Sunday, May 15, 2022

How Does Lyme Disease Affect The Brain

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History Of The Patient

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The new study focuses on a 69-year-old deceased woman who contracted Lyme disease at age 54. At the onset of her illness, she had a well-documented erythema migrans rash accompanied by severe headache, joint pain and a fever of 104º. Her standard two-tier tests for Lyme disease were positive on ELISA and both IgM and IgG Western blots.

She was prescribed 10 days of doxycycline which resolved her initial symptoms. Two years later, the patient developed many chronic symptoms consistent with late-stage Lyme disease, as well as dementia.

At age 60, the patient was treated with IV ceftriaxone for eight weeks, which led to 60% improvement in cognition and interpersonal engagement. Although oral amoxicillin was continued three times daily for the next six months, her symptoms gradually returned. Further antibiotic treatment with minocycline did not help. All the while her IgG Western blot for Lyme disease remained positive.

Over time, the patients visual, mental and executive functions continued to deteriorate. At age 62, a cerebrospinal fluid study demonstrated a positive Western blot. Unfortunately, a comparison of serum and CSF by a diagnostic ELISA was not performed at that time so she did not meet the full diagnostic criteria for neuroborreliosis.

The authors suggest that the initial symptoms of the woman at age 54 indicate brain involvement at the time of the EM rash, consistent with a mild meningitis early in the disease process.

What Is Lyme Disease

Lyme disease is a bacterial infection you get from the bite of an infected tick. At first, Lyme disease usually causes symptoms such as a rash, fever, headache, and fatigue. But if it is not treated early, the infection can spread to your joints, heart, and nervous system. Prompt treatment can help you recover quickly.

Know How To Remove A Tick

  • If possible, use pointy tweezers
  • Disinfect the tweezers with rubbing alcohol
  • Grab the tick close to the skin and use a slow, steady motion to pull the tick out
  • Disinfect the tweezers again
  • Keep an eye on the bite area
  • Lyme Symptoms: Days 1-30

    Treating an infection within the first 3 weeks is critical to reducing the risk of chronic Lyme disease, which can last for the rest of your life. If the following symptoms appear , seek medical assistance right away.

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    How Does Lyme Disease Affect The Brain

    Lyme disease is a bacterial infection that youcan catch if youve been bitten by an infected deer tick. The first symptoms ofLyme disease, which include a target-shaped rash, fatigue, swollen lymph nodes,muscle aches, and headache, can appear within a few days or weeks. Your doctorcan promptly recognize and diagnose Lyme disease and treat it with antibiotics.But when treatment is delayed, the infection can spread to other areas,including the nerves, liver, and eyes. The infection can also spread to thecentral nervous system – the brain and spinal cord – and cause the problemslisted below.

    Key Points For Healthcare Providers

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  • In patients with facial palsy who are unable to close one or both eyes, eye drops or an eye patch may be needed to prevent dry eyes.
  • Neurologic symptoms do not necessarily indicate central nervous system infection in a patient with Lyme disease.
  • Two-step serologic testing for Lyme disease is the recommended diagnostic test for neurologic Lyme disease.
  • Cerebral spinal fluid analysis is not necessary to diagnose Lyme meningitis, but can help exclude other causes of illness, such as bacterial meningitis.
  • Consider Lyme radiculoneuritis in patients who report severe limb or truncal radicular pain without preceding trauma who live in or who have traveled to Lyme-endemic areas.
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    Personal Health When Lyme Invades The Brain And Spinal System

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    A YOUNG woman, whose doctor declined to identify her, thought she was going crazy. Suddenly, this once perfectly healthy college freshman developed severe anxiety, panic attacks, insomnia and loss of appetite.

    A doctor and a psychologist at her college’s health service recommended rest for what they thought were problems in adjusting to being away from home. Forced to take a medical leave, she underwent an extensive examination that showed no abnormalities except one: evidence in her spinal fluid of infection by the spirochete Borrelia burgdorferi, which causes Lyme disease. Only then did she recall having had a circular rash characteristic of Lyme disease months earlier, followed by a brief bout of headaches and unusual fatigue. At the time, she did not take these symptoms seriously and did not seek medical attention.

    The young woman’s case is among dozens reported in which the Lyme spirochete was the apparent cause of a wide range of psychiatric and neurological problems. Three months after receiving a six-week course of intravenous antibiotics to eradicate the spirochete, the woman felt better. But a year later more therapy was needed when the anxiety and panic attacks returned, along with musical hallucinations, deja vu experiences and obsessional thoughts.

    Chronic Lyme And Mental Health

    The CDC lists having a chronic disease as a risk factor for developing mental illness. This underscores the reality that even for patients who do not develop neurological Lyme disease, the experience of Lyme disease alone can cause or exacerbate mental health problems like depression, anxiety, and others listed above.

    Getting diagnosed and treated for Lyme disease can be stressful and exhausting, especially the longer this process takes which, for many, can be several years. Patients often must deal with conflicting or inaccurate diagnoses, lack of support from health care professionals, and exorbitant medical bills, all while battling physically and mentally debilitating symptoms with no end in sight. This experience can lead to a drastic reduction in quality of life that creates the perfect conditions for mental illness.

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    Keeping It In Perspective

    Its relatively uncommon for Lyme disease to cause brain effects. When Lyme disease does result in or problems with thinking and emotions, there are treatments that can help. Its also important to remember that only a very small portion of cognitive or psychiatric conditions are due to Lyme disease. In any case, talk with your doctor about identifying the cause of your problems and the treatment thats right for you.

    What Causes Lyme Disease

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    Lyme disease is caused by bacteria. In the United States, this is usually a bacterium called Borrelia burgdorferi. It spreads to humans through the bite of an infected tick. The ticks that spread it are blacklegged ticks . They are usually found in the

    • Northeast
    • Upper Midwest
    • Pacific coast, especially northern California

    These ticks can attach to any part your body. But they are often found in hard-to-see areas such as your groin, armpits, and scalp. Usually the tick must be attached to you for 36 to 48 hours or more to spread the bacterium to you.

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    What Are The Symptoms Of Lyme Disease

    Early symptoms of Lyme disease start between 3 to 30 days after an infected tick bites you. The symptoms can include

    • A red rash called erythema migrans . Most people with Lyme disease get this rash. It gets bigger over several days and may feel warm. It is usually not painful or itchy. As it starts to get better, parts of it may fade. Sometimes this makes the rash look like a “bull’s-eye.”
    • Fever
    • Muscle and joint aches
    • Swollen lymph nodes

    If the infection is not treated, it can spread to your joints, heart, and nervous system. The symptoms may include

    • Severe headaches and neck stiffness
    • Additional EM rashes on other areas of your body
    • Facial palsy, which is a weakness in your facial muscles. It can cause drooping on one or both sides of your face.
    • Arthritis with severe joint pain and swelling, especially in your knees and other large joints
    • Pain that comes and goes in your tendons, muscles, joints, and bones
    • Heart palpitations, which are feelings that your heart is skipping a beat, fluttering, pounding, or beating too hard or too fast
    • Shooting pains, numbness, or tingling in the hands or feet

    Treating Neurological Lyme Disease

    Though neurological and psychiatric symptoms can be reduced with antibiotic treatment, emotional and cognitive problems arising from late-stage or chronic Lyme often call for a broader range of interventions. This includes lifestyle changes in such areas as diet, exercise, and environment.

    Again, its worth reiterating that the longer an infection goes undetected, the harder it is to treat, and the more likely it is that symptoms will require multi-pronged, multi-system interventions besides antibiotics alone.

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    Rnascope Is A Sensitive Technique For Finding Viable Pathogen But Requires Freshly Prepared Tissue

    Figure 8. Validation of RNA integrity on Fresh frozen NHP frontal cortex brain tissue using RNAscope assay. NHP tissue was stained with a 3-plex positive control probe POLR2A targeting DNA-directed RNA polymerase II RPB1, PPIB targeting cyclophilin B, and UBC that targets Ubiquitin C. In terms of relative expression levels, UBC is highest, PPIB is considered a moderate-high, POLR2A is moderate-to low expressor target. Successful staining has 49 dots per cell of PPIB/POLR2A and UBC of 1015 dots per cell. PPIB is considered a standard to determine the RNA quality of brain samples. Represents red fluorescence, indicating the specificity of PPIB, whereas, displays a far-red puncta targeting UBC gene. Absence of POLR2A signal in represents, quality of RNA being partially compromised. A merge image of all the channels can be seen in . White arrows were pointing toward the fluorescence puncta and orange arrows toward autofluorescence of the tissue.

    The Patient Harbored Borrelia in the Amygdala and Spinal Cord

    Tissue slices adjacent to the autopsy tissue specimens that were positive for DNA were stained for the presence of persisters. For this, slides were stained with the primary rabbit polyclonal antiB. burgdorferi antibody and a goat anti-rabbit IgG-Alexa Fluor 488 secondary antibody. An intact Borrelia spirochete with the expected morphology was identified within fixed tissue of the spinal cord . The spirochete appeared to be adjacent to vasculature.

    The Role Of Coinfections

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    Ticks carry more diseases than just Lyme and TBRF, and its not uncommon for patients to be infected with more than one type of disease-causing bacteria.

    Common coinfections such as Babesiosis and Bartonellosis can not only cause neurological and psychiatric symptoms of their own, but they can also complicate the diagnostic process, delaying proper diagnosis and treatment all of which increase the risk of developing emotional, behavioral, or cognitive problems from the infection.

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    What Kinds Of Neurological Problems Can Be Caused By Lyme Disease

    Dr. John J. Halperin responds:

    The typical starting point of Lyme disease is a bite by a small hard-shelled tick. The wound often goes unnoticed because ticks are small and inject local anesthesia when they bite. The hallmark sign of the disease is a red skin rash called erythema migrans. The rash can appear any time within the first 30 days after the bite. When an infected tick bites, it can inject Lyme bacteria into the skin. As the bacteria spread from that primary site, they may cause flu-like symptoms, including a low-grade fever, aches and pains, and a .

    What happens next depends on where in your body the bacteria go and how you react to them. About 10 percent of infected people will get meningitis, which can include a severe headache with flu-like symptoms. If left untreated, this bacterial infection can cause loss of muscle tone on one or both sides of the face . Between 5 and 10 percent of people will experience pain in the distribution of a nerve root either in a limb or in the chest and abdomen. This feels similar to when you get a in your neck or back, except with Lyme disease, the pain is due to inflammation instead of pinching. Also, patients with a Lyme infection that has been left untreated for many months or even years can get arthritis.

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    Posttreatment Lyme Disease Syndrome

    Posttreatment Lyme disease syndrome has been defined as the presence of any of: widespread musculoskeletal pain, cognitive complaints, radicular pain, paresthesias, or dysesthesias interfering with function within 6 months after initial diagnosis and treatment and persist for at least 6 months . The symptoms overlap extensively with those of Lyme encephalopathy, differing primarily by the requirement that encephalopathy occur in patients with active extraneurologic infection, whereas PTLDS patients have already been appropriately diagnosed with and treated for Lyme disease. Such symptoms are often present immediately after treatmentas they may be following treatment of other infectionsand usually resolve over time. PTLDS is diagnosed when symptoms persist for 6 or more months.

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    Why And How Lyme Disease And Tbrf Affect Mental Health

    Lyme disease and TBRF can wreak havoc on a patients mental health in the following ways:

    • Direct effects As with syphilis, the bacteria that causes Lyme disease and TBRF can invade the central nervous system and cause neurological and psychiatric symptoms that are organic in origin. This is what doctors call neurological Lyme disease or Lyme neuroborreliosis.
    • Indirect effects The discomforts and challenges of living with and/or being treated for Lyme disease or TBRF can lead to anxiety, depression, and other mental health conditions that are not necessarily caused by the bacteria, but are indirectly caused or exacerbated .

    Of course, these effects are not either/or, but rather can coexist and compound one another. Learn more about each below.

    How Is Lyme Disease Diagnosed

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    It can be hard for doctors to diagnose Lyme disease because:

    • The tick bites and rash might not be noticed.
    • Many early symptoms seem like the flu or other illnesses.
    • Blood tests are not always accurate, especially early in the illness.

    Doctors can diagnose early Lyme disease if they see a tick bite and rash. Blood tests usually aren’t helpful in the first month of Lyme disease.

    To diagnose late Lyme disease, doctors:

    • Ask about symptoms.
    • Do blood tests that look for signs of Lyme disease.

    Depending on the symptoms, doctors might order other tests, such as a spinal tap, which looks at the fluid around the brain and spinal cord.

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    What Are The Treatments For Lyme Disease

    Lyme disease is treated with antibiotics. The earlier you are treated, the better it gives you the best chance of fully recovering quickly.

    After treatment, some patients may still have pain, fatigue, or difficulty thinking that lasts more than 6 months. This is called post-treatment Lyme disease syndrome . Researchers don’t know why some people have PTLDS. There is no proven treatment for PTLDS long-term antibiotics have not been shown to help. However, there are ways to help with the symptoms of PTLDS. If you have been treated for Lyme disease and still feel unwell, contact your health care provider about how to manage your symptoms. Most people do get better with time. But it can take several months before you feel all better.

    Neurological And Psychiatric Issues Associated With Lyme Disease And Tbrf

    Home » Tick Talk » Neurological and Psychiatric Issues Associated with Lyme Disease and TBRF

    Chronic illness often has significant impacts on mental health, and Lyme disease is no different. With the accuracy and sensitivity of todays recommended Lyme testing still so lacking, many Lyme patients have to wait too long to get accurate diagnoses and treatment. To compound this problem, many patients with Lyme-like symptoms are not even tested for the similar, but biologically distinct, Tick-Borne Relapsing Fever . That gives infections time to spread throughout the body and cause neurological and psychiatric symptoms.

    This article will outline the direct and indirect effects that Borreliosis both Lyme disease and TBRF can have on mental health, including how and why untreated Lyme can develop into neurological Lyme disease.

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    Relationship Of Ptlds And Chronic Lyme Disease To B Burgdorferi Infection

    The key questions concerning these 2 entities are whether they truly exist, and if they do, what might the underlying mechanism be? With regard to the existence of PTLDS, 30% or more of patients treated for Lyme disease may report persisting, subjective posttreatment symptoms. However, several controlled trials have shown that identical symptoms are equally common in patients without Lyme disease . The few studies suggesting relatively more frequent subjective symptoms following treated Lyme disease show no increase in corroborating objective abnormalities . Studies of the general population indicate that up to a third of the normal, healthy population experiences the same symptoms to a varying degree , the same frequency as that found in the control populations of Lyme disease posttreatment studies. In the absence of any objective evidence of disease in these treated patients, and given that the identical symptoms are equally prevalent in control individuals, it seems plausible that the entity PTLDS is simply an example of anchoring bias. Patients who have been treated successfully for Lyme disease and subsequently experience common symptoms that they have heard are attributable to PTLDS incorrectly conclude that these nonspecific symptoms are indeed the sequelae of B. burgdorferi infection, perpetuating the notion of this construct.

    Misdiagnosis And Delayed Treatment

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    The fortunate ones are able to catch Lyme within the first few weeks when the appropriate antibiotics have a much better chance of working. Unfortunately, Lyme disease is often missed and the infection is allowed to take hold, disrupting the immune system and causing a cascade of inflammatory responses.

    Even when Lyme is suspected and a blood test is ordered, the common Western Blot test often results in false negatives while Lymes co-infection antibodies are rarely even looked for, although they may even be more common than Lyme itself! Its not uncommon for someone with Lyme to receive multiple negative test results before achieving a proper diagnosis. This leaves thousands of undiagnosed patients sick and confused, spending months, years, or even decades wandering around from doctor to doctor, trying to find out what is wrong with them. Ineffective testing methods combined with inadequate insurance coverage mean that people with Lyme often encounter financial ruin before a cure.

    After 3-6 months in the body, Lyme has taken hold of the immune system and becomes difficult to eradicate with antibiotics alone. A study published in 2012 showed that Lyme disease has tenacious survival skills. Inside the body, the Borrelia organism forms a biofilm, which allows it to constantly rearrange its structure, hide, and resist environmental conditions such as antibiotics.

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