Texas Man, 69

source: JAMA, Oct. 24/31. 1986--Vol. 256, No. 1 Letters Borrelia in the Brains of Patients Dying of Dementia "To the Editor.--I have identified spirochetes in serial subculture of autopsy brain tissues from two patients with dementia. Indirect immunofluorescence, using monoclonal antibodies specific for Borrelia species, resulted in fluorescence of spirochetes that had previously been identified by darkfield microscope examination (figures 1 through 4). "Case 1 was a 74-year old woman with mild dementia of less than one year's duration. She had resided in New York and Florida. Case 2 was a 69-year-old man who died in a nursing home in Texas after a four-to five- year history of progressive dementia. Parkinsonian symptoms were noted during his last year of life. Neither patient had symptoms of the skin, joint, or cardiac disorders described in Borrelia infection. "Recent reports have described patients with various chronic degenerative disorders whose blood or cerebrospinal fluid contains antibodies against B. burgdorferi (1) Individuals with cognitive impairment were found within the larger group of patients with chronic borreliosis. (2, 3) Borrelia species seem to share with Treponema pallidum " (syphilis) " the potential to survive in host tissues for prolonged periods of time and to cause disease in various organ systems after months or years of clinical latency. Pachner and Steere (4) have classified the neurological manifestations of B. burgdorferi infection into primary, secondary, and tertiary forms. If Borrelia infection can be linked to cases of dementia by serology or culture, a group of patients will be canidates for intensive parenteral" (iv) "antimicrobial therapy analogous to the treatment now used for neurosyphilis." Alan B. MacDonald, MD Southampton Hospital (NY) 1. Kohler J, Kasper J, Kern U, et al: Borrelial encephalomyelitis. Lancet 1986;2:35. 2. Reik L. Jr, Smith LM, Khan A, et al: Demyelinating encephalopathy in lyme disease. Neurology 1985;35:267-269. 3. Hansen K, Rechnitzer C, Pederson NS, et al: Borrelia meningitis and demyelinating CNS disease, Int J Microbiol Hyg 1986: in press 4. Pachner AR, Steere AC, Tertiary Lyme disease: Central Nervous System manifestations of long standing infection with Borrelia burgdorferi, Int. J Microbiol Hyg 1986: in press.