- Armin Alaedini, Ph.D
- Gad Baneth, DVM, Ph.D, Dipl. ECVCP
- Daniel Cameron, MD, MPH
- Peter Andras Csango, MD
- Randi Eikeland, Ph.D, MD
- Brian Fallon, MD, MPH, MED
- Volkhard Kempf, Ph.D, MD
- Carl Morten Motzfeldt Laane, Ph.D
- Neil Nathan, MD
- B. Robert Mozayeni, MD
- Garth L. Nicolson, Ph.D.
- Steven E. Phillips, MD
- Armin Schwarzbach, Ph.D, MD
- Ritche C. Shoemaker, MD
- Raphael B. Stricker, MD
- Ravilya Yegemberdiyeva, Ph.D
- Ying Zhang, Ph.D, MD
- Poster Session
- Hostess Lise Askvik
Armin Alaedini, Ph.D
Dr. Armin Alaedini is Assistant Professor of Medical Sciences in the Department of Medicine at Columbia University. His team’s research is aimed at understanding the link between immunologic response to foreign antigens and the development of immune-mediated disease processes, including those affecting the nervous system. Areas of research in his laboratory include investigation of immune mechanisms in Lyme disease, celiac disease, schizophrenia, and autism. Dr. Alaedini is currently a recipient of grants from the National Institutes of Health, the U.S. Department of Defense, and the Stanley Medical Research Institute.
Talk: Immunologic Mechanisms in the Persistence of Symptoms in Lyme Disease
Lyme disease is a multisystem infection, caused by bacteria of the Borrelia burgdorferi species complex and transmitted by Ixodes ticks. The initial skin rash may be followed by complications affecting joints, heart, and the nervous system, which usually respond to antibiotic therapy. However, some patients experience pain, fatigue, and difficulties with concentration and memory despite recommended treatment. The condition, sometimes referred to as post-treatment Lyme disease syndrome (PLDS), is associated with considerable impairment in the health-related quality of life in the affected patient population. However, few clues to the cause(s) of the symptoms have emerged. Lack of biomarkers to aid in the diagnosis and follow up of patients has also compounded the problem of understanding the condition and finding suitable therapies. This talk will review recent data that demonstrate the presence of specific immunologic abnormalities in PLDS, which may be relevant to the pathogenesis of the associated symptoms. Further characterization of the immune response in PLDS may reveal additional information about its etiology, identify novel biomarkers, and support a rationale for examining the efficacy of novel treatments in the future.
Gad Baneth, DVM, Ph.D, Dipl. ECVCP
Gad Baneth, DVM, Ph.D. Dipl. ECVCP is Professor of Veterinary Parasitology and Infectious Diseases and the The Rybak-Pearson Chair in Veterinary Medicine at the School of Veterinary Medicine, Hebrew University in Israel. He graduated from the Hebrew University Koret School of Veterinary Medicine in Israel in 1990. He did a Small Animal internship and residency at the Hebrew University until 1994 followed by a fellowship in Internal Medicine and Infectious Diseases Research at the College of Veterinary Medicine, North Carolina State University during 1994 and 1995. He received a PhD in veterinary parasitology from the Hebrew University in 2000. Prof. Baneth served as the head of the Small Animal Internal Medicine Department at the Hebrew University Veterinary Teaching Hospital. He is a diplomate of the European College of Veterinary Clinical Pathology (ECVCP) and an editorial advisory board member for the Journal Veterinary Parasitology since 2006. He is the chairman of the World Small Animal Veterinary Association (WSAVA) Scientific Advisory Committee (SAC), the vice president of the LeishVet group for standardization of the diagnosis, treatment and prevention of canine leishmanioasis, a member of the International Society for Companion Animal Infectious Diseases (ISCAID) Board of Directors, and a member of Board of Directors, Israel Society for Parasitology, Protozoology and Tropical Diseases. His research interests focus on the pathogenesis, diagnosis and treatment of veterinary and zoonotic vector-borne infectious diseases including leishmaniosis, relapsing fever borreliosis, canine ehrlichiosis, babesiosis, hepatozoonosis, trypanosomiasis and dirofilariasis. Prof. Baneth is involved in the study of zoonotic and veterinary diseases in the Mediterranean Basin, Uzbekistan, Ethiopia, Southern Europe and South America funded by the European Union, Bill & Melinda Gates Foundation, USAID, the DFG and other international research agencies. He is the author of more than 160 scientific publications and book chapters. Prof. Baneth serves as an advisor to the European Food Safety Authority (EFSA) on leishmaniosis.
Talk 1:Babesiosis – A Group of Tick-Borne Protozoal Diseases with Zoonotic Importance
Babesia species are tick-borne apicomplexan protozoal parasites of erythrocytes that infect a variety of animals and humans. Babesiosis caused by different Babesia species is a disease with a worldwide distribution characterized by erythrocyte destruction causing mild to severe systemic clinical manifestations. Human babesiosis caused by several Babesia species is an important emerging tick-borne zoonotic disease. Humans are considered accidental hosts of these infections that circulate in nature between wildlife animals, livestock and tick hosts. A fatal Babesia divergens infection reported in 1956 was the first confirmed case of human babesiosis. Babesiosis has since then been regarded as an important and potentially life threatening zoonotic infection of humans. Babesia divergens, a parasite of cattle, has been implicated as the most common agent of human babesiosis in Europe, causing severe disease in splenectomized individuals. Although several Babesia species have been involved in human infections worldwide, the major public health burden on man in North America is due to Babesia microti, especially in the eastern parts of the United States of America. Babesia microti, a babesial parasite of rodents, causes mild to severe disease, also in non-splenectomised patients. Human Babesia microti infection has also been reported in Europe and several studies have demonstrated the presence of B. microti in Ixodes ricinus ticks in northern and central Europe. New Babesia species have been recognized as causing human disease. These include Babesia venatorum (Babesia EU1), a parasite of deer transmitted by Ixodes ricinus ticks, reported in humans from Italy, Germany and Austria, Babesia duncani reported in humans from California, and several other less well characterized babesial species. The reasons for the increased incidence of human babesiosis are complex; most likely involving ecological changes, increased awareness of the disease, an increased number of susceptible individuals, such as those infected with HIV or immunocompromised patients and transmission of Babesia parasites by blood transfusion.
Talk 2:Ehrlichiosis: Tick-Borne Bacterial Diseases of humans and animals
The ehrlichioses are febrile tick-borne infections of humans and animals caused by members of the bacterial genus Ehrlichia (Anaplasmataceae). Ehrlichia canis has been known as a cause of canine ehrlichiosis in dogs and other canine species since 1935 but Human Monocytropic Ehrlichiosis (HME) caused by Ehrlichia chaffeensis was only reported and recognized as a human disease in 1987 in the USA. Both bacteria are closely related and infect monocytes as their host cells. Ehrlichia ewingii infects granulocytes and causes disease in both humans and canines termed Human Ehrlichiosis Ewingii (HEE) in humans. HME and HEE are mainly transmitted by the lone star tick Amblyomma americanum while canine ehrlichiosis is transmitted by the brown dog tick Rhipicephalus sanguineus. The ehrlichial agents are closely related to Anaplasma phagocytophilum which infects granulocytes of many domestic and wildlife animals and also humans causing Human Granulocytic Anaplasmosis (HGA) and transmitted by different Ixodes species in the northern hemisphere. The geographic distributions of these tick-borne diseases are mainly limited by the distribution of their tick vectors. HME, HEE and HGA mostly have similar clinical presentations including fever, headache, leukopenia, thrombocytopenia and elevated serum liver enzyme activities. Neurologic manifestations are most frequently reported with HME. They may appear as concurrent infections with other tick-borne diseases such as Lyme Disease or Babesiosis caused by Babesia microti. In contrast, canine ehrlichiosis has two main presentations, an acute disease presented with fever, bleeding tendency (diathesis) and thrombocytopenia, and a chronic form in which bone marrow suppression with pancytopenia is the main finding. ‘Candidatus Neoehrlichia mikurensis’ is a relatively newly-discovered intracellular bacterium member of the Anaplasmataceae family which causes severe disease with fever and septicemia in humans. It was first isolated and described from wild rats (Rattus norvegicus) and Ixodes ovatus ticks in Japan and in the decade since its first report, it was also reported in other areas of Asia, Europe and Africa, and has been associated with Ixodes ricinus ticks in Europe and other Ixodes spp. elsewhere. ‘Ca. Neoehrlichia mikurensis’ is an example of an “emerging” tick-borne infection that has been known only for a decade and appears to be dispersed in multiple regions. Similarly to other tick-borne agents, it is likely to have been circulating among wildlife animals and ticks long before it emerged as a recognized clinical cause of human disease.
Talk 3: Dirofilariases- Emerging Filarial infections in Europe
Filariasis is caused by a number of nematode species transmitted by arthropod vectors that vary from one geographic region to another. Some of the filarial species can be highly pathogenic and cause a life-threatening disease, whereas other species are associated with mild or asymptomatic infection. Dirofilaria immitis and Dirofilaria repens are two filarial species transmitted by mosquitoes that infect dogs, cats and humans and are emerging in Europe. These two species are expanding their geographic ranges and advancing northwards in the continent. Filariasis caused by D. repens is prevalent in several regions in the world including: the Mediterranean basin, Southern Europe, Africa and Southeast Asia. It has recently also been increasing reported in central and Eastern Europe. Dogs, foxes and cats are the reservoir for this infection and people are accidental “dead end” hosts in which the life cycle is not completed. The mosquito vectors of D. repens vary in different geographic regions and include species belonging to the genera Culex, Anopheles and Aedes. Canine infection is often an incidental hematological finding, or accompanied by mild clinical signs including skin swelling, hyperpigmentation or subcutaneous granulomas containing adult worms. In humans, immature D. repens migrate in connective tissues and elicit an inflammatory response resulting in the formation of nodules around the worms that are sometimes confused with tumors and treated by surgical excision. The manifestations of D. repens infection in people are associated with nodules which have been described from the lung, subcutaneous tissues, epididymis, spermatic cord, omentum, conjuctiva, and the breast. Infections have been recorded to persist for 8 years and can be detected in tourists that have visited endemic areas.
Dirofilaria immtis is a major dog pathogen in many parts of the world. It causes heartworm disease in domestic and wild canine hosts. It is present in southern Europe, North and South America, Africa, Asia and Australia. The life cycle of D. immitis includes migration of the larvae injected by mosquitoes into the skin through the dog’s muscles to the lung blood vessels reaching the pulmonary arteries where they continue to mature. Adult worms are found primarily in the pulmonary arteries and in severe infections also in the right atrium of the heart and occasionally in the vena cava. Chronic heartworm disease results from progressive proliferative endarteritis and thromboembolism of the pulmonary artery caused by adult worms with right ventricular hypertrophy or dilation and cor pulmonale. Humans can become infected with D. immitis but the worm does not complete its life cycle in people and the manifestations of infection are generally similar to those described in human D. repens infection. Wolbachia are Gram-negative bacterial endosymbionts of some filarial worms. They have been demonstrated to be transovarially transmitted in the human filarial pathogens Onchocerca volvulus and Brugia malayi and are also present in D. immitis. The presence of these bacterial endosymbionts in filariae opens venues for additional means of diagnosis and potential antibiotic treatment with tetracyclines which affect the longevity of the filarial worms by killing their bacterial endosymbionts.
Daniel Cameron, MD, MPH
Dr. Daniel Cameron graduated with a degree in Medicine and Epidemiology from the University of Minnesota as well as completed residencies at Beth Israel Medical Center and Mt. Sinai School of Medicine in New York. He works in a private medical practice in Mt. Kisco, New York, USA. He is a pioneer in Lyme disease as an author of practice guidelines, analytic reviews, and clinical trials. Dr. Cameron is widely recognized for conducting epidemiologic research while practicing medicine.
Talk: Essentials for Lyme disease diagnostics and evidence based treatment
An examination of the published literature is essential to understanding the growing spectrum of acute and chronic manifestations of Lyme disease. The all to common absence of a physical examination finding or a reliable test underlies the need for make a clinical diagnosis. The growing number of strains and species of Borrelia and other tick borne illness further complicates the need for reliable diagnostic tests. Our increasing understanding of pathophysiologic mechanisms further complicated finding an effective antibiotic regiment. ILADS published their evidence based treatment guideline in 2014 based on a GRADE assessment. A GRADE assessment of demonstrated the weakness of evidence for retreatment. The ILADS panel conclusion included that 1) guidelines should not constrain the treating clinician from exercising clinical judgment in the absence of strong and compelling evidence to the contrary, 2) recommendations take into account not only the quality of the evidence, but also the balance between benefits and harms and patient values and preferences, 3) patient-centered care focuses on achieving treatment outcomes that patients value, including the restoration of health, prevention of health deterioration and the provision of treatments that have the potential to improve quality of life, and 4) shared decision-making takes into account the best scientific evidence available, clinical expertise and the role of patient’s values and preferences in deciding among available treatment options. Specific recommendations will be highlighted.
Brian Fallon, MD, MPH, MED
Brian A. Fallon, MD, MPH, is the director of the Center for Neuroinflammatory Disorders and Biobehavioral Medicine and director of the Lyme and Tick-Borne Diseases Research Center at Columbia University. A graduate of Harvard College, he obtained his M.D. degree from the Columbia University College of Physicians and Surgeons, as well as a master’s degree in public health epidemiology from Columbia University. He did his medical internship at Columbia University Medical Center and research training and an NIH fellowship in biological psychiatry at Columbia Presbyterian Medical Center and the New York State Psychiatric Institute. In addition to his work on illness anxiety, hypochondriasis, obsessive compulsive disorder, and somatoform disorders, Dr. Fallon is recognized internationally for his research on neurologic and neuropsychiatric Lyme disease. He has served on expert panels for the National Institutes of Health in different areas, including OCD and neurologic and chronic Lyme Disease, and has received over $10 million in both private and governmental grants to continue his research. He is the recipient of many awards, including the Laughlin Award from the American College of Psychiatrists, two commencement awards from the Columbia University College of Physicians and Surgeons (Richard Raynor Watson Award and the Titus Munson Coan Prize for best essay in Biomedical Research (“The Rise of Tuberculosis among the Homeless Mentally Ill”), the Columbia University Horwitz Award for excellence in Research, the Columbia Universit Medical Student Teacher of the Year award for psychiatry, a NARSAD Principal Investigator Award (2006), and the Roseke award from the American Psychaitric Association for outstanding teaching to medical students (2008). His major research interests cut across the boundaries of medicine, psychiatry, nuclear medicine and neurology. A primary focus is on the pathophysiologic mechanisms and treatment underlying persistent cognitive impairment, fatigue, and pain among patients with histories of Lyme or other Tick borne diseases. This interest leads to collaborative studies involving proteomics, genomics, neuroimaging, cognitive remediation, treatment trials, and the search for more sensitive and specific diagnostic biomarkers. This expertise has also led to new projects in psychiatry, such a a NARSAD funded study of the role of ceftriaxone (an IV antibiotic) as a treatment for patients with refractory psychoses, examining improvement clinically and in glutamatergic change using MR Spectroscopy. Dr. Fallon is also a leader in the area of somatoform disorders, particularly the pharamcotherapy of hypochondriasis and is currently conducting both treatment and functional neuroimaging studies in these areas and serves as an advisor to the Anxiety and Obsessional Disorders DSM-V workgroup.
Talk 1: Neuropsychiatric Lyme disease – madness or reality?
Since the early 1990s in Europe and the United States, the neuropsychiatric manifestations have been described, ranging from depression to agitation to mania to dementia. Some experts claim that such manifestations have no basis in fact. Others claim that most patients with psychiatric symptoms really have undetected Lyme or other tick-borne infections. These conflicting statements have life-threatening implications. Unrecognized Lyme disease may lead to a treatment refractory psychiatric disorder. Depression mistakenly diagnosed as Lyme disease may mislead the patient into years of ineffective antibiotic treatments. In each scenario, the patient is at risk for increasing despair, disability, and suicide. What leads well-intentioned doctors to makes these mistakes? Where is the truth amidst these conflicting statements? The goal of this talk is to review the evidence, to describe typical and atypical neuropsychiatric manifestations, to review potential diagnostic tools, to discuss possible mechanisms of disease (including the PANS-model), and to clarify treatment strategies for both acute and post-treatment neuropsychiatric Lyme disease. New data will be presented.
Talk 2: When Lyme Symptoms Persist? Biologic and Treatment Results from the U.S. Clinical Trial of Lyme Encephalopathy
Much confusion exists regarding the manifestations, pathophysiology, and treatment of patients with post-treatment Lyme encephalopathy (PTLE). While a great deal needs to be understood about this disease, much has been learned over the past decade. This presentation reports the cumulative results from one of the 4 U.S. Clinical trials of post-treatment Lyme syndrome which we conducted at Columbia University Medical Center from 2000-2005. The focus of that study was on patients with rigorously defined prior Lyme disease with persistent cognitive deficits. Of the studies on patients with post-treatment Lyme syndrome, this dataset is unique in that it includes patients who were carefully defined and comprehensively studied using a variety of clinical and biologic methods, including neurocognitive testing, spinal fluid studies, biomarkers, immunologic and proteomic studies, structural imaging, cerebral blood flow imaging, and cerebral metabolic imaging. This talk will present the findings from the randomized double-blind placebo controlled 10 week IV ceftriaxone treatment both as measured immediately after treatment as well as in a 10 year follow-up study. The goal is to put these findings in the context of other studies in the U.S. and to draw inferences for clinicians that will have practical significance.
Volkhard Kempf, Ph.D, MD
Prof. Volkhard Kempf is since 2009 the Director of the Institute for Medical Microbiology and Infection control at Johann Wolfgang Goethe-Universität in Frankfurt am Main performing all relevant infectious disease diagnostics for patients, infectious diseases ward rounds and infection control measurements. Prof. Kempf studied medicine in Würzburg (Germany) and Oxford (UK) and worked formerly in the Max von Pettenkofer-Institute Munich and at the University Hospital in Tuebingen. He holds a board certification for “Medical Microbiology, Virology and Infection Epidemiology” and “Hospital Infection control”.Prof. Kempf heads the National Consiliary Laboratory for Bartonella-Infections (appointed by the Robert Koch-Institute, Berlin), is one of two leaders of the Robert-Koch-Insitute-initiated network “Zoonotic diseases, the Editor-in-Chief of “Medical Microbiology and Immunology” and the Chairman of the Frankfurt Medical Society. His research interests are bacterial pathogenicity and resistance and hypoxic host cell events in infections. He holds 14 Patents related to Bartonella diagnostics and clinical use of proteins. He has published 89 scientific articles in peer-reviewed journals and contributed to 9 books.
Talk: Bartonella: “sticky lollipops” & angiogenesis
In Europe, Bartonella henselae and Bartonella quintana, are considered the most relevant human pathogenic species responsible for cat scratch disease, bacillary angiomatosis, trench fever and other diseases. Although some details of the ecology and pathogenicity of these pathogens have been analysed in the past, many aspects of these medically underdiagnosed infections are still not understood. In particular, the serological diagnostics have methodically inherent limitations. Controversial data about animal hosts and arthropod vectors also exist. In terms of pathogenicity, trimeric autotransporter adhesins (TAAs) such as the Bartonella adhesin A (BadA) of B. henselae or the variably expressed outer-membrane proteins (Vomps) of B. quintana represent well accepted pathogenicity factors with possible implication in serodiagnostics. The exact molecular functions of these adhesins and their interplay with other pathogenicity factors (e.g., the VirB/D4 type 4 secretion system) need to be analyzed in detail to understand how these pathogens adapt to their mammalian hosts.
B. Robert Mozayeni, MD
Dr. Robert Mozayeni is a rheumatologist with graduate and post-graduate physician-scientist training from Albany Medical College, Yale University, Howard Hughes Medical Institute, and the National Institutes of Health (NCI, NHLBI, and NIAMS). He is presently in private practice in Bethesda, MD where he specializes in chronic inflammatory diseases having rheumatic and neurovascular manifestations. Dr. Mozayeni is the founder and Executive Director of the Translational Medicine Group where he has developed and commercialized software that supports data-driven methods to accelerate the evaluation and improvement of patient-centered care pathways. He is currently also the chief medical doctor at Galaxy Diagnostics. Under an ongoing research collaboration with Dr. Breitschwerdt, Dr. Mozayeni maintains an observational clinical evaluation of the significance of Bartonella infection in a cohort of several hundred human patients with otherwise unexplained chronic conditions. Clinical correlations between Bartonella species and various conditions are being determined as part of ongoing research which continues to redefine diagnostic and therapeutic options as dictated by clinical experience. Dr. Mozayeni has special research and clinical expertise with regard to autoimmune diseases and the effects of chronic infection and inflammation on vascular physiology and neurovascular conditions seen commonly with autoimmune and neurovascular diseases. He has published numerous papers on immunology and cerebrovascular blood flow hemodynamics. He has presented his work in numerous US and International talks and holds over 8 US and international patents with the greatest concentration of his work on methods related to evaluation of brain blood flow.
Talk: Bartonella: Clinical Expression of Small Vessel Disease, Treatment Experience and Overlap with Lyme Disease
Dr. Mozayeni will discuss his experience in diagnosing and treating chronically ill patients who have Bartonella infection, and how this chronic infection is expressed clinically as the various manifestations of small vessel inflammatory disease.
Bartonella spp. infection and bacteremia has been reported in association with an expanding spectrum of symptoms and lesions, including rheumatic symptoms in a Lyme-endemic region. Among 296 patients examined, prevalence of antibodies against Bartonella henselae, B. koehlerae, or B. vinsonii subsp. berkhoffii (185 [62%]) and Bartonella spp. bacteremia (122 [41.1%]) was high. Conditions diagnosed before referral included Lyme disease (46.6%), arthralgia/arthritis (20.6%), chronic fatigue (19.6%), and fibromyalgia (6.1%). B. henselae bacteremia was significantly associated with prior referral to a neurologist, most often for blurred vision, subcortical neurologic deficits, or numbness in the extremities, whereas B. koehlerae bacteremia was associated with examination by an infectious disease physician. This cross-sectional study cannot establish a causal link between Bartonella spp. infection and the high frequency of neurologic symptoms, myalgia, joint pain, or progressive arthropathy in this population; however, the contribution of Bartonella spp. infection, if any, to these symptoms should be systematically investigated.
Neil Nathan, MD
Neil Nathan MD is a Board-Certified Family Physician and a Founding Diplomate of the American Board of
Integrative and Holistic Medicine. His medical practice is with Gordon Medical Associates in Santa Rosa, California, with an additional office in Fort Bragg, California. His latest book is “Healing is Possible: New Hope for Chronic Fatigue, Fibromyalgia, Persistent Pain and Other Chronic Illnesses”, and he is the host for The Cutting Edge of Health and Wellness Today weekly radio program available internationally through Voice America. He has a special interest in understanding and treating chronic, complex illnesses including Lyme Disease, Mold Toxicity, Fibromyalgia, Chronic Fatigue Syndrome, Autism and patients with unclear diagnoses
Talk 1: Rebooting: A new paradigm for complex medical issues in chronically ill patients
The patients we are now seeing with Chronic Lyme disease and coinfections are complicated on many levels. As time moves forward, we are seeing patients who are increasingly compromised. They are suffering not only from an infectious process, but as a consequence of these unique infectious agents, they have significant immune dysregulation (allowing additional infectious microbes to become a part of the problem with an alarming increase in autoimmune conditions). There are effects upon the nervous system (which have infectious, inflammatory and toxic components)
and gastrointestinal system (from infectious and toxic effects coupled with leaky gut and biome dysregulation). There are effects creating endocrine dysregulation, mitochondrial dysfunction, methylation dysregulation, multiple food and chemical sensitivities as prominent, all of which interact together. We can no longer approach these infections with the use of antibiotics alone. We must be willing to evaluate and treat multiple complex systems concurrently. Merely treating a few of these imbalances will no longer suffice – we have to think about literally “rebooting” whole systems that are so compromised that they are incapable of returning to homeostatic balance on their own, even when the infections are under better control. This presentation will attempt to propose a new paradigm for healing at this level. I will refer to the ground-breaking conceptualization of Robert Naviaux, MD in his recent paper “The Cell Danger Response” as a part of this model.
Talk 2: The Importance of Evaluating Mold Toxicity and Methylation for Chronic Lyme Patients
We are beginning to understand that many of our sickest Lyme patients are also struggling with mold toxicity and methylation issues. Mold toxins stimulate the body to produce an inflammatory cytokine response so similar to that produced by Bartonella that separating the two from a diagnostic and treatment perspective can be especially difficult. We have also recently discovered that for patients with weakened immune systems (e.g. Lyme), when exposed to mold, they are predisposed to colonization by that mold, primarily in their sinus and intestinal tissues. This creates persistent production of mycotoxins internally, even when the patient is removed from their moldy environment. It is imperative that clinicians treating these complex illnesses understand the physiology, symptomatology and treatment approaches for mold toxicity and also how this is influences hormonal dysfunction and the body’s capacity for methylation. The results of new research by Dr. Ritchie Shoemaker and Dr. Joseph Brewer will be highlighted.
Garth L. Nicolson, Ph.D
Professor Emeritus Garth L. Nicolson is the President, Chief Scientific Officer and Research Professor of Molecular Pathology at the Institute for Molecular Medicine in Huntington Beach, California. He is also a Conjoint Professor at the University of Newcastle (Australia). He was formally the David Bruton Jr. Chair in Cancer Research and Professor and Chairman of the Department of Tumor Biology at the University of Texas M. D. Anderson Cancer Center in Houston, and he was Professor of Internal Medicine and Professor of Pathology and Laboratory Medicine at the University of Texas Medical School at Houston. He was also Professor of Comparative Pathology at Texas A & M University. Professor Nicolson has published over 630 medical and scientific papers, including editing 20 books, and he has served on the Editorial Boards of 30 medical and scientific journals and was a Senior Editor of four of these. Professor Nicolson has won many awards, such as the Burroughs Wellcome Medal of the Royal Society of Medicine (United Kingdom), Stephen Paget Award of the Metastasis Research Society, the U. S. National Cancer Institute Outstanding Investigator Award, and the Innovative Medicine Award of Canada. He is also a Colonel (Honorary) of the U. S. Army Special Forces and a U. S. Navy SEAL (Honorary) for his work on Armed Forces and veterans’ illnesses.
Talk 1: Chronic Bacterial and Viral Infections in Neurodegenerative and Neurobehavioral Diseases and other Chronic Illnesses
Chronically ill patients with neurodegenerative, neurobehavioural and psychiatric diseases commonly show presence of systemic and central nervous system bacterial and viral infections. Often these can be vector-associated bacterial and viral infections, such as Mycoplasma, Chlamydia, Borrelia, Brucella and Lyme disease-associated infections. In addition, in other chronic illnesses where neurological manifestations are routinely found, such as fatiguing and autoimmune diseases, among others, systemic bacterial and viral infections could also be important, such as in disease inception, progression or increasing the types/severities of signs and symptoms. Although the specific roles of chronic infections in neurodegenerative, neurobehavioural and psychiatric diseases have not been carefully determined, the data suggest that these infections are routine features and probably contribute to their pathogenesis.
1. Nicolson GL. Chronic infections in neurodegenerative and neurobehavioral diseases. Lab Medicine 2008; 39(5): 291-299.
2. Nicolson GL, Haier J. Role of chronic bacterial and viral infections in neurodegenerative, neurobehavioral, psychiatric, autoimmune and fatiguing illnesses: Part 1. Br J Med Practit 2009; 2(4): 20-28; Part 2. Br J Med Practit 2010; 3(1): 301-311.
3. Nicolson GL, et al. High frequency of systemic mycoplasmal infections in Gulf War veterans and civilians with Amyotrophic Lateral Sclerosis (ALS). J Clin Neurosci 2002; 9:525-529.
4. Nicolson GL, et al. Multiple co-infections (Mycoplasma, Chlamydia, human herpesvirus-6) in blood of chronic fatigue syndrome patients: association with signs and symptoms. APMIS 2003; 111:557-66.
5. Nicolson GL, et al. Evidence for Mycoplasma, Chlamydia pneunomiae and HHV-6 co-infections in the blood of patients with Autism Spectrum Disorders. J Neuroscience Res 2007; 85:1143-1148.
6. Nicolson GL, et al. Chronic Fatigue Syndrome Patients Subsequently Diagnosed with Lyme Disease Borrelia burgdorferi: Evidence for Mycoplasma species Co-Infections. J Chronic Fatigue Syndr 2008; 14(4): 5-17.
Talk 2: Loss of Mitochondrial Function in Chronic Illnesses and Infectious Diseases and its Treatment with Lipid Replacement Therapy
Most if not all chronically ill patients, especially those presenting with fatigue and neurological symptoms, show reductions in mitochondrial function. Often these same patients present with chronic bacterial and viral infections, such as Mycoplasma, Chlamydia, Borrelia, Brucella and Lyme disease-associated infections. Recent clinical trials on fatiguing illness patients using Lipid Replacement Therapy to replace damaged membrane glycerolphospholipids in mitochondrial inner membranes and other cellular membranes have shown that symptoms, such as fatigue, can be significantly reduced (35-45%, p<0.0001). Also, in chronic Lyme disease patients a combination of Lipid Replacement and other mitochondrial precursors (CoQ10, NADH) reduced fatigue by 30.1% within 60 days (p<0.001, r2=0.960). These all-natural supplements were completely safe and effective in reducing intractable fatigue and other symptoms in a variety of long-term chronic illness patients.
1. Nicolson GL. Mitochondrial dysfunction and chronic disease: treatment with natural supplements. Alt Ther Health Med 2014; 20(Suppl 1): 18-25.
2. Nicolson GL, Ash ME. Lipid Replacement Therapy: a natural medicine approach to replacing damaged phospholipids in cellular membranes and organelles and restoring function. Biochim Biophys Acta 2014; 1838: 1657-1479.
3. Nicolson GL, Settineri R, Ellithorpe R. Neurodegenerative and fatiguing Illnesses, infections and mitochondrial dysfunction: use of natural supplements to restore mitochondrial function. Funct Foods Health Dis 2014; 4(1): 23-65.
4. Nicolson GL, Settineri R, Ellithorpe E. Lipid Replacement Therapy with a glycophospholipid formulation with NADH and CoQ10 significantly reduces fatigue in intractable chronic fatiguing illnesses and chronic Lyme disease. Intern J Clin Med 2012; 3(3): 164-170.
5. Nicolson GL, Settineri R, Ellithorpe E. Glycophospholipid formulation with NADH and CoQ10 significantly reduces intractable fatigue in chronic Lyme disease patients: preliminary report. Funct Food Health Dis 2012; 2(3): 35-47.
Steven E. Phillips, MD
Steven E. Phillips, MD is a Yale-trained physician specializing in the diagnosis and treatment of Lyme disease and other zoonotic infections. Dr. Phillips began private practice in 1996 in Connecticut, one of the most Lyme endemic states in the US. His accomplishments include: Being well published in the medical literature on the topic of Lyme disease; having lectured at numerous continuing medical education approved scientific conferences; having provided, by their express invitation only, testimony for the states of Connecticut, New York, Rhode Island, & Vermont as a Lyme disease expert at their respective state hearings; and being a past president of The International Lyme and Associated Diseases Society.
Talk 1: Exploring the Evidence for Chronic Infection in Lyme disease
Lyme disease is a spirochetal zoonotic infection caused by Borrelia burgdorferi. Shortly after its discovery, this illness quickly began to engender controversy in the medical community, and the debate continues to this day. This is due to the breadth of its clinical presentations, the insensitivity of diagnostic testing, and the high rates of chronic illness despite frequently recommended antibiotic treatment regimens. Borrelia burgdorferi has been notoriously difficult to isolate from mammals with late stage Lyme disease, even before antibiotic therapy has been initiated. As such, the absence of a readily available microbiologic gold standard test for the illness has allowed the waters to stay muddy for years. This has resulted in discordant management guidelines being published from different medical societies. Such diverse views are exampled by The International Lyme and Associated Diseases Society (ILADS) and The Infectious Diseases Society of America (IDSA). The IDSA recommendations in regard to the question of the role of chronic borrelial infection in chronic Lyme disease are examined against the peer reviewed published medical literature. In so doing, it is found that despite the inherent difficulties in culturing Borrelia burgdorferi from the mammalian host, this organism has been isolated alive from animals and humans after antibiotic therapy that is frequently recommended as standard, and even after aggressive and/or longer term antibiotic therapy. New therapies and improved diagnostic testing is required to combat this global public health threat.
Talk 2: Exploring the Evidence for Chronic Infection in Brucellosis
Brucellosis is a globally distributed zoonotic infection caused by infection with a number of species of the genus Brucella. The spectrum of illness in brucellosis, like virtually all zoonotic infections, is quite broad, extending from asymptomatic infection to very significant disease. However, typical brucellosis is characterized by severe, disabling multi-system illness. Symptoms typically rise and fall like a wave, generally worsening in the late afternoon into the evening, providing the origin for one of its many names, ‘undulant fever’. Brucellosis can be spread by the consumption of infected dairy products or by exposure to body fluids of infected animals, however, it is not frequently discussed that brucella has been repeatedly isolated from a range of arthropod vectors. The likelihood of arthropod vector transmission has only recently been proposed in the medical literature. This would be consistent with the observation that roughly 90% of acute brucellosis occurs during the warmer months of the year. Brucellosis is very difficult to treat, with no uniformly curative antibiotic regimen. The genus is genetically related to bartonella, and the organisms share nearly identical in-vivo antibiotic resistance. High antibiotic failure rates have been documented despite long-term multi-drug regimens, and antibiotic treatment is complicated by Herxheimer reactions, which can be severe. The evidence for chronic brucella infection despite antibiotics is examined. Liposomes are spherical vesicles composed of a lipid bilayer. They can be used as a vehicle for the administration of antibiotics, improving pharmacokinetics, overcoming antimicrobial resistance, and lowering toxicity. Liposomal gentamicin is 20,000 times more effective than non-liposomal gentamicin against brucella in animals. This can likely be extrapolated to bartonella given its nearly identical antibiotic resistance pattern. Liposomal gentamicin is not commercially available. If it were to become available, it could markedly change the treatment and prognosis for not only brucellosis, but likely bartonellosis as well.
Armin Schwarzbach, Ph.D, MD
Dr. Armin Schwarzbach, MD, PhD is a MD and a specialist for laboratory medicine from the laboratory ArminLabs, Augsburg, Germany.
Dr. Schwarzbach began by studying biochemistry at Hoechst AG, Frankfurt/Germany and pharmacy at the University of Mainz/Germany in 1984. In 1985 he studied medicine for 6 years at the University of Mainz/Germany and finished his MD in 1991.Dr. Schwarzbach developed the worldwide first Radioimmunoassay (RIA) for human Gastric Inhibitory Polypeptide (hGIP) from 1986 – 1991, getting his PhD in 1992.He worked as a medical assistant at Limburg hospital in internal medicine, oncology, cardiology, gastroenterology, nephrology and infectiology afterwards for several years. By 1993 Dr. Schwarzbach started specializing in laboratory medicine for another 4 years in infectiology, microbiology, immunology, hematology, clinical chemistry, endocrinology and gynecological endocrinology. Dr. Schwarzbach took part as SME in the FP7 scientific research program of the European Union, together with 7 other European partners from Spain, Italy, Portugal, Finland and Belgium regarding the Hilysens I project from 2011 – 2013 (www.hilysens.eu). The aim of the European Hilysens I project was to develop a prototpye in form of a highly sensitive laboratory on a chip system for Borrelia burgdorferi IgG and IgM antibodies. The Hilysens I project was followed up by the Hilysens II project of the European Union, involving Dr. Schwarzbach for another 6 months.
Dr. Schwarzbach is C6 Board Member of the International Lyme and Diseases Society, ILADS, USA and the Chair of the laboratory test and the international committees of ILADS. He was appointed in March 2013 as the International expert for the Chief Medical Officer´s Clinical Advisory Committee on Lyme Disease in Australia (CACLD) of the Australian Government, Department of Health and Ageing, Canberra, Australia. In November 2013 Dr. Schwarzbach was appointend as the European expert for Lyme disease in Ireland by the Irish Parliament, Joint Committee on Health and Children, Dublin, Ireland. He was member of the working groups for Lyme disease of the Haut Conseil de la sante publique, Paris, France and the Complex Chronic Diseases Program BC Women’s Hospital and Health Centre, Vancouver, B.C., Canada. Dr. Schwarzbach took part at the Lyme disease Parliamentary Meeting, House of commons, 19th January 2015 in London, England. Dr. Schwarzbach is member of the German Borreliosis Society, the Swiss Association for Tick-borne diseases, the German Association of Clinical Chemistry and Laboratory Medicine, the German Society for Medical Laboratory Specialists and the Australasian Integrative Medicine Association.
Dr. Schwarzbach is the founder of ArminLabs, Augsburg/Germany and is specialized in diagnostic tests and treatment options for patients with tick-borne diseases for over 15 years now.
Talk: Tick-borne coinfections – A European overview
Lyme-Borreliosis along with its co-infections are the ‘chameleon’ of symptoms, laboratory tests and therapies. Chronic multiple symptoms of Lyme-Borreliosis and other tick-borne diseases and their co-infections include: chronic fatigue, joint and muscle pain, neck-pain, neurological symptoms like burning hands/feet or sensitivity problems, sleeplessness, short-term memory loss, concentration problems, psychiatric problems like aggressiveness or anxiety, autoimmune disorders and over 100 other symptoms. Therefore, chronic tick-borne diseases and their co-infections can be attributed to so-called unexplained syndromes like Chronic Fatigue Syndrome, Multiple Encephalitis, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Alzheimer’s, Parkinsonism, Rheumatoid Arthritis, Sjögren’s Syndrome, Hashimoto thyroiditis, tinnitus, depression, schizophrenia, Carpal Tunnel Syndrome, Autism and others.
Upon being bitten by a tick, patients can be infected with several kinds of bacteria that live within the ticks, hence why patients can have multiple infections. In general, most of the symptoms caused by tick-borne diseases are not highly-specific to Lyme-Borreliosis or other tick-borne diseases and their co-infections, hence the ‘overlapping’ of symptoms. Entomologists are more inclined to look at different kinds of ticks by PCR for other bacteria like Ehrlichia, Anaplasma, Rickettsia, Babesia and Bartonella and their subspecies. There are some studies on Ehrlichia/Anaplasma known to be the causative agents in patients with inflammatory arthritis. Medical doctors should note all symptoms being exhibited by a post-tick-bite patient and relate them to co-infections and rank them in order to rule out or confirm the possibility of infection. The next recommended step would be to use laboratory tests with the highest sensitivity and specificity for each possible co-infection. This should be done before starting any treatment, so that the most appropriate treatment decision is made for each patient.
This presentation aims to show symptoms for each of the most common co-infections in Europe; the various diagnostic tests for each of the co-infections and the treatment options according the individual findings of co-infections.
Raphael B. Stricker, MD
Dr. Stricker received his medical degree and training in Internal Medicine at Columbia University in New York. He did subspecialty training in Hematology/Oncology at the University of California San Francisco, and supplemental training in Immunology and Immunotherapy at California Pacific Medical Center in San Francisco. He is currently Medical Director of Union Square Medical Associates, a multi-specialty practice in San Francisco. Dr. Stricker is Past President of the International Lyme and Associated Diseases Society (ILADS). He is also a member of the American Society of Hematology (ASH), the American Society for Microbiology (ASM), the American Federation for Medical Research (AFMR) and the American Society for Reproductive Immunology (ASRI). He is a recipient of the American Medical Association Award for Physician Excellence and an Outstanding Reviewer Award from the Annals of Internal Medicine. He has authored over 200 medical journal articles and abstracts. Areas of special interest include coagulation disorders, immunodeficiency, immunologic infertility, emerging infectious diseases and tick-borne diseases.
Talk 1: Lyme Disease History and Evolution of Tick Borne Disease
Lyme disease is the most common tickborne illness in the world today. Until recently, the Centers for Disease Control and Prevention (CDC) reported an average of only 30,000 cases of Lyme disease per year in the USA. Three recent CDC studies have indicated, however, that the true incidence of Lyme disease may be greater than 300,000 cases and as high as one million cases per year in the USA. A majority of these cases occur in women and children. Based on this new information, Lyme disease should be recognized as a virulent epidemic that is at least six times more common than HIV/AIDS. This presentation will review the history of Lyme disease from its original description in Europe to its recognition and spread in the USA, and the review will provide a background for understanding the ongoing problems with diagnosis and treatment of Lyme disease and tickborne coinfections.
Talk 2: Sexual transmission of Lyme Disease
Preliminary clinical, epidemiological and immunological studies have suggested that infection with the Lyme disease spirochete Borrelia burgdorferi (Bb) could be transferred from person to person via intimate human contact without a tick vector. Detecting viable Borrelia spirochetes in vaginal and seminal secretions would provide evidence to support this hypothesis. We detected motile spirochetes in cultures of genital secretions from 12 of 13 subjects diagnosed with Lyme disease using light and darkfield microscopy. Morphological features of spirochetes were confirmed by Dieterle silver staining and immunohistochemical staining of culture concentrates. Molecular hybridization and PCR testing confirmed that the spirochetes isolated from semen and vaginal secretions were strains of Borrelia, and all cultures were negative for treponemal spirochetes. Control subjects who were asymptomatic and seronegative for Bb had no detectable spirochetes in genital secretions by PCR analysis. PCR sequencing of cultured spirochetes from three couples having unprotected sex indicated that two couples had identical strains of Bb sensu stricto in their semen and vaginal secretions, while the third couple had identical strains of B. hermsii detected in their genital secretions. The culture of viable Borrelia spirochetes in genital secretions suggests that Lyme disease could be transmitted by intimate contact from person to person.
Ying Zhang, Ph.D, MD
Dr. Ying Zhang is a Professor at Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. His research interests are in bacterial persistence, antibiotic resistance, and pathogenesis, and translation of research findings into improved disease control. Although most of his productive research career was on understanding mechanisms of antibiotic resistance and persistence in M. tuberculosis, more recently, he has been working on the problem of persistent Lyme disease. His group recently identified a range of FDA-approved drugs that have excellent activity against Borrelia burgdorferi persisters. This finding has generated considerable interest and opened up new opportunities for more effective treatment of chronic Lyme disease. In collaboration with colleagues, his group is interested to evaluate the promising drug candidates with high activity against Borrelia persisters in animal models and also in patients. He is also interested to develop more sensitive tests for improved diagnosis of Lyme disease.
Talk: Borrelia Persister Drugs: Implications for Improved Treatment
Lyme disease is the leading tick-borne disease in the US and Europe. Although early stage Lyme disease can usually be cured with doxycycline or amoxicillin, late stage Lyme disease with arthritis and neurological symptoms is often refractory to antibiotic treatment, likely due in part to persisting organisms or host response to their “remnants”. Recent animal studies have clearly demonstrated the persistence phenomenon of B. burgdorferi that is not eradicated by conventional Lyme antibiotic treatment. To address the problem of B. burgdorferi persistence, we first developed a new SYBR Green I/Propidium iodide (PI) assay and then performed the first high throughput drug screens against B. burgdorferi persisters using FDA-approved drug library. We identified a number of FDA-approved drugs that are more effective at killing B. burgdorferi persisters than the current Lyme antibiotics. Future studies are needed to identify optimal drug combinations that produce the best activity against B. burgdorferi persisters in vitro, and to evaluate the promising drug combinations against B. burgdorferi persisters for more effective treatment in animal models of Borrelia infection. The outcome of this study may not only lead to improved treatment of Lyme disease but also help to address the much debated issue of antibiotic efficacy and persistence problem that have divided the field.
Ritchie C. Shoemaker, MD
Ravilya Yegemberdiyeva, Ph.D
Peter Andras Csango, MD
Randi Eikeland, Ph.D, MD
Carl Morten Motzfeldt Laane, Ph.D
University of Oslo, Norway
Talk: Silent Babesia Infections in Norway
Hostess Lise Askvik
Lise Askvik (45) is a journalist, cand. mag, author, radio host and experienced patient of the Norwegian health care system. Married, mother of Leo (9).
She is the host of an every-day evening show, and of a media-critical weekend broadcast – both on Radio P4, the largest commercial radio station in Norway.
When Lise had to remove one breast due to cancer in 2011, she was shocked to find that the waiting list for the breast reconstruction surgery was up to ten years, with a minimum period of four to five years. Together with the Norwegian Breast Cancer Organization she initiated a number of debates in media, which included politicians, doctors and patients. After half a year, the Norwegian Parliament decided to fund NOK 150 Million extra to operate a few thousand women already on waiting lists. They also increased the number of plastic surgeons from 9 to 18, which ultimately helped all kinds of patients in need. The guidelines for breast cancer were changed, making primary breast reconstruction the standard also in Norway. Lise waited patiently in line and had her last reconstruction in April 2015. She has written six books since 2005, two of these on the subject of political challenges in the Norwegian health care system.
Lise has showed great dedication towards patients with different diagnoses. Patients’ rights seem under pressure as Norway currently has one the lowest numbers of hospital beds in the OECD (2,9 per 1000) and an occupancy of 94 percent. Her focus is on the rights of all patients. Many of these patient groups are severely challenged, which seems unexplainable in one of the richest countries in the world. Amongst others, she is particularly passionate about improving Lyme patients’ rights.