724. Does Borreliosis (Lyme Disease) Activate the Coagulation System and Is a Coagulation Regulatory Protein Defect Predispositional? C E CRIST1, D E BERG 2 and H H HARRISON 2,3. 1Springfield, MO, 2HEMEX Laboratories, Phoenix, AZ, 3Univ AZ Coll Med, Phoenix, AZ
Session: Poster Session: Immunology/Pathogenesis
Saturday, 11 October 2003: 12:00 AM
Room: Exhibit Hall A
Because coagulation activation is a proven part of the host defense against some bacterial and viral pathogens, we sought to determine if there is coagulation activation in Borreliosis.
Sixty five patients with a diagnosis of Borreliosis (Lyme Disease) were tested for Immune System Activation of Coagulation (ISAC) and hereditary traits for thrombophilia &/or hypofibrinolysis. The clinical diagnosis of borreliosis was based on history of tick bites, observation of erythema migrans rash and positive antibodies to B. burgdorferi confirmed by Western blot (including IgG or IgM to 18, 23-25, 28, 30, 31, 34, 39, 41 and 93 kD bands). Clinical diagnosis was also based on changes in symptoms and response to different antibiotics including tetracycline, metronidazale, azithromycin, clindamycin, quinine and amoxacillin. Geographically, the predominant location where patients received their tick bites was midwestern USA. Other symptoms were chronic and diffuse, but generally included pain, fatigue and cognitive changes.
Coagulation activation was measured by 4 sensitive markers of thrombin generation and platelet activation. These test plasma levels of: Prothrombin fragment 1+2 (F1+2); Thrombin/Antithrombin complexes (T/AT); Fibrinogen (Fib); Soluble Fibrin Monomer (SFM); and Platelet Activation (P Selectin). Hereditary predisposition to coagulation activation was evaluated by: Antithrombin, Protein C, Protein S, APC Resistance, Factor II, Lipoprotein (a), PAI-1 and Homocysteine.
Of the 65 patients, 53 (81.5%) had a positive test for low level activation of coagulation as defined by two or more markers positive (Blood Coag & Fibrinol 10: 435, 1999). Fifty six (86.2%) patients had one or more abnormal hereditary factors, which is a four fold increase over the background population rate of defects tested. These results demonstrate that Lyme disease symptoms may, in part, be a result of coagulation activation. Thus, low dose anticoagulation might be useful as an adjunct therapy in chronic Borreliosis.
David Berg, MS, HEMEX Laboratories, LLC, Phoenix, AZ and   D.E. Berg, HEMEX Laboratories, LLC 3.

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