The peripheral neuromotor apparatus of patients with tick-borne neuroborreliosis (Lyme disease)

Electroneuromyography and electromyography were performed in 48 and 102 patients, respectively, with Lyme disease-induced algic and amyotrophic syndromes. Electromyographic and clinical findings in the regions of the tick suction correlated. Multiple lesions of the nervous system may be considered as meningoencephalomyeloradiculoneuropathy as well as subclinical multiple mononeuropathy. Pronounced changes in the nerve potential against minimal shifts in peripheral nervous conduction reflect infectious-toxic nature of the condition.     

Diagnosis of Lyme neuroborreliosis

PUVA and UVB phototherapies are used in the treatment of psoriasis and other inflammatory skin diseases. Ultraviolet radiation causes inflammation and modulates cell kinetics in the skin. PUVA also has an inhibitory effect on skin DNA synthesis. In this study, the effects of PUVA and UVB treatments on epidermal would healing were examined using the suction blister wound model. The healing of the wound was studied indirectly by measuring water evaporation and blood flow in the wound area. On the fourth day, water evaporation was more abundant in PUVA-treated patients (42 +/- 5 g/m2h) than in UVB treated (36 +/- 4 g/m2h) or control patients (27 +/- 3 g/m2h) (analysis of variance, the least significant difference test at a level of 0.05). The P value for the difference of means between the PUVA and control groups was 0.014. Blood flow was also more abundant during the fourth (PUVA 162 +/- 11 arbitrary units, UVB 122 +/- 10, controls 115 +/- 15) and sixth (PUVA 108 +/- 18, UVB 73 +/- 17, controls 57 +/- 13) day in PUVA treated patients (analysis of variance, the least significant difference test at a level of 0.05). The results suggest that PUVA treatment decreases the restoration of the epidermal barrier function. The PUVA-treated patients also showed a more intense and prolonged vascular response that may be due to PUVA-related inflammation.     

Lyme disease (Lyme borreliosis)

Unlike the peripheral nervous system (PNS), the mammalian central nervous system (CNS) clearly lacks the robust regenerative characteristics and capacity of the former. Despite this fact, two unique regions of the adult mammalian CNS possess such regenerative potential and are capable of active regeneration following injury or structural compromise. These unique areas are the olfactory system and the neurohypophyseal system of the endocrine hypothalamus. Furthermore, it has been clearly demonstrated that primordial neuroblasts regarded as stem cells emerge from the subependymal parenchyma of the walls and floor of the third cerebral ventricle, migrate to the ventricular surface and undergo compensatory synaptogenesis within one week following hypophysectomy. In situ hybridization studies have unequivocally demonstrated that the up-regulation of nitric oxide synthase (NOS) is essential for neural (axonal) regeneration and neuronal (stem cell) migration to occur. Moreover, neuronal migration is reliably inhibited following the administration of the NO antagonist, nitroarginine. The current investigation serves to confirm a remarkable degree of plasticity and regeneration in the adult mammalian neurohypophyseal system coupled with the emergence of primordial neuroblasts that undergo apparent differentiation, migration and compensatory synaptogenesis in response to the up-regulation of NO that occurs following the trauma of hypophysectomy. Evidence from the current investigation appears to confirm that specialized glia of the neurohypophyseal system, the so-called pituicyte, proliferate following hypophysectomy and may serve as a growth matrix or structural template that may target and direct regenerating Supraoptic (SON) and Paraventricular (PVN) axons toward endothelial primordia in the regenerating neural stem and lobe.     

Lyme disease (borreliosis)

Brief data are submitted on etiology, clinical course, diagnosis, and treatment of the condition. The authors' personal observations (n = 11) are described. Nine patients presented with a clinical form of migrating erythema, two ones had acrodermatitis chronica atrophicans.     

Thoraco-abdominal manifestation of stage II Lyme neuroborreliosis

An 18-month-old girl was diagnosed as having GM1 gangliosidosis, on the basis of the clinical symptoms of muscle stiffness, developmental retardation, hepatosplenomegaly, and kyphoscoliosis and a laboratory study that revealed a deficiency in the lysosomal degradative enzyme beta-galactosidase. Magnetic resonance T1-weighted images showed persistent hyperintensity in the bilateral thalami, brainstem, and deep cerebellum at 14 and 18 months of age, indicating arrest of the myelination process in these areas, and that the arrest had occurred at the newborn stage. There was no myelination in the basal ganglia and diffuse leukomalacia developed in the cerebral hemispheres. Only supportive treatment was given; the patient died at 2 years of age. Myelination arrest at the newborn stage associated with progressive leukomalacia is a possible characteristic of GM1 gangliosidosis.     

Acute polyradiculoneuritis and Lyme disease

A thirty-three-year-old patient developed polyradiculoneuritis with several post-therapeutic relapses despite excellent response to treatment by intravenous polyvalent gammaglobulin. After the second relapse, positive titres for Borrelia burgdorferi were found in serum and C.S.F. We gave her intravenous antibiotic and clinical signs and electrophysiological data improved. Our report and the literature can distinguish two clinical and electrophysiological presentations of neurological peripheral involvement in Lyme disease: meningoradiculoneuritis with axonal involvement and polyradiculoneuritis with demyelinization.     

Neuropsychiatric manifestations of Lyme disease

Lyme disease is a multisystem illness that may affect the central nervous system and subsequently produce mild to severe psychiatric disorders. Physicians who treat patient with Lyme disease need to be aware of its neuropsychiatric symptoms, which may emerge months to years after the initial infection. Prompt diagnosis and effective treatment are needed to avoid the debilitating and possibly irreversible mental illness associated with the neurologic involvement of this spirochetal infection. The author reviews the neuropsychiatric manifestations of Lyme disease and provides diagnostic and therapeutic approaches for the management of the central nervous system disease that may cause them.     

Lyme disease in children and adolescents

148 children and adolescents with Lyme borreliosis and tick bite or suspection on tick bite were examined. The examined patients were aged from 14 months to 24 years and divided into four age groups. Skin lesions were discovered in 25 percent of patients with tick bite. Erythema migrans occurred in 91 percent, Lymphocytoma in 3 percent and sclerodermatous lesions (Lichen sclerosus et atrophicus and Morphea) in 6 percent of patients with Lyme disease. Serologic tests on the presence of antibodies to Borreliae burgdorferi were performed in 96 percent of cases with tick bite. Antibody titer 1:80 or higher in 8 percent of patients with tick bite, was discovered. We found positive serologic test results in 5 (29 percent) of 29 persons with Erythema migrans, in 4 (4 percent) of 110 patients with tick bite (without skin lesions), as well as, in 1 patient with Lymphocytoma. Antibiotic therapy was applied in all cases with Erythema migrans, in person with Lymphocytoma, as well as, in patients with asymptomatic infections (patients without skin lesion recalling a tick bite and with antibodies against Borrelia burgdorferi). A general sensitivity, to infection with Borrelia burgdorferi, is stressed, a fact based on appearance by Lyme borreliosis in all age groups even in the newborn children.     

Accelerated infectivity of tick-transmitted Lyme disease spirochetes to vector ticks

We determined whether the span of infectivity of Lyme disease spirochetes (Borrelia burgdorferi) to vector ticks varies with the mode of infection in laboratory mice. Noninfected larval deer ticks were permitted to feed on two strains of spirochete-infected mice that had been naturally (via tick bite) and parenterally (via needle injection) infected with B. burgdorferi 2, 4, or 8 weeks earlier, and engorged ticks were dissected and examined for spirochetes by direct immunofluorescence microscopy. After initial infection, spirochetal infectivity to ticks was less efficient in needle-infected mice than in mice infected via tick bites. Tick-transmitted spirochetes develop more rapidly from the skin of infected mice and do not induce a strong antispirochete antibody response during the early stage of infection.     

Ultrastructural characteristics of Lyme disease spirochetes (Borrelia burgdorferi) isolated from Ixodes persulcatus in China

Diluting composite materials with unfilled resin to facilitate clinical application during direct lamination will result in an alteration of filler loading with possible changes of physical properties. This study compared the surface hardness and abrasion resistance of a visible light-cured microfilled and hybrid resin with and without dilution. Samples were prepared, cured, and stored in distilled water at 37 degrees C for 24 hours before testing. Knoop hardness values were obtained from the upper surface of 10 samples in three dilution and control groups of each material. Three samples of the dilution and control groups were similarly prepared and stored for toothbrush abrasion testing. Data from the hardness and abrasion tests were subjected to analysis of variance and Tukey's test at a 0.05 level of significance. Results showed that dilution had a significant effect on surface hardness of the materials tested, although the diluted materials were not significantly different from the controls. Abrasion tests showed visible evidence of abrasion on all samples, but dilution showed no significant effect on abrasion resistance of the materials tested.     

Lyme disease: self-regulation and pathogen invasion

Ecological interactions underlying the epidemic of Lyme disease involve a spirochete, a tick (with larval, nymph and adult stages), and two (or more) vertebrate hosts. Juvenile ticks ordinarily feed on mice; adult ticks feed on deer. Mice acquire the spirochete from infected nymphs and then pass the infection to larvae of the next tick generation. Lyme disease may result when a human is inadvertently bitten by an infectious nymph. Our model of the Lyme phenomenon counts the total number of ticks in each stage, the numbers of infected ticks by stage, and the number of infected mice. We fix the total population sizes of deer and mice, assume the ticks self-regulate, and solve the homogeneous-mixing case for equilibrium abundances. A local stability analysis identifies a condition where extinction of the spirochete is stable. Reversing this condition implies that the spirochete can invade the system of ticks and vertebrate hosts. When the spirochete can invade, a positive equilibrium number of infected organisms is locally stable. Spirochete invasion is promoted by a sufficient density of mice suffering low mortality, high susceptibility to infection in both mice and ticks, a high attack rate of ticks on mice, a high density of larval ticks, and low mortality among tick nymphs. Low mouse mortality allows the frequency of infection among nymphs to approach an individual tick's susceptibility when feeding on an infected mouse.     

Prospects for a vaccine to prevent Lyme disease in humans

Vaccination with recombinant outer-surface protein A (OspA) preparations has been highly successful in protecting laboratory animals against challenge by strains of Borrelia burgdorferi closely related to the one from which the OspA was derived. Humoral immunity is sufficient for protection. Against natural infection introduced by ticks, the vaccine-induced immune response may begin to take effect in the tick itself--i.e., before the spirochete enters the host--and may extend to a broader spectrum of strains of B. burgdorferi than are represented in the vaccine. Single recombinant OspA vaccine preparations are currently being evaluated in two large-scale efficacy trials in adults in the United States. Greater heterogeneity among B. burgdorferi strains in Europe than among those in the United States will likely necessitate the development of a vaccine containing antigens from multiple strains; a multivalent vaccine may or may not be needed in the United States.     

Clinical manifestations and antibiotic treatment of Lyme disease

As the incidence of Lyme disease increases in Connecticut and world-wide, considerable attention has been given to its prompt diagnosis and treatment. Creating further interest in this infection is the awareness that inappropriate therapy may result in significant disabling sequelae many years later. In this review, we focus mainly on current treatment options, but stress that the recommendations may change appreciably, as more information appears on the efficacy of new antibiotics.     

Chain reactions linking acorns to gypsy moth outbreaks and Lyme disease risk

In eastern U.S. oak forests, defoliation by gypsy moths and the risk of Lyme disease are determined by interactions among acorns, white-footed mice, moths, deer, and ticks. Experimental removal of mice, which eat moth pupae, demonstrated that moth outbreaks are caused by reductions in mouse density that occur when there are no acorns. Experimental acorn addition increased mouse density. Acorn addition also increased densities of black-legged ticks, evidently by attracting deer, which are key tick hosts. Mice are primarily responsible for infecting ticks with the Lyme disease agent. The results have important implications for predicting and managing forest health and human health.     

Reactivity of umbilical and placental blood-vessels (author''s transl)

The adenosyltransferase inhibitory activities of a series of homoserine derivatives were studied using Hansch equations and CNDO/2 calculations. Structure-activity relationships are established involving electronic and lipophilic parameters.     

Outcomes of children treated for Lyme disease

OBJECTIVE: To study the outcome of Lyme disease (LD) in children identified in a total population survey of an endemic island. METHODS: We conducted a population-based retrospective cohort study off the coast of Massachusetts. Twenty-five children who met the Centers for Disease Control case definition for prior LD were compared with 26 children without LD from the same community. All children with LD received antibiotics during the acute phase of their disease. All 51 children were invited for a clinical evaluation, including 12-lead electrocardiogram (EKG), and measurement of antibodies to Borrelia burgdorferi by antibody-capture ELISA and Western blot. RESULTS: At a mean of 3.2 years from the initial manifestation of LD, children with prior LD did not have a higher prevalence of musculoskeletal or neurological symptoms, examination abnormalities, abnormal EKG, or behavioral difficulties, compared to children with no history of LD. CONCLUSION: Children who receive appropriate antimicrobial therapy for LD appear to have no demonstrable longterm morbidity.