Telling The Truth

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Telling The Truth my experiences with Lyme
borreliosis

• Bózsik, Béla Pál, M. D.
• Lyme Borreliosis Foundation,
• hUNGARY

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The PassionsequenceS ON THE TRUTH
What is the veritas, claudia?
Have You heard recognized if it would be said?
Yes, I do!
How?-could you tell me?
If you have not heard it nobody could tell You
By Mel Gibson
think of the real truth
If you have not heard the verity nobody could
tell You
Dialogue on veritas from Claudia pilatus
VERITAS?!My verity is THAT any way it will
bloodshed here!
VERITAS?!If it happens MY BLOOD WILL SHED BY
KAISER!
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WELL, What is the TRUTH?

• OMAN
• AN

It could be personally sense.
It depends on the principalities.
ANHEDRIN
It is better to sacrifice one for the people.
John 18,14
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What is the TRUTH in Lyme Borreliosis?
Y opinion
Lyme borreliosis ENDEMIC both in the World
in Hungary is
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This endemic Lyme borreliosis
Bózsik, Vienna 1985
Was estimated to affect as MUCH as 10 of the
population at least
Bózsik, Lancet 2004
Regarding to diagnostic and differential
diagnostic difficulties there is no exact
epidemiological data
Due to therapeutic problems and the long
persistence of Lyme borreliosis the patients
are accumulated in the population.
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This Estimation based on both the possibility of
ticks co-infections the cumulation of lyme
borreliosis
Bacterium
LB Ticks infectivity rate with ? TBE_cases
Virus
1 10
Lyme borreliosis incidence ? 200 TBE_cases/years
1 1 000
Twenty thousends new cases yearly in Hungary
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What thismeans causes?

• No definite
• Control popu- lation
• Diagnosis either in laboratory or clinical
  Hampered by the protean symptoms
• Proceedings against MD-s

• Vain
• Fiery debates
• in the society .
• Heavy long suffer-ing of patients
• Decreased producti-vity of the society.
• Increased claims
• to rx .
• Increased
• medical costs .

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ARE the FOLLOWING The right answerS?
Carl Brenner Science, 1992

• There is no such disease,
• if it could exist at all.
• You surely not have this!
• Doctors SAY in all countries of the world.
• Could it really answered
• by serology? - I have to try it .

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OUR PRACTICE WAS SINCE 1984 IN HUNGARY
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Lyme borreliosis is endemic in hungary
determinations at the nih, hungary
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Dinamic changing in serologyproduction of
antibodies
Summarized Diagram
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Dinamics of Antibody production.It binds to
every antigens of borrelia burgdorferi s.l.
Effects of reinfection(s)
igg
Persisting Igs lb
Effects on IgM production
Effects of abx
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Dinamic changing both in serology production of
antibodies
Changing in antigenecity Causes IgM elevations,
just as If it would be new infections
sec.ecm
Persistent Ig Persisting lb
TH
The problem is in determining the right cut-off
level
cut-off level?
Decapitated, inhibited immune response
infection
Spirochetaemia during the whole pathogenesis
ecm
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Is it possible to describe all of these changes
or diagnose Lyme borreliosis using any method?
The question arised
with one investigation
No, that is the answer of course.
Determining the cut-off level is also disputable
as it is hard to determine
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can Lyme borreliosis be over/UNDER-diagnosed

• Lyme borreliosis reinfectiosa
• could only be revealed
• with early serologic testing, as immune
  response of the body is slow lasting therefore
  existence of the antibody in the presence of ECM
  could be evaluated as reinfection.

Mis-diagnosis is the only possibility!
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Tail-cutting helps to evaluate the results of
passive haemagglutination
The evaluation is based on 120,000 samples
150,000 determinations since 1989. The cut-off
level can be calculated from the results alone
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Tail-cutting for evaluating serology
Sera with low reactivity
Reactivity of samples were Determined by the
dilution cross(1-4) -Number versus 2/base log
of dilution-
Highly reactive sera are few to delineate
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There are two populations Small
Positive(red) Large Negative(blue) They are
Clearly divided But missed diagnosis of 30500
patients
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Critical fields to evaluation
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Critical fields to evaluation
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Critical fields to evaluation
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Critical fields to evaluation
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Critical fields to evaluation
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Critical fields to evaluation
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Critical fields to evaluation
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Critical fields to evaluation
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Critical fields to evaluation
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The parts of The lasts Normal distribution curves
for determining the cut-off level
Critical fields to evaluation
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A Plato described By the errors of the
curves They Determined the cut-off levels
The cut-off level 1200 dilution 3 reactivity
Causing the smallest in both failures Less the
missed patients as seronegative under 1,5 or
it gives the less seropositivity to healthy
under 5,5 missed 7,0.
Plato area Where are potentially the less
missed cases
10 missed
Although This is excellent result, it needs
further evaluation For the benefit of the
lyme-patients
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Which method could became the golden standard?

Or Some Further new methods
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Lyme borreliosis seronegativain relation to
different methods
The missed proportion
is growing with newer methods
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As you have seenthere is a great difference
between biological biostatistical error

• Although 1.5 first order and 5.5 second
  order error are excellent results for any
  laboratory it is astonishing that the
  developments of science give possibility to
  determine further 60 or more cases as people,
  who are in bed need of treatment.
• This result is
• neither over-diagnosis,
• nor under-estimation,
• especially not fals/untrue determinations
• they really belong to both the development of
  methodology and
• the epidemic character of Lyme
  borreliosis.

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• I think of
• many ten-thousands of people
• with suspected symptoms
• stated by their physicians
• Who could not get
• the right answer or
• the definitive diagnosis.

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The BLUE COLUMNS related to the missed
proportions of patients
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theoretical graph!
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C6 ELISA Wbwere identical in 97 at CDC
comparing 180 samples
What is on C6-ELISA?
The molecular biology of the VlsE-antigen is
well known!
C6 ELISA
There was not any reactivity in Masters disease,
in which B. burgd. sensu lato were isolated with
substrain determination. Masters,EPhilipp,M C6
Lyme peptide ELISA serosurvey of Missouri
patients. AbstractsPresentations at the IX
Intl.Conf. on Lyme borreliosis Abstract at The
Clinical side of Lyme Disease, N.Y. Augustus
18-22., 2002.
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It also teaches us that for evaluation it
should not be forgotten Lyme borreliosis Is a
worldwide epidemic With countless Manifestations
The high incidence especially extra high
prevalence Is characteristic for Lyme borreliosis
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The Committee recognizes that the current state
of laboratory testing for Lyme disease is very
poor. The situation has led many people to be
misdiagnosed and delayed proper treatment. The
vaccine clinical trial has documented that more
that one third ( 36 percent ) of the people with
Lyme disease did not test positive on the most
sophisticated tests available. The ramifications
of this deficit in terms of unnecessary pain,
suffering and cost are staggering. The Committee
directs CDC to work closely with the Food and
Drug Administration to develop an unequivocal
test for Lyme disease. ( Public Law 107-116
Signed by President Bush 1/10/02 Departments of
Labor, Health, and Human Services, and Education,
and Related Agencies Appropriations Act 2002)
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Is there any solution of the diagnostic problems
There has been a simple good one!
Nearly one hundred years
Coleman, 1909
It is possible To detect spirochetes With
dark-field microscopy since Nearly that time at
least It is debated Because of the
so-called Myelin figures, which Look like
spirochetes ( pseudo-spirochetes )
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The largest energies in the nature
Among them Is the blood
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There is direct connection between the body the
tick
time Is important For the infectivity,
because Ticks infect us Either with saliva Or
with regurgitation.
this connection, makes possible for spirochetes
to circulate To reach the hidden places, too.
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therefore, there is no use to be distinguished
stages for a generalized ailment, as it will
be forgottenLyme borreliosis damages the whole
body from the first moment.
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Lyme borreliosis seronegativa
one third ( 36 percent ) of the people with Lyme
disease did not test positive Public Law 107-116
Signed by President Bush 1/10/02
Nearly the same proportions of lyme-patients
were proved As Lyme borreliosis seronegativa in
my practice with DF-microscopy
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My practice with darkfield-microscopy was proven
with real-time pcr
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According to my practice since 1986 borrelia
burgdorferi s. l. Could be demonstrated
studied with dark-field microscopy during the
whole pathogenesis.
Besides clinical signs/symptoms serology it
was proved immunocytologically with kindly
donated MC of Barbour Steiner of CDC ()
specific staining of rutenium red and electron
microscopy with negative staining.
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DualDur reagent method help to overcome
difficulties in diagnosis of Lyme borreliosis
seronegativa
first
second
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Division of Spirochete happens With Central
concentration splitting
Dividing Spirochete beside two thrombocytes
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immuncytology (1990) Indirect
immuno-fluorescence with Monoclonals anti-OspA és
anti-flagellaris antitestekkel(prof.Barbour)

anti-flagellaris
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Morphology of Borreliae
Kari Hovind-Hougen, 1976-1986
Theoretical Length 15-30 µm, Width 0,15-0,30
µm, Flagellum 7--20 This one Length 15 µm,
Width 0,15-0,30 µm, NO Flagellum
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In 1909 detailed in 1913 a new spirocheta was
found in Human blood at graves disease
Chambers,H-Royal Free Hospital BMJ, 1909
Lancet 1913,11728
HOMOLOGIES between proteins of Borrelia
burgdorferi Thyroid AUTOANTIGENS
THYROID 2004, 1486
great honour to helen chambers
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Borrelia burgdorferi s.s. -Morphology in the
friendly cultivation media-
Aberer-Duray, 1991
Meduza-like (paired-crossed-)
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various forms of Borrelia burgd.s.l. in blood
using DualDur
After the basic study of Aberer-Duray, 1991
End-joined Spirochetes
Before dividing? (Central splitting!)
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Vesiculum, extrabacterialis protein borrelia
burgd.s.l.
Patients Blood sample (27/72/105 72/14/14)
Phosphorwolframic-acid (1) negativ staining,
1000x
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Blebbing in medical literature During cultivation
under abx
blebs
A. KERSTEN, C. POITSCHEK, S. RAUCH, AND E. ABERER Effects of Penicillin, Cettriaxone, and Doxycycline on Morphology of Borrelia burgdorferi Antimicrob agent s chemother 1995,391127-33
Ghost-like reorganized membrans
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Periplasmatic space Blood sample, Lyme-patient
Magnification 80.000x.
Extrabacterialis clouds in the layer of the
Spirochete. Flagellum not visible.
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Borrelia burgdorferi s.l. Immuncytologic
experiments in 2003
Blood samples
Control
Blood sample
Blood sample
Blood sample
Blood sample
Blood sample
Patient blood sample (GD-222) CDC, Monoclonalis
antitest OspAAvidin-Biotin Immunperoxidáz
reaction, Original magnification 100x
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Morphology of Borrelia burgdorferi s.s. During
cultivation - for control
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Shed ding for both defe
nce disease As they are immu nocomplexes.
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Patient with Lyme borreliosis chronica Was healed
There were spirochetes in the patients blood
sample
Darkfields Same prep.
stained
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borreliae could be detected by specific staining
of the outer layer with rutenium-red (dark-gray)
protoplasma
protoplasma
Patient with Lyme borreliosis chronica Was healed
Acid Mucopolysaccharide layer (dark gray)
Please admire extra-bacterial material around the
spirochetes (yellow)
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Closing remarks
Definitive diagnosis for Lyme borreliosis could
be set up with laboratory methods.
indication of the treatment needs consultation,
that should be followed by control
determinations for years.
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we should have to unit our knowledge As our
enemy, the devil is circulating Wanted to
devour us.... 1st Letter of Peter 5thchapter
verse 8