Ultrastructural demonstration of spirochetal antigens in synovial fluid and synovial membrane in chronic Lyme disease:

 Hum Pathol. 1996 Oct;27,10:1025-34.Ultrastructural demonstration of spirochetal antigens 
in synovial fluid and synovial membrane in chronic Lyme disease: possible factors 
45contributing to persistence of organisms. Nanagara R, Duray PH, Schumacher HR Jr. 
Allergy-Immunology-Rheumatology Division, Department of Medicine, Faculty of Medicine, 
KhonKaen University, Thailand.
To perform the first systematic electronmicroscopic, EM, and immunoelectron microscopy, IEM, 
study of the pathological changes and the evidence of spirochete presence in synovial membranes 
and synovial fluid, SF, cells of patients with chronic Lyme arthritis. EM examination was 
performed on four synovial membrane and eight SF cell samples from eight patients with chronic 
Lyme disease. Spirochetal antigens in the samples were sought by IEM using monoclonal 
antibody to Borrelia burgdorferi outer surface protein A, OspA, as the immunoprobe. Prominent 
ultrastructural findings were surface fibrin-like material, thickened synovial lining cell layer and 
signs of vascular injury. Borrelia-like stru ctures were identified in all four synovial membranes 
and in two of eight SF cell samples. The presence of spirochetal antigens was confirmed by IEM 
in all four samples studied, one synovial membrane and three SF cell samples. OspA labelling was 
in perivascular areas, deep synovial stroma among collagen bundles, and in vacuoles of fibroblasts 
in synovial membranes; and in cytophagosomes of mononuclear cells in SF cell samples.Electron 
microscopy adds further evidence for persistence of spirochetal antigens in the joint in 
chronic Lyme disease. Locations of spirochetes or spirochetal antigens both intracellulary and 
extracellulary in deep synovial connective tissue as reported here suggest sites at which 
spirochaetes may elude host immune response and antibiotic treatment

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