BORRELIOOSI/RASKAUS

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Duodecim: ... Borreliabakteeri voi myös levitä sikiöön ja johtaa sikiön kuolemaan [/size]

http://www.duodecimlehti.fi/web/guest/e ... ku_p_auth=

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1. "Äiti sairastui borrelioosiin ja sai penisilliiniä raskauden ensimmäisen kolmanneksen aikana. Siitä huolimatta vastasyntynyt sairastui ja eli vain 23 tuntia synnytyksen jälkeen. Lapsen aivoista ja maksasta löytyi borreliabakteereita."

Artikkeli löytyy kokonaisuudessaan esim. seuraavalta sivulta: http://actionlyme.org/Congenital_Brain_ ... _Death.htm

2. "Mikä tahansa infektiotauti saattaa tarttua äidistä sikiöön. Tri Gardner suoritti laajan tutkimuksen (kirjallisuuskatsauksen v. 1998) ja löysi 263 raportoitua tapausta joissa äiti sairasti borrelioosia raskauden aikana. Näistä tapauksista 25 %:ssa ilmeni ongelmia; 8 % sikiöistä kuoli, 2 % kuoli syntyessään, 15 % syntyi elävänä, mutta lapsilla oli synnynnäisiä vikoja tai sairauksia. Antibioottihoitoa saaneiden äitien lapsista 85 % oli normaaleja, mutta hoitoa vaille jääneiden äitien lapsista vain 33 % oli normaaleja."

Koko artikkeli: http://www.geocities.com/playpub/TR-HH.htm
Weber K; Bratzke HJ; Weber K;Neubert U; Wilske B; Duray PH.

Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy.

Pediatric Infectious Disease Journal, 1988. 7:286-9

"We now demonstrate B. burgdorferi in the brain and liver of a newborn whose mother had been treated with oral penicillin for LB [Lyme borreliosis] during the first trimester of pregnancy. ...The death of the newborn was probably due to a respiratory failure as a consequence of perinatal brain damage

borrelioosi

[borrelioosi]

Unkarissa löydettiin ensimmäiset borrelioositapaukset 25 v. sitten. He ovat tutkineet myös borrelioosia sairastavia äitejä. Sellaisilla äideillä jotka eivät saaneet raskauden aikana hoitoa borrelioosiin, esiintyi normaalia enemmän raskauskomplikaatioita. (Unkari 2009)[/b]

Orv Hetil. 2009 Apr 19;150(16):725-32. [Lyme borreliosis - lessons learnt from 25 years.] [Article in Hungarian] Lakos A. Kullancsbetegsegek Ambulanciaja Budapest Visegradi u. 14. 1132.

We recognized the first Hungarian Lyme patients just 25 years ago, in 1984. Itwas exactly 20 years ago, when we opened the Lyme Disease Outpatient Service atthe Central (Laszlo) Hospital for Infectious Diseases. 15 years ago weestablished the financially independent Center for Tick-borne Diseases. Themilestones of this work at the Center for Tick-borne Diseases are thedescription of a new tick-borne rickettsial illness (tick-bornelymphadenopathy), development of a Lyme immunoblot kit and an automatedimmunoblot reader. We described a simple and reliable method for detection ofintrathecal borrelia antibody synthesis which is necessary for the diagnosis ofneuroborreliosis. We also developed and routinely apply the comparativeimmunoblot assay for the evaluation of serological progression and/orregression, which can help the clinicians to decide whether a serologicalreaction is resulted from a previous healed or an active borrelia infection. [
b]We studied the pregnancy outcome of borrelia infected mothers and provided that untreated borrelia infection is associated with higher chance of adversepregnancy outcome[/b].

Publication Types:English Abstract PMID: 19362925 [PubMed - in process]

Borrelia duttoniin aiheuttama infektio on tavallinen Afrikan maissa. Se aiheuttaa jatkuvasti lukuisia raskauskomplikaatioita, raskauden keskeytymisiä ja sikiöiden kuolemia. Seuraavan tutkimuksen mukaan spirokeetat kykenivät toistuvasti läpäisemään istukan. Seurauksena oli sikiön synnynnäinen infektio.

Toisintokuume (Febris recurrens, engl. relapsing fever) on Borrelia recurrentis -spirokeetan aiheuttama sairaus, jossa on noin viikon välein toistuvia kuumevaiheita. Euroopassa sekä muualla lauhkean ja arktisen alueen maissa se on esiintynyt tavallisesti vaatetäiden (Pediculus vestimenti) levittäminä epidemioina.

...http://www.saunalahti.fi/arnoldus/typh_rec.html Ensimmäiset varmat toisintokuumetapaukset Suomessa todettiin vuonna 1866 Hämeenlinnassa, jonne tauti oli tullut venäläisten kasakoiden mukana Etelä-Venäjältä. Tauti levisi Suomenlinnaan ja Helsinkiin jo samana vuonna. Erityisen runsaasti toisintokuumetta oli vuonna 1868. Epidemia lakkasi 1870-luvun alussa, mutta uusi aalto ilmaantui vuosina 1876 ? 1877. Seuraavat epidemiat todettiin vuosina 1917 ja 1918, mutta sen jälkeen tautia ei ole esiintynyt Suomessa.

Epideeminen toisintokuume alkaa keskimäärin viikon kuluttua tartunnasta, mutta itämisaika voi olla 2 ? 15 vrk. Tauti puhkeaa äkillisellä korkealla kuumeella, johon liittyy vilutusta, voimakasta päänsärkyä, lihas- ja nivelkipuja, sydämen lyönnin nopeutumista ja ensimmäisenä päivänä hikoiluvaiheita. Muina oireina esiintyy pahoinvointia, oksennuksia, silmien valonarkuutta, huimausta ja toisinaan nenäverenvuotoja. Alkuvaiheessa iholla on punoitusta ja myöhemmin vartalolle ja rajojen alueelle voi ilmaantua punoittavia läiskiä. Lisäksi voi esiintyä keltaisuutta kuumeen aikana ja varsinkin sen jälkeen, jolloin myös maksa on usein laajentunut. Korkean kuumeen yhteydessä on usein huimausta ja tajunnan sekavuutta. Unettomuus on yleinen oire ja lisäksi esiintyy kosketustunnon yliherkkyyttä. Ruokahaluttomuus on tavallista, samoin ummetus, mahakivut ja verenvuodot ruoansulatuskanavasta.

Kuumevaihe kestää tavallisesti viikon, joskus vain muutaman päivän tai 10 ? 14 päivää. Sen jälkeen kuume laskee nopeasti normaaliksi ja silloin esiintyy voimakasta hikoilua. Kuumeetonta aikaa kestää 3 ? 7 päivää ja sen jälkeen seuraa uusi kuumevaihe, joka on usein ensimmäistä lievempi, mutta se voi olla myös vaikeampi. Sitä voi seurata kuumeettoman väliajan jälkeen vielä yksi tai pari kuumevaihetta, jotka ovat yleensä edellisiä lievempiä. Taudista toipuminen voi kestää hoitamattomana 6 ? 8 viikkoa. Lisätauteina voi esiintyä keuhkokuumeita, silmä- ja korvatulehduksia, imusolmukkeiden ja sylkirauhasten tulehduksia, niveltulehduksia ja munuaistulehduksia. Pysyvinä haittoina voi jäädä halvauksia tai muita hermostollisia oireita. Kuolleisuus toisintokuumeessa on ollut hoitamattomissa tapauksissa 2 ? 10 %, lapsilla, vanhuksilla, heikoilla ja aliravituilla jopa 50 ? 60 %. .....


http://www.ncbi.nlm.nih.gov/entrez/quer ... &DB=pubmed

J Infect Dis. 2006 Nov 15;194(10):1367-74. Epub 2006 Oct 3.

Complications of pregnancy and transplacental transmission of relapsing-Fever borreliosis.

* Larsson C,
* Andersson M,
* Guo BP,
* Nordstrand A,
* Hagerstrand I,
* Carlsson S,
* Bergstrom S.

Department of Molecular Biology, Umea University, Umea, Sweden.

Relapsing-fever borreliosis caused by Borrelia duttonii is a common cause of complications of pregnancy, miscarriage, and neonatal death in sub-Saharan Africa. We established a murine model of gestational relapsing fever infection for the study of the pathological development of these complications. We demonstrate that B. duttonii infection during pregnancy results in intrauterine growth retardation, as well as placental damage and inflammation, impaired fetal circulation, and decreased maternal hemoglobin levels.

We show that spirochetes frequently cross the maternal-fetal barrier, resulting in congenital infection. Furthermore, we compared the severity of infection in pregnant and nonpregnant mice and show that pregnancy has a protective effect. This model closely parallels the consequences of human gestational infection, and our results provide insight into the mechanisms behind the complications of pregnancy that have been reported in human relapsing-fever infection.


PMID: 17054065 [PubMed - in process]

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Tutkimuksen mukaan raskaudenaikainen borrelioosi ei ole harvinaista. Sairaus saattaa aiheuttaa sekä sikiölle että vastasyntyneelle ongelmia. Yksittäisissä tutkimuksissa bakteerin on todettu aiheuttaneen ongelmia sikiölle ja/tai vastasyntyneelle, mutta asiasta ei ole selkeää laajempaa kausaalista näyttöä. Äidille raskauden aikana annettu antibioottihoito näyttäisi olevan suhteellisen tehokas tapa suojella sikiötä/vastasyntynyttä borrelioosilta.


http://www.medscape.com/medline/abstract/17176487

Lyme disease in pregnancy: case report and review of the literature.

Obstet Gynecol Surv. 2007; 62(1):41-50 (ISSN: 0029-7828)
Walsh CA; Mayer EW; Baxi LV
Department of Obstetrics and Gynecology, Columbia University Medical Center at the New York Presbyterian Hospital, New York, New York 10032, USA.

Lyme disease is the most common vector-borne disease in the United States. A number of other spirochetal diseases, if contracted in pregnancy, have been shown to cause fetal harm and there is concern over a similar effect with gestational borreliosis. Previously published individual case reports have suggested a possible association between gestational borreliosis and adverse pregnancy outcome; however, no specific pattern of teratogenicity has been shown, and a causal relationship has never been proven. In addition, larger epidemiological and serological series have consistently failed to demonstrate an increased risk to pregnant women who develop Lyme disease if they receive appropriate antimicrobial therapy. We describe a favorable outcome in a 42-year-old woman who developed Lyme disease in the third trimester and was treated with a full course of oral amoxicillin. In addition, we offer a review of the relevant literature regarding Lyme disease and pregnancy. The appropriate investigation and management of a woman with gestational borreliosis are discussed.

TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that Lyme disease is not an uncommon disease during pregnancy and can occur in states outside of the Northeast, explain that the diagnosis is made clinically and may be confirmed by laboratory tests, state that treatment is recommended during pregnancy, and summarize that there is no consistent data of adverse fetal effects even though the placenta is infected.

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Seuraavalta sivulta löytyy muutamia videoita borrelioosiin sairastuneista ihmisistä esim englantilaisen Wendyn tarina. Hän halvaantui alaraajoistaan ja on nyt pyörätuolissa. Wendy synnytti jokin aika sitten poikalapsen. Lapsella todettiin borrelioosi, mutta poika on tällä hetkellä oireeton.

http://www.youtube.com/watch?v=llFR2kJF ... ed&search=

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Useita tutkimuksia joissa käsitellään borrelioosin tarttumista äidistä lapseen

http://www.ncbi.nlm.nih.gov/sites/entre ... me=Related Articles&IdsFromResult=4003991&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

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Lääketieteellinen artikkeli v. 1990:

Lapsuusiän borrelioosi Euroopassa.

"Synnynnäinen borrelioosi on mahdollista... sairaus etenee todennäköisesti useimmiten oireettomana... laboratoriotestit voivat olla virheellisesti negatiivisia taudin varhaisvaiheessa ja hoidon jälkeen... tauti paranee useimmilla riittävällä antibioottihoidolla mutta ei auta välttämättä kaikkia.."

Eur J Pediatr. 1990 Sep;149(12):814-21.

Childhood Lyme borreliosis in Europe.
Huppertz HI.

Children's Hospital, University of Würzburg, Federal Republic of Germany.

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.

PMID: 2226564 [PubMed - indexed for MEDLINE]

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Mikä tahansa taudinaiheuttaja jonka äiti saa raskauden aikana voi tarttua myös sikiöön (suom. huom. todennäköisesti myös äidin jo olemassaolevat infektiot). Lääkäri Tessa Gardner on tutkinut ja kirjoittanut aiheesta. Hän arvioi, että USA:ssa esiintyy n. 40 synnynnäistä borrelioositapausta vuosittain. Gardnerin tekemän selvityksen mukaan 263 tapauksesta 25 %:ssa todettiin ongelmia, esim. sikiön tai vastasyntyneen kuolema, 15 %:lla esiintyi erilaisia epämuodostumia.

Antibioottihoidolla oli merkittävä vaikutus raskaudenkulun ennusteeseen. Mikäli äiti/vastasyntynyt sai antibioottihoitoa epänormaaleja tapauksia esiintyi 15 %:lla. Hoitoa vaille jääneissä tapauksissa erilaisia ongelmia esiintyi 67 %:lla. Ennuste on siis melko hyvä mikäli infektio diagnosoidaan ja hoidetaan ajoissa.


http://www.medscape.com/viewarticle/418440

Gestational and Congenital Lyme Disease

Any infectious disease contracted during pregnancy has the potential to be transmitted to the fetus.

Tessa D. Gardner, MD,[10] of Washington University School of Medicine,who has recently written an extensive chapter on the subject,[11] discussed the rare conditions of gestational and congenital Lyme disease (borreliosis) and the best approaches (based on limited case reports) to diagnosis and treatment.

How rare are these conditions? According to published figures, 16,000-17,000 cases of Lyme disease are reported each year in the United States. Roughly 8000 cases are in women, and approximately 1200-3400 cases are in women of childbearing age (20-49 years old).

Dr. Gardner did some back-of-the envelope estimates to get a sense of how many cases of gestational Lyme disease may be occurring. If you assume that one quarter of the women in the child-bearing age group are pregnant (a gross overestimate, by Dr. Gardner's admission), and that 10% are either untreated or inadequately treated, and that one fifth transmit the organism to the fetus or newborn, this calculates to approximately 40 cases of congenital Lyme disease a year in the United States. It would be unusual for any large city to have more than 1 or 2 cases a year, and it would be extremely rare for any physician to see more than a few cases in a lifetime.

Dr. Gardner has conducted an extensive literature review (through 1998) that turned up 263 cases.[10] She found that 25% resulted in adverse outcomes: 8% resulted in fetal death and 2% in neonatal death. Fifteen percent of the babies were liveborn but were ill or had an abnormality. The effect of antibiotic therapy was dramatic in these patients: with antibiotics, 85% of neonates were normal, while 15% had an adverse outcome. In striking contrast, without antibiotics, only 33% were normal, while 67% had an adverse outcome. The conclusion: Proper, prompt diagnosis and antibiotic therapy are vital for healthy neonates born with congenital Lyme disease.

However, it can be quite difficult to recognize such a rare disease. The differential diagnosis is extensive and includes sepsis/meningoencephalitis (bacterial or viral), other congenital infectious diseases (eg, syphilis, leptospirosis, relapsing fever, toxoplasmosis), congenital heart or bone disease, inherited or infectious immunodeficiency, sudden infant death syndrome, and more. A history suggestive of Lyme disease in the mother or positive serologic or other tests for B burgdorferi can suggest the diagnosis. Dr. Gardner has provided a list of clues to the various presentations of congenital Lyme disease (Table). One interesting radiologic clue is "celery stalking" -- lucent metaphyseal bands -- on the long bones of the neonate. These are occasionally seen in infants with gestational syphilis or viral infections. In 2 neonates Dr. Gardner has treated, the bands disappeared shortly after treatment.

Table. Signs and Symptoms of Congenital Lyme Borreliosis

Stage
Mild Early
Severe Early
Late

Onset
Usually first 2 weeks of life
Usually first week of life
Usually > 2 wks and < 2 yrs of age

Maternal gestational Lyme borreliosis
Usually first or second trimester
Usually first or second trimester
Usually second or third trimester

Signs and symptoms
Mild suspected sepsis or meningoencephalitis
Hyperbilirubinemia
Adenopathy
Rash
Intrauterine growth retardation
Miscellanous anomalies (eg, genitourinary [GU], skeletal, cardiac)

Severe suspected sepsis or meningoencephalitis
Respiratory distress
Perinatal death
Intrauterine growth retardation
Fever
Rash
Adenopathy, hepatosplenomegaly
Hyperbilirubinemia
Miscellaneous anomalies (eg, GU, skeletal, cardiac)
Subacute illness
Developmental delay/meningoencephalitis
Growth retardation/failure to thrive
Prematurity
Fever
Adenopathy
Rash
Hepatosplenomegaly
Miscellaneous anomalies (eg, GU, skeletal, cardiac)

Prematurity?
< 4 weeks
< 5 weeks
--


The prognosis for gestational Lyme disease is good if diagnosed and treated adequately. The prognosis for neonates with early congenital Lyme disease depends on prompt diagnosis, especially in severe early cases. Similarly, the prognosis in late congenital Lyme depends not only on prompt diagnosis and treatment, but also on the extent of irreversible damage present at the time of diagnosis. Long-term follow-up is important for detecting possible recurrence of disease.

This summer, Dr. Gardner will be starting the North American Gestational and Congenital Lyme Disease Watch to evaluate the relationship of various factors (clinical and laboratory characteristics, antibiotic regimens) to outcomes for gestational Lyme disease, and to evaluate short- and long-term outcomes (infants, stillborns, miscarriages) of pregnancies complicated by Lyme disease and develop clinical and laboratory case definitions of these outcomes. Interested people (physicians and affected women) can enroll on the Internet once the sites are launched in July 2001:

www.LymeInPregnancy.org

www.GestationalLyme.org

www.CongenitalLyme.org

References



9. Fried M. Gastrointestinal manifestations of Lyme disease. Program and abstracts of the 14th International Scientific Conference on Lyme Disease and Other Tick-Borne Disorders; April 21-23, 2001; Hartford, Connecticut.

10. Gardner T. Lyme disease in pregnancy. Program and abstracts of the 14th International Scientific Conference on Lyme Disease and Other Tick-Borne Disorders; April 21-23, 2001; Hartford, Connecticut.

11. Gardner T. Lyme disease. In: Remington J, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. Philadelphia, Pa: WB Saunders; 2001: 519-641.

Suggested Reading
MacDonald AB. Gestational Lyme borreliosis. Implications for the fetus. Rheum Dis Clin North Am. 1989;15:657-677. Abstract available at: http://www.ncbi.nlm.nih.gov/entrez/quer ... d=Retrieve &db=PubMed&list_uids= 2685924&dopt=Abstract

Maraspin V, Cimperman J, Lotric-Furlan S, et al. Treatment of erythema migrans in pregnancy. Clin Infect Dis. 1996;22:788-793. Abstract available at: http://www.ncbi.nlm.nih.gov/entrez/quer ... d=Retrieve &db=PubMed&list_uids= 8722932&dopt=Abstract

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Kahdeksan koiranpentua 12:sta oli synnynnäisesti borreliapositiivisia. Pennut testattiin viikon kuluttua syntymästä.

Vet Ther. 2008 Fall;9(3):184-91.

Effect of passive immunoglobulin transfer on results of diagnostic tests for antibodies against Borrelia burgdorferi in pups born to a seropositive dam.

Eschner AK.

Merial Limited, 4 Pepper Place, Gansevoort, NY 12381, USA.

The event that 8 of 12 pups born to a Lyme borreliosis-positive dam tested positive on a commonly used in-hospital Lyme borreliosis test kit at 1 week of age prompted breeder concern about the possibility and implications of transplacental Lyme borreliosis infection. Almost 2 weeks after the initial serologic test results were obtained, blood was collected from the puppies for comprehensive testing. Assessment of the findings indicate the possibility that passive transfer of maternally derived antibody to the in vivo expressed C6 peptide of Borrelia burgdorferi can temporarily render pups serologically positive for antibodies on the in-hospital C6 Lyme borreliosis antibody test kit when the test is run on very young animals.


Publication Types:
Research Support, Non-U.S. Gov't

PMID: 19003779 [PubMed - in process]

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"Raskaana olevien tulee poistaa ihossaan oleva punkki välittömästi, profylaktista antibioottihoitoa ei suositella - paremminkin "odota ja katso" - strategia, hoito aloitetaan heti mikäli oireita ilmenee tai esim. ihomuutos. Hoidoksi keftriaksonia 2 g päivittäin 14 päivän ajan." (Slovenia 2009)

Curr Probl Dermatol. 2009;37:183-190. Epub 2009 Apr 8.

How Do I Manage Tick Bites and Lyme Borreliosis in Pregnant Women?

Maraspin V, Strle F. Department of Infectious Diseases, University Medical Center Ljubljana,Ljubljana, Slovenia.

In this report, we present basic data pertinent to the current understanding ofborrelial infection in pregnancy, and propose a rationale for the management ofLyme borreliosis in pregnant women. We advocate early detection of attachedticks and their prompt removal. We do not recommend the use of prophylacticantibiotics in pregnant women but support the 'wait and watch' strategy,including early treatment with antibiotics if signs/symptoms of the diseasearise. We encourage the approach that antibiotic treatment of pregnant patientsis restricted to those having a reliable clinical diagnosis of Lyme borreliosis,and propose intravenous antibiotic treatment with penicillin, or preferably ceftriaxone 2 g daily for 14 days, not only for patients with early disseminateddisease but also for those with solitary erythema migrans.



Copyright (c) 2009 S.Karger AG, Basel. PMID: 19367103 [PubMed - as supplied by publisher]

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Tapausselostus: Todennäköinen synnynnäinen babesioosi vastasyntyneellä.

Volume 15, Number 5?May 2009
Dispatch

Probable Congenital Babesiosis in Infant, New Jersey, USA

Sonia Sethi, David Alcid, Hemant Kesarwala, and Robert W. Tolan, Jr.
Author affiliations: The Children's Hospital at Monmouth Medical Center, Long Branch, New Jersey, USA (S. Sethi); Saint Peter's University Hospital, New Brunswick, New Jersey, USA (D. Alcid, H. Kesarwala, R.W. Tolan, Jr.); Robert Wood Johnson Medical School, New Brunswick (D. Alcid); and Drexel University College of Medicine, Philadelphia, Pennsylvania, USA (H. Kesarwala, R.W. Tolan, Jr.)

Suggested citation for this article

Abstract
Only 2 neonates with transplacentally or perinatally acquired (congenital) babesiosis have been reported. We describe a probable third congenital case of babesiosis in a 26-day-old infant; transmission was determined on the basis of a blood smear from the infant (15% parasitemia) and serologic results from the infant and mother.

Victor Babes first described the pathogen of babesiosis in 1888 (1). Babesiosis is a tick-borne malaria-like illness transmitted by the same Ixodes spp. ticks that transmit Borrelia burgdorferi (2). It is endemic to the northeastern and northwestern United States and also occurs in Europe and parts of Asia. Babesiosis is an intraerythrocytic parasitic infection that ranges from subclinical to severe (possibly fatal) disease with fever, thrombocytopenia, hemolytic anemia, and hyperbilirubinemia. Appropriate antimicrobial drug therapy, transfusion, and exchange transfusion remain the mainstays of treatment.

free full text continues at this url: http://www.cdc.gov/eid/content/15/5/788.htm

Babesiosis occurs rarely among neonates, although it is gaining increasing attention as an emerging tick-borne zoonosis. In 1987, Esernio-Jenssen et al. (3) reported an apparent case of transplacentally or perinatally transmitted congenital babesiosis. In 1997, New et al. (4) reported another case. We describe a third case of probable congenital babesiosis in a 26-day-old infant with 15% parasitemia. She was treated successfully with atovaquone (Mepron; GlaxoSmithKline, Research Triangle Park, NC, USA) and azithromycin (Zithromax; Pfizer, New York, NY, USA).

[soijuv]

Alla on esitetty useita tutkimuksia joissa borreliabakteerin todetaan voivan aiheuttaa raskauden aikana erilaisia komplikaatioita; sikiökuoleman, vesipäisyyden, hengitysvaikeuksia, liiallista bilirubiinin esiintymistä, kasvun heikkenemistä, sokeutta, kätkytkuolemaa, äidin toksemiaa jne.


Gestational Lyme borreliosis. Implications for the fetus.
MacDonald AB.
Rheum Dis Clin North Am, 15(4):657-77. 1989.

Autopsy and clinical studies have associated gestational Lyme borreliosis with various medical problems including fetal death, hydrocephalus, cardiovascular anomalies, neonatal respiratory distress, hyperbilirubinemia, intrauterine growth retardation, cortical blindness, sudden infant death syndrome, and maternal toxemia of pregnancy.

Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy.
Weber K, Bratzke HJ, Neubert U, Wilske B, Duray PH.
Pediatric Infectious Disease Journal, 7:286-9. 1988.
We have found B. burgdorferi in human neonatal brain and liver although the mother had been treated with an orally administered penicillin for LB during early pregnancy.

Congenital infections and the nervous system.
Bale JF Jr, Murph JR.
Pediatr Clin North Am Aug;39(4):669-90 1992

Despite vaccines, new antimicrobials, and improved hygienic practices, congenital infections remain an important cause of death and long-term neurologic morbidity among infants world-wide. In addition, several other agents, such as the varicella zoster virus, human parvovirus B19, and Borrelia burgdorferi, can potentially infect the fetus and cause adverse fetal outcomes.

Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi.
Schlesinger PA, Duray PH, Burke BA, Steere AC, Stillman MT.
Ann Intern Med. 1985 Jul;103(1):67-8. PMID: 4003991

We report the case of a woman who developed Lyme disease during the first trimester of pregnancy. She did not receive antibiotic therapy. Her infant, born at 35 weeks gestational age, died of congenital heart disease during the first week of life. Histologic examination of autopsy material showed the Lyme disease spirochete in the spleen, kidneys, and bone marrow.

Culture positive seronegative transplacental Lyme borreliosis infant mortality.
Lavoie PE, Lattner BP, Duray PH, Barbour AG, Johnson HC.
Arthritis Rheum, Vol 30 No 4, 3(Suppl):S50. 1987.

"Transplacental infection by Borrelia burgdorferi (Bb), the agent of Lyme Borreliosis (LB), has recently been documented (L.E. Markowitz, et al; P.A. Schlesinger, et al). Fetal infection confirmed by culture has been reported by A.B. MacDonald (in press) from a highly endemic region (Long Island, NY).

We report a culture positive neonatal death occurring in California, a low endemic region. The boy was born by C-section because of fetal distress. He initially appeared normal. He was readmitted at age 8 days with profound lethargy leading to unresponsiveness. Marked peripheral cyanosis, systemic hypertension, metabolic acidosis, myocardial dysfunction, & abdominal aortic thrombosis were found. Death ensued. Bb was grown from a frontal cerebral cortex inoculation. The spirochete appeared similar to the original Long Island tick isolate. Silver stain of brain & heart was confirmatory of tissue infection.

The infant was the second born to a California native. The 20 m/o sibling was well. The mother had been having migratory arthralgias and malaise since experiencing horse fly & mosquito bites while camping on the Maine coast in 1971. The family was seronegative for LB by ELISA at Yale. Cardiolipin antibodies were also not found."

Stillbirth following maternal Lyme disease.
MacDonald AB, Benach JL, Burgdorfer W.
N Y State J Med, Nov;87(11):615-6 1987

This report describes a clinicopathologic investigation of a stillborn fetus that led to a retrospective diagnosis of Lyme disease contracted during the first trimester of pregnancy.

The infectious origins of stillbirth.
Goldenberg RL, Thompson C.
Am J Obstet Gynecol. 2003 Sep; 189(3):861-73. 2003. PMID: 14526331

Toxoplasma gondii, leptospirosis, Listeria monocytogenes, and the organisms that cause leptospirosis, Q fever, and Lyme disease have all been implicated as etiologic for stillbirth.

Lyme disease during pregnancy.
Markowitz LE, Steere AC, Benach JL, Slade JD, Broome CV.
JAMA Jun 27;255(24):3394-6. 1986.

Of the 19 pregnancies, five had adverse outcomes, including syndactyly, cortical blindness, intrauterine fetal death, prematurity, and rash in the newborn. Adverse outcomes occurred in cases with infection during each of the trimesters. Although B burgdorferi could not be implicated directly in any of the adverse outcomes, the frequency of such outcomes warrants further surveillance and studies of pregnant women with Lyme disease.

Infections in Obstetrics: Lyme disease during Pregnancy
Helayne M. Silver, MD
Infectious Disease Clinics of North America Vol 11 Number 1 1 March, 1997

The infant had severe congenital cardiac defects resulting in neonatal death at 39 hours of life. The neonatal autopsy revealed hypoplastic left side of heart and other cardiac anomalies. Spirochetes compatible with B. burgdorferi were found in the spleen, kidneys, and bone marrow; however, no inflammatory response to the organisms was seen.

Human fetal borreliosis, toxemia of pregnancy, and fetal death.
MacDonald AB.
Zentralbl Bakteriol Mikrobiol Hyg [A]. Dec; 263(1-2):189-200. 1986. PMID: 3554838

Congenital relapsing fever (Borrelia hermsii).
William A. Dittman
Sr, Sacred Heart Medical Center, Spokane, WA.
Blood, 15 November 2000, Vol. 96, No. 10, pp. 3333-3333

A 35-week infant was delivered by cesarean section because of fetal distress. Her mother presented to Sacred Heart Medical Center early because of decreased fetal movement. At delivery, the child demonstrated respiratory depression requiring intubation and manual resuscitation. Apgar scores were 1 at one minute and 5 at five minutes. The "admitting" diagnosis was sepsis with shock. Cord blood counts revealed a white blood cell count at 8.2/µL, hemoglobin level at 16.4g/dL, hematocrit level at 48.8%, and platelet count at 8/µL. Nucleated red blood cells were 88 per 100 white blood cells. During verification of the platelet count with the blood film, multiple spirochetes were seen (A), many in clumps (B). These spirochetes were further classified and confirmed by immunofluorescent antibody staining as Borrelia hermsii.
No organisms were seen on multiple blood films of the mother. Although the placenta was grossly and microscopically normal, silver stains demonstrated spirochetes.

A review of the prenatal history identified an episode of fever, chills, aching, headache, and fatigue which occurred at week 16 of the pregnancy. The mother recalled a similar one-day illness at week 19. There were no other untoward events until presentation.

The child was treated with fluids for the septic shock. Ampicillin and cefotaxime were given initially, and erythromycin was added when the spirochetes were found. Dexamethasone was administered for the septic shock and thrombocytopenia. Improvement was progressive until day 9 when hypotension, pallor, and abdominal distension occurred. Autopsy revealed bleeding into a liver abscess with subsequent rupture of a subcapsular hematoma. No organisms were found in the abscesses at autopsy.

Relapsing fever (tick-borne borrelia hermsii) is endemic to the western United States. It is transmitted by the Ornithodoros hermsii tick.

Tick-borne relapsing fever and pregnancy outcome in rural Tanzania.
Jongen VH, van Roosmalen J, Tiems J, Van Holten J, Wetsteyn JC.
Acta Obstet Gynecol Scand. Oct; 76(9):834-8. 1997. PMID: 9351408
The impact of tick-borne relapsing fever (TBRF) on pregnancy outcome was investigated in a case-control study of 137 pregnant women and 120 non-pregnant women infected with this condition and treated at a rural hospital in Tanzania's Tabora region during 1985-95. The risk of premature delivery during TBRF was 58%, with a perinatal mortality of 436 per 1000 births. Total pregnancy loss, including abortions, was 475 per 1000. The case-fatality rate was 1.5% in pregnant women compared with 1.7% in non-pregnant controls. The relapse rate was 3.6% in pregnant women and 1.7% in controls. Pregnant women with TBRF had higher densities of spirochetes than controls, and the risk of delivery during an attack was significantly correlated with increasing spirochete density and gestational age.

Complications of pregnancy and transplacental transmission of relapsing-fever borreliosis.
Larsson C, Anderson M, Guo BP, Nordstrand A, Hagerstrand I, Carlsson S, Bergstrom S.
J Infect Dis. 2006 Nov 15;194(10):1367-74. Epub 2006 Oct 3. PMID: 17054065

Relapsing-fever borreliosis caused by Borrelia duttonii is a common cause of complications of pregnancy, miscarriage, and neonatal death in sub-Saharan Africa.

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Tunnetun amerikkalaisen lastentauteihin erikoistuneen borrelioosilääkärin R. Jonesin mukaan borreliabakteeri voi tarttua äidistä lapseen n. 50 %:ssa sellaisista tapauksista joissa äiti ei ole saanut raskauden aikana antibioottihoitoa. Antibioottihoitoa saaneiden äitien kohdalla tarttumisriski alenee 5 %:iin... Borreliabakteeri tarttuu lapseen äidinmaidon välityksellä. Borrelioosia sairastavien äitien tulisi välttää rintaruokintaa.

http://lymebytes.blogspot.com/2009/11/m ... ilads.html

*According to Dr. Charles Ray Jones, mothers with Lyme who don't take antibiotics during their pregnancies have a 50% chance of passing the disease on to their children. For mothers who take antibiotics during pregnancy, however, the risk drops to %5

*Lyme is transmitted through breast milk. Mothers with Lyme should avoid breastfeeding

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Ranska 2010: Antibiooteista keftriaksoni takaa paremman hoitotuloksen kuin muut beta laktaamiryhmän antibiootit raskauden aikana.

NICE, France -- May 10, 2010 -- Treatment with ceftriaxone is more effective that other beta-lactams in treatingLyme borreliosis infections during pregnancy, according to a study presented here at the 28th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID).

http://www.docguide.com/news/content.ns ... 1F006B7B44

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Saksa 2010:

Borrelioosi raskauden aikana - riski lapselle?
Borrelia-bakteeri on samankaltainen bakteeri kuin kupan aiheuttaja. Bb:n aiheuttamista mahdollisista haitoista raskauden aikana tiedetään kuitenkin vielä melko vähän ja suoranaista syy-seuraus suhdetta on ollut vaikea osoittaa. Bakteerin siirtyminen sikiöön istukan kautta on todettu useissa eläinkokeissa. Borrelioosiin ei ole olemassa rokotetta joten Borrelioosin hoito riippuu ihmisten tietoisuudesta taudista sekä raskauden aikaisesta antibioottihoidosta.
_______________________________________________________________
Viestien lopussa on henkilökohtainen viesti amerikkalaiselta kätilöltä joka on erikoistunut puutiaisten levittämiin sairauksiin (suom.huom. mielenkiintoinen seikka sillä Suomessa lääkärikoulutuksessa ei voi erikoistua nimenomaan niihin tauteihin. Täällä erikoistutaan infektiotauteihin joka pitää sisällään kaikki mahdolliset infektiotaudit.)

"Kätilö kertoo hoitavansa 10-15 Borrelioosia ja/tai Bartonellaa sairastavaa, raskaana olevaa naista vuosittain. Äidit saavat raskauden aikana antibioottihoitoa. Hän epäilee että siinä on syy siihen että vastasyntyneillä on harvoin oireita. Hän näkee bakteerien aiheuttamat oireet lapsilla vasta myöhemmin, n. 14 - 30 kuukauden ikäisinä. Yksi keskenmeno ja toinen sydämen anomalia ovat saattaneet olla bakteerin aiheuttamia. Vaikka äideille on kerrottu rintaruokinnan mahdollisista vaaroista, ovat kaikki äidit päättäneet aloittaa rintaruokinnan. He ovat sinä aikana kuitenkin saaneet antibioottihoitoa.

Kaksi äitiä sairasti jo ennen raskaaksi tuloaan aktiivivaiheessa olevaa Borrelioosia ja toisella oli myös Bartonella. Ohjeista huolimatta he halusivat saada lapsen. Bartonellaa sairastavan äidin tila paheni koko ajan antibiootista huolimatta. Hänelle lisättiin Azithromycin-antibioottia ja 28 viikon kohdalla oireet alkoivat hävitä. Molemmat ovat nyt synnyttäneet. Toisen lapsi on vuoden ikäinen ja jonkin verran kasvukäyrien alapuolella, toinen lapsi on vasta 9 viikkoinen ja ainakin tällä hetkellä oireeton. Kaikki muut äidit on diagnosoitu raskauden aikana - osalla on ollut akuuttivaiheen-osalla krooninen Borrelioosi. Yhdellä äidillä oli borrelian lisäksi babesia joka todettiin raskauden jälkeen. Lapsi on nyt 2-vuotias ja oireeton.
Hän toivoo että borrelia/bartonella-infektioiden vaikutusta raskauteen tutkittaisiin ja myös hänen potilaansa vosivat osallistua tutkimukseen."
______________________________________________________________
Vector Borne Zoonotic Dis. 2010 Oct 6; [Epub ahead of print]

Borreliosis During Pregnancy: A Risk for the Unborn Child?

Mylonas I.

Division of Infectious Diseases in Gynaecology and Obstetrics, 1st Department of
Obstetrics and Gynaecology, Ludwig-Maximilians-University Munich , Munich,
Germany .

Abstract Little is known regarding the possible harmful effects of Borrelia
infections in pregnancy, since such a risk analysis is difficult to perform.
Transplacental transmission of Borrelia burgdorferi has been documented in
several animal studies. Therefore, it had been thought that fetal infection and
teratogenicity was possible from B. burgdorferi, especially considering the
similarities between Lyme borreliosis and syphilis. However, several clinical,
serological, and epidemiological studies have failed to confirm a causal
association between B. burgdorferi infection and a pregnancy adverse outcome.
Moreover, there have been no reported cases of transmission of Borrelia via
breast milk. However, the therapeutic approach to pregnant women with Lyme
disease should be antibiotic treatment, according to the clinical manifestation
and the timing of the tick bite. An effective vaccine is not yet available and
the prevention of Lyme borreliosis depends on public and physician education,
and appropriate antibiotic therapy during pregnancy.

http://eutils.ncbi.nlm.nih.gov/entrez/e ... d=20925520 begin_of_the_skype_highlighting              20925520      end_of_the_skype_highlighting&retmode=ref&cmd=prlinks
PMID: 20925520 [PubMed - as supplied by publisher]

___________________________________________________________
Henkilökohtainen viesti amerikkalaiselta kätilöltä:

"I am both a nurse practitioner and a nurse midwife. As a nurse practitioner, my specialty is tickborne illnesses. This due professional certification place me in a unique position for treating lyme and other tickborne illnesses in pregnancy. I treat about 10-15 pregnant women with lyme or bartonella each year, or consult with a local OB or other midwives to help them know how to treat their pregnant patients.


If there is a study out there on pregnancy and tickborne illnesses I would love to enroll my patients in it. What I am seeing most of the time is symptoms in the "baby" when it reaches 14 months to 30 months old. Arthropathy and tiredness are the 2 prevailing presenting symptoms in these children. Of course, I am treating the mother during the pregnancy, so not seeing stillbornns. One miscarriage may have been due to lyme, but no proof. One cardiac anomaly, but mom refused lyme test, even though history of lyme with short treatment course and no retest to prove cure (treated by another doc). All of our mother's choose to nurse despite risk vs benefit discussion. All choose antibiotics while nursing.

I have had 2 women with active lyme/bartonella who got pregnant despite my advice. Both took Amoxicillin during pregnancy. One of the 2 had bartonella also. Her bartonella got progressively worse and so added azithro at 28 weeks and her bartonella symptoms receded. Both have now delivered. One's baby is a year old and slightly low on length/height charts, but negative for lyme at Igenex. The one with lyme/bartonella - her baby is now 9 wks old, now symptoms so far, but as I said, most seem to show symtpoms at 14-30 months old, IF going to show symptoms.

All the rest of the pregnant women were diagnosed during pregnancy. Some with acute and some with chronic lyme. One had babesia and lyme - her baby is now 2 yrs old without symptoms. She was treated for the lyme during the pregnancy, but not for the babesia until after she delivered."

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Itävalta 2010. Mikäli odottavalla äidillä on Borrelioosi, tulee hänen saada raskauden aikana antibioottihoitoa (amoksisilliini) jotta bakteerin tarttuminen sikiöön saadaan estettyä. Doksisykliiniä ei tule käyttää."

Hautarzt. 2010 Nov 17; [Epub ahead of print]
[Skin infections in pregnancy.]

[Article in German]

Mullegger RR, Glatz M.

Abteilung fur Dermatologie, Landesklinikum Wiener Neustadt, Corvinusring 3-5,
2700, Wiener Neustadt, Osterreich, robert.muellegger@wienerneustadt.lknoe.at.

The article outlines examples of a viral (varicella-zoster virus, VZV), a
bacterial (Lyme borreliosis) and a parasitic (scabies) infection in pregnancy
with their risk for the mother and/or child as well as their management. VZV
infections cause various clinical scenarios depending on the maternal immune
status and the time of infection. Herpes zoster usually poses no risk to the
pregnant woman and there is no need for antiviral therapy. VZV infection of a
seronegative mother, however, may lead to severe varicella in the pregnant woman
and to congenital malformations (congenital varicella syndrome) in case of early
infection or neonatal varicella in case of perinatal infection. Prompt therapy
with acyclovir or administration of VZV immunoglobulin for prophylaxis is
mandatory in those patients.

In case of Lyme borreliosis of the mother, adequate antibiotic therapy with amoxicillin prevents harm to the fetus. Doxycycline is contraindicated during pregnancy.

Scabies represents an important differential
diagnosis of pruritic dermatoses in pregnancy and should be treated with
permethrin 5% cream.

http://eutils.ncbi.nlm.nih.gov/entrez/e ... md=prlinks
PMID: 21079901 [PubMed - as supplied by publisher]

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- Weber ym (1988): Vastasyntyneellä Borrelioosi vaikka äiti sai antibioottihoidon raskauden aikana.
- Nadal ym (1989): 12:lla äidillä borrelia vasta-aineet koholla, samoin jokaisella vastasyntyneellä. Lapsilla esiintyi erilaisia oireita esim. rytmihäiriöitä, isopäisyys, lihasten velttoutta, voimakasta keltaisuutta jne.
http://resources.metapress.com/pdf-prev ... ze=largest
- Williams ym (2008) http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract
Endeemisillä alueilla asuvien äitien riski sairastua Borrelioosiin on 5 - 20X. Lapsilla esiintyy muita alueita enemmän epämuodostumia esim. sydämessä, vesipäisyyttä, ylimääräisiä sormia ja verisuoniluomia.

Maternal Lyme disease and congenital malformations: a cord blood serosurvey in endemic and control areas

1. C. L. Williams1,*,
2. B. Strobino2,
3. A. Weinstein2,
4. P. Spierling1,
5. F. Medici3

Article first published online: 7 APR 2008

DOI: 10.1111/j.1365-3016.1995.tb00148.x
Summary. This report describes a cohort study of over 5000 infants and their mothers who participated in a cord blood serosurvey designed to examine the relationship between maternal exposure to Lyme disease and adverse pregnancy outcome. Based on serology and reported clinical history, mothers of infants in an endemic hospital cohort are 5 to 20 times more likely to have been exposed to B. burgdorferi as compared with mothers of infants in a control hospital cohort. The incidence of total congenital malformations was not significantly different in the endemic cohort compared with the control cohort, but the rate of cardiac malformations was significantly higher in the endemic cohort [odds ratio (OR) 2.40; 95% confidence interval (CI) 1.25,4.59] and the frequencies of certain minor malformations (haemangiomas, Polydactyly, and hydrocele), were significantly increased in the control group. Demographic variations could only account for differences in the frequency of Polydactyly. Within the endemic cohort, there were no differences in the rate of major or minor malformations or mean birthweight by category of possible maternal exposure to Lyme disease or cord blood serology. The disparity between observations at the population and individual levels requires further investigation. The absence of association at the individual level in the endemic area could be because of the small number of women who were actually exposed either in terms of serology or clinical history. The reason for the findings at the population level is not known but could be because of artifact or population differences.
http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract

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Vastasyntyneellä oli sydänvaurioita. Lapsi kuoli 39 tunnin ikäisenä. Ruumiinavauksessa borrelia-bakteereita löytyi mm. pernasta, munuaisista ja luuytimestä. Tulehduksia ei havaittu. (1997)

Infections in Obstetrics: Lyme disease during Pregnancy
Helayne M. Silver, MD
Infectious Disease Clinics of North America Vol 11 Number 1 1 March, 1997
The infant had severe congenital cardiac defects resulting in neonatal death at 39 hours of life. The neonatal autopsy revealed hypoplastic left side of heart and other cardiac anomalies. Spirochetes compatible with B. burgdorferi were found in the spleen, kidneys, and bone marrow; however, no inflammatory response to the organisms was seen.

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Ei tutkimus, mutta mielenkiintoinen tapausselostus:

Borrelioosi - linkki äidin sairauden ja lapsen autismin välillä.

VIDEO: http://www.fox40.com/news/headlines/ktx ... 1075.story

19-vuotiaalla Mary Hendricksillä diagnosoitiin vaikea autismi 2-vuotiaana.
Hän menetti puhekyvyn ja katsekontaktin. Maryllä oli lukuisia muitakin oireita kuten ruuansulatusongelmia, ihotulehduksia ja sisäelinongelmia jotka aiheuttivat hänelle jatkuvia kipuja.

Tätä jatkui 17 vuotta. Silloin Tina sai lähetteen autismiin erikoistuneelle lääkärille joka kertoi lapsen oireiden johtuvan äidistä. Tina oli vuosien ajan sairastanut jatkuvia nuhia, suolitulehduksia, fibromyalgiaa jne. Lääkäri otatti Tinalta borreliatestin ja se oli positiivinen. Myös Maryn testi oli positiivinen. Tina kertoi löytäneensä aikoinaan, raskauden alussa, iholtaan kaksi punkkia. Hän poisti ne eikä ajatellut asiaa sen kummemmin.

"Mikäli lapsella on autismi syntymästään saakka, on se usein äidiltä saadun infektion aiheuttama. Olen sitä mieltä että erityisesti synnynnäinen Borrelioosi on autismin aiheuttaja, sanoo Autismin asiantuntija tohtori Lynn Mielke. Hän sanoo Maryn saaneen borrelia-bakteerin äidiltään raskauden aikana ja sen aiheuttaneen suurimman osan Maryn oireista." Mary saa nyt hoitoa Borrelioosiin ja jotkin hänen autismioireistaan ovat jo alkaneet hävitä. "Hän hymyilee ja nauraa .. emme ole kuulleet sitä vuosiin - Mielke kertoo.

Mielken mukaan Maryn autismioireiden vakavuus voi olla esteenä täydelliselle paranemiselle. Hänellä on kuitenkin ollut potilastapauksia joissa autismioireet ovat hävinneet Borrelioosihoitojen ansiosta kokonaan."

Doctors Find Link Between Mother's Illness & Child's Autism


Video: A Push For Tougher Lyme Disease Testing Standards

Eric Harryman FOX40 News

9:48 p.m. PDT, September 26, 2011
SACRAMENTO?

The mystery of autism may never be solved, but research is giving doctors new hope in trying to put the puzzle pieces together. Doctors are starting to find links between children with autism and other diseases that may play a role. One of those links now has a name, it?s called ?Lyme Induced Autism?.

19-year-old Mary Hendricks was diagnosed with severe autism and developmental delay before she was 2 years old.

"She had a little bit of language and lost it. A little bit of eye contact and lost it," said Mary?s mom, Tina Hendricks.

But there was something more going on with Mary that was going undiagnosed, and it stayed that way for 17 years.

"She was having these developmental issues, but she was also sick," continued Tina.

Mary was sick with digestive problems, skin infections and internal problems that caused Mary to be in pain for a large majority of every day. The Hendricks took Mary to doctor after doctor in hopes of finding one that could pinpoint the problem, but each doctors visit seemed to be only a quick fix for the immediate issue.

"If she was awake she was moaning, crying out in pain, biting herself, chewing on herself, banging herself in the head," said Mary?s dad, Danny Hendricks.

That cycle continued for 17 years, until the Hendricks were sent to an Autism Specialist who had a whole new take on Mary and the issues that had taken over her life. That specialist asked Tina about her own health history.

Tina told the doctor that for years she had battled her own health issues; including colitis, fibromyalgia and symptoms that seemed like a never ending bout with the flu.

"He said the key to diagnosing Mary, is diagnosing you," Tina told FOX40.

The specialist ordered a Lyme Disease test for Tina and it came back positive and a few days later, Mary also tested positive for Lyme. Tina says before she got pregnant with Mary, she found two ticks on her skin. She removed them and never really thought much about the possibility of Lyme.

"If a child has autism from birth, many times it's because the child inherited an infection from the mother. I do think that Lyme disease, especially congenital Lyme is a cause of autism ," said Autism Specialist Dr. Lynn Mielke.

Dr. Miekle says Mary contracted Lyme disease from Tina through pregnancy and she believes the Lyme played a big role in the development of Mary?s autism. Immediately, Mielke started a full assault on Mary?s Lyme symptoms and in a matter of weeks the success was beyond their expectations.

"As we treat Mary for her Lyme, some of her check list autism symptoms are disappearing," said Tina.

"For her to wake up, smile and giggle and laugh .. we haven't heard that for years," added Danny.

Miekle told FOX40 the severity of Mary?s autism may prevent her from having improvement beyond minimal, but for the Hendricks even small improvements translate to be huge miracles.

"I have had patients in my practice with autism who when we treated their Lyme disease, their autism improved so much that they were no longer autistic,? said Mielke.


Copyright © 2012, KTXL-TV

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Eri punkkilajit kantavat erilaisia Borrelia-bakteereja.Toisintokuume on yhdentyyppisen borrelia-bakteerin, Borrelia hermsiin, aiheuttama infektiotauti. Allaolevassa artikkelissa kuvataan äidin ja vastasyntyneen infektio. 24-vuotias aiemmin terve nainen hakeutui hoitoon kuumeen, pahoinvoinnin, päänsäryn, niskajäykkyyden ja ajoittaisten näköhäiriöiden vuoksi. Hän oli synnyttänyt 20 tuntia aikaisemmin tyttölapsen.(2011)

Tickborne Relapsing Fever in a Mother and Newborn Child ? Colorado, 2011
Weekly
March 16, 2012 / 61(10);174-176

Tickborne relapsing fever (TBRF) is a bacterial infection caused by certain species of Borrelia spirochetes and transmitted through the bite of Ornithodoros ticks. Clinical illness is characterized by relapsing fever, myalgias, and malaise. On May 10, 2011, CDC and the Colorado Department of Public Health and Environment were notified of two patients with TBRF: a young woman and her newborn child. This report summarizes the clinical course of these patients and emphasizes the importance of considering a diagnosis of TBRF among patients with compatible clinical symptoms and residence or travel in a TBRF-endemic area. Pregnant women and neonates are at increased risk for TBRF-associated complications and require prompt diagnosis and treatment for optimal clinical outcomes. Public health follow-up of reported TBRF cases should include a search for persons sharing an exposure with the patient and environmental investigation with remediation measures to prevent additional infections.

On May 2, 2011, a previously healthy woman aged 24 years sought treatment at a local emergency department in Colorado after 1 week of fever, nausea, headache, stiff neck, and occasional blurred vision. Approximately 20 hours earlier, she had delivered a newborn (at 39 weeks' gestation) in a mountain cabin, without medical attendance. She had received limited prenatal care. Delivery was notable for amniotic fluid discoloration consistent with meconium. Physical examination revealed an ill-appearing and afebrile woman with hypotension (blood pressure: 70/40 mmHg). Gynecologic examination was unremarkable. A complete blood count revealed an elevated white blood cell count of 18,000/µL (normal: 4,500?10,000/µL), a decreased hematocrit of 30% (normal: 37%?47%), and a decreased platelet count of 42,000/µL (normal: 130,000?400,000/µL). Blood chemistries were remarkable for an elevated creatinine of 1.6 mg/dL (normal: 0.6?1.3 mg/dL), elevated aspartate aminotransferase of 61 IU/L (normal: 15?37 IU/L), and elevated alkaline phosphatase of 422 IU/L (normal: 50?136 IU/L). She was admitted and treated empirically using intravenous piperacillin with tazobactam for postpartum sepsis and fluid resuscitation for hypotension. Antibiotics were changed to oral amoxicillin after 48 hours. A blood culture drawn at admission revealed no growth, and the patient remained afebrile during hospitalization. Because of worsening anemia, she was transfused with packed red blood cells on May 3. Her condition improved, and she was discharged on May 5.

The newborn female accompanied her mother to the emergency department on May 2. Although physical examination was normal, the newborn was admitted for observation. An initial complete blood count was unremarkable, and blood culture collected at admission had no growth after 5 days. The patient developed neonatal jaundice on May 4 and remained hospitalized. On May 7, she became febrile with a temperature of 101.2°F (38.4°C) and had a platelet count of 34,000/µL (normal: 130,000?400,000/µL). Blood chemistries revealed an elevated alkaline phosphatase of 196 IU/L (normal: 50?136 IU/L) and a decreased albumin of 2.4 g/dL (normal: 3.4?5.0 g/dL). Treatment for sepsis was initiated with administration of gentamicin, ampicillin, and acyclovir. Subsequently, her platelet count decreased further to 14,000/µL. A review of the peripheral blood smear to evaluate the newborn's thrombocytopenia incidentally revealed spirochetes consistent with TBRF (Figure). A 10-day course of intravenous penicillin-G and platelet transfusions for progressive thrombocytopenia were initiated. The newborn recovered and was discharged on May 20. Because of the newborn's spirochetemia, the mother was presumptively treated for TBRF with doxycycline.

Blood and serum samples from the mother and her newborn were tested by CDC's Bacterial Diseases Branch, Fort Collins, Colorado. Presence of spirochetes was visually confirmed from the newborn's blood smear prepared May 7; a whole blood sample collected the same day yielded evidence of relapsing fever Borrelia species by polymerase chain reaction. Sequencing of polymerase chain reaction targets revealed 100% match to Borrelia hermsii. Testing of the newborn's serum also obtained May 7 did not detect B. hermsii antibodies by either enzyme immunoassay (EIA) or immunoglobulin M (IgM) and immunoglobulin G (IgG) Western immunoblots. A sample collected from the newborn 3 days later had equivocal results by EIA and three bands visible on IgM immunoblot and one band visible on IgG immunoblot. Serum collected from the mother on May 13 produced a positive B. hermsii EIA, >10 bands by IgM immunoblot, and 10 bands by IgG immunoblot. The mother's clinical history and dominant IgM antibody response supported acute maternal B. hermsii infection acquired during the weeks preceding delivery; the limited antibody response by the newborn also supported a diagnosis of acute TBRF infection.

The mother was not employed and had moved from a densely populated urban area in Colorado to the previously vacant cabin 18 days before delivery. This rural Colorado cabin was situated near the base of a mountain range within a juniper and piñon tree forest at an approximate elevation of 8,800 feet. The single-room structure lacked electricity and running water. An environmental assessment indicated no ongoing rodent activity, and no ticks were recovered. The cabin owner declined to permit access to internal wall spaces to search for rodent nests.
Reported by

Elisabeth W. Lawaczeck, DVM, Colorado Dept of Public Health and Environment. Paul S. Mead, MD, Martin E. Schriefer, PhD, Div of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases; Meghan E. Brett, MD, Jeffrey T. McCollum, DVM, EIS officers, CDC. Corresponding contributor: Jeffrey T. McCollum, jmccollum@cdc.gov, 303-692-2745.
Editorial Note

B. hermsii is the most frequent cause of TBRF in the United States. This spirochete is transmitted to humans by the soft tick Ornithodoros hermsi, which usually is associated with the nests of chipmunks and other wild rodents (1). Unlike hard ticks, O. hermsi transmit spirochetes through a brief (<30 minutes' duration) and painless nocturnal bite. Humans typically are exposed to these ticks during an overnight stay in rodent-infested dwellings at elevations >2,000 feet.

After an average incubation period of 7 days (range: 2?18 days), TBRF symptoms include fever, headache, myalgias, nausea, and chills with a median duration of 3 days (range: 2?7 days) alternating with afebrile periods of a median duration of 7 days (range: 4?14 days) (1). Febrile periods can recur ≤10 times without treatment. Moderate to severe thrombocytopenia is typical during acute TBRF illness (1). As occurred in the newborn's illness, spirochetes are not detected by automated blood cell counts but can be observed on direct examination of stained (Wright's or Giemsa) blood smears, with sensitivity approaching 70% during febrile episodes (2). Blood smears most often reveal spirochetes during acute infection and before antibiotic treatment. Alternatively, serologic testing for TBRF can be used for diagnosis but is not widely available. Antibiotics recommended for treatment include penicillin, doxycycline, and erythromycin. Patients with TBRF infection should be monitored for ≥2 hours after initial antibiotic dose for a Jarisch-Herxheimer reaction, an acute worsening of symptoms that can be life-threatening.* One case series documented such reactions among 54% of patients, demonstrating that this reaction is common (3).

TBRF infection can pose serious risks for mothers and neonates. Only 12 TBRF infections among pregnant women have ever been reported in the United States, including the one in this report (1,3?9). Among these cases, serious maternal complications of TBRF infection have been documented and include adult respiratory distress syndrome, Jarisch-Herxheimer reaction, and precipitous or premature delivery (4?6). Among newborns born to these TBRF-infected mothers, six (55%) of 11 had a documented perinatal TBRF infection; two (33%) died despite treatment.? Potential routes of perinatal TBRF infection include transplacental transmission or acquisition during delivery; however, studies have been limited.

The findings in this report are subject to at least two limitations. First, transmission route for the newborn was not determined, but possibilities include transplacental, during birth, or during residence in the cabin. Second, the cabin remains the most likely site of exposure for the mother on the basis of arrival date and acute nature of her illness; however, no rodent nests or ticks were identified within the structure to provide more substantial evidence.

TBRF should be considered a potential diagnosis among febrile patients who reside in or have traveled to the western United States, especially those inhabiting rustic housing. Cases should be reported immediately to public health officials to facilitate identification of other potentially exposed persons and to evaluate and treat those persons for TBRF infection. Additionally, TBRF is a reportable disease in 12 western U.S. states.§ An environmental investigation should be undertaken to search for rodent nests. Reinfection and additional TBRF illnesses can occur in housing previously linked to TBRF cases (10). Remediation efforts should include rodent-proofing and treatment of structures with pesticides (particularly crack- and crevice-type) by pest control specialists to reduce risk for continued tick exposure.
Acknowledgments

Local clinicians and clinical laboratories; local health department personnel; Ken Gershman, MD, Communicable Disease Epidemiology Program, Colorado Dept of Public Health and Environment. Christopher Sexton, John Young, Bacterial Diseases Branch Laboratory, Div of Vector-Borne Diseases; Kris Bisgard, DVM, EIS Field Assignments Branch, Scientific Education and Professional Development Program Office, CDC.
References

Dworkin MS, Schwan TG, Anderson DE Jr. Tick-borne relapsing fever in North America. Med Clin North Am 2002;86:417?33, viii?ix.
Southern PM Jr, Sanford JP. Relapsing fever: a clinical and microbiological review. Medicine 1969;48:129?49.
Dworkin MS, Anderson DE Jr, Schwan TG, et al. Tick-borne relapsing fever in the northwestern United States and southwestern Canada. Clin Infect Dis 1998;26:122?31.
Davis RD, Burke JP, Wright LJ. Relapsing fever associated with ARDS in a parturient woman. A case report and review of the literature. Chest 1992;102:630?2.
Guggenheim JN, Haverkamp AD. Tick-borne relapsing fever during pregnancy: a case report. J Reprod Med 2005;50:727?9.
Fuchs PC, Oyama AA. Neonatal relapsing fever due to transplacental transmission of Borrelia. JAMA 1969;208:690?2.
Morrison SK, Parsons L. Relapsing fever: report of three cases, one in a six day old infant. JAMA 1941;116:220?1.
Steenbarger JR. Congenital tick-borne relapsing fever: report of a case with first documentation of transplacental transmission. Birth Defects Orig Artic Ser 1982;18(3 Pt A):39?45.
Malison MD. Relapsing fever. JAMA 1979;241:2819?20.
Wynns HL. The epidemiology of relapsing fever. In: In: Moulton FR, ed. A symposium on relapsing fever in the Americas. Washington, DC: American Association for the Advancement of Science; 1942.


* A Jarisch-Herxheimer reaction is characterized by hypotension, tachycardia, chills, rigors, diaphoresis, and elevated body temperature and can occur after initial antibiotic therapy for infections caused by spirochetes, including relapsing fever (1).

? One woman with TBRF infection elected to terminate her pregnancy.

§ Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, North Dakota, Oregon, Texas, Utah, and Washington.

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http://www.newsobserver.com/2010/05/21/ ... nella.html

Artikkelin mukaan bartonellan voi saada hyönteisten lisäksi myös ihmisestä toiseen, esim. äidistä lapseen.
Maailman johtava infektiotautien, erityisesti bartonellan, tutkija tri Breitschwerdt, on dokumentoinut ensimmäistä kertaa bartonella-bakteerin mahdollisen siirtymisen perheenjäseneltä toiselle.

Tutkijaryhmä dokumentoi tapauksen jossa aviopuolisoilla kummallakin alkoivat erilaiset oireet; kipuja, fatiikkia jne, pian naimisiinmenon jälkeen. Pariskunta sai kaksoset v1998. Toinen lapsista kuoli sydänongelmiin 9 päivän ikäisenä. Toisella lapsella todettiin krooninen sydänvika.

Perheen kudoksia tutkittaessa, löydettiin kaikilta perheenjäseniltä samaa bartonella bakteerin alalajia. Löydös on lääketieteellisesti erittäin merkittävä, sanoo Breitschwerdt.

Hänen mukaan bakteeri saattaa olla monien kroonisten oireiden tosiasiallisena syynä esim. lihaskivut, neurologiset oireet, fatiikki, niveltulehdukset jne. Ongelmana on, että normaqllisti käytössä olevat vasta-ainetestit eivät kykene luotettavasti toteamaan bakterin olemassaoloa. Antibioottien tehoon vaikuttaa merkittävästi bakteerin alalaji. Koska alalajeja on monia, on oikean hoidon aloittaminen vaikeata.

BY SARAH AVERY - Staff Writer

A bacterial infection typically spread by fleas, lice and biting flies could be more prevalent than many think, and may have been transmitted from a mother to her children at birth, scientists from N.C. State University say.
Dr. Edward Breitschwerdt, an infectious disease veterinarian and one of the world's leading researchers of bacteria called Bartonella, has for the first time documented evidence that the pathogen may have been passed between family members.

Although more studies are needed to back up his findings, Breitschwerdt and colleagues describe the case of a mother and father who began battling chronic aches, fatigues and other symptoms soon after they were married. When their twins were born in 1998, the daughter died after nine days from a heart defect, and the son developed chronic health problems.

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Using tissue from the daughter's autopsy and blood from the surviving family members, Breitschwerdt's team discovered that the entire family was infected with the same species of Bartonella bacteria, despite having no shared exposures to flea or lice infestations. Bartonella is known to causes such illnesses as trench fever and cat scratch disease, and it is increasingly suspected of triggering a variety of aches and inflammations that doctors have been unable to diagnose.

"I think we have stumbled across something that is of monumental medical importance," said Breitschwerdt, whose findings were published recently in the Journal of Clinical Microbiology.
Proving the mother-child transmission could be difficult, however. Little funding is available for such research because the bacteria are still not considered a major source of human disease.
Dr. Michael Kosoy, who heads the Bartonella laboratory for the Centers for Disease Control and Prevention in Fort Collins, Colo., said scientists are only beginning to build evidence that Bartonella infections may be more common than previously thought.

"Bartonella are circulated around the world in many animals, but there are different Bartonella species, and the question is how can they be transmitted to humans?" Kosoy said, noting that most known cases have been transmitted from biting insects. He said the NCSU findings about the potential family transmission are compelling but inconclusive.
Dozens of strains

At least 26 strains of Bartonella have been named worldwide, and the list is growing. The most notorious Bartonella infection is cat scratch disease, a fever illness passed to humans from flea-infected cats. Fleas are the primary hosts, and they spread the bacteria in their feces.
Other Bartonella strains spread more serious diseases. Kosoy is studying how often heart inflammation is caused by a Bartonella that thrives among rat fleas in Thailand. He has already established that about 25 percent of unexplained fever illnesses among a group of patients there was caused by Bartonella .

"This is not limited to cat scratch," Kosoy said. "That's just the tip of the iceberg."
Breitschwerdt said he thinks the bacteria may be the hidden cause behind a host of chronic symptoms - muscle aches, neurological problems, fatigue, arthritis - that defy diagnosis.

About two years ago, Breitschwerdt began testing blood samples from a doctor in Maryland, who was curious whether Bartonella infections might be causing problems for some of his patients.

"There are lab tests showing inflammation," but no discernible cause, said Dr. Robert Mozayeni, a Yale-educated rheumatologist who practices in Rockville, Md.
Mozayeni contacted Breitschwerdt and his NCSU colleague, Ricardo Maggi, who together developed a more sensitive test for Bartonella.

Routine blood tests fail to detect Bartonella because they search for antibodies that the body is slow to produce.
Instead, Breitschwerdt and Maggi figured out how to cultivate the bacteria in the laboratory from blood samples of infected people. They founded a company called Galaxy Diagnostics to handle the laboratory volume.

Of Mozayeni's mystery patients tested at the lab, nearly 20 percent had Bartonella infections.
"I suspect this is going to be one of the causes of rheumatoid arthritis and a few other things, but it's too speculative right now to say," Mozayeni said.

Human testing
More studies are needed, and Mozayeni has joined Breitschwerdt and Maggi in the diagnostic company to oversee human testing.
"Certainly, the prevalence of Bartonella infection in people with chronic illness is higher than I would have ever guessed, but we still don't know what that means," Breitschwerdt said.

Among the biggest unknowns is how to treat people who have been infected. The effectiveness of antibiotics depends on which strain of Bartonella is at work, and with so many strains, treatments can be hit or miss.

Breitschwerdt said the family in his most recent study declined to comment about their experience. He said they were having difficulty finding a doctor.

"It is very difficult to find a physician who wants to see someone with a chronic illness that is poorly defined," he said, adding that many such patients often think they have Lyme disease, a tick-borne bacterial infection with similar symptoms - and stigma. "With an unexplained illness, it becomes problematic."

sarah.avery@newsobserver.com or 919-829-4882

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Tri John Drullen artikkeli Borrelioosista raskauden aikana ja hoito-ohjeet:

http://www.johndrullelymefund.org/pregn ... isease.htm

Pregnancy and Lyme Disease

John Drulle, M.D. December 1990

When a pregnant woman is infected with Lyme disease, not only is she subject to its devastation, but her baby is too. At this time there is only a small amount of information available in the medical literature. I will review the major articles, and after describing our own experiences with Lyme and pregnancy, present what I feel is a rational approach to this issue.

The first case of transplacental passage of Borrelia burgdorferi was reported in 1985 in Wisconsin by Schlesinger. The woman was bitten during her first trimester and developed an EM rash with two satellite lesions. This was followed by typical Lyme symptoms. She did not receive medical treatment as Lyme was not diagnosed at the time. She delivered a male baby at 35 weeks. The baby died 39 hours later from congestive heart failure, and at autopsy there were several major defects of the heart. Spirochetes were found in the spleen, kidneys, bone marrow and the heart. The mother tested positive for Lyme. Here we can only speculate that the Lyme might have been responsible for the birth defects, as these same types of problems can occur in non-Lyme situations.



In 1987, Dr. Alan MacDonald reported a case of a woman infected with Lyme in her first trimester of pregnancy, which unfortunately was not diagnosed or treated. She had developed a circular red rash which was followed by painful swelling of her knee. These resolved spontaneously. The woman went into labor at term, and delivered a 2,500 gram stillborn baby. Autopsy revealed a ventricular septal defect, i.e. a hole in the wall of the heart which separates the two main pumping chambers. The Lyme bacterium was cultured from the baby?s liver, and it was demonstrated in the brain, heart, adrenal gland and the placenta. The mother?s blood tested positive for antibodies to the Lyme spirochete and negative for syphilis. Dr. MacDonald reported three other cases of fetal death in the second trimester, in which the Lyme spirochete was cultured from the livers. None of the mothers gave any history suggesting Lyme infection.



In 1986, Weber reported a case of Lyme infection in a newborn baby. The mother had been bitten by multiple ticks during her first trimester. She developed an EM rash several weeks later. She was treated with a ?standard? course of oral penicillin for seven days, three times a day. The baby was delivered at term and appeared normal. During the next 23 hours the baby developed breathing problems and died. Autopsy showed brain hemorrhages. Spirochetes compatible with Borrelia burgdorferi, the Lyme spirochete, were demonstrated in the brain and the liver. Initial testing of the mother?s blood was negative for antibodies to the Lyme spirochete; however, at a later date her frozen blood tested positive for IgM antibodies by the ELISA test.



Markowitz published a study of Lyme and pregnancy in 1986. He described nineteen patients who were infected during pregnancy. Five of these had adverse outcomes (one fetal death at 20 weeks, high bilirubin level in a four-week premature baby, webbed toes, blindness and developmental delay, and a newborn rash). Thirteen of the nineteen had received antibiotics. The authors concluded that there was no proof that Lyme was responsible for the adverse outcomes since all of them were dissimilar. However, there was a consensus that this was an abnormally high frequency of adverse outcomes, and that pregnant women with diagnosed Lyme should be treated immediately with penicillin.

Williams and colleagues conducted a study in a Lyme-endemic area in New York of umbilical cord blood. Of 255 infants tested, 10.2% had detectable antibody to the Lyme spirochete. Of 166 infants born in a non-endemic area, 2.4% had detectable antibodies. The rate of birth defects did not differ significantly between the two groups; however, the first group tended to be of lower birth weight and smaller for their gestational age, and tended to have more jaundice. The authors concluded that these differences were not significantly different. A glaring flaw in this study is that it only included live births. Since miscarriages, stillbirth and perinatal infant deaths were not included, the possibility of congenital defects possibly associated with Lyme and incompatible with life are not included. Therefore, the author?s contention that no association exists between gestational Lyme and congenital defects should be viewed with skepticism.



Dr. Andrea Dlesk, of the Marshfield clinic in Wisconsin, studied 143 healthy pregnant women. Lyme serologic tests were obtained on the initial and postpartum visits. At the time the data were reported, 116 women had completed their pregnancies and 12 had miscarried, one of whom tested positive. Of the 104 women who did not miscarry, 13 women tested positive for Lyme. The conclusion was that healthy women who test positive for Lyme are at no increased risk for miscarriage. Again this study is flawed in that there are no autopsy data on the 12 miscarriages. It is quite possible that, in the 11 seronegative mothers who miscarried, seronegative Lyme was present and may have caused defective fetuses. Seronegative Lyme is a real entity and nay account for 25% of all cases of Lyme.



In 1988, Carlomango studied 49 women who had either a 1st or 2nd trimester spontaneous abortion. Six (6) of them (12.2%) tested positive, compared to 3 of 49 women who delivered at term. The authors concluded that there was no statistical significance between the two groups.



In 1988, Nadal surveyed 1,416 women and their 1,434 infants at delivery for presence of antibodies to the Lyme spirochete. Twelve women tested positive (only one had a history compatible with EM during pregnancy), six had a history of pre-existing Lyme and five had unremarkable histories. Of these twelve women, seven had remarkable outcomes:



1. Two had elevated bilirubinemia

2. One had muscle hypotonia (laxness)

3. One was post-term, small for age, and evidenced chronic placental insufficiency

4. One had transient macrocephaly (large head)

5. One had transient supraventricular extrasystoles (?skipped heart beats?)

6. The infant born of the mother with EM had a VSD-hole in the heart connecting the two main pumping chambers.



Since none of these babies had positive blood tests for antibodies to Lyme, the conclusion was that the adverse outcomes were not due to Lyme. The major flaw in this conclusion is the assumption that congenital Lyme babies are seropositive. This has been refuted by the work of Dr. Alan MacDonald, and is analogous to the findings of seronegativity in congenital syphilis.



In 1989, Dr. Alan MacDonald reported his findings in autopsies performed following perinatal deaths at Southhampton Hospital between 1978 and 1988. It must be noted that routine pathology studies on tissues will not demonstrate the Lyme spirochete. Unless there is a high index of suspicion for Lyme disease, the special silver or immunologic stains which can identify the spirochete are not used. He also reports four cases where there was live birth and spirochetes were demonstrated in the placentas. In the group of perinatal deaths there was no history or eveidence of Lyme disease in the mothers. Their blood tests were negative in all but one case. Spirochetes compatible with Borrelia burgdorferi were identified in the vital organs and numerous developmental defects were observed. Dr. MacDonald?s conclusions are:



1. Tissue inflammation is not seen in fetuses with transplacentally acquired infection with the Lyme spirochete.

2. Lyme disease acquired in utero may result in fetal death in utero, fetal death at term or infant death after birth. Babies may also survive in spite of the bacteria being isolated in the placenta.

3. In all but one of these cases where the Lyme organism was identified in the placenta or the fetal tissues, the maternal blood had no evidence of antibodies to the Lyme bacteria. In only two of the fourteen cases was there a maternal history compatible with Lyme disease, yet neither of the two were serologically confirmed.



This is the extent of the currently available information on Lyme and Pregnancy in the medical literature in 1990. Comparing the various studies have led us to arrive at the following conclusions:



1. Lyme disease is a serious threat to pregnant women in that it may cause fetal damage and death.

2. Pregnancy may mask symptoms of Lyme in the mother and may result in seronegativity.

3. Serologic screening of pregnant women in highly endemic areas is not recommended.

4. Pregnant women who test positive for Lyme antibodies, yet have no symptoms suggesting active Lyme, are probably at a lower risk of passing the infection across the placenta. It may be possible that the presence of antibody prevents the Borrelia burgdorferi from crossing the placenta.

5. Babies born with Lyme disease can be expected to have a negative blood test for Lyme antibodies. Few have positive test.

6. We desperately need a better test for detecting Lyme in pregnant women. It is clear that serologies are inadequate. Efforts should be directed at evaluating urine antigen and PCR testing in pregnancy and in neonates.



In our practice we have seen several dozen pregnant women with Lyme disease. I feel that a much more aggressive approach must be taken with them than with non-pregnant patients. It is preferable to err on the side of overtreatment than undertreatment, especially since the antibiotics we use have not been associated with birth defects or adverse effects on the developing fetus. These are general recommendations that we have developed over the last three years:



A pregnant woman who presents with a deer tick bite in an endemic area for Lyme disease is treated as if she had Stage 1 Lyme disease. We would treat with one to two months of oral antibiotics, such as Amoxicillin or Ceftin. (Tetracycline and Doxycycline are contraindicated in pregnancy.)



A pregnant woman with an EM rash should receive three to four weeks of intravenous Claforan, Rocephin or aqueous penicillin. We have evidence that even without constitutional symptoms the Lyme spirochete may have spread throughout the mother?s body by the fifth day after an infected tick bite. As noted above, treatment failure with oral penicillin has been reported.



Pregnant women who are diagnosed as having Lyme by symptoms and blood tests, who do not have a clear history of a tick bite or EM rash, and have not yet been treated, should be treated with intravenous antibiotics. Here, since the length of infection is unknown, we must assume that the spirochetes have spread throughout the mother?s body. It has generally been assumed that it is only possible to culture the Lyme spirochete from the blood only in the early stages of Lyme disease, so that a woman in the later stages of Lyme is safe from having blood-borne spirochetes reaching and crossing the placenta to the fetus. Yet unpublished data suggests that blood drawn from chronic Lyme patients during the afternoon, when they usually spike a mild fever, may yield spirochetes, using a specially modified BS Kelly culture Medium. Animal studies with chronically infected dogs show that when their immune systems are suppressed by injecting them with dexamethasone, a steroid similar to prednisone, it is possible to culture the Lyme spirochete from their blood the day after the injection. It may be possible that the state of pregnancy, which is also immunosuppressive, may induce the spirochete to enter the bloodstream and reach the placenta.



We recommend that pregnant women with active Lyme, or a history of treated Lyme, have monthly urine antigen tests for Lyme until the seventh month of pregnancy. There is some evidence that during the 3rd trimester, false positive urine tests may occur.



When the baby is delivered, we recommend that the placenta be examined for spirochetes. If spirochetes are demonstrated in the placenta, the baby should be treated with intravenous antibiotics.



I must again stress that these are guidelines that we use in our own practice. I realize that many physicians might criticize them fro being an over-reaction and too aggressive: however, I have seen a number of babies born with congenital Lyme, and am quite aware of the devastating effects it can cause. Following the recommendations I?ve outlined above, we have had normal outcomes in all the pregnant women whom we have treated.



Written by John Drulle, M.D. in December, 1990 and reprinted by the John Drulle, MD Memorial Lyme Fund, Inc. in 2006.

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Äiti sairastui borrelioosiin raskauden aikana. Lapsi kuoli pian syntymänsä jälkeen sydänperäisiin ongelmiin. Lapsen pernasta, munuaisista ja luuytimestä löydettiin borreliabakteereita.

Maternal-Fetal Transmission of the Lyme Disease Spirochete, Borrelia burgdorferi.

PETER A. SCHLESINGER, M.D.; PAUL H. DURAY, M.D.; BARBARA A. BURKE, M.D.; ALLEN C. STEERE. M.D.; and M. THOMAS STILLMAN. M.D.

Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, Minnesota; Yale University School of Medicine, New
Haven, Connecticut.

From the text :
"We report the case of a woman who developed Lyme discase during the first trimester of pregnancy. She did not recive antibiotic therapy. Her infant, born at 35 weeks gestational age, died of congenital heart disease during the first week of life. Histologie examination of autopsy material showed the Lyme disease spirochete in the spleen, kidneys, and bone marrow."

"A 28-year-old mother of two healthy children became pregnant for the third time in September 1983. Soon thereafter, she participated in outdoor
activities in an area of northwestern Wisconsin known to be endemic for Lyme disease (3).

On 7 November 1983, she noted an expanding annular skin lesion in the left poplileal region reaching a size of 20 X 30 cm. She also developed two secondary skin lesions, headache, stiff neck, arthralgias, malaise, and inguinal lymphadenopathy. All symptoms resolved within several
weeks without treatment. Thereafter, the antepartum course was normal except for recurrent arthralgias during the third trimester. No medications were taken during the pregnancy.

On 6 May 1984, the patient delivered a 3000-g male infant whose estimated gestational age was 35 weeks. No skin lesions were seen. The baby had respiratory distress. An echocardiogram and cardiac catheterization showed a dilated. poorly contractile left ventricle; aortic valvular stenosis; patent ductus arteriosus; and coarctation of thc aorta. Despite emergency balloon catheter dilatation of the coarctation and aortic valvotomy, the infant died after 39 hours."

Annals of internal medicine july 1985 volume 103 number 1

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Ei tutkimus, mutta mielenkiintoinen haastattelu. Darude kertoo vaimonsa sairastaneen borrelioosia todennäköisesti jo ennen rskautta ja lapsen saaneen tartunnan äidiltä.

VIDEO:
http://www.seiska.fi/Viihdeuutiset/Daru ... na/1006277

Daruden vaimo ja poika sairastavat borrelioosia: Vuosien piina!

Maailmalla DJ:nä mainetta niittävä Darude eli Ville Virtanen, 37, on asunut Michelle-vaimonsa kanssa jo viisi vuotta Atlantassa Yhdysvalloissa. Ville keikkailee ympäri maailmaa, mutta perheen sairastelu on rauhoittanut tahtia viimeisten neljän vuoden aikana.

− Sekä vaimollani että nelivuotiaalla pojallani on borrelioosi. Tauti on vaivannut vaimoani jo neljä vuotta, mutta syy kummallisiin oireisiin, kuten huimaukseen ja väsymykseen, löytyi vasta puolitoista vuotta sitten. Vaimoni sairasti borrelioosia todennäköisesti jo ennen raskautta, ja siten myös poikamme sai taudin, Ville kertoi Seiskalle taannoin LeBonk-ravintolan kattoterassin avajaisissa Helsingissä.

KATSO VILLEN VIDEOHAASTATTELU!

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Allaolevan artikkelin mukaan: Istukan kautta tapahtuva tartuntamahdollisuus on todennäköisesti pieni. Endeemisellä alueella vastasyntyneillä esiintyi kuitenkin tilastollisesti selvästi enemmän sydämen epämuodostumia. Useissa eläimillä ja ihmisillä suoritetuissa tutkimuksissa on havaittu borreliabakteerin siirtyvän istukan kautta sikiöön. Aiheuttaako tartunta vastasyntyneelle infektion? Tähänastisten tutkimusten mukaan tartunta on harvinainen.

Saksa 2004. Lyme borreliosis: from infection to autoimmunity
S. K. Singh and H. J. Girschick

http://onlinelibrary.wiley.com/doi/10.1 ... 0895.x/pdf


Perinatal Lyme disease

Case reports have suggested that adverse out-
comes of pregnancies may be complicated by
maternal Lyme borreliosis [62]. The risk of trans-
placental transmission of
B. burgdorferi
is probably
minimal when appropriate antibiotics are given to
a pregnant woman with Lyme borreliosis. There
have been several published case series investi-
gating the relationship between gestational Lyme
disease and fetal outcome. The questions
addressed in these series were as follows. Does
B. burgdorferi
cross the placenta and invade the
foetus? If there is transplacental transmission,
does this have any significance for the develop-
ment of the foetus?

Several studies have shown a
relationship between seropositivity in pregnancy
and pregnancy outcome. A large serological study
of 2014 women, of whom 12 were seropositive,
revealed no increased risk of congenital malfor-
mations, low birth weight, abnormal length of
gestation or risk of fetal death among children
born to seropositive mothers [63]. A second study
of 1416 pregnant women, of whom 12 were
seropositive at delivery, also revealed no adverse
outcomes attributable to seropositivity [64]. A
study comparing 5000 infants, divided equally
between a Lyme-endemic area and a control area,
showed no significant differences in the incidence
of congenital malformations, except for a statisti-
cally significant increase in the rate of cardiac
malformations in the Lyme-endemic area [65].

However, it is not known whether this finding
represents an artefact or a valid difference
between the two populations. A further epidemi-
ological study conducted in a Lyme-endemic area
has questioned the connection between maternal
Lyme disease and congenital heart disease [66]. In
this study of 796 patients and 704 control subjects,
there was no significant association between
congenital defects and maternal Lyme disease.
In another clinical study, a higher incidence of
neurological disorders was not found in children
of women with gestational Lyme disease in an
epidemic area.

Studies in both human and animal models have
established that
B. burgdorferi
can cross the pla-
centa, presumably during the period of initial
spirochaetaemia. Despite documentation of trans-
placental transmission of
B. burgdorferi
, there has
been no clinical evidence for a fetal inflammatory
or immune response, or an adverse neonatal
outcome resulting from gestational Lyme disease
[67]. The above studies indicated that an adverse
fetal outcome resulting from maternal infection
with
B. burgdorferi
at any point during pregnancy
in humans is, at most, extremely rare.

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Borrelioosia sairastavilta löydetään usein artkkelissa mainittuja viruksia kuten sytomegalovirusta. Artkkelissa mainitaan kupan aiheuttajan siirtyvän äidistä sikiöön. Borreliabakteeri ja kupan aiheuttaja ovat molemmat spirokeettoja.

"... esim. bakteerit eivät normaalioloissa läpäise istukan veriestettä, joten istukka toimii sikiön kannalta myös eräänlaisena suojamuurina tartuntoja vastaan. Toisaalta on samalla todettava, että istukan läpi sikiöön voi päästä myös sitä vahingoittavia tekijöitä, joita ovat mm. useat virukset, kemialliset yhdisteet ja lääkkeet."

http://www.saunalahti.fi/arnoldus/placenta.html


Arno Forsius

Istukan tutkimuksen historiaa

Sikiökauden tartuntataudit

Istukka antaa sikiölle suojan useita alkueläinten ja bakteerien aiheuttamia tauteja vastaan. Vain harvat bakteerit pääsevät terveen istukan läpi. Jos istukka on viallinen tai jos bakteeri aiheuttaa vaurion istukassa, se voi päästä myös sikiön verenkiertoon ja edelleen sikiön kudoksiin. Sikiökaudella esiintyvät useat infektiotaudit osoittavat, että näin on tapahtunutkin. Sen sijaan virukset läpäisevät usein vaikeuksitta istukan veriesteen ja aiheuttavat sikiölle sairauden ja toisinaan myös vakavia vammoja.

Alkueläintaudeista toksoplasmoosi on huomattava vaara sikiölle, sillä se aiheuttaa usein sikiölle vaikeita ja pysyviä vaurioita. Malariaa on tavattu sikiöillä joskus harvoin. Trypanosoma cruzi, joka aiheuttaa Chagasin taudin, voi myös tarttua sikiöön.

Nykyään bakteeritaudeista hankalin on listerioosi, joka voi läpäistä istukan ja aiheuttaa vakavan sairauden sikiössä. Kuppatauti (syfilis) oli aikaisemmin merkittävä tauti sikiökaudella. Muita sikiökaudella tartuntoja joskus aiheuttaneita bakteeritauteja ovat olleet tuberkuloosi, lepra ja tularemia. Nautatuberkuloosi on ollut aikoinaan melko yleinen vasikoilla sikiökauden aikana. Toinen eläimillä sikiökauteen vaikuttanut ja keskenmenoja aiheuttanut tauti on ollut Brucella -bakteerien aiheuttama luomatauti. Ihmisellä tauti tunnetaan yleensä bruselloosin nimellä ja tietyt Brucella -lajit ovat aiheuttaneet keskenmenoja myös tautiin sairastuneilla naisilla.

Virustaudeista vihurirokko ja parvorokko (aiheuttajana parvovirus B 19) voivat aiheuttaa sikiössä hengenvaarallisen tai pysyviä vammoja aiheuttavan taudin. Parvorokosta voi olla seurauksena myös sikiön vakava anemia. Lisäksi polio voi aiheuttaa sikiössä epämuodostumia. Kehittyneissä maissa vihurirokon haitoista on päästy eroon tyttöjen rokotuksilla. Muita sikiössä joskus taudin aiheuttavia virustauteja ovat tuhkarokko, sikotauti, vesirokko, isorokko ja tarttuva keltatauti (hepatitis A) sekä sytomegalo-, herpes simplex-, influenssa- ja coxsackie- virusten aiheuttamat infektiot. Isorokkorokotuksessa aikoinaan käytetty lehmärokko tarttui sikiöön hyvin harvoin. [Katso myös kirjoitusta Vyöruusu eli herpes zoster, lisäys huhtikuussa 2005.]

Tämän ajan tärkeä virustauti on HIV-tartunta, joka voi siirtyä raskaana olevasta myös sikiöön. Toisaalta on olemassa viitteitä siitä, että istukka voisi muodostaa vasta-aineita virusta vastaan ja vähentää sikiön tartunnan mahdollisuutta. Asia vaatii kuitenkin lisätutkimuksia.

Eläinkuntaan kuuluvista monisoluisista taudinaiheuttajista Bilharzia -loinen voi tartuttaa bilhartsioosin eli skistosomiaasin myös sikiöön. Joskus harvoin tiedetään sileäpäisen heisimadon (Taenia saginata) ja suolinkaisen (Ascaris lumbricoides) aiheuttaneen tartunnan sikiökaudella.

[soijuv]

Tri Maynen mukaan "saman borreliabakteerikannan löytyminen pariskunnilta viittaa vahvasti siihen että tauti voi tarttua myös sukupuoliteitse."

The Journal of Investigative Medicine 2014;62:280-281

Borreliosiohjelma KPFA-kanavalla. Ohjelmassa kerrotaan uudesta tutkimuksesta jonka mukaan Borrelioosi näyttäisi olevn sukupuoliteitse tarttuva tauti. Ohjelmassa esiintyy mm. kaksi tutkijaa, R.Stricker ja M.Middelween. "Borrelitartunnan voi saada metsästä punkin välityksellä, mutta sitä suurempi riski saattaa olla sukupuoliteitse tapahtuvat tartunnat."

Ohjelman voi ladata tietokoneelle tai kuunnella osoitteesta:

http://www.kpfa.org/archive/id/99786


TIETOA TUTKIMUKSESTA: [/b]

http://lymedisease.org/news/lyme_diseas ... ssion.html

25.1.2014. Tutkijat tutkivat kolmen ryhmän siemenneste- tai emättimen limakalvonäytteet. Kaikilla borrelioosia sairastavila naisilla emättimestä otettu limakalvonäyte oli positiivinen ja puolella borrelioosia sairastavista miehistä siemennestenäyte oli borrelia positiivinen. Yhdellä heteroseksuaalipariskunnalla oli kummallakin sama bakteerikanta genitaalinäytteissä. Ne jotka eivät sairastaneet borrelioosia, olivat myös tässä testissä borrelia negatiivisia.

NEWS: Recent study suggests that Lyme disease can be sexually transmitted
25th January 2014

spirochete image

Notes one researcher: "There is always some risk of getting Lyme disease from a tick bite in the woods. But there may be a bigger risk of getting Lyme disease in the bedroom.”

Press release, January 25, 2014:

Carmel, CA – A new study suggests that Lyme disease may be sexually transmitted. The study was presented at the annual Western Regional Meeting of the American Federation for Medical Research, and an abstract of the research was published in the January issue of the Journal of Investigative Medicine.

Lyme disease is a tick-borne infection caused by Borrelia burgdorferi, a type of corkscrew- shaped bacteria known as a spirochete (pronounced spiro’keet). The Lyme spirochete resembles the agent of syphilis, long recognized as the epitome of sexually transmitted diseases. Last summer the Centers for Disease Control and Prevention (CDC) announced that Lyme disease is much more common than previously thought, with over 300,000 new cases diagnosed each year in the United States. That makes Lyme disease almost twice as common as breast cancer and six times more common than HIV/AIDS.

“Our findings will change the way Lyme disease is viewed by doctors and patients,” said Marianne Middelveen, lead author of the study presented in Carmel. “It explains why the disease is more common than one would think if only ticks were involved in transmission.”

The present study was a collaborative effort by an international team of scientists. In addition to Middelveen, a veterinary microbiologist from Canada, researchers included molecular biologists Jennie Burke, Augustin Franco and Yean Wang and dermatologist Peter Mayne from Australia working with molecular biologists Eva Sapi and Cheryl Bandoski, family practitioner Hilary Schlinger and internist Raphael Stricker from the United States.

In the study, researchers tested semen samples and vaginal secretions from three groups of patients: control subjects without evidence of Lyme disease, random subjects who tested positive for Lyme disease, and married heterosexual couples engaging in unprotected sex who tested positive for the disease.

As expected, all of the control subjects tested negative for Borrelia burgdorferi in semen samples or vaginal secretions. In contrast, all women with Lyme disease tested positive for Borrelia burgdorferi in vaginal secretions, while about half of the men with Lyme disease tested positive for the Lyme spirochete in semen samples. Furthermore, one of the heterosexual couples with Lyme disease showed identical strains of the Lyme spirochete in their genital secretions.

“The presence of the Lyme spirochete in genital secretions and identical strains in married couples strongly suggests that sexual transmission of the disease occurs,” said Dr. Mayne.

“We don’t yet understand why women with Lyme disease have consistently positive vaginal secretions, whilst semen samples are more variable. Obviously there is more work to be done here.”

Dr. Stricker pointed to the unknown risks of contracting Lyme disease raised by the study. “There is always some risk of getting Lyme disease from a tickbite in the woods,” he said. “But there may be a bigger risk of getting Lyme disease in the bedroom.”

Reference: The Journal of Investigative Medicine 2014;62:280-281.

\Presented at the Western Regional Meeting of the American Federation for Medical Research, Carmel, CA, January 25, 2014. http://afmr.org/Western/.

Additional information: officemanager@usmamed.com
- See more at: http://lymedisease.org/news/lyme_diseas ... YLZZG.dpuf



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"Johtopäätös: Borreliabakteereita löydettiin siemennesteestä ja emättimen limakalvoilta. Näyttäisi siltä että borreliabakteeri saattaa tarttua sukupuolikontaktissa henkilöltä toiselle."

7th Annual Medical-Scientific Conference on Morgellons
March 29th and 30th, 2014 Austin, TX

CONTROL ID: 1848565
CONTACT (NAME ONLY): Raphael Stricker
PRESENTATION TYPE: Oral Only
CURRENT CATEGORY: Infectious Diseases
Abstract
TITLE: ISOLATION AND DETECTION OF BORRELIA BURGDORFERI FROM HUMAN VAGINAL AND SEMINAL SECRETIONS

AUTHORS (FIRST NAME, LAST NAME): Marianne J. Middelveen1, Cheryl Bandoski2, Jennie Burke3, Eva Sapi2, Peter J. Mayne4, Raphael B. Stricker5
INSTITUTIONS (ALL): 1. Atkins Veterinary Services, Calgary, AB, Canada.
2. University of New Haven, West Haven, CT, United States.
3. Australian Biologics, Sydney, NSW, Australia.
4. Laurieton Medical Centre, Laurieton, NSW, Australia.
5. CPMC, San Francisco, CA, United States.

ABSTRACT BODY:
Purpose of Study: Recent reports indicate that more than 300,000 cases of Lyme disease are diagnosed yearly in the USA. Previous epidemiological and immunological studies suggest that infection with the Lyme disease spirochete Borrelia burgdorferi could be transferred from person to person via intimate human contact without a tick vector (Harvey and Salvato, Med Hypotheses 2003;60:742; Stricker et al, J Investig Med 2004;52:S151). Detecting viable spirochetes in vaginal and seminal secretions would provide additional evidence to support this hypothesis.

Methods Used: Three North American patients with a history of Lyme disease, one male and two female, were selected for the study after informed consent was obtained. Serological testing for B. burgdorferi was performed on all three subjects. Blood and semen or vaginal secretions were used to inoculate BSK-H medium for Borrelia culture. Motile spirochetes were detected in cultures by light and/or darkfield microscopy, and cultured spirochete concentrates were subjected to Dieterle silver staining, scanning electron microscopy (SEM) and anti-B. burgdorferi immunohistochemical staining for further characterization. Polymerase chain reaction (PCR) testing was performed by two independent laboratories for specific identification of the cultured isolates. Positive and negative controls for immunohistochemical staining and PCR were performed in all experiments.

Summary of Results: Serum antibodies to B. burgdorferi were detected in all three patients. Motile spirochetes were observed in culture fluid inoculated with blood and genital secretions from the three subjects. Morphological features of spirochetes were confirmed by Dieterle staining, SEM and immunohistochemical staining of culture concentrates. PCR testing confirmed that the spirochetes isolated from blood and genital secretions were strains of B. burgdorferi, and PCR subtyping indicated that the strains were B. burgdorferi sensu stricto.

Conclusions: The culture of viable B. burgdorferi in genital secretions suggests that Lyme disease could be transmitted by intimate contact from person to person.