Chronic or late lyme neuroborreliosis: analysis of evidence compared to chronic or late neurosyphilis.

Judith Miklossy

doi:10.2174/1874205x01206010146

Abstract

Whether spirochetes persist in affected host tissues and cause the late/chronic manifestations of neurosyphilis was the subject of long-lasting debate. Detection of Treponema pallidum in the brains of patients with general paresis established a direct link between persisting infection and tertiary manifestations of neurosyphilis. Today, the same question is in the center of debate with respect to Lyme disease. The goal of this review was to compare the established pathological features of neurosyphilis with those available for Lyme neuroborreliosis. If the main tertiary forms of neurosyphilis also occur in Lyme neuroborreliosis and Borrelia burgdorferi can be detected in brain lesions would indicate that the spirochete is responsible for the neuropsychiatric manifestations of late/chronic Lyme neuroborreliosis. The substantial amounts of data available in the literature show that the major forms of late/chronic Lyme neuroborreliosis (meningovascular and meningoencephalitis) are clinically and pathologically confirmed. Borrelia burgdorferi was detected in association with tertiary brain lesions and cultivated from the affected brain or cerebrospinal fluid. The accumulated data also indicate that Borrelia burgdorferi is able to evade from destruction by the host immune reactions, persist in host tissues and sustain chronic infection and inflammation. These observations represent evidences that Borrelia burgdorferi in an analogous way to Treponema pallidum is responsible for the chronic/late manifestations of Lyme neuroborreliosis.Late Lyme neuroborreliosis is accepted by all existing guidelines in Europe, US and Canada. The terms chronic and late are synonymous and both define tertiary neurosyphilis or tertiary Lyme neuroborreliosis. The use of chronic and late Lyme neuroborreliosis as different entities is inaccurate and can be confusing. Further pathological investigations and the detection of spirochetes in infected tissues and body fluids are strongly needed.

Highlights

Whether spirochetes persist in host tissues and play a direct role in late/chronic manifestations of tertiary syphilis was the subject of long debate
DIRECTIONS Whether spirochetes persist in the affected host tissues and are responsible for the chronic/late manifestations of neurosyphilis was the subject of strong debate in the history of medicine
The evolution was slow until they concluded, based on clinical, serological and pathological observations, that the tertiary manifestations of the disease have a syphilitic infection as origin and T. pallidum plays a direct role in the clinical and pathological manifestations of late/chronic neurosyphilis [1, 19]

Summary

Introduction

Whether spirochetes persist in host tissues and play a direct role in late/chronic manifestations of tertiary syphilis was the subject of long debate. Failure to detect Treponemapallidum (T. pallidum) in infected tissues has contributed to the general concept that in the progressive degenerative process, of syphilitic origin, spirochete infection does not play an active role. Neuropathological demonstration of T. pallidum in the brains of general paretic patientssolved the debate and defined that spirochetes play a direct role in the neuropsychiatric manifestations of late/chronic neurosyphilis. The same question is in the center of debate with respect to Lyme disease. The goal of this study was to review historic data related to the debate on syphilis and compare the established pathological features of chronic or late neurosyphilis with those available on late/chronic Lyme neuroborreliosis.

Objectives

Findings

Conclusion