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Vertical and Sexual transmission of Lyme disease

This is an even hotter topic of denial

Firstly it looks like it can be spread as an STD - refer to 
Culture and identification of Borrelia spirochetes in human vaginal and seminal secretions [v1; ref status: awaiting peer review, http://f1000r.es/4rm]
available at http://f1000research.com/articles/3-309/v1

Secondly here is a long list of references to vertical transmission (thats in utero) from Pubmed firstly, then others after number 22

1. Vector Borne Zoonotic Dis. 2011 Jul;11(7):891-8. doi: 10.1089/vbz.2010.0102. Epub

2010 Oct 6.

 

Borreliosis during pregnancy: a risk for the unborn child?

 

Mylonas I.

 

Author information:

Division of Infectious Diseases in Gynaecology and Obstetrics, 1st Department of

Obstetrics and Gynaecology, Ludwig-Maximilians-University Munich, Munich,

Germany.

 

Little is known regarding the possible harmful effects of Borrelia infections in

pregnancy, since such a risk analysis is difficult to perform. Transplacental

transmission of Borrelia burgdorferi has been documented in several animal

studies. Therefore, it had been thought that fetal infection and teratogenicity

was possible from B. burgdorferi, especially considering the similarities between

Lyme borreliosis and syphilis. However, several clinical, serological, and

epidemiological studies have failed to confirm a causal association between B.

burgdorferi infection and a pregnancy adverse outcome. Moreover, there have been

no reported cases of transmission of Borrelia via breast milk. However, the

therapeutic approach to pregnant women with Lyme disease should be antibiotic

treatment, according to the clinical manifestation and the timing of the tick

bite. An effective vaccine is not yet available and the prevention of Lyme

borreliosis depends on public and physician education, and appropriate antibiotic

therapy during pregnancy.

 

PMID: 20925520  [PubMed - indexed for MEDLINE]

 

 

2. J Infect Dis. 2006 Nov 15;194(10):1367-74. Epub 2006 Oct 3.

 

Complications of pregnancy and transplacental transmission of relapsing-fever

borreliosis.

 

Larsson C(1), Andersson M, Guo BP, Nordstrand A, Hagerstrand I, Carlsson S,

Bergstrom S.

 

Author information:

(1)Department of Molecular Biology, Umea University, Umea, Sweden.

 

Relapsing-fever borreliosis caused by Borrelia duttonii is a common cause of

complications of pregnancy, miscarriage, and neonatal death in sub-Saharan

Africa. We established a murine model of gestational relapsing fever infection

for the study of the pathological development of these complications. We

demonstrate that B. duttonii infection during pregnancy results in intrauterine

growth retardation, as well as placental damage and inflammation, impaired fetal

circulation, and decreased maternal hemoglobin levels. We show that spirochetes

frequently cross the maternal-fetal barrier, resulting in congenital infection.

Furthermore, we compared the severity of infection in pregnant and nonpregnant

mice and show that pregnancy has a protective effect. This model closely

parallels the consequences of human gestational infection, and our results

provide insight into the mechanisms behind the complications of pregnancy that

have been reported in human relapsing-fever infection.

 

PMID: 17054065  [PubMed - indexed for MEDLINE]

 

 

3. Teratology. 2001 Nov;64(5):276-81.

 

Teratogen update: Lyme disease.

 

Elliott DJ(1), Eppes SC, Klein JD.

 

Author information:

(1)Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania

19107, USA.

 

We reviewed the world literature concerning the reproductive effects of Lyme

disease (LD). Borrelia burgdorferi, which is the etiology of LD, is a spirochete

and, as such, may share the potential for causing fetal infection, which may

occur in the setting of maternal spirochetemia. Information concerning the

effects of gestational LD derives from case reports and series, epidemiologic

studies, and experimental animal models. Although provocative, these studies fail

to define a characteristic teratogenic effect. However, skin and cardiac

involvement have predominated in some reports. Pregnancy wastage has been

suggested primarily by animal studies. Gestational LD appears to be associated

with a low risk of adverse pregnancy outcome, particularly with appropriated

antibiotic therapy. Suggestions for management of clinical situations are

presented.

 

Copyright 2001 Wiley-Liss, Inc.

 

PMID: 11745834  [PubMed - indexed for MEDLINE]

 

 

4. Enferm Infecc Microbiol Clin. 1998 May;16(5):239-44.

 

[Treatment of borreliosis].

 

[Article in Spanish]

 

Segura Porta F(1), Fernández MM.

 

Author information:

(1)Programa Asistencial de Enfermedades Infecciosas, Corporació Sanitària Parc

Taulí, Sabadell, Barcelona.

 

PMID: 9666589  [PubMed - indexed for MEDLINE]

 

 

5. Infect Dis Clin North Am. 1997 Mar;11(1):93-7.

 

Lyme disease during pregnancy.

 

Silver HM.

 

Author information:

Department of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island,

Providence, USA.

 

There has been great concern in the past regarding the possible fetal infection

and teratogenicity from Lyme disease contracted during pregnancy because of the

similarities of disease caused by Borrelia burgdorferi to syphilis. Although the

initial retrospective case reports were alarming, more recent prospective data

have been reassuring. This article reviews the evidence that currently supports

the assurance of the benign nature of this infection with respect to the fetus.

 

PMID: 9067786  [PubMed - indexed for MEDLINE]

 

 

6. Paediatr Perinat Epidemiol. 1995 Jul;9(3):320-30.

 

Maternal Lyme disease and congenital malformations: a cord blood serosurvey in

endemic and control areas.

 

Williams CL(1), Strobino B, Weinstein A, Spierling P, Medici F.

 

Author information:

(1)Child Health Center, American Health Foundation, Valhalla, New York 10595, USA.

 

This report describes a cohort study of over 5000 infants and their mothers who

participated in a cord blood serosurvey designed to examine the relationship

between maternal exposure to Lyme disease and adverse pregnancy outcome. Based on

serology and reported clinical history, mothers of infants in an endemic hospital

cohort are 5 to 20 times more likely to have been exposed to B. burgdorferi as

compared with mothers of infants in a control hospital cohort. The incidence of

total congenital malformations was not significantly different in the endemic

cohort compared with the control cohort, but the rate of cardiac malformations

was significantly higher in the endemic cohort [odds ratio (OR) 2.40; 95%

confidence interval (CI) 1.25, 4.59] and the frequencies of certain minor

malformations (haemangiomas, polydactyly, and hydrocele), were significantly

increased in the control group. Demographic variations could only account for

differences in the frequency of polydactyly. Within the endemic cohort, there

were no differences in the rate of major or minor malformations or mean

birthweight by category of possible maternal exposure to Lyme disease or cord

blood serology. The disparity between observations at the population and

individual levels requires further investigation. The absence of association at

the individual level in the endemic area could be because of the small number of

women who were actually exposed either in terms of serology or clinical history.

The reason for the findings at the population level is not known but could be

because of artifact or population differences.

 

PMID: 7479280  [PubMed - indexed for MEDLINE]

 

 

7. Infect Immun. 1995 Jan;63(1):66-72.

 

Fetal outcome in murine Lyme disease.

 

Silver RM(1), Yang L, Daynes RA, Branch DW, Salafia CM, Weis JJ.

 

Author information:

(1)Department of Obstetrics and Gynecology, University of Utah School of Medicine,

Salt Lake City 84132.

 

Lyme disease is an inflammatory syndrome caused by infection with Borrelia

burgdorferi. Although this syndrome has important implications for human

pregnancy, little is known about gestational infection with B. burgdorferi. Fetal

death occurred in 33 of 280 gestational sacs (12%) in 39 C3H/HeN female mice

infected by intradermal injection of B. burgdorferi 4 days after mating (acute

infection), compared with 0 of 191 sacs in 25 control mice (P = 0.0001).

Forty-six percent of acutely infected mice suffered at least one fetal death,

compared with none of the control animals (P = 0.0002). There were no fetal

deaths in 18 C3H/HeN mice infected 3 weeks prior to mating (chronic infection). A

sensitive PCR technique detected B. burgdorferi DNA in the uteri of acutely

infected mice but did not detect DNA in the uteri of controls or chronically

infected mice. Spirochete DNA was only rarely detected in fetal tissues, and its

presence was not required for fetal death. The inclusion of an internal

competitive PCR target indicated that the lack of B. burgdorferi sequences in

fetal DNA was not due to the presence of a PCR inhibitor. Histologic analysis of

gestational tissues from infected animals demonstrated nonspecific pathology

consistent with fetal death. These findings indicate an association between

murine fetal death and acute infection with B. burgdorferi early in gestation but

not with chronic infection. Our data suggest that fetal death is due to a

maternal response to infection rather than fetal infection. These findings could

provide an explanation for observations in humans in which sporadic cases of

fetal death in women infected with B. burgdorferi during pregnancy have been

reported, while previous infection has not been associated with fetal death.

 

PMCID: PMC172958

PMID: 7806385  [PubMed - indexed for MEDLINE]

 

 

8. Angiology. 1994 Jan;45(1):85-6.

 

A most unusual case of a whole family suffering from late Lyme borreliosis for

over 20 years.

 

Gasser R, Dusleag J, Reisinger E, Stauber R, Grisold M, Pongratz S, Furian C,

Feigl B, Klein W.

 

PMID: 8285392  [PubMed - indexed for MEDLINE]

 

 

9. Am J Obstet Gynecol. 1993 Aug;169(2 Pt 1):367-74.

 

Lyme disease and pregnancy outcome: a prospective study of two thousand prenatal

patients.

 

Strobino BA(1), Williams CL, Abid S, Chalson R, Spierling P.

 

Author information:

(1)Department of Pediatrics, New York Medical College, Valhalla 10595.

 

OBJECTIVE: The purpose of the study was to determine if prenatal exposure to Lyme

disease was associated with an increased risk of adverse pregnancy outcome.

STUDY DESIGN: Approximately 2000 Westchester County, New York, women completed

questionnaires and had sera tested for antibody to Borrelia burgdorferi at their

first prenatal visit and at delivery. Fetal death, birth weight, length of

gestation at delivery, and congenital malformations were examined in relation to

maternal Lyme disease exposure before and during pregnancy.

RESULTS: Maternal Lyme disease or an increased risk of exposure to Lyme disease

was not associated with fetal death, decreased birth weight, or length of

gestation at delivery. Tick bites or Lyme disease around the time of conception

was not associated with congenital malformations. Tick bites within 3 years

preceding conception were significantly associated with congenital malformations,

but this could have reflected reporting differences between exposed and unexposed

women.

CONCLUSIONS: Maternal exposure to Lyme disease before conception or during

pregnancy is not associated with fetal death, prematurity, or congenital

malformations taken as a whole. We have not ruled out the possibility that

exposure to Lyme disease as defined by maternal history increases the risk of

specific malformations or has an effect if it is not treated. We have

insufficient numbers of women who were seropositive at their first prenatal visit

to determine if this subgroup of exposed women are at a moderately increased risk

of having a child with a congenital abnormality. The low frequency of

seroconversion at delivery in this endemic area suggests that preventive measures

are being taken by obstetricians and patients.

 

PMID: 8362948  [PubMed - indexed for MEDLINE]

 

 

10. Am J Vet Res. 1993 Jun;54(6):882-90.

 

Intrauterine transmission of Borrelia burgdorferi in dogs.

 

Gustafson JM(1), Burgess EC, Wachal MD, Steinberg H.

 

Author information:

(1)Department of Medical Sciences, University of Wisconsin-Madison, School of

Veterinary Medicine 53706.

 

To determine whether intrauterine transmission of Borrelia burgdorferi could

exist in dogs, 10 female Beagles were inoculated intradermally with approximately

1,000 B burgdorferi on day 1 of proestrus; inoculation was repeated every 2 weeks

during the gestation period. Ten female control Beagles were similarly inoculated

with phosphate-buffered saline solution. Prior to the start of the study, all

females and 3 males used for breeding were seronegative for B burgdorferi on the

basis of results of the indirect fluorescent antibody test and immunoblot

(western analysis. Similarly, results of culture of blood for B burgdorferi were

negative. All 20 of the females were bred naturally. Blood samples were collected

weekly for serologic testing and culture. Blood samples were obtained from live

pups on day 1 of life, then weekly until pups were 6 weeks old when they were

euthanatized. Tissues were obtained for culture and testing by use of polymerase

chain reaction (PCR). Of 10 spirochete-inoculated (SI) females, 8 became infected

with B burgdorferi as evidenced by spirochete culture results and/or PCR-detected

B burgdorferi DNA in the tissues of females or their pups. Of the 10 SI females,

8 delivered litters (3 to 7 pups) that had at least 1 neonatal or 6-week-old pup

with B burgdorferi DNA-positive tissues (by PCR), and spirochetes were cultured

from tissues from pups of 2 litters.(ABSTRACT TRUNCATED AT 250 WORDS)

 

PMID: 8323057  [PubMed - indexed for MEDLINE]

 

 

11. Vet Microbiol. 1993 May;35(1-2):61-77.

 

Borrelia burgdorferi infection in dairy cows, rodents, and birds from four

Wisconsin dairy farms.

 

Burgess EC(1), Wachal MD, Cleven TD.

 

Author information:

(1)Department of Medical Science, University of Wisconsin, School of Veterinary

Medicine, Madison 53706.

 

A combination of culture and subsequent spirochete identification with the

polymerase chain reaction technique was used to identify cows, rodents, and birds

infected with Borrelia burgdorferi. Animals were trapped on four Wisconsin dairy

farms during the summer of 1990. Farms 1 and 2 were located in counties

nonendemic for Lyme disease and Farms 3 and 4 were located in counties endemic

for Lyme disease. The results of the rodent and bird samples were as follows

given as the number yielding organisms number tested: Farm 1, 1/17 Mus musculus

and 2/52 Peromyscus domesticus; Farm 2, 4/49 M. musculus, 1/2 P. maniculatus, 1/1

P. leucopus, and 1/35 P. domesticus; Farm 3, 0/27 M. musculus, 0/5 P. leucopus,

0/12 P. maniculatus and, 3/58 P. domesticus; and Farm 4, 1/24 M. musculus, 2/19

P. leucopus, 1/12 Microtus pennsylvanicus, and 0/17 P. domesticus. One P.

leucopus and one M. musculus from Farm 2 were pregnant and fetal tissues from

both were positive. Cow blood sample results were as follows: Farm 1, 7/47 in

July, and 2/45 in August; Farm 2, 0/28 in August and 0/23 in October; Farm 3,

0/13 in July and 1/18 in August 29; and Farm 4, 3/45 in August. Ticks were found

on rodents on Farm 4 and on one bird on Farm 3. Spirochetemic cows, rodents, and

birds were found in non-Lyme endemic counties suggesting that alternate modes of

transmission other than by ticks may be important. Transplacental transmission

was shown in M. musculus and P. leucopus.

 

PMID: 8362496  [PubMed - indexed for MEDLINE]

 

 

12. West J Med. 1991 Jun;154(6):706-14.

 

Lyme disease.

 

Rahn DW(1), Malawista SE.

 

Author information:

(1)Department of Internal Medicine, Yale University School of Medicine, New Haven,

Connecticut.

 

PMCID: PMC1002871

PMID: 1877201  [PubMed - indexed for MEDLINE]

 

 

13. Am J Trop Med Hyg. 1991 Feb;44(2):135-9.

 

Relative infectivity of Borrelia burgdorferi in Lewis rats by various routes of

inoculation.

 

Moody KD(1), Barthold SW.

 

Author information:

(1)Section of Comparative Medicine, Yale University School of Medicine, New Haven,

Connecticut.

 

Various routes of Borrelia burgdorferi infection were studied in laboratory rats.

Three-week-old Lewis rats were inoculated either intradermally (i.d.),

intraperitoneally (i.p.), or oronasally (o.n.) with serial 10-fold dilutions of

B. burgdorferi. Thirty days later, groups of rats were killed and serology,

splenic culture, and histology were used to evaluate infection. Rats were

successfully infected i.d. with 10(2-4) organisms or i.p. with 10(4-5) organisms.

Neither three-day-old nor three-week-old rats were successfully infected o.n.

with up to 10(6) organisms. For contact transmission, three-day-old or

three-week-old inoculated rats were housed with unexposed littermates for 30

days. Inoculated rats became infected but contact rats remained free of

infection. To study in utero transmission, five pregnant female Lewis rats were

inoculated i.p. with 10(6) spirochetes at four days gestation. Although adult

females seroconverted or had positive splenic cultures at 20 days gestation, the

placentas and fetuses were uniformly culture-negative. Venereal transmission from

seven infected females or six infected males to uninfected rats of the opposite

sex was not demonstrated.

 

PMID: 2012256  [PubMed - indexed for MEDLINE]

 

 

14. Rheum Dis Clin North Am. 1989 Nov;15(4):657-77.

 

Gestational Lyme borreliosis. Implications for the fetus.

 

MacDonald AB.

 

Author information:

Southampton Hospital, New York.

 

Great diversity of clinical expression of signs and symptoms of gestational Lyme

borreliosis parallels the diversity of prenatal syphilis. It is documented that

transplacental transmission of the spirochete from mother to fetus is possible.

Further research is necessary to investigate possible teratogenic effects that

might occur if the spirochete reaches the fetus during the period of

organogenesis. Autopsy and clinical studies have associated gestational Lyme

borreliosis with various medical problems including fetal death, hydrocephalus,

cardiovascular anomalies, neonatal respiratory distress, hyperbilirubinemia,

intrauterine growth retardation, cortical blindness, sudden infant death

syndrome, and maternal toxemia of pregnancy. Whether any or all of these

associations are coincidentally or causally related remains to be clarified by

further investigation. It is my expectation that the spectrum of gestational Lyme

borreliosis will expand into many of the clinical domains of prenatal syphilis.

 

PMID: 2685924  [PubMed - indexed for MEDLINE]

 

 

15. Z Hautkr. 1989 Aug 15;64(8):649-52, 655-6.

 

[Clinical aspects of Borrelia burgdorferi infections].

 

[Article in German]

 

Neubert U.

 

Author information:

Dermatologische Klinik der Ludwig-Maximilians-Universität München.

 

Skin lesions due to Borrelia burgdorferi-like erythema migrans, lymphadenosis

cutis benigna, and acrodermatitis chronica atrophicans - are hall-marks of a

systemic infection, which tends to a chronically relapsing course. Even if the

skin lesions are missing, or disappear spontaneously, the infection may persist

and affect other organs. This presumption is supported by the outcome of a

long-term follow-up study on seropositive forest workers. In association with

meningopolyneuritis (Garin-Bujadoux-Bannwarth disease) and acrodermatitis

chronica atrophicans - myositis and fasciitis have been recently reported as

further possible manifestations of Borrelia burgdorferi infection. Borrelial

infection during pregnancy should promptly be treated with antibiotics in high

dosages, in order to prevent maternal-fetal transmission of borrelial organisms

resulting in stillbirth or congenital defects of the newborn.

 

PMID: 2678790  [PubMed - indexed for MEDLINE]

 

 

16. Conn Med. 1989 Jun;53(6):341-2.

 

Lyme disease and pregnancy.

 

Cartter ML, Hadler JL, Gerber MA, Mofenson L.

 

PMID: 2758822  [PubMed - indexed for MEDLINE]

 

 

17. J Wildl Dis. 1989 Jan;25(1):47-51.

 

Borrelia sp. infection in coyotes, black-tailed jack rabbits and desert

cottontails in southern Texas.

 

Burgess EC(1), Windberg LA.

 

Author information:

(1)Department of Medical Sciences, School of Veterinary Medicine, University of

Wisconsin, Madison 53706.

 

Coyotes (Canis latrans) from southern Texas were sampled for antibodies to

Borrelia burgdorferi from 1980 to 1986; black-tailed jack rabbits (Lepus

californicus) and desert cottontails (Sylvilagus audubonii) were sampled in 1986.

Coyote fetuses, adult coyote kidneys, and black-tailed jack rabbit and desert

cottontail kidneys were cultured for B. burgdorferi in 1986. Results of indirect

immunofluorescent antibody (IFA) tests for B. burgdorferi in coyotes were as

follows (number positive at a dilution of greater than or equal to 1:128/number

tested): 1980 (0 of 30), 1981 (0 of 21), 1982 (0 of 53), 1983 (0 of 78), 1984 (47

of 97), 1985 (20 of 88), and 1986 (42 of 80). Eight of 26 black-tailed jack

rabbits and two of seven desert cottontails tested in 1986 had IFA titers to B.

burgdorferi of greater than or equal to 1:128. Borrelia burgdorferi was isolated

from one of five coyote fetuses, three of 31 adult coyote kidneys, and two of 10

black-tailed jack rabbit kidneys in 1986. These results indicate that B.

burgdorferi infection has been present in coyotes in Texas, at least since 1984

and that transplacental transmission occurs.

 

PMID: 2644452  [PubMed - indexed for MEDLINE]

 

 

18. N Y State J Med. 1987 Nov;87(11):615-6.

 

Stillbirth following maternal Lyme disease.

 

MacDonald AB, Benach JL, Burgdorfer W.

 

PMID: 3480464  [PubMed - indexed for MEDLINE]

 

 

19. Zentralbl Bakteriol Mikrobiol Hyg A. 1986 Dec;263(1-2):189-200.

 

Human fetal borreliosis, toxemia of pregnancy, and fetal death.

 

MacDonald AB.

 

PMID: 3554838  [PubMed - indexed for MEDLINE]

 

 

20. Ann Intern Med. 1985 Jul;103(1):67-8.

 

Maternal-fetal transmission of the Lyme disease spirochete, Borrelia burgdorferi.

 

Schlesinger PA, Duray PH, Burke BA, Steere AC, Stillman MT.

 

PMID: 4003991  [PubMed - indexed for MEDLINE]

 

 

21. Birth Defects Orig Artic Ser. 1982;18(3 Pt A):39-45.

 

Congenital tick-borne relapsing fever: report of a case with first documentation

of transplacental transmission.

 

Steenbarger JR.

 

PMID: 7126796  [PubMed - indexed for MEDLINE]

 

 

22. JAMA. 1969 Apr 28;208(4):690-2.

 

Neonatal relapsing fever due to transplacental transmission of Borrelia.

 

Fuchs PC, Oyama AA.

 

PMID: 5818572  [PubMed - indexed for MEDLINE]

================================================================================================================

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the Lyme disease spirochete, Borrelia burgdorferi. Annals of Internal Medicine, 103(1), 67-8. [Fetal

death] http://www.ncbi.nlm.nih.gov/pubmed/4003991 http://dx.doi.org/10.7326/0003-4819-103-1-67

“Women who acquire Lyme disease while pregnant should be treated promptly with penicillin, or if

allergic, erythromycin …“

MacDonald A. (1986) Human Fetal Borreliosis, Toxemia of Pregnancy and Fetal Death. Zbl. Bakt.

Hyg. A 263 (1-2), 189-200.

Markowitz LE, Steere AC, Benach JL, et al. (1986) Lyme disease during pregnancy. JAMA

1986 Jun 27; 255(24), 3394-6. Abstract

Lavoie PE, Lattner BP, Duray PH, Barbour AG, Johnson HC. (1987) Culture positive seronegative

transplacental Lyme borreliosis infant mortality. Arthritis Rheum, 30(4), 3(Suppl), S 50

Mikkelsen AL, Palle C (1987) Lyme disease during pregnancy. Acta Obstet Gynecol Scand 66(5), 477-

8. Full Citation

MacDonald AB, Benach JL, Burgdorfer W (1987) Stillbirth following maternal Lyme disease. N Y State

J Med. 87(11), 615-6.

Weber K; Bratzke HJ, Neubert U, Wilske B, Duray PH (1988) Borrelia burgdorferi in a newborn

despite oral penicillin for Lyme borreliosis during pregnancy. Pediatric Infectious Disease

Journal, 7(4), 286-9 Full Citation http://www.ncbi.nlm.nih.gov/pubmed/3130607

http://dx.doi.org/10.1097/00006454-198804000-00010

Carlomagno G, Luksa V, Candussi G, et al. (1988) Lyme Borrelia positive serology associated with

spontaneous abortion in an endemic Italian area. Acta Eur Fertil 19(5), 279-81. Abstract

MacDonald AB. (1989) Gestational Lyme borreliosis: implications for the fetus. Rheumatic

Diseases Clinics of North America, 15(4), 657-677. W B Saunders Pub 1990.

Nadal D, Hunziker UA, Bucher HU, et al. (1989) Infants born to mothers with antibodies against

Borrelia burgdorferi at delivery. Eur J Pediatr 148(5), 426-7. Abstract

Stiernstedt G (1990) Lyme Borreliosis during pregnancy. Scand J Infect Dis Suppl 71, 99-100

Schutzer SE, Janniger CK, Schwartz RA (1991) Lyme disease during pregnancy. Cutis 47(4), 267-8.

Abstract

Strobino BA, Williams CL, Abid S, et al. (1993) Lyme disease and pregnancy outcome: a

prospective study of two thousand prenatal patients. Am J Obstet Gynecol 169(2 Pt 1), 367-74.

Abstract

Jovanović R, Hajrić A, Cirković A, et al. (1993) Lyme disease and pregnancy. Glas Srp Akad Nauka

Med (43), 169-72. Abstract

Burgess, E. (1993) Animal findings regarding in utero Lyme borreliosis. 6th Annual Lyme Disease

Scientific Conference, Atlantic City, New Jersey, May 5-6 [transplacental transmission in Beagle

females; one pup was a stillborn]

Gustafson JM, Burgess EC, Wachal MD, Steinberg H. (1993) Intrauterine transmission of Borrelia

burgdorferi in dogs. Am J Vet Res. 54(6), 882-90 http://www.ncbi.nlm.nih.gov/pubmed/8323057

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PMID: 8920118

2

Schmidt BL, Aberer E, Stockenhuber C et al. (1995) Detection of Borrelia burgdorferi DNA by

polymerase chain reaction in the urine and breast milk of patients with Lyme borreliosis. Diagn

Microbiol Infect Dis 21, 121-128

Williams CL, Strobino B, Weinstein A, et al. (1995) Maternal Lyme disease and congenital

malformations: a cord blood serosurvey in endemic and control areas. Paediatr Perinat Epidemiol

9(3), 320-30. Abstract

"Infectious Diseases of the Fetus and Newborn," 5th edition, (1995) Gardner T

http://www.amazon.com/Infectious-Diseases-Fetus-Newborn-Infant/dp/0721667821

http://www.amazon.com/exec/obidos/ASIN/0721667821/thelymediseasene

Tessa Gardner: Chapter 11, page 447 – 528. In: Mothers with active Lyme Disease, Treated: “14.6% of the

pregnancies with sequelae, Untreated: 66.7% of the pregnancies with sequelae, Unknown as to treatment:

30.3% with sequelae, Specific adverse outcomes included: cardiac 22.7%, neurologic 15.2%, orthopedic

12.1%, opthalmic 4.5%, genitourinary 10.6%, miscellaneous anomalies 12.1%, 2nd trimester demise

12.1%, Highest rate of adverse outcome (72.7%) in women with infection acquired prior to or during first

trimester, without treatment Risk of transmission varies by trimester, thus decision-making re antibiotic

choice may be influenced by the trimester in which exposure occurred. Highest risk of adverse congenital

sequella occurs in the first and early second trimester. Per Tessa Gardner's compilation of studies of

gestational exposure (Infectious Diseases of the Fetus and Newborn, Chapter 11, 5th ed, 2001): "...[some]

recommend longer duration of antibiotic therapy in gestational Lyme borreliosis because of concern

about transplacental spread...Other investigators recommend more aggressive therapy, such as

intravenous antibiotic therapy, for all cases of gestational Lyme borreliosis because of concern that there

is a significant potential risk to the fetus, which is not yet fully appreciated, following any gestational

Lyme borreliosis infection; also, they believe that high-dose intravenous antibiotic therapy is more

successful at achieving antibiotic levels above the MIC of the spirochete on both the maternal and fetal

sides of the placenta, and that parenteral antibiotic therapy should be considered for some patients with

gestational Lyme borreliosis, particularly in those with first- or early second-trimester or disseminated

gestational Lyme borreliosis.....There are investigators who favor more aggressive therapy for gestational

Lyme disease. The National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National

Institute of Allergy and Infectious Diseases recommend consideration of intravenous antibiotic therapy

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