This application proposes to study the pathogenesis of a post Lyme disease syndrome (PLS) which is characterized by chronic musculoskeletal pain, fatigue-and disordered cognition, resembling fibromyalgia (FM). The paradigm of an infection-induced FM syndrome offers the major advantage of conducting prospective studies from disease onset and determining host, infectious or immunologic factors that lead to the development of the condition. This will be a prospective as well as a cross-sectional study. In the prospective arm, l00 patients with the constitutional features of early Lyme disease will have genetic analysis(HLA typing); psychological and neurocognitive testing; SPECT brain scanning; blood and spinal fluid cultures and PCR analysis for Borrelia burgdorferi, and measurement of anti-Borrelial antibodies, anti-Borrelial containing immune complexes and lL-6 and lL-6 complexes. Somatomedin, a growth hormone-related peptide found to be low in FM serum, will also be measured. These patients will be followed after treatment, clinically for the development of PLS and FM and will undergo repeat SPECT scanning, psychological and neurocognitive testing, and blood testing every 8-12 months for 2 more times. In this way, it can be determined if host genetic and psychological factors play a role in predisposition to PLS and FM. Also, the role of B. burgdorferi and the immunological response to it in the development of PLS can be assessed. It may also be possible to correlate changes in cerebral blood flow by SPECT scanning to neurocognitive abnormalities and relate these to infectious or immunological central nervous system injury. In the cross sectional analysis, 25 PLS patients will be compared to age, gender and education matched controls. The control groups are 25 recovered Lyme disease patients, 25 spontaneous FM patients and 25 normal spouse controls. PLS patients and controls will be evaluated using all the above clinical, psychological, neurocognitive, imaging and serological tests. This will relate the abnormal findings in PLS to those in FM and should provide us with insights into the pathogenesis of FM

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
1R01AR043135-01
Application #
2082750
Study Section
Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Project Start
1994-09-25
Project End
1997-08-31
Budget Start
1994-09-25
Budget End
1995-08-31
Support Year
1
Fiscal Year
1994
Total Cost
Indirect Cost
Name
New York Medical College
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
Valhalla
State
NY
Country
United States
Zip Code
10595
Pavia, C S; Wormser, G P; Bittker, S et al. (2000) An indirect hemagglutination antibody test to detect antibodies to Borrelia burgdorferi in patients with Lyme disease. J Microbiol Methods 40:163-73
Bujak, D; Guardino, S; Weinstein, A (1998) Lyme disease. Lippincotts Prim Care Pract 2:87-92
Nadelman, R B; Wormser, G P (1998) Lyme borreliosis. Lancet 352:557-65
Wormser, G P; Nowakowski, J; Nadelman, R B et al. (1998) Efficacy of an OspA vaccine preparation for prevention of Lyme disease in New York State. Infection 26:208-12
Pavia, C S; Wormser, G P; Norman, G L (1997) Activity of sera from patients with Lyme disease against Borrelia burgdorferi. Clin Infect Dis 25 Suppl 1:S25-30
Rikihisa, Y; Zhi, N; Wormser, G P et al. (1997) Ultrastructural and antigenic characterization of a granulocytic ehrlichiosis agent directly isolated and stably cultivated from a patient in New York state. J Infect Dis 175:210-3
Horowitz, H W; Dworkin, B; Forseter, G et al. (1996) Liver function in early Lyme disease. Hepatology 23:1412-7
Aguero-Rosenfeld, M E; Horowitz, H W; Wormser, G P et al. (1996) Human granulocytic ehrlichiosis: a case series from a medical center in New York State. Ann Intern Med 125:904-8
Aguero-Rosenfeld, M E; Nowakowski, J; Bittker, S et al. (1996) Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans. J Clin Microbiol 34:1-9
Warshafsky, S; Nowakowski, J; Nadelman, R B et al. (1996) Efficacy of antibiotic prophylaxis for prevention of Lyme disease. J Gen Intern Med 11:329-33

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