The authors performed a clinical and serologic follow-up study after 4.2 +/- 1.2 years in 44 patients with clinical signs of neuroborreliosis and specific intrathecal antibody production. All patients had been treated with ceftriaxone 2 g/day for 10 days. Although neurologic deficits decreased significantly, more than half the patients had unspecific complaints resembling a chronic fatigue syndrome and showed persisting positive immunoglobulin M serum titers for Borrelia in the Western blot analysis.
With great interest, we have read the study results reported by Sriram and colleagues, 1 which point to an association between an infection with Chlamydia pneumoniae and multiple sclerosis (MS). A literature research of the Institute for Infectious diseases of the University of Frankfurt showed several other arguments for the hypothesis that MS is a chronic, persisting infectious disease associated with the Gramnegative intracellular organism C pneumoniae, which was first described in 1985. 2 The analysis of the MS epidemic in the Faeroer Islands after 1940 shows that C pneumoniae fulfills the epidemiological criteria postulated by Kurtzke and associates 3 to be necessary for an infectious agent. The geographical epidemiologies of MS and arteriosclerosis show a remarkable similarity. Both diseases show a similar North-South gradient and a similar worldwide distribution. The migration pattern of MS, ie, that emigrants have the MS risk of the country in which they lived through their puberty fits well into the hypothesis that the primary infection with C pneumoniae occurs, in general, during late childhood or adolescence.Sriram and colleagues 1 report that almost 100% of MS patients were C pneumoniae positive in the polymerase chain reaction (PCR). A pilot study performed in cooperation between the University Clinic Homburg and the University Clinic Lübeck showed no convincing agreement with the data by Sriram and colleagues. 1 In our study, serum and cerebrospinal fluid (CSF) of 22 patients with confirmed MS was tested for an infection with C pneumoniae. In addition, the CSF of 8 of these patients was tested with PCR for Chlamydia-specific gene sequences. Only two CSF samples tested positive. Eight of the 22 patients (36%) showed an intrathecal production of Chlamydia-specific IgG antibodies. IgM antibodies, which would point to a new infection, were not observed in the CSF. Neither the 8 patients with autochthonous Chlamydia-specific antibody production, nor the two PCR-positive patients, showed unspecific signs of an acute infection of the brain, such as increased cell count in the CSF or increased protein content of the CSF.In our opinion, these positive Chlamydia-antibody findings could also be explained as the result of an unspecific reaction with subsequent unspecific production of antibodies in the CSF. One example for this is the intrathecal production of antibodies against various viruses in patients suffering from MS. 4,5 The PCR findings could be the result of a secondary infection of damaged central nervous tissue, a hypothesis that Sriram and colleagues 1 consider as well. One must consider, however, that the lacking agreement of our results with the findings by Sriram and colleagues 1 could also be explained through methodological problems. Chlamydia diagnostics is not yet sufficiently standardized.In sum, we think that because of the differing study results, antibiotic therapy of MS is not justified yet. 6 We agree with Sriram and colleagues 1 that several findings point to an association between a...
Several authors have reported a chronic fatigue-like syndrome in patients that have suffered from Lyme borreliosis in the past. To further investigate this suspicion of an association without sample bias, we carried out a prospective, double-blind study and tested 1,156 healthy young males for Borrelia antibodies. Seropositive subjects who had never suffered from clinically manifest Lyme borreliosis or neuroborreliosis showed significantly more often chronic fatigue (p = 0.02) and malaise (p = 0.01) than seronegative recruits. Therefore we believe it is worth examining whether an antibiotic therapy should be considered in patients with chronic fatigue syndrome and positive Borrelia serology.
Neuroborreliosis, a tick-borne spirochaetosis of the central nervous system, is diagnosed by the presence of intrathecally synthesized Borrelia burgdorferi-specific antibodies. Multiple sclerosis and neuroborreliosis can show similarities in clinical symptoms as well as lymphocytic cell reactions and oligoclonal bands in the isoelectric focusing of cerebrospinal fluid. To differentiate between multiple sclerosis and neuroborreliosis we tested intrathecally synthesized IgM and virus antibodies. The IgM indices were higher for most of the neuroborreliosis patients studied than for those with multiple sclerosis, and cell counts were also significantly higher in the acute stage of the disease. In 84% of multiple sclerosis patients we were able to demonstrate intrathecal antibody production against measles, rubella or mumps virus. Neuroborreliosis patients had no intrathecal virus antibody synthesis. The specification of oligoclonal bands resulting from isoelectric focusing of cerebrospinal fluid with an ELISA for B. burgdorferi can further substantiate the diagnosis of neuroborreliosis or help to rule it out in multiple sclerosis patients with positive borrelia-specific serology.
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