LYME DISEASE

BEHANDLE MIT EHRFURCHT,
WAS DEINER EINSICHT
NOCH VERBORGEN 1^ST!
AUGUSTINUS

TREAT A CAUSE WITH RESPECT,
WHEN THE CAUSE IS STILL HIDDEN
TO YOUR UNDERSTANDING
AUGUSTINUS

Mrs Dr med. Laurence Meer Scherrer
Family Practitioner
Medical office
Aumatt 6
CH 3175 Flamatt Switzerland
Phone ++ 41 31 741 17 07
FAX ++41 31 741 24 63
EMail dr.meerl@dplanet.ch

Board member of ILADS
www.ilads.org

Ladies and Gentlemen
Dear Colleagues

I thank you for the invitation to speak at this Congress about Tick- borne diseases Since 17 years I have been working in a rural medical office between the cities of Bern and Freiburg, next to a river. In this rural region the presence of the Spirochaetes Borrelia burgdorferi / afzelii / garinii seems to be endemic. In my office alone I see about 40-50 Erythema chronicum migrans (ECM) every year - the first stage of Lyme disease. About sixty percent of infections with Borrelia will avoid this cutaneous first stage and start clinically with the second stage. I am not directly working at a University, but share the care of my patients with different professors of Neurophysiology, Psychiatry, Nuclear Medicine, Radiology and others.

I will introduce you to the clinical approach of Lyme patients, based on follow up experiences of a large number of Lyme patients over many years. You will not hear the CDC diagnostic criteria nor the “evidence based medicine” applied on Lyme patients. In Switzerland there are no official diagnostic or therapeutic guidelines, the Universities mostly follow the CDC guidelines. The care of Lyme patients over many years has created the basis of both my lectures, the patient being the most important factor of my research

THE DIAGNOSIS OF LYME AND ASSOCIATED DISEASES

Lyme Disease is a clinical diagnosis and can be confirmed by laboratory test results, but cannot be excluded by a negative laboratory test result

Lyme Disease is a multisystem illness and can involve every human organ
The illness can produce very different clinical features
The clinical feature is a result of interaction between microorganisms and the host immune answer
The Lyme Disease is an illness with different stages, like Syphilis

There are hints of not yet understood immunosuppression due to Lyme disease
Many studies prove the impossibility of spirochetes eradication

Lyme Disease is only a part of Tick-borne Diseases

A mixture of microorganism invasion into the human body
Co-infections like Ehrlichia, Rickettsia, Babesia, Bartonella henselae and others are frequent

Lyme Disease can pass ,”imperceptibly” and can also induce acute or chronic illness and finally even physical and mental disabilities and death

Ticks are Inoculating Immunsupressor substances while biting

There are different sub-groups of Borrelia bacteria causing Lyme Disease, three of them are well known:
Borrelia burgdorferi - "American sub-group" causing especially Arthritis and , "rheumatic” pains.
Borrelia afzelii – “European sub-group” causing Acrodermatitis atrophicans chronic, Lichen sclerosis, locally scleroderma
Borrelia garinii - “European “sub-group” causing neurological illnesses
Surface antigen presentation can be changing, more man one sub-group can be transmitted from the same tick

Borrelia spirochaetes are going in tissues with poor blood circulation avoiding the immune response of the blood cells and antibodies (fibroblasts, fat cells, glial cells, cartilage and perhaps bone)
Borrelia Spirochetes are going intracellular - evading the antibiotic attacks
Borrelia can change surfactant proteins troubling the antibody production
Borrelia can be transformed into spherical and / or L forms causing a pseudoresistence to the usable antibiotics

Cytokine are raised

There are patients with humoral response, others without any humoral response, cell transmitted immunity is every time present but mostly hyperactivated causing an autoimmune cascade

OVERVIEW 0F A PART OF POSSIBLE SYMPTOMS OF LYME DISEASE

The best known
Bell’s palsy and mild meningitis
Erythema chronicum migrans
Acrodermatitis chronicans atrophicans (ACA)
Acute monarthritis

The less known
Optical neuritis
Loss of hearing
Difficulties swallowing
Acrodermatitis chronicans in the inflammatory stage
Paralysis of abdominal muscles
Pancreatitis / Hepatitis
Myocarditis
A-V block
Dysaestheses
Vasculitis
Muscle weakness
Signs of encephalopathy

The misdiagnosed
Urticaria
Multiple sclerosis
Parkinson
ALS
Dementia
Depression / Panic attacks I Psychosis / Obsessive disorders
Seizures
Strokes / Aneurysms
Lymphoma (cutis benignum and malignum)

This list could be prolonged by symptoms and diagnosis of every human organ

HOW TO PROCEED FOR DIAGNOSIS

Elaborate the medical history of patient (multisystem illness)
ECM: Look and feel, then make a picture, take blood for serology and treat

All other stages
The clinical examination of the patient including neurological / neuropsychiatry tests
An excellent documentation of all observations by photos, videos, skin biopsy for histology and PCR

Exclude all differential diagnoses (PCP, Sudeck atrophy, tumour, cancer, thyroid illnesses and so on)
BIood tests: Haematological tests, Liver tests, Thyroid tests, Vitamin B Complex, rheumatological tests,
other serological tests such as HIV, Hepatitis B/C, Lues, Chlamydia pneumonia, EBV.
Borrelia tests: serology: IgG,IgM, Westernblots, IgG / IgM Antigen- Antibody - Immuncomplex, Urine-Antigen, PCR in Blood / CSF / body fluid / biopsy
CSF for cells, glucose proteins (IgG, IgA, 1gM oligoclonal bands)
Serology and PCR of Borrelia / Lues / Herpes / CMV
EEC, MRI-Brain SPECT, Douplex-Sono of Vessels, ECG
Ophthalmological tests

Co-infections to check Ehrlichiosis, Babesiosis, Bartonella henselae

NEVER FORGET !!!
We treat a patient and NOT laboratory tests

You will miss the similarity of all clinical features of Lyme patients but you will find come common signs

SUSPICION OF CO-INFECTIONS

Overlapping symptoms are common, but the following symptoms could be present more in:

LYME:
Spasms
Dysaesthesia
Light / Noise Hypersensitivity
Paralysis
Major neurological disorders
Seizures
Memory loss, word confusion
Cold feeling, low body temperature
Worsening symptoms during passage of Spirochaetes in blood usually between 4 pm to 8 pm
Sleeplessness
Neuropathy pains
Vasculitis

BABESIOSIS::
Fever chills,
profuse sweats,
severe headache,
moods lability,
severe muscle pains,
cough,
conjunctivitis
Vasculitis

EHRLICHIOSIS:
Fever decreased white and platelet count
Splenomegaly

BARTONELLA henselae:
Infectious haemangiomatosis
Encephalopathy
Increased lymph node

THE OTHER DEFINITION OF LYME PATIENTS

The Lyme patient usually has visited many doctors before finally finding a Lyme activist physician
Mostly he has the diagnosis of a hysterical illness
Unfortunately he is often seronegative
He is addicted to antibiotics
He has troubles with his insurance
He normally needs a lawyer
His illness is the cause of a controversy amongst physicians and researchers never seen before in the whole of medical history!
He has to fight against the illness. He has to fight for understanding in his family. He has to fight to get the treatments paid for. He has to fight against organic depression. He has to fight to be able to work. In the USA he has to fight for the licence of his physician and he has to fight for a long time

FINALLY SOME DANGER POINTERS

Lyme disease could be sexually transmitted
Other transmission possibilities: by other insects, leeches, blood, transfusions, needle injuries and the well documented vertical transmission

The best strategy of Tick-borne micro-organisms against the medicine is to have successfully divided the medical corporation, paralysed research, and chosen a time of instability in public health policy, not to mention lack of financial reserves and time of specialisation of physicians