When Lyme Disease Strikes an Unborn Child

Excerpted from Scientific American: (01/25/2019)

A mom can pass the pathogen to her fetus—but the World Health Organization has removed “congenital Lyme disease” from its definitive diagnostic reference

 

Let’s say, for the sake of argument, you plummet from a ski gondola. Or, equally bad, you contract a fatal illness from eating human brains.

Your risk of experiencing such disasters is low. But these calamities, and many more, are nonetheless covered by the world list of illnesses and injury known as the International Classification of Diseases, or ICD, published by the World Health Organization (WHO). The document tells doctors what to look for, insurers what they might pay for, and health officials—by virtue of numbers—what needs attention.

Last June, seven years into a project involving 30 committees and 11,000 proposals, the WHO released the eleventh version of this tally of human malady. Its 55,000 entries were undergoing final, mostly technical, review when, in December of 2018, something unusual happened: one diagnosis—congenital Lyme disease—slipped from the list. The condition occurs when a pregnant woman infected with the tick-borne disease passes the bacterium, known as a spirochete, to her developing fetus.

Cases of Lyme spirochetes crossing the placenta have been documented since the 1980s, with sometimes terrible consequences for fetuses and newborns. Consider a report in the journal PLOS One, published in November, which examined, among other evidence, the outcomes of 59 women with Lyme disease in pregnancy.

“Newborn died at 39 hours,” reads one entry for a baby with a heart deformity. “Spirochetes … found in spleen, renal tubes and bone marrow.”

“Newborn died at 23 hours due to prenatal brain damage,” reads another. “Spirochetes identified in the brain and liver.”

In all, 10 miscarriages and 10 deaths occurred, along with 16 complications and defects, six of them long-lasting. The overall tally: bad outcomes in 61 percent of cases.

Nine other studies have found indirect evidence of harm: among Lyme-infected mothers who were not treated in pregnancy, 50 percent had adverse outcomes such as congenital abnormalities and miscarriage; just 11 percent of treated women did. This suggests that Lyme disease should be on every obstetrician’s radar.

These and other studies had convinced ICD overseers to include the diagnosis in the first place. But the expansive PLOS One review, published after the new list was unveiled, actually might have convinced WHO otherwise. Fetal outcomes were simply too varied, knowledge gaps large, and study results inconsistent, said the article. For example, six studies showed no significant association between infection and fetal harm. “The global evidence does not fully characterize the potential impact of gestational LD,” the PLOS One article concluded.

In response to questions about the removal of the diagnosis, WHO said in a statement: “(T)here is not sufficient evidence to justify a separate statistical category for congenital Lyme disease.” Instead, when newborns are found to harbor Lyme spirochetes, the statement said, other diagnostic codes can be used. But patient advocates fear this does not give the condition the recognition it deserves.

To its credit, WHO accepted 14 Lyme-related conditions in the new ICD, compared to just four in the previous edition. The new list includes Lyme-related dementia; central nervous system demyelination (similar to multiple sclerosis); ophthalmic complications; neuroborreliosis (which afflicts the nervous system); and carditis, a potentially fatal heart-rhythm dysfunction.

For more: httpshttps://blogs.scientificamerican.com/observations/when-lyme-disease-strikes-an-unborn-child/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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~ by Rob on January 27, 2019.

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