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2000 Polish Study Ms Is Lyme PDF
2000 Polish Study Ms Is Lyme PDF
2000 Polish Study Ms Is Lyme PDF
Abstract: A total of 769 adult neurological patients hospitalised in clinics and hospitals
situated in the Lublin region (eastern Poland) were examined during the years 1997-
2000 with ELISA test for the presence of anti-Borrelia burgdorferi sensu lato
antibodies. A statististically significant (p = 0.0422) relationship was found between the
clinically confirmed diagnosis of multiple sclerosis and the positive serologic reaction
with Borrelia antigen. Ten out 26 patients with multiple sclerosis (38.5%) showed
positive serologic reaction to Borrelia, whereas among the total number of examined
neurological patients the frequency of positive findings was twice as low (19.4%). The
result suggests that multiple sclerosis may be often associated with Borrelia infection.
anti-Borrelia burgdorferi sensu lato antibodies during the Table 1. Clinical diagnosis of multiple sclerosis versus seropositive
years 1997-2000. The patients were hospitalised in 12 ELISA rection to Borrelia burgdorferi in neurological patients:
frequency of observed cases in 2 × 2 chi-square table.
clinical units: in two clinics in the city of Lublin and in 10
hospitals situated in the Lublin region (eastern Poland). Multiple Multiple Total
Twenty six patients, were diagnosed with multiple sclerosis, sclerosis sclerosis
based mainly on the characteristic symptomatology diagnosed not
+ diagnosed
(including paralysis of lower limbs) and the results of (-)
magnetic resonance imaging. Twenty five patients were
diagnosed with Lyme neuroborreliosis based on the result Reaction to B. burgdorferi N = 10 N = 149 N = 159
positive +
of serological examination, tick bite history and
symptomatology. Reaction to B. burgdorferi N = 16 N = 594 N = 610
negative (-)
the view on the possible relationship between these two 4. Coyle PK, Krupp LB, Doscher C: Significance of reactive Lyme
serology in multiple sclerosis. Ann Neurol 1993, 34, 745-747.
clinical entities. The proportion of the MS patients
5. Garcia-Monco JC, Miro Jornet J, Fernandez Villar B, Benach JL,
showing positive serological reaction to B. burgdorferi Guerrero Espejo A, Berciano JA: Multiple sclerosis or Lyme disease? a
(38.5%) was much higher compared to the earlier studies diagnosis problem of exclusion. Med Clin (Barc) 1990, 94, 685-688 (In
by Coyle [3], Coyle et al. [4] and Schmutzhard et al. [19] Spanish).
6. Heller J, Holzer G, Schimrigk K: Immunological differentiation
who found respectively 1.1%, 6.7% and 14.2% positive
between neuroborreliosis and multiple sclerosis. J Neurol 1990, 237,
reactions among MS patients. The difference may be 465-470.
partly explained by the overall high positive rate of 7. Kaiser R: Intrathecal immune response in patients with
serologic response to LB agent in eastern Poland, due to neuroborreliosis: specificity of antibodies for neuronal proteins. J Neurol
1995, 242, 319-325.
frequent exposure to bite of tick vector, Ixodes ricinus. 8. Karussis D, Weiner HL, Abramsky O: Multiple sclerosis vs
The nature of the stated relationship between infection Lyme disease: a case presentation to a discussant and a review of the
with LB agent and MS disease remains obscure. In some literature. Mult Scler 1999, 5, 395-402.
cases, neuroborreliosis may be misdiagnosed as MS. A 9. Kölmel HW: Differential diagnosis in human neuroborreliosis.
Zentbl Bakteriol 1999, 289, 687.
direct provoking of MS by B. burgdorferi does not look 10. Kurtz SK: Relapsing fever/Lyme disease. Multiple sclerosis. Med
probable, but it cannot be excluded that the LB agent may Hypotheses 1986, 21, 335-343.
aggravate the pathogenic processes in the initial stage of 11. Lana-Peixoto MA: Multiple sclerosis and positive Lyme serology.
MS and thus increase a number of the symptomatic, Arq Neuropsiquiatr 1994, 52, 566-571.
12. 0HOGXQHN5RF]Q\R=DFKRURZDQLDFKQD&KRURE\=DND(QHL
clinically diagnosed cases. This hypothesis, similar to that =DWUXFLDFK =ZL]NDPL &KHPLF]Q\PL =JáRV]RQ\FK Z URNX <HDUO\
proposed by Karussis et al. [8], may be supported by the Report on Incidence of Infectious Disease and Intoxications with
resemblance of the pathologic processes in both diseases: Chemicals Reported in 1999). PDVWZRZ\ =DNáDG +LJLHQ\ :DUVDZ
activation of the lymphocytic system [6], inducing of the 2000 (in Polish).
13. Murray R, Morawetz R, Kepes J, el Gammal T, LeDoux M:
matrix metalloproteinases (MMPs) production [15], Lyme neuroborreliosis manifesting as an intracranial mass lesion.
inducing of the autoantibodies production, including Neurosurgery 1992, 30, 769-773.
antibodies to neuronal proteins [7] and to myelin basic 14. Pachner AR: Neurologic manifestations of Lyme disease, the new
protein [8, 23]. In the late period of neuroborreliosis, "great imitator". Rev Infect Dis 1989, 11(Suppl 6), S1482-S1486.
15. Perides G, Tanner-Brown LM, Eskildsen MA, Klempner MS:
demyelinating involvement of CNS can develop, similarly Borrelia burgdorferi induces matrix metalloproteinases by neural
as in MS [5]. cultures. J Neurosci Res 1999, 58, 779-790.
Considering certain limitations of the present work 16. Piccolo I, Thiella G, Sterzi R, Colombo N, Defanti CA: Chorea
(lack of detailed clinical analyses, relatively low number as a symptom of neuroborreliosis: a case study. Ital J Neurol Sci 1998,
19, 235-239.
of definite MS cases under study), it cannot therefore be a 17. Polskie Towarzystwo Stwardnienia Rozsianego (Polish Association
basis for suggestions on the nature of the stated significant for Multiple Sclerosis): Report. Warsaw 1999 (in Polish).
relationship between LB and MS. Nevertheless, it does 18. Schmutzhard E: Lyme borreliosis and multiple sclerosis. Biomed
indicate a need for further studies on this subject. Pharmacother 1989, 43, 415-419.
19. Schmutzhard E, Pohl P, Stanek G: Borrelia burgdorferi antibodies
In conclusion, the result of this study suggests that in patients with relapsing/remitting form and chronic progressive form of
multiple sclerosis may be often associated with Borrelia multiple sclerosis. J Neurol Neurosurg Psychiatry 1988, 51, 1215-1218.
infection. 20. Scott TF: Diseases that mimic multiple sclerosis. Postgrad Med
1991, 89, 187-191.
21. Stelmasiak Z, Bekiesinska-Fugatowska M, Walecki J, Janowska
Acknowledgement D, Cisak E: MRI in patients with positive boreliosis tests treated due to
This study was supported in part by the Polish State Committee MS. European Society of Neuroradiology, XXII Congress and 6th
for Scientific Research (KBN), grant 4PO5DO3417. Advanced Course, 17-21 September 1996, Milan, Italy. Neuroradiology
1996, 38(Suppl 2), S91.
22. Triulzi F, Scotti G: Differential diagnosis of multiple sclerosis:
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