Lyme disease--success for academia and the community

Lyme disease: Is it or is it not?

This past summer, Lyme disease was the topic of a Focus section in the Globe and Mail (1). In this section, the reporter described her experience of having physicians unable and then unwilling to diagnose her symptoms of "skin on fire, dizziness and chest pains, twitching muscles, and trouble keeping balance" as Lyme disease following a tick bite three years previously on Prince Edward Island. She reported finding support for her diagnosis after obtaining a positive test from a California laboratory and after seeing approximately 20 physicians. In her article, she speaks to the controversy surrounding the diagnosis and treatment of Lyme disease, and the tension it creates between those who believe they have it and the physicians they see.

Childhood Lyme borreliosis in Europe

Lyme borreliosis is a multisystem disorder common in childhood. It is an acute and persistent anthropozoonotic infection caused by the spirochete Borrelia burgdorferi (Bb) which is transmitted by Ixodes ticks. After the tick bite in summer, erythema migrans, meningoradiculoneuritis, or carditis may develop within the same season. Later manifestations may be oligo-arthritis, progressive encephalomyelitis, or acrodermatitis chronica atrophicans. The most common course is probably asymptomatic. Connatal infection is possible. Diagnosis is established mainly by history and clinical manifestations. The antibody response to Bb can be measured in serum and cerebrospinal fluid. Tests may be false-negative early in the course of the disease or after early treatment. False-positive results may be caused by cross-reactions. Interpretation of test results must also consider unrelated anamnestic titres or asymptomatic infection. Treatment with appropriate antibiotics cures the disease in most patients, however some patients may not respond. The optimal drug has not yet been found. Best prophylaxis is by early removal of the tick from the skin.

Advances in immunology and uveitis

*Subspecialty synopses are intended to present major clinical developments and innovations in diagnosis, treatment, surgical technique, and recent clinical research. Each synopsis, written by a recognized knowledgeable subspecialist, is co-sponsored by a major subspecialty society or organization. This subspecialty synopsis is co-sponsored by the Ocular Microbiology and Immunology Group.

Endotoxin-like activity associated with Lyme disease Borrelia

The newly recognized spirochete, Borrelia burgdorferi, the causative agent of Lyme Disease, has been examined for endotoxin-like activities as measured by the standard Farmacopea Ufficiale della Republica Italiana rabbit fever test and the Limulus amoebocyte lysate assay. The suspension of heat-killed microorganism caused a febrile response at a dose of 1 X 10(8) bacteria pro kilo. Similar results were obtained in the Limulus assay where the heat-killed spirochetes stimulated formation of solid clot until the concentration of 1 X 10(5) per ml. Both in pyrogen test and in Limulus assay heat-killed Escherichia coli exhibited a higher degree of potency. These results show that LD-Borrelia possess endotoxin-like activities which could help in understanding the pathogenesis of the clinical symptomatology of the disease.