Thesis: Neuroborreliosis Borrelia Burgdorferi or Bb

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Neuroborreliosis

Borrelia burgdorferi or Bb is a species of spirochetes or small and round-shaped bacteria, which cause lyme disease in human beings.

They are delivered to the human body by any of the several strains of Ixodes ticks, which suck on white-footed mice and white-tailed deer. The Lone Star tick is also a suspect species for transmitting relapsing fevers. Ixode ticks occur in these animal hosts in larval, nymph and adult stages. They are tinier than a grain of sand. Infection of humans takes 12 to 72 hours. Even fetuses can be infected. After a tick bite, an average person develops erythema migrans. This is a reddish rash at the bite site, which looks like a "bull's eye." The rash usually disappears in 3 or 4 weeks during which time no rash develops. Many victims do not even recall a tick bite.

The disease goes through an early stage and a persistent or recurrent stage.

In both stages, it affects the muscles, bones, the skin and the central nervous system. Early symptoms include chills, fatigue, influenza-like fever, muscle pain and migraine pain in the joints. More than half of those afflicted develop secondary skin signs, which do not imply tick bites. Most of these early signs are brief. When the disease is not diagnosed and treated at this early stage, acute neurological disease may develop in 20% of the cases. Bell's Palsy, encephalitis, aseptic meningitis with headache and still neck are examples of neurological disease. The heart is involved in 5-10% of the cases, which develop arrhythmias and atrioventricular heart block. More than half of those in the later stage complain of chronic arthritis, joint pains or inflammation of synovial membranes. Frequent central and peripheral nervous system effects of Lyme Disease include axonal polyneuropathy, encephalomyelitis, and encephalopathy. Loss of memory, mood changes and sleep disturbances result from sub-acute encephalopathy. Broad psychiatric signs and symptoms include anorexia nervosa, bipolar disease, dementia, major depression, obsessive-compulsive disorder, panic attacks, paranoia, and schizophrenia. The increase in the incidence of Lyme Disease in the U.S. is attributed to a number of factors. These are the spread of suburbs into the rural areas, an increase in the population of white-tailed deer, and the spread of tick carriers to new regions.

Diagnosis is made either on the basis of laboratory findings of symptoms or on exposure to area endemic for the ticks.

Signs and symptoms may be in the early or late stage or overlap. They may also be numerous, varied and similar to other conditions, such as syphilis. The usual serologic tests for Lyme disease are the ELISA and Western blot. The ELISA test looks for antibodies that react to antigens in Bb but is unable to differentiate those without the disease. It, thus, can produce false positives or negatives. The Western blot records antibody proteins. But serologic antibody reactions of patients differ from person to person. They may also produce false negatives. And, at times, antibodies become detectable when antibiotic therapy is no longer effective.

High Incidence in the United Kingdom

Surveillance peaked over the increased incidence of erythema migrans in certain parts of the United Kingdom between 1986 and 1996.

Erythema migrans was reported in 41% of the cases, arthritis in 4%, musculoskeletal manifestations in 18% and neuroborreliosis in 15%. The increased incidence in the later period was attributed to greater awareness of the disease, better access to diagnostic facilities, more efficient methods and better reporting. Cases were high in recreational and occupational areas. B. burgdorferi and Lyme borreliosis are prevalent and highest in Eastern Europe because of the favorable ecological conditions the ticks and spirochetes. Other favorable factors include changing patterns of land use, numerous animal hosts for the ticks and spirochetes, and climatic conditions, such as drought and prolonged cold weather.

Neuro-psychiatric Symptoms

At present, detected symptoms of late-stage neuroborreliosis appear in the brain stem, limbic system, cortical system, and the peripheral system.

In the brain stem, it produces autonomic, hormonal and cerebellar symptoms. These include migraine, temperature dysregulation, sexual dysfunction, sensitivity to bright light, mitral valve prolapse, irregular pulse, hypotension, asthma, non-ulcerative dyspepsia, irritable bowel and irritable bladder. Hormonal symptoms may be a thyroid disase, HPS axis dysregulation, reduced sex hormone functioning and hypoglycemia. Lymbic system symptoms can be altered attention, emotional and behavioral changes and pathological psychiatric syndromes. There may be signature and processing difficulties in the cortical system. When a more detailed and well-focused interview and mental status examination are performed, diagnostic accuracy is improved. A more responsive treatment strategy can then be devised based on these inputs.

Late-Stage Neuroborreliosis

Aside from skin, bone, heart, eye and nerve symptoms, psychiatric disorders also develop in the late stage.

These are depression, panic attacks, schizophrenia-like psychotic state, bipolar disorder and dementia. It has been called the "great imitator" because of its ability to mimic other psychiatric disorders. Its presentations are as diverse and debilitating as neurosyphilis. The best steps to take are primary prevention and early treatment but neurologic symptoms often appear months to even years after the start of infection. Early diagnosis may exclude neuroborreliosis, especially when the patient has moved out of the endemic area. The disease may be less responsive to antibiotic therapy when eventually diagnosed. Psychiatrists are, therefore, advised to consider Lyme disease in evaluating a patient for treatment.

Pathogenesis

The spirochetes enter the host through a tick bite on the skin and spreads to secondary organs, including the central nervous system.

They first attack the immune system then cross the blood-brain barrier to reach the central nervous system. When they get to the cerebrospinal fluid, the invaders elicit an inflammatory reaction. Understanding the spirochetes' microbiological mechanisms can lead to a better understanding of other spirochetal diseases, such as syphilis and Weil syndrome. These have high incidence and higher morbidity and mortality than neuroborreliosis.

Chronic Lyme Disease

The controversial disease creates the perceived "Axis of Evil.

" This axis consists of the physician, specialty laboratories, and the internet. The physician treats the patient with uselessly prolonged antibiotics regimen. Specialty laboratories conduct inaccurate testing. And the internet promotes the Lyme hysteria. But from this axis, the Infectious Diseases Society of America drew a viewpoint and principles, which would eliminate the "Axis of Evil" It would re-evaluate the clinical approach to chronic Lyme disease diagnosis and treatment and other tick-borne diseases.

Neuroborreliosis and Aggression

Studies show that Lyme disease and other tick-borne diseases contribute to human aggression and violence.

This new knowledge is of potential value to crime and saving lives. On the other hand, the lack of or narrow knowledge can neglect cases of Lyme disease and push them to the late stage. Aggression and violence develop in this last stage. The violent behavior has been described as bizarre and senseless. This is because most lyme neuroborreliosis patients are not violent. Only a few of them have displayed reduced frustration tolerance and irritability. Only in a few and rare cases have there been reported case of explosive anger, reduced empathy, suicidal tendencies, suicide, interpersonal aggressiveness, homicidal tendencies, predatory aggression and homicide.

The use of antibiotics is an effective treatment in combination with psychiatric interventions.

The presence of an infectious disease can be particularly dangerous if the person himself is powerful or influential. Hence, there is a strong need for early and adequate diagnosis and treatment of Lyme disease.

Depression and Suicide and Neuroborreliosis

Depression is more common in Lyme disease than in any other chronic disease.

Psychologically, the patient appears overwhelmed by the massive symptoms of the disease. Most other medical conditions involve only one part or organ system. The patient can still function because his other organ systems are un-affected. But Lyme disease affects the multiple systems. There is no relief even when in recovery because of recurrence. The disappointment, grief, chronic stress and frustration only go on a cycle. In the late state, the patient may also suffer from attention deficit disorder, panic disorder, and obsessive-compulsive disorder. These conduce to the development of depression. The malfunction or dysfunction of normal pathways may also give rise to depression. Neural injury from stroke can lead to neural dysfunction and, in turn, to depression. Effective treatment of the psychiatric syndromes will also improve the Lyme disease condition and prevent more serious consequences, such as suicide, from developing.

Suicidal tenders are also common among Lyme disease sufferers at a third of encephalopathy patients.

Homicidal tendencies registered at 15%. Suicidal tendencies among individuals suffering from chronic illnesses, such as cancer, heart disease and diabetes were fewer.

Tick-Borne Diseases

The culprit is a tick, which delivers harmful microorganisms into the human host, which lead to pulmonary disease.

A high degree of suspicion and recognition of the clinical features of the disease is needed for its successful management. A patient bitten by a tick may be co-infected with two or more pathogens. Prevention involves avoidance. At first presentation of symptoms, differential diagnosis and antibiotic therapy should produce good outcome. Effective therapy for tick-borne diseases also depends on public awareness. An increase in reporting… [END OF PREVIEW]

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