Thread by @lymehopecanada

When will @GovCanHealth update website to acknowledge mom to baby transmission #Lymedisease? Alberta Health does, CDC does, Health Canada officials did in 1988. Why take pause in alerting 🇨🇦 to what has been known + documented since 1985? See thread /1
open.alberta.ca/dataset/58776f…

Is there evidence that Borrelia burgdorferi, the agent of Lyme disease can be transmitted from an infected mother to her baby? YES! Below my 2019 presentation for
@ilads_lyme. Not sure how much more #evidence is needed to acknowledge the risk. /2

Can Borrelia burgdorferi cross the placental barrier + transmitted in-utero? /3

Transplacental transmission of #Lyme currently acknowledged by @CDC @NIH High Council of Public Health France, @YourAlberta, UK Royal College of Ob/Gyn /4

9 published studies in animals - cows, horses, dogs, mice, rats, coyote have identified intrauterine infection of Borrelia burgdorferi. 'Bb might be naturally maintained in an enzootic cycle by transplacental transmission.' /5

Current edition of Remington and Klein Infectious diseases of the Fetus and Newborn Infant, Chapter 1, recommends expanding acronym for Micro-organisms responsible for infection of the Fetus to TORCHES CLAP, L= Lyme disease /6

Importance of Longitudinal Multidisciplinary followup and Prospective studies in offspring of pregnant women with Lyme disease - NOT been done. /7

Observations from Chagas' and Syphilis. Infected mothers often asymptomatic + infected infants often asymptomatic too. Could the same be happening with Lyme disease? /8

Initial case reports of Maternal-fetal transmission of Borrelia burgdorferi. Bb identified in fetal autopsy tissues and in some cases w culture confirmation. /9

Dr. Burgdorfer (Bb named after his discovery of the spirochete) identifies Bb can be transmitted transplacentally. A US vaccine patent also acknowledges maternal-fetal transmission of Lyme and 'for every symptomatic infection, there is at least on asymptomatic infection.' /10

@CDCgov @WHO and @GovCanHealth all recognize maternal-fetal transmission of Lyme in 1985, 1986 and 1988 respectively. /11

Published cases of possible maternal-fetal transmission of Lyme in asymptomatic, seropositive mothers. Tick-bite not always remembered by mother / 12

Cases of asymptomatic, unspecific symptoms (no reported EM), seronegative mothers and Bb identified in baby either upon autopsy (case 1), in CSF (case 2) - authors/scientists of these studies highly acclaimed in Lyme research /13

'It is clear that B. burgdorferi can be transmitted in the blood of infected pregnant women across the placenta into the fetus..'
pubmed.ncbi.nlm.nih.gov/2847622/
nejm.org/doi/full/10.10… /14

/15

Case series by pathologist Dr. Alan MacDonald identifies borrelia spirochetes in fetal tissue. In 9/14 cases mothers were negative by standard serology but spirochetes discovered in fetal tissue. /16

Bb identified by PCR in 2 placentas of asymptomatic, seropos moms w/o history of tick-bite. Authors recommend long-term f/u in infants born to mothers w placenta spirochetes, to determine what effect if any placental spirochetes have on their health.
pubmed.ncbi.nlm.nih.gov/8793493/ /17

Healthy Pregnancy outcomes in women with Lyme in pregnancy. Often infants not tested or reports of longitudinal f/u. / 18

Detection of Bb in breastmilk by PCR. No reports of Bb transmission via breastmilk. /19
pubmed.ncbi.nlm.nih.gov/7648832/
As an aside, Bb has been shown to survive in whole milk, low fat milk and skim milk.
meridian.allenpress.com/jfp/article/54…

1996 sero-study - Tanzania - 38% of pregnant women had antibodies specific to Bb w EIA test. 30% of blood donors. Authors calling for immediate efforts to conduct clinical, entomological and bacteriological investigations to confirm what extend Lyme exists in Tanzania. /20

Italian case of congenital Lyme w neonatal skin lesions which developed at 3 weeks of age. Infant intially seronegative at 9 months, seroconversion at 13 months by WB. Bb isolated by PCR from skin biopsy samples.
pubmed.ncbi.nlm.nih.gov/9352409/ /21

2005 Case reported from St Petersburg Russia - a Congenital Neuroborreliosis - child seronegative by EIA but pos through PCR, started developing complex clinical symptoms at 2 years of age. /22

Textbook chapter (4th + 5th ed) on Lyme disease written by Pedi ID MD identifies - serology alone not adequate for infant diagnosis, identifies a framework to identify infants infected congenitally, makes comparisons to congenital syphilis. /23

Gestational Lyme disease case studies of 102 live births. lymedisease.org/wp-content/upl… /24

Treated vs Untreated Gestational Lyme disease. Notice
@GovCanHealth SR meta-analysis identifies untreated pregnancies = 50% rate of adverse outcomes compared with 11% in treated. /25 journals.plos.org/plosone/articl…

Current testing recommendations for neonates to detect congenital infections - most often using PCR/ NATs direct detection in infant serum, urine. /26

Authors identify that they were not able to test placentas and offspring for Bb by culture or PCR. Therefore it 'cannot be concluded that adverse outcomes were a result of Borrelia invasion of the fetus or placenta.'
pubmed.ncbi.nlm.nih.gov/19926325/ /27

Bb cultured from 7 pregnant women w Lyme (all treated w IV ceftriaxone). Apart from EM rash, 5/7 women did not display local/systemic symptoms (asymptomatic). Case #5 - patient was seronegative, no seroconversion no recollection of tick-bite, had EM.
pubmed.ncbi.nlm.nih.gov/21917394//28

Authors hypothesize two different but connected forms of Bb infection - Zoonotic transfer + Congenital transfer. Sexual transmission also of concern.
pubmed.ncbi.nlm.nih.gov/12710914/ /29

Questions, Observations /30

Next Steps - Research, Study and Solutions - must be anchored in patient engagement which values + welcomes patient/family priorities in partnership, inclusion with a 'Nothing About Us, Without Us' model. end.