the history of lyme disease · june 5, 2004 conference "ms vs. lyme disease", eindhoven 5...

June 5, 2004 Conference "MS vs. Lyme disease", Eindhoven 1

The History of Lyme disease

by Robert Bolderdijk



1883 German Alfred Buchwald first describes skin lesion

1902 Herxheimer gives ACA it’s name

1909 Arvid Afzelius first describes EM and links it to a tick bite

1909 Ricketts demonstrates that Rickettsia causes Rocky

Mountain spotted fever and is transmitted by ticks

1910 Austria W. Balban describes the EM rash caused by insect

bites

1911 Swiss Jean Louis Burckhardt describes lymphocytoma

1913 Austrian Benjamin Lipschütz describes ECM



1920 Strandberg links lymphocytoma with tick bites

1922 Charles Garin and Charles Bujadoux report about EM and

meningoradiculoneuritis, later called Bannwarth’s syndrome

1930 Sven Hellerström connects ECM and meningitis

1936 German Askani suggests a tick bite is the cause of EM

1941 German Alfred Bannwarth describes the neurological

LD triad: - severe nerve pain

- cranial nerve palsy- meningitis



1942 German R. Kahle reports of 6 of 7 ACA patients having

serum positive for syphilis

1946 Penicillin effective in ACA

1948 Carl Lennhoff finds spirochetes in EM biosy

1949 At Southern Medical Ass. In Ohio, Sven Hellerström

describes that a tick bite results in a rash and neurological

problems

1949 G. Schaltenbrand reports 8 cases of Bannwarth’s syndrome

1950 Low-dose I.V. penicillin effective in EM patients



1951 Jarish-Herxheimer reaction seen in ACA patients

1952 T. Grüneberg thinks J-HR in ACA patients due to spirochetes

1954 J. Pascoud relates a tick bite to EM, lymphocytoma and

Bannwarth’s syndrome

1954 Hans Götz performs skin transplants of ACA

1956 EM description first time in US medical textbook

1960 V. Sedlacek sees correlation between EM and peak season

for Ixodes ticks bites

1965 W. Hauser suggests, ACA, EM, lymphocytoma is one entity



1968 H.C. Hoff reports about a cluster of 300 ACA cases

1970 Rudolf Scrimenti, Wisconsin, reports the first EM in the US

1971 Richard Kelly develops a culture media for Borrelia which

causes relapsing fever

1973 Rudolf Ackermann reports on 47 patients with

meningoradiculitis and rediscovers the Bannwarth’s

syndrome

1974 Klaus Weber reports a case of EM and meningitis failed oral

penicillin treatment but cured with high dose of I.V.



1975 Polly Murray contacts Yale University

Judith Mensch contacts Connecticut State Health Dept.

1975 David Snydman begins the investigation

Allen Steere rheumatologists is asked to lead the study

1976 W. Mast and W. Burrows describe 10 cases of EM and treat

with ABX

1977 Steere describes a new arthitis form in children and calls it

Lyme arthritis and treats it with aspirin

- short-term ABX failed- Steere thinks it’s a virus



1981 Willy Burgdorfer et al. report on the discovery of spirochetes in Ixodus scapularisLater they are called after him Borrelia burgdorferi



1982 Barry Marshall and Robin Warren discover the Helicobacter pylori

1982 Rudolf Ackermann finds spirochetes in Ixodus ricinus in Germany and treats successfully EM with ABX



1983 Borrelia burgdorferi isolated from LD patients in Conn.

1983 R. Ackermann finds antibodies to Bb in patients with EM and

Bannwarth’s syndrome

1983 W. Burgdorfer predicts LD will be Nr.1 tick-borne disease

in US

1984 Ackermann finds negative antibody test in EM patients

1985 1ste case of maternal-fetal transmission

1988 The Lyme Disease Foundation is founded



1991 Intracellular capability of Bb and survival in macrophages

1991 Intralaboratory comparison of test results for detection

of LD; of 516 laboratories only gave 45% accurate identified

serum samples

1992 Klempner demonstrates Bb invade skin fibroblasts and

survive ceftriaxone

1993 The Borrelia burgdorferi sensu lato group entails

- Borrelia burgdorferi s.s.- Borrelia garinii- Borrelia afzelii



1993 Dr. L. Mattman presents her book

Cell Wall Deficient Forms: Stealth Pathogens



1996 Vera Preac-Mursic proves different antibiotic responses

among Borrelia strains

She recommends dual ABX and longer than a few weeks



1998 SmithKline-Beacham gets approval for their LYMErix vaccine

1998 L. Mattman presents the Gold Standard for spirochetal

infection, the Q-RiBb test

1999 The ILADS is founded

1999 Goossens tested 15 commercial immunotest-kits for

Borrelia: - sensitivity 38-92% for Elisa

- sensitivity 50% for Western Blot

2001 OspA vaccination induced arthritis in 4 cases

2001 Scientists find cyst form reconversion into motile

spirochetes



2002 LYMErix vaccine withdrawn from market

2004 CBO guidelines for Lyme treatment published

2004 ILADS guidelines for Lyme treatment published

2004 June 5th, the 1rst ILADS conference in Holland


Salmonella detection

Salmonella detection by motility on MSRV


Salmonella detection

2nd World Congress Foodborne Infections and Intoxications

Berlin 26-30 May 1986

Rapid Salmonella Detection From Foods By Motility Enrichment.

J.M. De Smedt, R.F. Bolderdijk and H. Rappold.

Journal of AOAC International 1996 Mar-Apr;79(2):441-50

Salmonella detection in dried milk products by motility

enrichment on modified semisolid Rappaport-Vassiliadis medium.

Collaborative study: R.F. Bolderdijk and J.E. Milas.


Lyme disease from a patients view

My Storyby Robert Bolderdijk


My Story

1995Change from office work to physical labourComplaints: - Joint and muscle pain

- Low back pain- Numbness, tingling and cramps in hands- Leg, under feet pain, cramps in calves - Facial left side tingling- Excessive sweats- Fatigue- Short of breath


My Story

1996Diagnosed with fibromyalgieSevere pain in the left calfDiagnosis: deep venous thrombosis DVT

1997December, pulmonary emboli due to recurrent DVT in legSource of DVT: lupus coagulant antibodies positiveAntiphopholipidesyndrom APS


My Story

1999Helicobacter pylori infection Sent to rheumatologist in University Hospital #1Results: - No SLE

- APS primary- IgM for Lyme negative (IFA)- IgG for Lyme positive (IFA)- Erythrocyturie e.c.i- ALAT of 368 mg/L- Hypertension


My Story

1999Diagnosis: - Complaints due to primary APS

- No Lyme because of negative IgMMedication: prednisone and atenolol

My Lyme disease awakening!!

1974 Hospital treated twice for EM


My Story

From my medical records1974 Cardiological examination1976 Neurological conductivity examination1981 Nose-sinus operation

Neurological conductivity examination1981-today Regular low back pain, headache and numbness and

tingling in handsLyme disease can trigger APS

F.D. gave me 14 days Doxycycline 200mg/d


My Story

2000Visit to Lyme specialist University Hospital #2Immunotestsresults: ELISA IgM negative

ELISA IgG negativeDiagnosis: no active Lyme disease

Visit to Lyme specialist University Hospital #3No tests doneDiagnosis: no active LymeComplaints between the ears


My Story

2001Visit internist University Hospital #1Requested immunotests for ELISA and Western BlotResults: in house IFA, IgM negative and IgG positiveResults from RIVM: ELISA IgM negative

ELISA IgG borderlineWB IgG: 17kD+, 22kD(+), 34kD++, 41kD+

Remark: incomplete but very suspect IgG patternCould be an old extinguished response of two years after ECM Diagnosis: extinguished infection or may be Lyme!Treatment proposal: Doxycycline for 21 days


My Story

2001Blood examination at Laboratoriumsmedizin in Köln (Germany) by Prof. Dr. Rudolf AckermannImmunotest with whole cell-lysates of 3 genospecies of BorreliaResults: ELISA IgM negative >200=pos.

ELISA IgG positive 920E >400=highWB IgG: p30, p34, p41

Visit to the 3rd Lyme specialistGerman results were wrong because of the standard deviationDiagnosis: no Lyme serological scar from old Lyme


My Story

2003Blood examination at Laboratoriumsmedizin Köln GermanyResult: ELISA IgM negative

ELISA IgG positive 660EWB IgG: p20, p30, p34, p41

Diagnosis Prof Ackermann: active Lyme disease

Visit neurologist at local hospital with German resultsLumbar puncture for CSF examination


My Story

Results:

Treatment proposal: 21 days of Rocephin I.V. Immunotiter before and 3 months after the treatment

Local hospital Laboratoriumsmedizin

Serum IgM negative Not done

IgG negative Not done

CSF Dubious for intrathecallyantibodies

Protein 269mg/l

Positive for intrathecallyantibodies

Not done


My Story

2003September: start of I.V. treatmentImmunotestsresults:

January: immunotests at Laboratoriumsmedizin- IgG positive 840E- WB not done, at own costs- Conclusion: I.V. treatment had no effect

Local hospital Laboratoriumsmedizin

Serum IgM negativeIgG negative

WB not done

Not doneIgG positive 700E

WB IgG; p20, p34, p39p41, p83


My Story

TodayComplaints not changed

- Joint and muscle pain- Tingling and cramps in hands- Cramps in calves- Leg en feet pain- Breast pain- Neck pain

- Facial tingling- Sweats- Pain at the bite- APS- Hypertension- Erythocyturie- Proteinurie (Dr. Kirmizis, Lyme

and MPGN)

2004 Next, starts treatment with FDDoxycycline 2 X 200mg/d for 8 weeksMethronidazole 2X500mg/d pulsed weekly


Learnings

Clinical symptoms are not recognizedLyme disease diagnosed by: family doctor 6%

specialists 44%patient 33%

Doctors rely on the immunotests instead of clinical signs

Immunotests are insufficient sensitive and performance is poor38-92% sensitivity for Elisa50% sensitivity for Western Blot(Goossens)


Learnings

Standard antibiotic treatment in chronic Lyme often inadequateCBO guidelines needs to be revisedAfter standard treatment the patient is left aloneGeneral opinion about Lyme disease needs adjustment

Lyme disease does not (immediately) killhowever,

it does take your life!!

the history of lyme disease · june 5, 2004 conference "ms vs. lyme disease", eindhoven 5...

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