1. LATE STAGE LYME DISEASE
Kenny L. De Meirleir, internal medicine
Emeritus Gewoon Hoogleraar V.U.B.
Clinical Professor of Pathology, University of Nevada, Reno, U.S.A.
Medical Director Himmunitas VZW (Brussels) & WPI, University of Nevada, Reno, Nevada, U.S.A.

2. Chronic Fatigue Syndrome / M.E. (Fukuda & Canadian criteria)
+ 95 % Late Stage Lyme Disease
Lyme Stage III
+ 95 % Borrelia burgdorferi LTT 

3. Lyme Stage III = Late Stage Lyme Disease
Multisystem disease with high morbidity
Incidence in Belgium: UNKNOWN
> (up to ) patients
Transmission:
Blood sucking arthropods (Ixodes Ricinus): ticks, insects, ...
Sexual transmission between humans (new S.O.A.)
Mother-fetus transmission
Blood transfusion
Co-infections:
Bartonella - Rickettsia
Babesia - Tularemia
Chlamydiae - Parvovirus B19
Mycoplasmae - Yersinia
Campylobacter

4. Borrelia species – gramnegative bacteria
U.S.A.: Borrelia burgdorferi
Europe:
Borrelia burgdorferi
Borrelia afzelii
Borrelia garinii
other

5. DIAGNOSTIC TESTS
Borrelia burgdorferi antibody tests (Elisa, C6 peptide, Western Blot
→ mostly negative in LSLD
Borrelia PCR tests:
Low sensitivity in blood
High specificity when combined and confirmed by sequencing (U.L.)
Borrelia burgdorferi LTT*:
Indirect test
Valuable in LSLD
LTT accepted by FDA in 2011
Borrelia culture
→ not widely used; still investigational
Microscopic detection of Borrelia spirochetes:
Semen
Vaginal swap

6. Early treatment (< 2 months): no chronic disease
Late treatment: outcome uncertain – many develop “chronic diseases”: ME/CFS, ALS, MS, ...
Chronic microglial activation in LSLD – low grade neuroinflammation
Markers blood:
sCD14 (LPS)
PGE2
IL-8
Number of CD57+ lymphocytes in the blood
Other pro-inflammatory cytokines and chemokines
No vaccine available

7. Bartonella – gramnegative bacteria
Bartonella henselae – cat scratch disease
Bartonella quintana – trench fever
31 other species (8 subspecies are known to infect humans)
Only commercial antibody tests for Bartonella henselae
PCR with sequencing (only in Belgium)
Culture of Bartonella – not approved by FDA yet for clinical use
Infects endothelial cells in humans
Infect red blood cells – 3-4 Bartonella / millions red blood cells
Cats = reservoir: Bartonella / million red blood cells

8. Symptoms Bartonella positive vs. Bartonella negative
Pearson Chi-Square
weight change
0,005
anxiety - which may include panic attacks
0,007
emotional labiality (mood swings)
frequent, unusual nightmares
0,002
difficulty moving your tongue to speak
0,024
alcohol intolerance
0,015
Rash of Herpes Simplex of Shingles
impotence

10. Box plots ( line in box is median and size box is interquartile range : 50 % of centrally located points)

13. so all three increased medians for CFS group.
Non-parametric Mann – Whitney test performed for two independent groups :
Conclusion : for all three variables : MW is significant with p-value < ,
so all three increased medians for CFS group.

16. Regulation of T-cell immunity
TH1
cells
Protection against
intracellular pathogens
(viruses, bacteria)
Excess: hypersensitivities
IL-12
IFN-g
Naïve T cells
TH2
cells
Protection against
extracellular pathogens
(parasites, bacteria)
Excess: allergies
IL-4
TGF-b + IL-6
TH17
cells
Local immunity
(mucosa, skin)
Protection against
fungi, bacteria
Excess: autoimmunity, inflammation 16

17. Borrelia: prevention
Reservoir: Rodents / mammals mice / cats / deer ...
new strategies to control tick-born diseases
Early detection tick-born diseases – G.P. education
Screening all pregnant women
Screening of blood – blood transfusion
Recognize Borrelia as a S.O.A.