Borreliose-Gesellschaft e.V.

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Pathology of late or chronic Lyme neuroborreliosis compared to neurosyphilis
Judith Miklossy

International Alzheimer Research Center
Alzheimer Prevention Foundation, 1921 Martigny-Combe, Switzerland

Whether spirochetes persist in the affected host tissues and are responsible for the chronic or late manifestations of neurosyphilis was also the subject of strong debate in the history of medicine. The early and late clinical and pathological manifestations of neurosyphilis are distinct. It was Noguchi and Moor (1913), who, by detecting Treponema pallidum in brains of patients suffering from general paresis, established a direct pathogenic link between spirochetal infection and dementia. Today it is generally accepted that Treponema pallidum can persist in the brain even decades following the primary syphilitic infection and cause various chronic neuropsychiatric symptoms, including stroke and dementia. The terms chronic or late neurosyphilis were both used to define tertiary neurosyphilis.

Today, the same question is in the center of debate with respect to Lyme neuroborreliosis. As in neurosyphilis the neuropsychiatric and neuropathological manifestations of early and late neuro-borreliosis are distinct. The secondary manifestations are mostly confined to the leptomeninges, leptomeningeal arteries, cranial and peripheral nerves and are clinically reflected as meningitis, vasculitis and neuritis. In contrast, brain parenchymal involvement defines late or chronic Lyme neuroborreliosis. The existence of both, the meningovascular and meningoencephalitic forms of late or chronic Lyme neuroborreliosis were clinically and pathologically confirmed. In these cases, Borrelia spirochetes were detected in the affected tissues and/or were cultivated from the brain or cerebrospinal fluid. The existence of these late forms of Lyme neuroborreliosis indicates that Borrelia burgdorferi in an analogous way to Treponema pallidum can evade from destruction by the host immune system, persist in the host tissues and cause chronic inflammation and slowly progressive tissue damage. 

The confirmation of late or chronic Lyme neuroborreliosis should be based on the characteristic clinical symptoms and pathological changes, on the positive serology of Borrelia burgdorferi and on the cultivation or detection of spirochetes or their specific antigens or DNA in the affected tissues.

The existence of late Lyme disease is approved by all guidelines established in the U.S.A. and Eu-rope. The use of chronic Lyme neuroborreliosis as a different entity is not justified as, in analogy to syphilis, both determine tertiary Lyme neuroborreliosis.

Further research, exchange of knowledge and open discussions at an international level are important.

Dr. Miklossy is the director of the International Alzheimer Research Center and president of Pre-vention Alzheimer Foundation in Switzerland. For ten years she was head of the Neurodegenera-tion research group in the University Institute of Pathology, CHUV, Lausanne, Switzerland. For seven years she was involved in molecular biology research in Temple University, Philadelphia and in neurological researches in the University of British Columbia, Vancouver, Canada. She is involved in Lyme disease and Alzheimer's disease research for more than 20 years. Dr. Miklossy received her M.D., Ph.D. and Board Certificates (FRCPH) in Neurology, Psychiatry and Psychotherapy in the University Medical School of Debrecen, Hungary (all with EU and Swiss federal conformity certificates). She has received the academic titles of Privatdozent (Dr. habil. or D.Sc) and MER and the Board Certificate in Neuropathology (FMH) in the University of Lausanne Switzerland (www.miklossy.ch).