care demonstreaza boala conform ghidurilor !( deci nu seronegativi ) Daca s-ar utiliza seronegativi atunci studiul ar fi contestat.
Fals-pozitivul testelor serologice .
Frecvent auzi la Bals sau la Cantacuzino ca daca testul este pozitiv , atunci este fals-pozitiv. Fals-pozitiv inseamna fie ca testele nu pot avea siguranta pentru ca interfereaza cu alte bacterii, fie ca suntem in zona endemica . Atentie , daca nu suntem in zona endemica ( doar Lyme-ul nu exista in Romania ) , fals-pozitiv este dovada ca testele serologice nu au valoare diagnostica si nici prognostica.
Cei de la infectioase , cauta anticorpi pentru boli autoimune in cazul in care apare un „fals-pozitiv ” . Dar nu exista un studiu care sa confirme ca ,de exemplu :
Anticorpi antimielina interfereaza cu anticorpi impotriva borreliei ! Si nu SM-ul mimeaza Lyme ci invers!

Ia citeste asta :
The pathological hallmarks of Alzheimer’s disease (AD) consist of β-amyloid plaques and neurofibrillary tangles in affected brain areas. The processes, which drive this host reaction are unknown. To determine whether an analogous host reaction to that occurring in AD could be induced by infectious agents, we exposed mammalian glial and neuronal cells in vitro to Borrelia burgdorferi spirochetes and to the inflammatory bacterial lipopolysaccharide (LPS). Morphological changes analogous to the amyloid deposits of AD brain were observed following 2–8 weeks of exposure to the spirochetes. Increased levels of β-amyloid presursor protein (AβPP) and hyperphosphorylated tau were also detected by Western blots of extracts of cultured cells that had been treated with spirochetes or LPS. These observations indicate that, by exposure to bacteria or to their toxic products, host responses similar in nature to those observed in AD may be induced.
http://www.sciencedirect.com/science/article/pii/S0197458005000709

Electron cryotomography was used to analyze the structure of the Lyme disease spirochete, Borrelia burgdorferi. This methodology offers a new means for studying the native architecture of bacteria by eliminating the chemical fixing, dehydration, and staining steps of conventional electron microscopy. Using electron cryotomography, we noted that membrane blebs formed at the ends of the cells. These blebs may be precursors to vesicles that are released from cells grown in vivo and in vitro. We found that the periplasmic space of B. burgdorferi was quite narrow (16.0 nm) compared to those of Escherichia coli and Pseudomonas aeruginosa. However, in the vicinity of the periplasmic flagella, this space was considerably wider (42.3 nm). In contrast to previous results, the periplasmic flagella did not form a bundle but rather formed a tight-fitting ribbon that wraps around the protoplasmic cell cylinder in a right-handed sense. We show how the ribbon configuration of the assembled periplasmic flagella is more advantageous than a bundle for both swimming and forming the flat-wave morphology. Previous results indicate that B. burgdorferi motility is dependent on the rotation of the periplasmic flagella in generating backward-moving waves along the length of the cell. This swimming requires that the rotation of the flagella exerts force on the cell cylinder. Accordingly, a ribbon is more beneficial than a bundle, as this configuration allows each periplasmic flagellum to have direct contact with the cell cylinder in order to exert that force, and it minimizes interference
between the rotating filaments.
http://jb.asm.org/content/191/2/600.short

Morfologi diferite:
http://journals.lww.com/amjdermatopathology/Abstract/1996/12000/Heterogeneity_of_Borrelia_burgdorferi_in_the_Skin.4.aspx

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0463.2004.apm1120110.x/abstract;jsessionid=C6458910651E225DCBD386C6B24D60C1.d03t01?systemMessage=Wiley+Online+Library+will+be+disrupted+on+27+October+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance&userIsAuthenticated=false&deniedAccessCustomisedMessage=

O microscopie mai buna ca PCR
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0560.2007.00977.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+27+October+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance&userIsAuthenticated=false&deniedAccessCustomisedMessage=

Diferenta de patogenitate intre specii:
http://www.sciencedirect.com/science/article/pii/S1438422104001110

Minociclina si ALS :
http://www.sciencedirect.com/science/article/pii/S0969996102904870