Borrelia burgdorferi in Argentina: Scientific publications part I

Author: Monica Carugatti

 

In this entry I am going to cite the scientific and journalistic publications made in Argentina in relation to BB from the first that I have a record in 1988 to 2002. My objective is to demonstrate the existence of a serious debate in relation to the presence of the bacterium in Argentine ticks and their contagion in humans. And to record that despite the overwhelming evidence of the potential danger of the spread of the disease in society, the corresponding procedures for the search for the vector, the cultivation of the bacteria from humans and the opening of valid lines of research were not followed. Preventive campaigns were not even started.

 

1988 – Borrelia in ticks in dogs – Rosario
Mazzonelli, J; Hutter, E.; Brihuega, B; Laballen, H. (1988). ” Lyme borreliosis: serological survey in Lyme borreliosis: serological survey in dogs”  Proceeding of the Annual Associación Argentina Veterinária Diagnostic Laboratory, 4a, Tandil, Argentina. : Prevalence in dogs around the city of Rosario: of the dogs were positive for Lyme disease

3 – Anti-borrelia antibody in farmers with arthritis – BrandsenStanchi* (1993) “Lyme disease: antibodies against Borrelia Burgdorferi in farm workers in Argentina” Rev Saude Publica 1993 Aug;27(4):305-7 -Pubmed 8209163: NO*Faculty of Veterinary Sciences National University of La Plata.

Abstract:
Lyme Disease is a tick-borne (especially by Ixodes ticks) immune-mediated inflammatory disorder caused by a newly recognized spirochete, Borrelia burgdorferi. Indirect fluorescent antibody (IF) staining methods and enzyme-linked immunosorbent assay are frequently relied upon to confirm Lyme borreliosis infections. Although serologic testing for antibodies has limitations, it is still the only practical means of confirming B. burgdorferi infections. Because we have no previous report of Lyme disease in human inhabitants in Argentina, a study was designed as a seroepidemiological investigation of the immune response to B. burgdorferi in farm workers of Argentina with arthritis symptoms. Three out of 28 will be positive Serum #1 was positive for Immunoglobulin G at dilution 1:320, serum #5 and #9 both to dilution 1:160; while for Immunoglobulin M all (#1, 5 and 9) were positive at low dilution (1:40) using IF. The results showed that antibodies against B. burgdorferi are present in an Argentine population. Thus caution should be exercised in the clinical interpretation of arthritis until the presence of B. burgdorferi be confirmed by culture in specific media.

1999 – Detection of BB with molecular method – Rosario

Campodónico M, Fay M, Alvarez G, et al., Search for Lyme Disease in Argentina. Borrelia burgdorferi sensu lato detection using a Nested PCR Approach”-  Poster C-470.
CTSP-National University of Rosario, Rosario, Argentina. Session 282/C. Diagnostic Bacteriology II: Molecular-Based Detection and Identification Methods, Abstract C-473, June 3, 1999, ASM 99th General Meeting, Chicago

2000 – Patients with atypical depression who present symptoms of Lyme.
Hector R. Battaglia, MD; Guido Alvarez, MD; Augusto Mercau, MD; Marcelo Fay, MD; and Martin Campodonico. (2000) “Psychiatric Symptomatology Associated with Presumptive Lyme Disease: Clinical Evidence.” Journal of Spirochetal and Tick-Borne Diseases. Vol. 7, No. 1, 2000. pgs. 22-25.

43 patients with atypical depression, 7 experienced panic attacks and all considered hypochondriacal patients, they were selected from the psychiatric office for having associated multisystemic polysymptomtology according to that of Lyme disease. The selected patients had lived or frequently visited areas at risk for zoonosis, been bitten by ticks, had a history of skin injuries or dermatosis compatible with erythema migrans (EM), and had positive IgG and IgM serology for Borrelia burgdorferi Combination therapy with specific antibiotic treatment for Lyme disease and specific psychotropics was indicated.

Psychopharmacological therapy included a first 90-day period with monnaminoxidase inhibitors followed by later periods with state-of-the-art tricyclic and tetracyclic antidepressants and serotonin-specific reuptake inhibitors. Psychopathologies, as well as multisystemic polysymptomatology, diminished and even disappeared after the combination treatment. We conclude that an infectious disease whose closest definition could be Lyme disease produced the psychiatric symptoms described in this manuscript. Isolation of the causative agent remains.

This investigation was cited by La Nación on 05-24-2000 “An evil with a thousand faces”

2002 – Complaint about the decision to ignore the 1997 report on patients infected by Tick Meningopolyneuritis – Rosario
Clarifications on Lyme DiseaseTick ​​Meningopolyneuritis, Lyme Borrelliasis, ICD-9-695.9, 716.59 –  Ecological Environment Edition 83 / March – April 2002.
*Member of the MAE Academic [email protected]

Article exerpt:
In Argentina, the first two registered cases of this disease occurred in March 1997 in : At the home of the two infected patients, at the suggestion of the undersigned, only Rhipicephalus sanguineus could be collected in various stages, as ectoparasites of dogs from that home.At the request of the Health and Environmental Sanitation authorities of the Municipality of Rosario, I sent a report – given my experience on the subject in the US – proposing the hypothesis that the vectors in our country were other Ixodidae, and due to their finding at home, the suspicion that the Dog Tick was our vector However, the specimens they sent me were dead, so the presence of B. burgdorferi could not be investigated in them.

In addition, I proposed a serious line of action to better understand this disease, its reservoirs and vectors, since in Argentina there are many representatives of the Ixodes genusI do not rule out that any of them may not be imputed as a vector.The curious thing – as a funny anecdote, since to consider it in another way would be to give it a value that it does not have – in a journal (the same one to which in 1997 I sent what I believe to be the first serious report on this disease to its director, when everyone in Rosario was perplexed by this pathology) now a couple of “experts” appear talking very happily about the subject and I find out, with surprise, that in Argentina the vectors are horseflies, scorpions, wasps and “water kissing bugs” (?) without explaining how they reached those conclusions or clarify the taxa, neither specific nor generic; they also name the “genus of ticks” without, of course, identifying which ones.

But the “specialists” (excuse the misuse of the term) do not end their errors there: I also learned that this Borrelliosis causes “some cases of Alzheimer’s disease” since “its common pattern is psychiatric symptoms.” Well, after reading that the causal agent “has not been isolated yet” it is time to archive the magazine and think that they have learned little from 1997 until now*.

“*”Lyme disease and ticks” Modified and with additions in Environment and Health Plagues, year lll, No. 12, July 2000, p. 16, Drs. Battaglia, H.; Alvarez, G.; Mercao, A., SOURCE: LA NACIÓN NEWSPAPER, ADRIANA GIANNINI, 2000.

At present (10-2021) there are publications on the existence of BB in horseflies and mosquitoes and that today the existence of BB has been registered in patients with Alzheimer’s (Dr. Mac Donald Studies on brain tissues Blog Dr MacDonald

2003 – Presence of vectors in the area where patients diagnosed with Lyme live – Rosario
Arango, J.; Battaglia*, H.; Alfieri, A.; Seghesso, A.; Lapalma, A.; Zerpa, C.; Piccado, A. (2003) ” Survey of clinical cases of Lyme disease for the detection of risk areas”

*National University of Rosario, Faculty of Veterinary Sciences  Chair of Hygiene, Epidemiology and Health Administration. Faculty of Veterinary Sciences, UNR

Article excerpt
In the city of Rosario, the existence of human cases with a clinical and serological diagnosis of this disease has been reported (1) The Lyme spirochete can be serologically cross-reactive with other borrelia and treponemes, including the one that causes syphilis, but not with leptospira. The international scientific community accepts as sick or infected those who present clinical symptoms prescribed by standards, serology by PCR and a positive response to antibiotic treatment

(2). It is very difficult to isolate it from human patients. The few isolations made in the USA and France have been from blood, chronic erythema and cerebrospinal fluid. It is difficult to visualize in tissue sections. In man it has a very varied symptomatology and difficult serological and confirmatory diagnosis; its treatment is also very complex and not always successful. This is due to characteristics of the agent, such as the ability to mutate, remain viable within macrophages, lymphocytes, endothelial cells, neurons and fibroblasts, which hinders the action of antibiotics and immuno-recognition, it also has L forms that do not contain cell walls, which also limits effective antibiotics. Due to its pathogenicity, it produces severe and disabling injuries.

The investigation of the aspects that make its prevention, such as the availability of a vaccine and the identification of risk factors specific to each ecosystem, such as human behavior and the presence of reservoir rodents and vector ticks, are relevant for its combat. The existence of rodents and vectors in the town of Funes was investigated during the years 2000, 2001 and 2002. neurons and fibroblasts, which hinders the action of antibiotics and immuno-recognition, it also has L-forms that do not contain cell walls, which also limits effective antibiotics. Due to its pathogenicity, it produces severe and disabling injuries. The investigation of the aspects that make its prevention, such as the availability of a vaccine and the identification of risk factors specific to each ecosystem, such as human behavior and the presence of reservoir rodents and vector ticks, are relevant for its combat.

The existence of rodents and vectors in the town of Funes was investigated during the years 2000, 2001 and 2002. neurons and fibroblasts, which hinders the action of antibiotics and immuno-recognition, it also has L-forms that do not contain cell walls, which also limits effective antibiotics. Due to its pathogenicity, it produces severe and disabling injuries. The investigation of the aspects that make its prevention, such as the availability of a vaccine and the identification of risk factors specific to each ecosystem, such as human behavior and the presence of reservoir rodents and vector ticks, are relevant for its combat. The existence of rodents and vectors in the town of Funes was investigated during the years 2000, 2001 and 2002. Due to its pathogenicity, it produces severe and disabling injuries.

The investigation of the aspects that make its prevention, such as the availability of a vaccine and the identification of risk factors specific to each ecosystem, such as human behavior and the presence of reservoir rodents and vector ticks, are relevant for its combat. The existence of rodents and vectors in the town of Funes was investigated during the years 2000, 2001 and 2002. Due to its pathogenicity, it produces severe and disabling injuries. The investigation of the aspects that make its prevention, such as the availability of a vaccine and the identification of risk factors specific to each ecosystem, such as human behavior and the presence of reservoir rodents and vector ticks, are relevant for its combat. The existence of rodents and vectors in the town of Funes was investigated during the years 2000, 2001 and 2002.

The results highlight the presence of Ixodes loricatus (larvae, nymphs and adults) in rodents Akodon azarae and Oligoryzomyz flavescens. The importance of the discovery of I. loricatus lies in the communication of the isolation in Brazil of Borrelia sp (3).Another relevant result for the epidemiology of Lyme disease refers to the capture of cricetidae, which are involved in the transmission of other zoonoses, and the ticks carried by them in a perimeter but urbanized area with permanent residents, which includes public squares equipped with recreational games for children. In order to specify the risk factors linked to the capture area, a survey was designed to collect information through personal interviews arranged by the doctors who treated the cases.

The date of appearance of the first symptoms and residence at that time were taken into account, as well as contact with cats, dogs, farmyard animals, food animals and rodents, occupation, non-professional activities,The results of 8 cases confirmed to have presented the clinical form of the disease and 2 positive contacts by laboratory tests are reported. Exposure history based on retrospective collection suffers from significant underreporting and imprecision. The survey will continue to be perfected to suggest the incorporation of the epidemiological diagnosis in the first consultation.

Conclusions
This article demonstrates the existence of publications, indications to the authorities and a scientific debate that refer to the presence of Borrelia Burgdorferi in Argentina for several decades. Health authorities should have known and acted accordingly long ago.

Lyme Argentina in the media: La Nación November 26, 2021 – Right to reply

Author: Monica Carugatti

New note from La Nación about Lyme in Argentina : “The Lyme enigma: is the disease that Justin Bieber and celebrities have in Argentina?”

Mrs Gabriela Navarra’s note for La Nación gives us a fairly adequate view of the Lyme disease situation in Argentina. I recognize that it was difficult to develop due to the different discourses of patients and health authorities. It is a politically correct publication that allows us, the patients, to replicate some of the concepts issued by representatives of the health authorities.

In this article on my blog I try to explain some of the reasons why I consider the arguments expressed to be controversial and imply taking a position in a debate, others to be empty and highly contradictory arguments, and others just an act intended to deny the existence of Lyme in Argentina.

In all the explanations and in the publication to which the article refers, and signed by some of the professionals interviewed, the objective seems to be more to dismiss the evidence of the existence of a disease with a Lyme clinic after the bite of a tick, and positive in specialized laboratories abroad, than to look for how this disease originated, its characteristics, ticks, vectors, bacterial culture, etc. Nothing is said about this.

Before continuing, I would like to introduce two observations that, in my opinion, help to understand the dissidences in general.

We learned with Covid-19 that science is not unequivocal. The constant presence of infectious disease doctors in the media put us in the position of questioning ourselves about concepts that we often did not know and that were not part of our usual terminology. So the decision of who is right, in the vast majority of cases, goes more through ideology and empathy than through scientific foundation and / or an adequate understanding of dissidence. 

In recent decades, unfortunately, evidence-based medicine replaced MEDICINE. The concept has been used and abused. If doctors base their profession only “on the evidence”, they leave without considering most of the aspects that must be taken into account in the medical care of a patient. Evidence should not be confused with existence. Evidence-based medicine is undoubtedly a fundamental advance for medicine, “but it brings us closer to knowing through a keyhole.” To this we must add the frequent non-compliance with the many necessary conditions in a scientific investigation. But this is a discussion that exceeds this space.

“From the ANLIS Malbrán they indicate that “neither the tick —the vector— nor the bacterium are in Argentine territory and that there are no autochthonous cases of Lyme. ” 

This statement is false:

“In Argentina there are borrelias close to those that cause Lyme in Europe and North America, but they are not the same. It is not known if they cause any disease in humans or animals, they are of unknown pathogenicity.” Santiago Nava (La Nación, November 26, 2021) * (1) * (2) * (3)

1. Ixodes Scapularis is not the only tick that transmits Borrelia Burgdorferi sl and it is also not the only tick that transmits Lyme Disease. I do not know if Ixodes Scapularis exists in Argentina, but I do know that Ixodes Pararicinus, at least, is in Argentina and does transmit Borrelia spp. agent that causes Lyme disease. So Borrelia Burgdorferi sl is not the only Borrelia that transmits Lyme Disease and/or Relapsing Fever.*(4) *(6)

The truth is that there are many strains of Borrelia that cause the disease, for example Borrelia Miyamotoi, Borrelia Garini, Borrelia Afzelii, etc. Others isolated and others without isolation. Amblyomma Cajennense transmits in Brazil a borrelia with a different morphology and that does not belong to the Borrelia Burgdorferi group, which has not been cultivated and which generates a disease called Baggio-Yoshinari or Brazilian Lyme that gives a very serious clinical picture very similar to Lyme. *(5) * (3)

2. The arguments given to us in the note by ANLIS and Dr. Nava indicate a lack of knowledge of the situation in the world, where new ticks carrying different strains of borrelia are constantly being found, generating similar clinical pictures and which are included in the diagnosis of Lyme disease. If we were rigorous with the denominations and only called Lyme disease the borreliosis caused by the borrelia isolated by Willy Burgdorfer, we should give another name to the borreliosis produced by Borrelia Garini, B. Afzeli, B. Miyamotoi, etc., which is not the case. is done or is done less and less.

3. Fundamentally, these arguments deny the reality that we patients with a Lyme Disease clinic have and that in addition to responding to antibiotics (specific and in sufficient quantity), they have positive laboratories by different techniques and that they have been stung in the national territory. .

4. The arguments in the note from ANLIS and Dr. Nava are perverse in intent and want to make the interviewer and the population believe that there is no Lyme in Argentina, using technical language from a place of power and knowledge, to confuse.

“Between 2014 and 2019, Malbrán analyzed 31 clinical samples with suspected autochthonous Lyme; some with positive results in tests carried out with methods not validated by the US FDA.” All were negative, “they indicated.” * (7)

I hope that this study is not the only one that concludes that there are no patients with autochthonous Lyme in Argentina, that the bacteria is not present and neither is the vector. The only thing that this Malbrán study says is that the Western Blot results in a US laboratory are negative. A conclusion cannot be drawn from this publication indicating that there is no indigenous Lyme in Argentina because the conditions are not met.

1. The diagnosis of Lyme is clinical. In mid -2019, the CDC issued a disclaimer where it rightly says that the double standard tests used for research (Elisa and Western blot) “are not suitable” for the diagnosis and treatment of patients, whose diagnosis must be be a clinician * (8) * (9) *(10)

“A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance.

The surveillance case definition for Lyme disease is not intended to be used by health care providers to make a clinical diagnosis or determine how to meet the health needs of an individual patient.”…

A systematic meta-analysis of published data shows that the mean sensitivity of the test at two levels is only 35.4% in the acute stage and 64.5% in the convalescent stage, with an overall sensitivity of 59.5% . The unreliability of the two-tier test is compounded by the widespread misconception among health care providers and insurers that patients must test positive according to surveillance criteria to confirm they have a legitimate case. of Lyme disease. This action was taken after a Data Quality lawsuit for a complaint filed by the Patient-Centered Care Advocacy Group on May 20, 2019.

The CDC surveillance case definition included the presence of Erythema Migrans. However many patients never have the rash. (Between 30% and 70% of patients do not have MS, according to different investigations.)

2. On the other hand, these tests were performed after the first positive tests, by different laboratories, by different technicians, and nothing is said about the clinical picture of these patients. “Serologic tests…do not identify the presence or absence of BB, but instead detect the presence of an antibody response that can be attributed to exposure to this pathogen. Of the dozens of serologic tests available on the U.S. market, none are FDA-approved Rather, they are all FDA-approved, meaning the test compares favorably with other tests already in use and works at least as well as the others, but has not been clinically validated in studies None have shown clear performance superiority. The reliability of diagnostic tests depends on their accuracy and reproducibility. Precision is the ability of a test to detect disease when it is present and not detect disease when it is absent, and reproducibility is the ability of a test to give the same result for a sample on repeated testing. High-precision tests generate few false negatives and few false positives. Unfortunately, Lyme serology produces many false negatives and false positives. In addition, investigators have repeatedly shown that both Lyme Elisa and immunoblot tests have poor reproducibility.”*(11)

“Don’t forget that these are just tests that don’t show the presence of an infection. To show a Borrelia infection you need to isolate Borrelia Burgdorferi from joint biopsies and then try to culture.” – Armin Schwarzbach *(12)

*(1) Borrelia Burgdorferi in Argentina: scientific publications (part 1)

*(2) Borrelia Burgdorferi in Argentina: scientific publications (part 2)

*(3) Lyme in neighboring countries

*(4) Wild birds as host of Borrelia burgdorferi sensu lato in northwestern Argentina

*(5) Borrelia sp. phylogenetically different from Lyme disease- and relapsing fever-related Borrelia spp. in Amblyomma varanense from Python reticulatus

*(6) Microbiology in Clinical Practice (Second Edition), 1989 (Borrelia)

* (7) SUSPECTED LYME DISEASE IN ARGENTINA, STATUS.

* (8) CDC Information Correction Request

* (9) CDC Response

*(10) CDC agrees to add disclaimer to Lyme disease case definition

* (11) ILADS – Research and Literature: Controversies and Challenges

* (12) Complexities of modern laboratory techniques Dr. Armin Schwarzbach