Dr. Burrascano  is a  well recognized specialist in the diagnosis and treatment of Lyme and associated complex infectious diseases, and the chronic illnesses that accompany them. With over two decades of experience and research in this field, he has appeared in and on virtually every form of media, has advised the CDC and NIH, testified before the U.S. Senate, an armed services joint subcommittee, and at various governor’s councils. A founding member of ILADS, he currently is an active Board Member of the International Lyme and Associated Diseases Educational Foundation.

No longer in clinical practice, Dr. Burrascano works full time in the biotech arena to further medical research in tick-borne and other chronic illnesses.

Dr. Rasa’s notes from Dr. Burrascano’s presentation:

Ticks can attach to rodents, deer, raccoons, foxes, birds, reptiles and more. To think that they are only infected with B burgdorferi is ridiculous.

Bartonella -In  ticks collected from New Jersey, more ticks harbor Bartonella species than Borrelia burgdorferi.  

Nearly every chronic Lyme patient is co-infected. Co-infected people tend to me more ill and are more treatment resistant.  

• Test sensitivity for co-infections is very poor.
• Treatment regimens differ for many of these 
• Dificult to sort out diagnosis and treatment
• Difficult to judge when to change or stop a regimen.
• treatment resistance and failures may actually be due to the presence of an unrecognized co-infection..

Bartonella

CSD Tests are insensitive (serologies and PCR) – Miss up to 80% of clinically defined cases

Clinical Picture: 

-CNS symptoms out of proportion to physical

-Encephalopathy- encephalitis, irritability, anxiety, seizures, psychiatric syndromes, insomnia, gastritis, rashes, tender skin nodules, sore soles, AM fevers, light night sweats

-Persistent CNS symptoms despite Lyme Rx

Many species of Bartonella – each may have different antibiotic susceptibilities and you can be co-infected with more than one species

Treatment duration unknown and relapses are too common

BABESIA

Many cases of undiagnosed Babesiosis.

-Are at least 13 pathogenic species, yet we can test for only two!

MYCOPLASMA

Not clear of its origin or source.

More often seen in the immunosuppressed

Clinically, see unrelenting fatigue and neurological dysfunction

-Dysesthesias, pain syndromes

-Autonomic dysfunction

- Strongly suspected in the most chronic, treatment-resistant cases, especially if the DC-57 is below 20

Management of Lyme

Because every circumstance is unique, cannot use a "cook book" approach

Best to learn about Borrelia biology and why this family of bacteria aere so diffcult to pin down

-Complex genetics

-Impact on immune system

-Diagnostic challenges

-Treatment challenges

Why Borrelia Can Cause A Chronic Infection

• Induction of immune dysfunction
• Epitope switching allows evasion of immune respone
• Very slow growth, with a doubling time measured in days to weeks
• -the slower the growth, the longer it takes to be killed (example: tuberculosis)
• Periods of dormancy/latency with no division but continued production of toxic prodcts
• -antibiotics may not kill dormant bacteria
• Ability to morph among spiral, systic and granular forms in respons to stressors-further immune evasion and resistance to antibiotic treatments
• Protective hiches-ligamentous tissue, eye, CNS, within cells
• Biofilm formation – provides protection for persistent organisms

DIAGNOSIS

Lyme is always a clinical diagnosis.

Positive lab tests may support a diagnosis, but negative results can never exclude Lyme

Why the need for a clinical diagnosis:

• Only 17% recall a bite (Texas Dept. of Health)
• Only 36% recall a rash (Texas Dept. of Health)
• Serologic testing is nearly useless in early disease
• Paradoxicaly, in those with a late, disseminated infection, the more ill patients re more likely to be seronegative (immune complex, immune suppression)
• Signs of Active Infection
• Symptoms wax and wane in a clear cycle (usually 4 weeks long)
• Symptoms are migratory
• Symptoms change type
• Low grade fevers in the afternoon
• Elevated C4a with normal C3a
• Positive Bb direct tests (culture PCR, antigen)

Required Supportive Measures

Low glycemic index, low fat diet

Abstinence from alcohol

Never any high-dose steroids or other immunosuppressives unless already on an aggressive antibiotic regimen

Key nutritional supplements

Specific exercise program, performed regularly

Enforced rest

Sound sleep

Psychological and emotional support for patient, family and other caregivers

Notes from Dr. Bransfield presentation:

 Dr. Bransfield’s primary activity is an office based private practice of psychiatry. In addition, Dr. Bransfield is the Associate Director of Psychiatry and Chairman of Psychiatric Quality Assurance at Riverview Medical Center in Red Bank, NJ, Past Immediate President of the International Lyme and Associated Diseases Society,

The following slides are from Dr. Bransfield’s power point presentation.

 With increasing incidence of suicide, violence and murder among young people this particular

slide was particularly disturbing.

 The slide reads…

 "Violent behavior is the result of a complex

interaction of many contributors and deterrents.

Infections may cause impairments that contribute

to violence through multiple mechanisms and some

appear immune mediated by proinflammatory and

autoimmune mechanisms. The resulting

impairments include cognitive impairments; sensory

hyperacusis; decreased frustration tolerance;

decreased impulse control; intrusive symptoms of an

aggressive and or sexually aggressive nature;

homicidal preoccupations; mood instability;

depersonalization; dissociative states; paranoia;

psychosis; social anxiety contributing to social

isolation; altered sexual behavior; decreased

bonding capacity, empathy, facial recognition and

emotional insight; and decreased tolerance to the

effects of drugs and alcohol"

Be sure to read the final thought on this slide.

 It can now be said–To know Lyme disease is to know medicine, neurology, psychiatry, immunology, psychoimmunology, ecology, law, politics and ethics.

This statement alone explains why the approach to caring for patients with Tick Borne diseases is complex and riddled with holes.  Even the best educated, lyme literate and experienced practitioner has restrictions and limitations as we move forward to meet the ever increasing number of cases before us.

Facts about Lyme