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Treatment of Lyme disease during pregnancy
Source publication
Lyme disease is the most commonly transmitted vector-borne disease in the United States, with many regions of the country at risk. Like other spirochete-borne infections, Lyme disease progresses in stages, making diagnosis in the early stages of the illness and prompt treatment important for cure. An early diagnosis is made difficult by the less-th...
Similar publications
Lyme disease is usually diagnosed and treated based on clinical manifestations. However, laboratory testing is useful for patients with confusing presentations and for validation of disease in clinical studies. Although cultivation of Borrelia burgdorferi is definitive, prior investigations have shown that no single test is optimal for Lyme disease...
To better define areas of human Lyme disease risk, we compared US surveillance data with published data on the seroprevalence of Borrelia burgdorferi antibodies among domestic dogs. Canine seroprevalence >5% was a sensitive but nonspecific marker of human risk, whereas seroprevalence <1% was associated with minimal risk for human infection.
Citations
... There have been relatively few well-documented cases of Lyme disease (also known as Lyme borreliosis), reviewed in [1][2][3][4] caused by several different sensu strictu strains of the spirochetal bacterium Borrelia burgdorferi occurring during pregnancy with potential congenital transmission. As a result, the transmission rate to the fetus and potential harmful effects were largely unknown for a long time [1,4]. ...
... There have been relatively few well-documented cases of Lyme disease (also known as Lyme borreliosis), reviewed in [1][2][3][4] caused by several different sensu strictu strains of the spirochetal bacterium Borrelia burgdorferi occurring during pregnancy with potential congenital transmission. As a result, the transmission rate to the fetus and potential harmful effects were largely unknown for a long time [1,4]. More up-to-date information on this topic has become available in recently published detailed reports [2][3][4] that discuss the diagnosis, clinical course, and treatment of this spirochetal disease, with an emphasis on the pregnant patient. ...
... Currently, there is insufficient evidence, based on epidemiological research reviewed in [1][2][3][4], to rule out the possibility that uncommon abnormal manifestations of Lyme disease can occur during pregnancy as compared to their occurrence in the general non-pregnant population. This has yet to be reported by the obstetrical coam amunity. ...
In this report, we describe a 23-year-old female who, while pregnant, was exposed to Borrelia burgdorferi but did not develop significant signs or symptoms (joint pain, arthritis) of Lyme disease until shortly after delivering a healthy child at term. Serologic testing confirmed infection with B. burgdorferi. A 3-week course of treatment with doxycycline was completely curative. There was no evidence for congenital or perinatal transmission of this pathogen at any point pre-term or postnatally. The key reasons that could account for this unique clinical scenario are discussed in the context of previously published related reports.
... Tick-borne diseases can pose significant risks to both the mother and fetus during pregnancy. Maternalfetal transmission has been reported for babesiosis [12][13][14][15][16], as well as multiple tick-borne bacterial infections, including B. burgdorferi (Lyme disease) [32][33][34][35][36][37][38][39], relapsing fever borrelia (B. hermsii) [40][41], A.phagocytophilum (human granulocytic anaplasmosis) [42], Ehrlichia chaffeensis (human monocytic ehrlichiosis) [43,44], and Rickettsia rickettsii (Rocky mountain spotted fever) [45,46]. ...
... 36 The Ad Hoc International Lyme Disease Group and the Infectious Diseases Society of America (IDSA) make the assumption that patients' continuing symptoms of fatigue, joint and muscle pain, and cognitive dysfunction and disability are not the results of persistent, active infection. 37,38 Other clinicians believe that there is persistence of Lyme and other tick-borne diseases 39 and that these might be putting future generations at risk through maternal-fetal transmission 40 and contaminated blood supplies. 41 A validated screening questionnaire detecting Lyme disease in its initial stages when it is potentially curable, as well as in later stages, would benefit a rapidly growing number of individuals infected by Lyme. ...
Purpose
Lyme disease is spreading worldwide, with multiple Borrelia species causing a broad range of clinical symptoms that mimic other illnesses. A validated Lyme disease screening questionnaire would be clinically useful for both providers and patients. Three studies evaluated such a screening tool, namely the Horowitz Multiple Systemic Infectious Disease Syndrome (MSIDS) Questionnaire. The purpose was to see if the questionnaire could accurately distinguish between Lyme patients and healthy individuals.
Methods
Study 1 examined the construct validity of the scale examining its factor structure and reliability of the questionnaire among 537 individuals being treated for Lyme disease. Study 2 involved an online sample of 999 participants, who self-identified as either healthy (N=217) or suffering from Lyme now (N=782) who completed the Horowitz MSIDS Questionnaire (HMQ) along with an outdoor activity survey. We examined convergent validity among components of the scale and evaluated discriminant validity with the Big Five personality characteristics. The third study compared a sample of 236 patients with confirmed Lyme disease with an online sample of 568 healthy individuals.
Results
Factor analysis results identified six underlying latent dimensions; four of these overlapped with critical symptoms identified by Horowitz – neuropathy, cognitive dysfunction, musculoskeletal pain, and fatigue. The HMQ showed acceptable levels of internal reliability using Cronbach’s coefficient alpha and exhibited evidence of convergent and divergent validity. Components of the HMQ correlated more highly with each other than with unrelated traits.
Discussion
The results consistently demonstrated that the HMQ accurately differentiated those with Lyme disease from healthy individuals. Three migratory pain survey items (persistent muscular pain, arthritic pain, and nerve pain/paresthesias) robustly identified individuals with verified Lyme disease. The results support the use of the HMQ as a valid, efficient, and low-cost screening tool for medical practitioners to decide if additional testing is warranted to distinguish between Lyme disease and other illnesses.
... Maternal and fetal prognosis seems to be favorable if the diagnosis is established rapidly and an appropriate antibiotic therapy is indicated. (1,2) . Aceste insecte sunt vectori pentru transmiterea infecțiilor cu spirochete din complexul Borrelia burgdorferi (sensu lato), care reuneşte principalii agenți etiologici ai bolii Lyme. ...
... Deşi rar, căpuşele pot transmite şi agenți patogeni virali, cel mai periculos dintre aceştia fiind virusul meningoencefalitei de primăvară (1,3) . Borelioza a fost descrisă prima dată în 1975, la copiii care păreau afectați de artrită reumatoidă, forma juvenilă, care însă prezentau o manifestare cutanată aparte, înainte de apariția simptomatologiei articulare, şi anume eritemul migrator (1) . ...
... Deşi rar, căpuşele pot transmite şi agenți patogeni virali, cel mai periculos dintre aceştia fiind virusul meningoencefalitei de primăvară (1,3) . Borelioza a fost descrisă prima dată în 1975, la copiii care păreau afectați de artrită reumatoidă, forma juvenilă, care însă prezentau o manifestare cutanată aparte, înainte de apariția simptomatologiei articulare, şi anume eritemul migrator (1) . ...
Borreliosis is one of the most common diseases transmitted by ticks. Clinical diagnosis is difficult due to non-specific symptoms and the fact that usually the patient does not remember when he was bitten by a tick, especially since the skin lesion, erythema migrans, is inconstant. We report the case of a 33-year-old patient, secundigesta, secundiparous, who attended her obstetrician during the 22nd week of pregnancy for fatigue and the appearance of erythematous lesions on the posterior region of her left calf. Following clinical and para-clinical examination she was diagnosed with borreliosis. Rapid antibiotic treatment was indicated. The evolution of pregnancy was normal. No fetal malformations were detected. At 39 weeks of pregnancy she delivered by cesarean section due to uterine rupture imminence a healthy male, weighing 3450 g, IA = 9. The impact of Lyme disease on pregnant women is difficult to assess. Maternal and fetal prognosis seems to be favorable if the diagnosis is established rapidly and an appropriate antibiotic therapy is indicated.
Lyme disease in pregnancy is understudied. The few available reports of Borrelia infection during pregnancy collecting clinical outcomes, with or without confirmed fetal infection both in utero and neonatal, are limited to case reports and small series. Population-based studies are not available. We propose a prospective study of Borrelia infection during pregnancy based in obstetrical practices in both endemic and nonendemic areas, with long term follow-up of pregnancy outcomes and development assessment of offspring infected or exposed to Borrelia in utero using current serological, microscopic, culture, and molecular techniques. In addition to detection of Borrelia burgdorferi sensu stricto, additional Borrelia species and other pathogens known to be transmitted by ticks will be tested. Serial biospecimens including maternal and cord blood, maternal peripheral blood mononuclear cells and urine, and, when clinically indicated, amniotic fluid, chorionic villi, intrauterine cord blood, will be collected with clinical data, imaging, and for infections treatment medications. Offspring will be followed until age 5 years with annual developmental assessments to assess pregnancy outcomes. The study will require parallel development of a biorepository with strategies for management, data security and data sharing. A public-private partnership will be required to support the study.
This chapter discusses the risks, manifestations, treatments, and prevention measures for some of the most common neurological infections occurring in pregnancy. Listeria monocytogenes is the most common cause of an infectious rhombencephalitis. In 2011, there were an estimated 8.7 million new cases of tuberculosis (TB), and 1.4 million people died from TB worldwide. Although clinical neurological disease associated with HIV infection is common, acute neurological disease occurring during pregnancy by and large is secondary to opportunistic infection. MRI is the superior imaging modality, demonstrating abnormalities 24-48 hours earlier than CT. The high mortality rate of influenza during pregnancy highlights the importance of preventative measures including immunization and early use of neuraminidase inhibitors. Management of CNS toxoplasmosis in pregnancy is with pyrimethamine, sulfadiazine, and supplemental folate; it also involves addressing concomitant HIV infection. Neurocysticercosis (NCC) can present during pregnancy and has been reported as being confused with eclampsia.
Arthropod-borne bacterial diseases affect more than 25,000 Americans every year and thousands more around the world. These infections present a diagnostic dilemma for clinicians because they mimic many other pathologic conditions and are often low on or absent from the differential diagnosis list. Diagnosis is particularly challenging during pregnancy, as these infections may mimic common pregnancy-specific conditions, such as typical and atypical preeclampsia, or symptoms of pregnancy itself. Concerns regarding the safety in pregnancy of some indicated antibiotics add a therapeutic challenge for the prescriber, requiring knowledge of alternative therapeutic options for many arthropod-borne bacterial diseases. Physicians, especially those in endemic areas, must keep this class of infections in mind, particularly when the presentation does not appear classic for more commonly seen conditions. This article discusses presentation, diagnosis, and treatment of the most common of these arthropod-borne bacterial diseases, including Lyme disease, Rocky Mountain spotted fever, tick-borne relapsing fever, typhus, plague, cat-scratch disease, and Carrión disease.
