| Eligibility |
- INCLUSION CRITERIA:
SCREENING FOR SUSPECTED PTLDS
Age >= 13 years old, suspect of suffering from Lyme disease
POST-TREATMENT LYME DISEASE SYNDROME (PTLDS)
For the purposes of this study, PTLDS is defined as (1) occurring in male or female
patients aged 13 and above (2) who have been diagnosed with confirmed or probable Lyme
disease per CDC definition
(https://wwwn.cdc.gov/nndss/conditions/lyme-disease/case-definition/2017/). Study physician
will review history to confirm probable cases. (3) They have received recommended
antibiotic therapy (4) and have persistent or relapsing symptoms and/or signs for at least
six months after therapy [4, 5]. (5) They also should have no other documented explanation
for their signs and symptoms.
LYME ARTHRITIS CONTROLS
For the purposes of this study, Lyme arthritis is defined as occurring in an otherwise
healthy male or female aged 18 and above who have intermittent episodes of arthritis
involving one or few joints, without any other cause being documented, and have positive
serum antibodies to B. burgdorferi confirmed by IgG Western blot according to the CDC
criteria.
RECOVERED CONTROLS
For the purposes of this study, a recovered control is defined as an otherwise healthy male
or female aged 18 and above who has had confirmed or probable Lyme disease, fulfilling the
CDC Lyme Disease National Surveillance Case Definition (appendix 5), and who had received
accepted antibiotic treatment for Lyme disease [5] (at least 3 months since the end of
antibiotic therapy before protocol evaluation) and who are currently asymptomatic.
SEROPOSITIVE CONTROLS
For the purposes of this study, a seropositive control is defined as an otherwise healthy
male or female aged 18 and above who has positive serum IgG antibody response to B.
burgdorferi by Western blot according to the CDC criteria and are asymptomatic and who
recall no episodes of disease compatible with Lyme infection and have not received
antibiotic therapy for Lyme
disease.
OSPA VACCINATED CONTROL
For the purposes of this study, an OspA vaccinated control is defined as an otherwise
healthy male or female age 18 and above who has received at least two doses of the OspA
vaccine for Lyme disease (Lymerix ). These controls may have a positive ELISA for B.
burgdorferi but a negative (or unreadable) IgG western blot.
MULTIPLE SCLEROSIS CONTROLS
For the purposes of this study, a multiple sclerosis control is defined as an otherwise
healthy male or female aged 18 and above with relapsing-remitting or progressive multiple
sclerosis as defined by the Clinical Trial Committee of the National Multiple Sclerosis
Society and no evidence of prior exposure to B. burgdorferi as indicate by negative history
for Lyme disease and negative western blot for B. burgdorferi in the serum by the CDC
criteria. Patients should have a Kurtzke or Expanded Disability Status Scale (EDSS) between
1 and 5.
HEALTHY VOLUNTEERS
For the purpose of this study, a healthy volunteer is defined as healthy male or female,
age 18 and above, with no history compatible with Lyme disease and negative serological
testing to B. burgdorferi by the CDC criteria.
GENERAL EXCLUSION CRITERIA
1. Age less than 18 (less than 13 for patients with PTLDS)
2. Weight less than 70 Lb. (35 kg)
3. Pregnancy or lactation
4. Women with childbearing potential who are sexually active with a male partner and
unwilling to use effective contraception during the evaluation and treatment phases of
the protocol.
5. Clinically significant laboratory abnormalities including positive test for syphilis
(RPR), HBsAg, anti-HCV, anti-HIV.
6. Chronic medication use will be evaluated in a case-by-case basis.
7. Not able to understand all of the requirements of the study or unable to give informed
consent and/or comply with all aspects of the evaluation.
8. All study participants must agree to allow their samples to be used for future
research.
EXCLUSION CRITERIA FOR PTLDS PATIENTS AND LYME ARTHRITIS CONTROLS:
In addition to the general exclusion criteria, these individuals will be excluded for:
1. Use of immunosuppressive drugs such as systemic (but not topical or inhalant) steroids
and cytotoxic agents.
2. History of any recognized autoimmune disease such as rheumatoid arthritis, vasculitis,
systemic erythematous lupus, etc.
3. Serious pre-existing or concurrent chronic medical or psychiatric illnesses other than
Lyme disease.
4. Past history of significant head trauma, alcohol or substance abuse in the past 5
years or other medical illness that might produce neurologic deficit (such as
cerebrovascular disease).
5. Use of systemic antibiotics in the previous month.
6. Use of immunomodulators such as interferons.
7. Chronic medication use will be evaluated in a case-by-case basis
8. Patients will be excluded from this protocol if they are judged by the principal
investigator as having a significant impairment in their capacity for judgment and
reasoning that compromise their ability to make decisions in their best interest.
EXCLUSION CRITERIA FOR RECOVERED, SEROPOSITIVE, OSPA VACCINATED AND HEALTHY VOLUNTEERS
CONTROLS:
In addition to the above applicable exclusion criteria (general exclusion criteria and
exclusion criteria for PTLDS patients and Lyme arthritis controls), these individuals will
be excluded for:
1. Pre-existing or concurrent serious chronic medical or psychiatric illness.
EXCLUSION CRITERIA FOR MULTIPLE SCLEROSIS CONTROLS:
In addition to the above general exclusion criteria, these individuals will be excluded
for:
1. Pre-existing or concurrent serious psychiatric or chronic medical illness besides
Multiple Sclerosis.
2. Past history of significant head trauma, alcohol or substance abuse in the past 5
years or other medical illness, besides Multiple Sclerosis, that might produce
neurologic deficit (such as cerebrovascular disease).
3. Previously received total lymphoid irradiation (TLI) or cladribine.
4. Has used immunoactive medications (excluding beta-interferon) in the three months
preceding the study.
5. In the three months prior to the study initiation, was given such investigational
treatments as plasmapheresis, hyperbaric oxygen, gangliosides, Copolymer 1, etc.
ELIGIBILITY OF SPECIAL POPULATIONS
Children: Children 13 years and older are eligible to participate in the PTLDS cohort
because the condition under study can affect children. This age was selected as appropriate
for the children to provide assent to and comply with the study procedures. Children
younger than 13 will be excluded from the PTLDS cohort, and no children will be enrolled in
the other study cohorts.
Pregnant and lactating women: Pregnant and lactating women are excluded from study
participation. An enrolled participant who becomes pregnant during the study will be
withdrawn
Adults who lack capacity to consent: Adults who lack decision-making capacity to provide
informed consent are excluded at screening, and enrolled adult participants who permanently
lose the ability to consent during study participation will be withdrawn
NIH staff members: NIH staff may be enrolled if they meet eligibility criteria. Neither
participation nor refusal to participate as a subject in the research will have an effect,
either beneficial or adverse, on the participant s employment or position at NIH. Every
effort will be made to protect participant information, but such information may be
available in medical records and may be available to authorized users outside of the study
team in both an identifiable and unidentifiable manner.
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