Geschiedenis van de ziekte van Lyme in Amerika

[Sproetje]

Lyme Disease History and Evolution of Tick borne Disease HD
2014

https://www.youtube.com/watch?v=tMWCvJWVFDs

Dr. Josef Burrascano

* 1965 Dr. Sidney Robbin, semi-retired Internist living in Montauk, NY described expanding circular rashes that respond to penicillin treatment.
* He also described a peculiar monoarthritis that he named " Montauk Knee "
* 1970 Dr. Rudolph Scrimenti, Wisconsin Dermatologist, published the first report of ECM rash in the United States
* He too reported that the rash responded to treatment with penicillin.


Lyme werd lyme disease na 1975

* 1975 After many calls from local residents led by Polly Murray, the CDC sent Dr. Alan Steere to Connecticcut to study a cluster of unusual rashes and painful swollen joints, especially in children.
* 1977 He published a study of 51 cases of a new clinical entity and called it "Lyme Arthritis".
* Steere, a rheumatologist, (hij is ook een immunoloog) thought that Lyme was an autoimmune disease and not a bacterial infection.
* Recommended treatment with aspirin and steroids; he considered it self-limited, and postulated a viral etiology.

In 1982 Dr. Willi Burgdorfer, NIH entomologist and specialist in relapsing fever Borrelia, examined ticks from Shelter Island, NY and discovered that a spirochete is the causative agent of Lyme.
This spirochete was subsequently named Borrelia burgdorferi in honor of Willi.

Na deze ontdekking bedacht men met penicilline te behandelen gezien syfflilis ook een spirocheet is.
Sommige patienten werden beter en bij anderen mislukte de behandeling
Men bedacht: laten we eens kijken naar de kenmerken van lyme: de hoofdkenmerken.

DE GEBOORTE VAN DE TERM "POST-LYME SYNDROOM"

* Eventually, Steere and his group tried antibiotic therapy, which in retrospect consisted of suboptimal regimens
* Unwilling to publicly consider that their minimal treatments may have failed, this group redefined lyme as consisting of two components-
the "major" and "minor" symptoms
- Major symptoms are the bell's Palsy, carditis, and arthritis
- Minor symptoms are everything else- the fatigue, headaches, neuropathy, encephalopathy, arthralgias, etc.
* They defined success as the elimination of the "major" symptoms of lyme
* However, the major symptoms would resolve over time without treatment!
* The persistence of the "minor symptoms" after antibiotic therapy was assumed by these immunologists that it was a non-infectious, immune-mediated phenomenon, and they named it the "post lyme syndrome"

Halverwege de jaren 80 kwam Burrascano en behandelde lyme patienten met een 10 of 14 daagse ab kuur, en zag een aantal van zijn patienten terug komen met dezelfde klachten.
Hij vroeg zich af hoe dat mogelijk was en ging met het afgenomen bloed van de patienten die hij reeds behandeld had naar het lab. van Alan MacDonald met het afnomen bloed van zijn reeds behandelde patienten.
Hier zag hij tot zijn grote verbazing dat er nog steeds spirocheten in het bloed zichtbaar waren.

POST OR PERSISTENT LYME?

* I was fortunate to have access to Dr. MacDonald's cultures
* Not only did I see seronegativity, I also was able to appreciate "atypical" presentations of lyme
* More importantly, those patients who had what Steere called the "post lyme syndrome" were culture positive, meaning that they still had lyme.
THESE WERE TREATMENT FAILURES, NOT AUTOIMMUNITY
* Certainly could not call this POST-lyme!