Borrelia Ebook

Lyme Strategies

This latest updated text, in digital eBook form and available for immediate download, has been expanded nearly eightfold over the original guide of 2004 in terms of the exact, step-by-step lue-print and essential information designed to maximize this protocol. Just some of the valuable information contained in this 193-page guide includes: How to do the protocol, including the exact, specific method or procedure that is critical to its success. Schedule chart, measurements guide, tips and recommendations. The basic elements of the protocol are actually five, not just salt and vitamin C what these are and why Understanding what a Jarisch-Herxheimer reaction (or Herx) is. Particular djunct items found to be extremely helpful and particular items for special issues. A Technical Section detailing why the protocol works (posited mechanisms), including scientific citations and and studies. The right salt versus wrong salt and why. the low-salt, no-salt myth and scientific truth. the historical, medicinal use of natural salt. Did you know salt was used to treat syphilis, caused by Lyme's bacterial cousin, in the 1800s? Why Vitamin C and what does it do? The protocol and specific body considerations (heart, adrenals, etc.) Key Characteristics of the Lyme bacterium (Borrelia burgdorferi), including nearly 20 extraordinary mechanisms and features it uses to elude the immune and proliferate in the body

Lyme Strategies Summary


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Contents: 193 Pages EBook
Author: M. Fett
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Postlyme Disease Syndrome

The terms post-Lyme disease syndrome and post-treatment chronic Lyme disease are used to describe patients who were previously diagnosed with Lyme disease and develop persistent encephalopathic symptoms months to years after antibiotic treatment. Not all patients with a clinical history of Lyme disease who later present with encephalopathic symptoms are seropositive or have abnormal CSF. Most patients who are seronegative do not have Lyme disease, although it is possible to be seronegative and have post-Lyme syndrome. There are also reported cases of seronegative patients with CSF evidence of Lyme infection however, this is rare. Most patients diagnosed with post-Lyme syndrome are seropositive for Lyme disease and develop symptoms after treatment. In 1991, Krupp and colleagues compared a group of treated Lyme disease patients who continued to report memory problems after treatment, to a group of healthy controls. All subjects received a similar neuropsychological test battery to those...

The Genus Borrelia

The borreliae are motile, helical rods that range from approximately 5 to 30 pm in length and 0.2 to 0.5 pm in width. 1 They are similar in structure to other spirochetes, although Borrelia are generally longer and less tightly coiled. The organisms are highly motile, and they have 7 to 30 periplasmic flagella, which are partly responsible for maintaining the shape of the organism. The flagella are attached to the protoplasmic cylinder, which is enclosed by a cytoplasmic membrane and bounded by the periplasmic space and an outer membrane. Borreliae are unique with respect to their genetic composition in that they possess a linear chromosome, along with a complement of linear and circular plasmids. The chromosome comprises approximately 950 kbp, whereas the plasmids may consist of another 40-50 more genetic material. The linear plasmids tend to encode surface proteins, whereas the circular plasmids encode proteins related to transmission and pathogenesis. Sequencing of the Borrelia...

Lyme Disease

Isolation of the organism Borrelia burgdorferi from a clinical specimen or demonstration of antibody (IgM or IgG) against B. burgdorferi in serum or cerebral spinal fluid confirms the diagnosis. A two-test approach (enzyme-linked immunosorbent assay followed by Western blot) is recommended.

Gramnegative outer membrane

Form transmembrane channels involved in the nonspecific transport of small hydrophilic solutes across the membrane. Other proteins mediate specific uptake of larger metabolites. Expression of some OMPs is regulated by environmental factors, such as growth medium composition. For example, many gram-negative bacteria express iron-regulated OMPs when growing in iron-deficient media. In vivo such proteins are involved in scavenging iron in mammalian tissues, a prerequisite for bacterial growth, and are therefore important virulence determinants of bacterial pathogens. Many OMPs are antigenic, and antigenic variation in these proteins is important in the pathogenesis of diseases such as gonorrhea (caused by Neisseria gonorrhoeae) and relapsing fever (caused by Borrelia spp.). Some OMPs contain T cell epitopes and stimulate cell-mediated responses which may modulate the immune response during infection. OMPs are also involved in the resistance of some intracellular bacteria to the...

Arthropoda As Microbial Virulencefactor Reservoirs In Emerging Reemerging Disease

Passed from rodent to man by an arthropod host, namely the flea (65). Since antiquity, many diseases have been arthropod-borne, and many diseases that are today considered emerging infectious diseases employ arthropod hosts as vectors therefore, arthropods serve as major reservoirs for increasing virulence when manifested in mammalian hosts. These diseases include (i) tick mite-borne diseases arenavirus hemorrhagic fevers including Lassa fever, hantavirus pulmonary syndrome, which also involves rodent intermediates, Lyme disease spirochete Borrelia, Ehrlichioses, and various spotted fevers and (ii) insect-borne diseases malaria, via the mosquito, typhus, via the louse (66). Note in Table 2 the number of emerging diseases that are fever-causing (typically gram negative or viral) and those that are arthropod-borne. Lyme disease

Zoonotic Encephalitis And Meningitis

Zoonotic encephalitis is most often transmitted hematologically as an arboviral infection with an arthropod vector and animal host. Often the vector is a mosquito or tick and the animal host is a small animal or bird. The one exception is rabies, which follows peripheral nerve tracts after inoculation from an infected animal's bite. Additionally, encephalitis may be seen in the nonviral zoonotic infections of Bartonella henselae, Brucella canis, borreliosis, Coxiella burnetii, Ehrlichia sp., listeriosis, leptospirosis, Lyme disease, RMSF, psittacosis, and toxoplasmosis.1 ,29,30 The presentation is one of a prodromal illness with malaise, myalgia, fever and, occasionally, parotiditis. This prodromal phase advances to a sudden decline in mental status associated with headache and fever. Prompt recognition and therapy of encephalitis is important, given the high morbidity and mortality rates. However, it is significant to recognize that there are no pathognomonic signs and symptoms that...

Viral infection and acute myocarditis

It is probable that human myocarditis can be caused by viruses other than those from the coxsackie group, and the adeno group is beginning to be seen as potentially cardiotoxic. A very wide range of viruses such as those responsible for chicken pox, measles, rubella, and mumps often cause a minor degree of what is taken to be myocarditis based on ECG changes. A small subgroup of myocarditis may be caused by non-viral organisms, such as the spirochaete Borrelia burgdorferi in Lyme disease, toxoplasma, and leptospira, while in South America Trypanosoma cruzi is by far the most common cause of the acute myocarditis of Chagas' disease.

Neurological Manifestations

The classic neurological symptoms of early disseminated Lyme disease are meningitis, cranial neuritis, and radiculoneurotis. These occur alone or in combination in approximately 15 of untreated patients. A unilateral or bilateral facial nerve palsy is also a relatively common symptom of early disseminated disease. Symptoms usually last for weeks to months but can become chronic. Chronic neurologic manifestations of the disorder, which include encephalopathy, polyneuropathy, and leukoencephalopathy, usually occur late in the illness. Although there have been reports of cases with severe cognitive impairment, including psychosis and dementia, and vasculitic lesions, such cases are rare. A mild chronic Lyme encephalopathy (LE) is the most common neurologic symptom in patients with late-stage disease. Months to years after disease onset, sometimes following long periods of latent infection, a small percentage of patients develop a mild to moderate encephalopathy. The symptoms tend to be...

Neuropsychological Studies

For most neuropsychological procedures, the presence or absence of functional impairment is made on a statistical basis. Ideally, performance on a given test is interpreted in comparison to normative data appropriate to the patient's age, sex, and education. Probable impairment on a specific cognitive test is inferred when performance falls below a designated cutoff score, usually two standard deviations below the normative mean. Whether or not a particular test will discriminate between normal and abnormal function for either individuals or clinical populations depends on a number of critical factors. Reliability and validity data are essential for understanding the limits of a given test. Additionally, the ability of a test to discriminate between groups depends on the purpose and population for which the test was developed. For example, tests such as the Mini-Mental State Examination that were developed to screen for dementia in elderly populations are relatively...

Population Studies

In the laboratory studies of the LE described previously patients were selected on the basis of neurologic complaints. Although these types of studies have been helpful in understanding the nature and severity of neurologic deficits in Lyme disease, they tell us little about the prevalence of these symptoms. Nancy Shadick and colleagues studied the prevalence of persistent neurologic symptoms in a sample of un-selected patients with a history of Lyme disease in Ipswich, Massachusetts, a community endemic for Lyme disease. These investigators initially studied 38 people who met CDC criteria for previous Lyme disease and 43 people who did not. There was a slight but statistically significantly difference between groups on the CVLT, with the Lyme disease group performing more poorly. Twelve of the 38 Lyme patients scored two or more standard deviations below mean on the word list test, compared to only 5 of the 43 controls. Patients with residual symptoms, neurologic and musculoskeletal,...

Evasive strategies by the organism

Cular importance in human disease is the ability of strains of Coxiella burnetii with particular plasmid (or sometimes chromosomal) sequences to persist in the patient and later cause chronic hepatitis or endocarditis. The basic evasive strategy of the rickettsiae is their ability to invade host cells to escape the activated macrophages and antibody-dependent destruction mechanisms arrayed against them. Most rickettsiae appear able to induce their own phagocytosis in a variety of cells which are not professional phagocytes. Species of Rickettsia then escape from the phagosome directly into the cytoplasm and sometimes even invade the nucleus. In contrast Ehrlichia remain in the phagosome but prevent its fusion with lysosomes. Finally, Coxiella not only permits acidification of the phagosome by lysosome fusion but is actually activated metabolicaily by this step. How Coxiella persists in the liver and endocardium, despite antibiotic treatment, is not understood. Each of these genera...

Other causes of acute myocarditis

Lyme disease caused by Borrelia burgdorferi, a tick borne organism carried by deer, may cause an acute myocarditis, typically with a long PR interval as occurs with acute rheumatic fever. Left ventricular dysfunction is usually transient but the organism has been cultured from endomyocardial biopsy material in a patient with a dilated cardiomyopathy.

Dermatologic Zoonotic Infections

Systemic zoonoses are also accompanied by dermatologic findings, usually a generalized maculopapular rash, which is common in bartonellosis, lymphocytic choriomeningitis, Colorado tick fever, leptospirosis, psittacosis, and rickettsial infections. However, the maculopapular rash associated with most zoonotic infections is nonspecific and does not facilitate the diagnosis. Those zoonotic infections with specific dermatologic findings aiding in the diagnosis are infections from Aeromonas sp., Lyme disease, RMSF Vibrio sp., and viral hemorrhagic fevers (Table idS-Z).5,11

The Origins and Meanings of Disease Pattern Categories

To underlying variations in number of mosquitoes (for malaria or yellow fever), ticks (for plague or Lyme disease), or infected raccoons (for rabies). Time also enters studies through so-called cohort effects, where people born during a certain period or of a certain age have similarly patterned illnesses. And time as history also influences health research, both through changes in diagnosis or terminology and through changing patterns of behavior (popularity of smoking, age at first sexual experience) or even the changing significance of specific life-cycle achievements. For example, getting married or obtaining a high school degree elevated the status of young adults more in the 1950s than it did in the 1990s.

MagNA Pure Lc Instrument

Comparison of the MagNA Pure and a manual extraction protocol (phenol chloroform) showed equivalent detection sensitivities for the extraction of Borrelia burgdorferi DNA from a variety of specimens such as urine, blood, and cerebral spinal fluid. All 80 positive samples (as determined by an independent method) were also tested positive by MagNA Pure extraction.1-8-1

Entrapment Neuropathies

Several alternative diagnoses should be considered. Stroke can lead to sudden facial weakness that involves only the lower face but also leads to neurologic involvement below the neck or other cranial neuropathies. Lyme disease and GBS can cause facial paralysis, as discussed elsewhere in this chapter. In patients with cancer, facial weakness may herald the metastatic spread of malignancy. The ear should be inspected carefully to rule out ulcerations caused by cranial herpes-zoster activation (Ramsay Hunt syndrome), which should be treated with oral acyclovir. Facial paralysis also can be seen in sarcoidosis, collagen vascular disease, and polio. All patients with facial weakness should be screened for HIV risk factors, since seventh nerve palsy can occur at the time of seroconversion. Lyme disease affects individuals exposed to the tick-born pathogen Borrelia burgdorferi. Although its neurologic manifestations are multiple, one of the most common sites of involvement is the...

Ticks Ixodes Dermacentor and Others

The main concern with ticks is that they are disease vectors. Typhus, tularemia, Colorado tick fever, Rocky Mountain spotted fever, viral encephalitis, and Lyme disease (Borrelia burgdorferi) all can be transmitted through tick bites. Tick paralysis, a symmetric ascending paralysis, occurs from the secretion of a neurotoxin by some species and may lead to respiratory failure in humans. It is treated by removing the tick. Insect repellants and tight-fitting clothing can be helpful in preventing tick bites in infested areas. Although organic solvents, heat, and other methods have been advocated to aid in dislodging a tick so as not to leave its mouth parts beneath the skin surface and to prevent further toxin release, no technique has definitively proven superior.14 The often insidious presentation of tick-borne illnesses such as Lyme disease has prompted some physicians to prophylactically administer antibiotics following tick bites. However, less than 5 percent of tick bites in highly...

Acute Peripheral Neuropathies

Patients will have a modest CSF pleocytosis (up to 100 lymphocytes mm3), the presence of cells in the CSF should prompt consideration of other systemic diseases sometimes associated with GBS, such as HIV infection, lupus, and lymphoma. Lyme disease can present with a clinical picture similar to GBS and would be suggested by a CSF pleocytosis in combination with a history of tick bites or the presence of CSF Lyme antibodies. Carcinomatous meningitis also can present with similar symptoms but will be evident with malignant cells in the CSF or extremely high protein or low glucose levels. Tick paralysis mimics GBS, and all patients with suspected GBS should be examined thoroughly for ticks. Acute intermittent porphyria (discussed below) and spinal cord compression should be considered in the differential diagnosis the presence of upper motor neuron signs and bowel and bladder incontinence would suggest the latter.

Clinical Features

Tingling Vermilion Border

Ruling out of other conditions is important in making the diagnosis. The results of a detailed examination of the cranial nerves should be normal except for the aforementioned findings associated with CN VII. The findings on examination of the ear, tympanic membrane, mastoid, and parotid gland should be normal in order to make a diagnosis of Bell's palsy. A CN VII palsy in association with otitis media, mastoiditis, or parotitis is a potential ear, nose, and throat (ENT) emergency and should prompt immediate consultation. The presence of vesicles on the tympanic membrane or in the ear canal is diagnostic of the Ramsay Hunt syndrome and is discussed in the section on VZV. A history of chronic ear infections, prior ear surgery, or tumor or recent head trauma excludes a diagnosis of Bell's palsy. If the presentation and examination are consistent with Bell's palsy, imaging of the CNS (CT or MRI) is not indicated, but if there are atypical features, recent trauma, or doubt, then imaging...

Differential Diagnosisdisease Variants

Other illnesses that present as a relapsing-remitting type of illness include Behcet's disease, characterized by oral or genital ulcerations, iridocyclitis, menin-goencephalitis, and thrombophlebitis. Lyme disease typically has radicular or peripheral nerve involvement but can be mistaken for MS because of its relapsing-remitting course and occasionally by its appearance on MRI. Sjogren's syndrome, in which individuals have vasculitis of the skin and peripheral nervous system associated with dry eyes and dry mouth, has also been confused with MS, in part because of MRI abnormalities that may mimic MS. Neurosarcoidosis may be a relapsing-remitting type of illness, but it generally has multiple cranial mononeuropathies. MRI shows lep-tomeningeal enhancement associated with intracranial disease. Cerebrovascular disease may be confused with MS, especially when interpreting MRI scans. Primary central nervous system vasculitis or systemic lupus erythematosus (SLE) may mimic the disease...

Prokaryotic Biodiversity And Prokaryotic Phylogenetics

Relman et al. point out that an entire domain of prokaryotes, Archaeah, has been found to colonize the human gut, oral, and vaginal cavities, but no association with disease causation has been found (19,20), presumably because, until recently, it has not been searched for with the right tools. According to Mayer, Archaea do not contain LPS (21) but rather are held together via peptidoglycan or some chemical variant thereof. One can also gather this from Gupta's claim that the Archaea are actually gram-positive organisms. At any rate, after being studied with advanced tools, they are being implicated in disease causation (22-24). Similarly, it is only in a host vector that many prokaryotes have made themselves known by causing disease in humans. Arthropod-borne gram-negative bacteria including Rickettsia (25), Borrelia, and Bartonella, the causative agents of typhus, relapsing, and trench fevers, respectively, are examples (26) for the numerous, newly emerging arthropod-borne diseases...

Popular and Professional Ideas about Risk

Medicine Clinical Epidemiology Cartoons

In some ways people do not seem to do a very good job at estimating the health risk posed by their environment or their behavior. They are anxious about (unlikely) large disasters with catastrophic consequences and forget about (quite probable) exposure to more common but smaller-scale accidents or health problems. That is, they worry more about dying in an airplane crash than dying in their car on the way to the airport, and they think nuclear radiation causes more cancer than radon gas. They are more concerned about the risks of their children having peanut allergies than of being obese. The media make much of new diseases such as West Nile virus, Lyme Disease, or SARS but do not sensationalize the real mass murderers called heart disease and cancer.

Differential gene expression in trypanosomes results in antigenic variation

Despite the enormous VSG gene pool available, the reproduction of variant antigenic types is limited in the trypanosome this prevents the exhaustion of the surface glycoprotein repertoire at an early stage of disease. Antigenic variation also occurs in trypanosome surface receptors involved in food uptake. These variants are limited in number, making these proteins a better target for vaccine development. The bacterium Borrelia hermsii, which causes relapsing fever, uses DNA rearrangement

Mechanisms of immunopathology

See also Bacillus, infection and immunity Bacterial cell walls Bacteroides, infection and immunity Bord-etella, infection and immunity Borrelia, infection and immunity Brucella, infection and immunity Campylobacter, infection and immunity Complement, alternative pathway Chlamydia, infection and immunity Coccidioides, infection and immunity Complement, classical pathway Complement deficiencies Complement fixation test Complement, genetics Complement, membrane attack pathway Complement

Chronic Lyme Encephalopathy

Unfortunately, hypoperfusion in these brain regions is not specific to Lyme disease. Similar SPECT findings have been reported in other conditions that have symptoms similar to LE, such as depression and chronic fatigue syndrome. Although some investigators argue that the pattern of hypoperfusion in LE may differ from that seen in other disorders, current quantitative SPECT studies have not yet been done. Therefore, SPECT alone is not sufficient in diagnosing LE.

Features of the immune response to specific types of pathogens within the CNS

See also Acquired immune deficiency syndrome (AIDS) Acute inflammatory reaction Adhesion molecules Antigen-presenting cells Bacillus, infection and immunity Borrelia, infection and immunity Bun-yavirus, infection and immunity Chemotaxis Coronavirus, infection and immunity Cryptococcus, infection and immunity Cysticercosis Cytokines Cytomegalovirus, infection and immunity Endothelium Fungi, immunity to Haemophilus, infection and immunity Herpes simplex virus, infection and immunity Herpesvirus-6, infection and immunity Histoplasma, infection and immunity Human immunodeficiency viruses Immune surveillance Transmissible spongiform encephalopathies, infection and immunity Listeria, infection and immunity Lymphocyte trafficking Malaria Monocytes Mycobacteria, infection and immunity Neisseria, infection and immunity Nocardia, infection and immunity Opportunistic infections Opsonization Picornavirus, infection and immunity Rhabdovirus, infection and immunity Rickettsia, infection and...

Changing Perspectives On Contaminants

The lines of disease causation have become blurred at the genetic level by the discovery of microbe-induced disease processes not originally associated with microbial causes and only recently identified by genotypic approaches. The latter include viral-induced cancerso (83-85), schizophrenia (86), and diabetes mellitus (87). Borrelia burgdorferi DNA incorporated in the genome of arthritic mice (88) and detected in humans (89) and a list of organisms referenced by Relman (87) have been found using genotypic approaches to detect microbial genes inserted into the genome of man and animals and therefore associated with specific diseases. These include Helicobacter pylori (peptic ulcer disease), hepatitis C virus (non-A, non-B hepatitis), bartonella henselae (Bacillary angiomatosis), Tropheryma whippelii (Whipple's disease), sin nombre virus (Hantavirus pulmonary syndrome), and Kaposi's sarcoma-associated herpes virus (Kaposi sarcoma). In this context Fredricks and Relman have called for...

Differential Diagnosis

Careful history taking and physical examination should be used to rule out neurologic disease. A high index of suspicion should be maintained for physical disorders that have a vague onset, such as systemic lupus erythematosus, multiple sclerosis, polymyositis, Lyme disease, and drug toxicity or poisoning. Schizophrenia and depression may have associated conversion disorders. In somatization disorders, the symptoms are more chronic and involve multiple organ systems. With hypochondriasis, patients are usually without loss of function and display the conviction that some terrible undiscovered illness is present. Hypochondriacal patients will be overly concerned with symptoms. In cases of factitious symptoms, usually associated with malingering, patients will consciously complain about symptoms to

Relapsing Fever

Louse-borne relapsing fever is caused by B. recurren-tis, which enters the host through skin abrasions or through mucous membranes that have made contact with hemolymph from crushed lice. Borrelia are not transmitted through a louse bite, as they are not present in the louse saliva. B. recurrentis is the only Borrelia species for which humans are the sole host all other species are maintained in various wild-animal reservoirs. Because of the nature of the vector, including the increased prevalence in regions with poor hygienic practices, louse-borne relapsing fever can result in epidemics, and it is often referred to as epidemic relapsing fever. Mortality rates can be greater than 50 for untreated cases, although this drops to less than 5 following antibiotic treatment. Currently, disease outbreaks are relatively rare, and they are primarily found in Africa, although historically, cases have been reported throughout Europe and Asia as well. Tick-borne relapsing fever, or endemic...


Infection with the murine strain, B. microti, is typically a mild illness in healthy people however, in the asplenic or immunocompromised patient, such as those with AIDS, lymphoma or transplant patient, the disease may be overwhelming. Infection with bovine strains B. divergens and B. bovis, as seen in Europe, occurs in asplenic patients and is often fatal. Initial symptoms of babesiosis are nonspecific and include fever, chills, nausea, vomiting, arthralgia, myalgia, headache, fatigue and dark urine. The presence of a rash similar to erythema chronicum migrans probably reflects simultaneous infection with Borrelia burgdorferi, which is transmitted by the same vector. Laboratory studies may show decreased haptoglobin, elevated reticulocytes and parasitized red cells on blood films. Leukocytosis is rare however, thrombocytopenia is common. Patients often have a positive direct Coombs test, and urine studies reveal proteinuria and hemoglobinuria. Liver function tests often show mild...

Cardiac Syncope

Although both brady- and tachydysrythmias may lead to transient cerebral hypoperfusion, there is no absolute high or low heart rate that will produce syncope. Symptoms depend on both the autonomic nervous system's ability to compensate for a decrease in cardiac output and the degree of cerebrovascular atherosclerotic disease. A variety of dysrythmias may lead to syncope (Tab. e 46z1). A bradydysrhythmia is more likely to be an incidental finding on EKG rather than the actual cause of syncope.6 Dysrhythmias are most likely to occur in the setting of ischemic heart disease but also may occur in other disease processes, such as in prolonged QT syndrome (torsades de pointes) and Lyme disease (heart blocks). Syncope from dysrhythmias is typically sudden, with prodromal symptoms lasting less than 3 s. Many patients report lack of any warning or premonition when questioned.


Arthropods Crabs Respiratory System

Ticks and mites are the most abundant arachids and the most important from an economic and medical viewpoint. They attach to plants and animals, puncturing their surface to suck out fluids or blood. Besides the direct harm this causes, they are the most important insect disease vector after mosquitoes. They spread Lyme disease and Rocky Mountain spotted fever in humans, as well as many cattle diseases.


Babesia is a protozoan that, like Plasmodium species, possesses an erythrocytic phase. It is transmitted by Ixodes ticks and occasionally by blood transfusion. Babesiosis has been reported in the northeastern United States (especially Nantucket, MA, and Long Island, NY). Babesiosis in the northeast is caused by the murine species, Babesia microtti, and is transmitted by the deer tick, Ixodes, which also serves as a vector for Lyme disease. Patients may have intermittent fever, splenomegaly, hemolysis, and jaundice. Infection can be fatal in splenectomized patients, but its incidence is apparently not increased in immunocompromised patients. Diagnosis can be made on a Giemsa-stained peripheral smear. Occasionally, Babesia on smear can be confused with the ring forms of P. falciparum malaria. Babesiosis can simulate rickettsial diseases, such as Rocky Mountain spotted fever and Lyme disease. Treatment is with clindamycin and quinine.

Perinatal Infection

Infectious encephalitis are mainly caused by viruses, such as enteroviruses, mumps, measles, lymphocytic choriomeningitis and herpes viruses, arboviruses, HIV and CMV, but other diseases, particularly Lyme disease and mycoplasma pneumonia can sometimes cause a similar picture. Most cases of herpes infection including type 1 and 2 develop in the neonatal period.29,52 A 16-fold increase in unprovoked seizures was reported with viral encephalitis and the risk was more when associated with early seizures.24


Prokaryotic genomes are composed of a chromosome plus various accessory elements. The former is most commonly a circular double-stranded DNA molecule but may be a linear molecule in some major groups, such as Streptomyces and Borrelia (the causative agent of Lyme disease). Acces-

Chronic Conditions

Patients with some frequency present to the ED with neuropathy associated with an underlying condition. Many are of a chronic nature, and a few are subacute. Most of these do not present acute management issues. However, conditions such as syphilis, Lyme disease, and vitamin B 12 deficiency benefit from early detection. A

Infectious Exanthems

Many viral infections are associated with generalized morbilliform cutaneous eruptions. The list is exhaustive, but the most common include adenoviruses cytomegalovirus coxsackie and echoviruses Epstein-Barr virus hepatitis B virus human herpesvirus-6 paramyxovirus respiratory syncytial virus rotaviruses rubella virus, and human immunodeficiency virus. Other agents associated with generalized eruptions include mycoplasma Borrelia spp Legionella Leptospira Listeria meningococci rickettsiae and Treponema pallidum. Erythematous macules and papules, or, less often, vesicles and petechiae, usually develop centrally, sparing the palms and soles. Diagnosis and differential diagnosis are based upon history and physical examination. Drug eruption should always be considered in the differential. Skin lesions usually resolve in 7 to 10 days, and are treated symptomatically.


Complications by TBE are very seldom and mainly found in elderly patients typical is a cure with defects. Damage of the cardiac excitations system is reported. Tick-Born encephalitis infections could be more severe if Borrrelia burgdorferi causing Lyme disease infection is present in parallel with an infected tick.

Clinical Diagnosis

The diagnosis of MS is clinically based, relying heavily on the neurologic history and physical examination. The diagnosis is suggested when a patient has either two or more prolonged (days to weeks) episodes with neurologic dysfunction that suggests distinct white matter pathology or spinal cord dysfunction that worsens over several months.11 Optic findings, lack of focal pathology, clinical remissions, cerebrospinal fluid (CSF) findings, and typical features such as dysautonomias all suggest the diagnosis of MS.12 Symptoms that mimic MS are seen with systemic lupus erythematosus (SLE), Lyme disease, neurosyphilis, and HIV disease. The clinical features of these other diseases, as well as the presence of consistent laboratory and neuroimaging findings in MS, can help to confirm the diagnosis of MS.


Tetracycline are bacteriostatic antibiotics with a broad spectrum of activity. They have been used clinically since the 1940s and as a result acquired resistance to them is widespread. In veterinary medicine tetracyclines are used most frequently for atypical bacterial diseases due to Chlamydia (particularly in cats), Borrelia, Rickettsia, Haemobartonella and Mycoplasma. Tetracyclines are the drugs of choice for Erlichia canis and Rickettsia rickettsii infections.