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.     

Psychiatric manifestations of Lyme borreliosis

BACKGROUND: Lyme borreliosis (Lyme disease), a tick-borne spirochetal illness, has later manifestations that may include arthritic, neurologic, ophthalmologic, and cardiac symptoms. Recent reports suggest psychiatric symptoms may also be part of the clinical picture. METHOD: Using a structured interview (SCID), we interviewed three patients who had developed a psychiatric disorder for the first time after infection with Borrelia burgdorferi. RESULTS: During Lyme borreliosis, one patient had major depression and panic disorder, one patient had an organic mood syndrome with both depression and mania, and the third patient had panic disorder. These disorders remitted after adequate antibiotic treatment. CONCLUSION: While depression has been previously linked to neuroborreliosis, this is the first report to link panic disorder and mania with borrelial infection. Because of the rapid rise of Lyme borreliosis nationwide and the need for antibiotic treatment to prevent severe neurologic damage, mental health professionals need to be aware of its possible psychiatric presentations.     

Lyme borreliosis and cranial neuropathy

In a 2-year study of 37 consecutive adult patients with isolated cranial nerve affection of primarily unknown origin, seen at a neurological clinic, borrelia infection was identified as the cause in six cases. Four patients had a peripheral facial palsy and two had a sixth nerve palsy. The patients with borreliosis had headaches or other pain considerably more often than patients with other or unknown aetiology. All six patients had accompanying symptoms and/or signs; in five cases these were obvious, and pointed to a borrelia infection. This study indicates that a careful history to elicit other symptoms of Lyme borreliosis will usually identify the cranial nerve affections with borrelial aetiology in adult patients. To verify the diagnosis, both serum and CSF analysis should be performed. Routine testing for borrelia serology in all patients with cranial neuropathy is generally not indicated.     

An avian reservoir (Turdus merula) of the Lyme borreliosis spirochetes

The reservoir competence of passerine birds for the Lyme borreliosis spirochetes was studied in an enzootic focus in Switzerland. Skin aspirates and skin biopsies were used to isolate Borrelia spirochetes from Turdus species. B. burgdorferi sensu lato was isolated and/or PCR-detected in BSK medium containing skin biopsy or skin aspirate from 5 blackbirds (T. merula) and one song thrush (T. philomelos). Seven isolates were obtained from 3 different blackbirds. Either B. garinii or Borrelia from the genomic group VS116 was found in bird skin samples. Mixed infection occurred in 2 cases. Tick xenodiagnosis was used to determine whether blackbirds transmitted Borrelia to ticks. Five xenodiagnoses were performed on 3 different blackbirds. Borrelia DNA was detected in BSK medium inoculated with xenodiagnostic ticks from all the passerines tested. Isolates cultured from xenodiagnostic ticks were obtained from 2 blackbirds. Isolates belonged to group VS116 (n = 10) and to B. garinii (n = 1). Our study has shown that Turdus sp. are infected by B. garinii and by Borrelia from group VS116 and that blackbirds are implicated as reservoirs for these 2 genomic groups of Borrelia, as they transmit living borreliae to ticks. An association seems to exist between birds and Borrelia VS116, and to a lesser extent, B. garinii, similar to the association existing between small rodents and B. afzelii. Our observations emphasize the fact that different enzootic cycles maintain Lyme borreliosis spirochetes in nature.     

Laboratory diagnosis of Lyme borreliosis

Three stages can be observed in Lyme borreliosis: the acute stage (with dermal and systemic disease), an intermediate stage (with neurological and cardiovascular complaints and myositis), and a chronic stage (with arthritis, low back pain, dermatological and neurological complaints). If no acute stage with erythema chronicum migrans is seen, laboratory tests must provide the diagnosis. In the so-called two-test protocol at least two different tests must be positive for a definite diagnosis. Because culture is difficult, serology (demonstration of specific IgM and IgG antibodies against spirochaetal antigens) is the preferred technique. Cross reactions, antigenic variations and differences in antigenic expression in American and European strains may cause false-negative and false-positive results with the current tests. Moreover, previous use of antibiotics can interfere with the production of specific antibodies, and the effect of therapy is not correlated with height and behaviour of antibody titres. Additional investigation with immunoblot techniques, demonstrating specific antibody patterns may be valuable. An interesting alternative, not yet fully developed, is detection of specific antigens in tissues.     

Lyme borreliosis neuropathy. A case report

Lyme borreliosis is responsible for a large variety of peripheral neurologic manifestations including axonal polyneuropathy, radiculopathy, and facial nerve palsy. The prevalence of the disease must draw our attention on the possible responsibility of Borrelia burgdorferi in the pathogenesis of such symptomatology. Electrophysiologic studies demonstrate a proximal and distal axonal involvement, whereas neuropathologic studies suggest that vasculitis might be one of the primary pathophysiologic mechanisms. Electromyography provides a useful diagnostic tool and an important measure of response to treatment. Although peripheral neuropathy usually improves, our case report confirms the fact that chronic neurologic manifestations may not consistently resolve with appropriate treatment.     

Canary finches (Serinus canaria) as an avian infection model for Lyme borreliosis

Head and neck cancer is often associated with second primary neoplasms. These cancers most commonly involve other regions of the head and neck, esophagus, and lung. The majority of cases are also squamous cell carcinomas. In view of this rather frequent occurrence of multiple primary cancers and how they adversely affect the patient's survival, it becomes imperative to analyze how the clinician can intervene effectively. One such approach is to detect multiple primaries as early as possible. As such, panendoscopy as a part of the tumor-staging procedure has been advocated by many investigators to search for simultaneous second primary malignant neoplasms in patients presenting with head and neck cancer. In a 24-month period, data were gathered from 127 consecutive patients referred to University Hospital, Gheni with previously untreated, squamous cell carcinomas of the head and neck. One hundred-eighteen patients underwent an endoscopic examination under general anesthesia, during which 4 simultaneous second primary tumors were found in 3 patients. This represents an incidence of 3.4% of simultaneous second primary neoplasms. The results for the different parts of the endoscopy are discussed and compared with literature findings. Guidelines are given for the initial evaluation of the head and neck cancer patient.     

Apoptosis in the morphology of Lyme borreliosis

BACKGROUND: Morphological, mainly ultrastructural changes in borreliosis has been the matter of contemporary interest indeed and it seems to be more and more clear that they are the product of an immunologic reaction. The aim of this study is to find out the epidermal changes of erythema migrans and acrodermatitis chronica on the ultrastructural level. METHODS AND RESULTS: There were 14 cases of erythema migrans and 5 acrodermatitis examined and many apoptotic keratinocytes, but also Langerhans cells and melanocytes were the dominant findings. Considering the very short time needed for apoptosis there is a good reason to take our findings as an important component of the borreliosis pathogenesis. CONCLUSIONS: The presence of many apoptotic cells in Lyme disease epidermis emphasises the importance of the immunology in the borreliosis pathogenesis. The striking number of apoptotic melanocytes suggests the higher affinity of the borrelia to the neuroectodermal tissue.     

Diagnosis of Lyme borreliosis with western blotting]

The endemic and seasonal nature of cholera depends upon the survival of Vibrio cholerae 01 in a viable but not necessarily culturable state in ecologic niches in aquatic environments during interepidemic periods. To understand the ecology of V. cholerae it is necessary to know which aquatic ecosystems can harbor it and thus contribute to the endemic presence of cholera in Latin America. This article presents a summary of the ecology of V. cholerae 01, organized according to the abiotic and biotic factors that are relevant to the microbe's survival in aquatic environments. This pathogen finds favorable conditions in waters characterized by moderate salinity, high nutrient content, warm temperature, neutral or slightly alkaline pH, and the presence of aquatic macrophages, phytoplankton, zooplankton, fish, mollusks, and crustaceans. These ecologic conditions are typical of estuaries and coastal swamps, and toxigenic V. cholerae 01 is now considered an autochthonous member of the microbial flora of these environments. The microorganism has also shown the ability to colonize freshwater ecosystems in its viable but not necessarily culturable form, if organic or inorganic substrates that favor its survival are available.     

Unilateral recurrent nerve paralysis in suspected Lyme borreliosis

This study evaluates functional vision in visually impaired children with stage IV to V cicatricial retinopathy of prematurity (CROP) by comparing results derived from the Teller acuity cards and a battery of behavioral tasks, the visual function battery (VFB). Vision was evaluated in 26 eyes of 15 children ages 6 months to 14 years, who underwent retinal reattachment procedures for active stage IV and stage V retinopathy of prematurity. Results showed that 10 of 26 eyes (38%) had a recordable grating acuity to Teller acuity card assessment. Twenty-five of 26 eyes (96%) showed a response to the VFB. Sixteen of 26 eyes (62%) showed recordable scores with the VFB but no corresponding scores with the Teller acuity cards. The VFB may be more reliable than the Teller acuity cards in measuring visual function in the very low acuity range.     

Epidemiology of Lyme disease in France: Lyme borreliosis in the region of Berry sud: a six year retrospective

A 51 year old female patient has been diagnosed for IgG lambda multiple myeloma. In spite of treatment an aggressive course of the disease has been observed. The autopsy revealed multiorgan plasmocytic infiltrates.     

Zoonoses transmitted by ticks in forest workers (tick-borne encephalitis and Lyme borreliosis): preliminary results

In order to investigate the diffusion of infections transmitted by ticks (TBE and Lyme borreliosis) in forest workers, a serological investigation was carried out in the Province of Trento (Northern Italy) on the sera of 465 subjects at potential risk (foresters, hunters, woodcutters, gamekeepers). Antibodies for TBE virus were found in 5 subjects (1.07%) working in the same area, and antibodies for Borrelia burgdorferi were found in 15 subjects (3%). All three clinical cases of TBE identified in the Province of Trento reported that they had been bitten by ticks in the same geographical area. The presence of specific antibodies for TBE virus was tested on the sera of animals grazing in several areas: 4 positive cases were observed in the same area as the human cases reported above.     

Peptide-based OspC enzyme-linked immunosorbent assay for serodiagnosis of Lyme borreliosis

Sera from 210 patients with Lyme borreliosis (LB) were studied by an enzyme-linked immunosorbent assay (ELISA) based on a synthetic peptide (pepC10) comprising the C-terminal 10-amino-acid residues of OspC of Borrelia burgdorferi. We found that 36.3 and 45.0% of the serum samples from patients with erythema migrans (EM) and neuroborreliosis (NB), respectively, displayed immunoglobulin M (IgM) anti-pepC10 reactivities, while these samples rarely (相似文献   

Lyme borreliosis in the southern United States: a review

OBJECTIVES: To evaluate the efficacy and morbidity of surgical treatment of carcinoma of the penis. This series of patients was derived from a retrospective multicentre study (1959-1989), initially concerning 506 patients, all treatments combined. METHODS: One hundred and sixty-eight patients treated by surgery or surgery followed by external radiotherapy between 1959 to 1989 were included. The mean follow-up is 14.4 years and the mean participation is 4.7 years. Total or partial amputation was performed as first-line treatment in 89 patients (53%) and as second-line treatment in 11 patients (7%). Thirty-two patients received external radiotherapy as a complement to surgery. Inguinal lymph node dissection was performed as first-line treatment in 68 patients (41%) and secondarily in 19 patients (11%). Postoperative inguinal radiotherapy was performed in 52 patients. Monofactorial statistical analysis of prognostic factors is proposed. RESULTS: The 5-year local control rate was 84%; it was independent of the stage of the tumour; the survival of the patients dying from any cause was 53%, the progression-free survival was 69% and the survival of patients dying from cancer of the penis was 75%. The vital prognosis is statistically significant related to the lymph node status. No significant relationship was observed between lymph node status and tumour stage. 61 complications involving the penis were observed in 40 patients (24%). Thirty-seven patients developed complications secondary to the lymph node dissection (24 cases of oedema of the lower limbs and 13 cases of inguinal sclerosis). CONCLUSION: Surgical treatment ensured a local control globally comparable to that obtained with brachytherapy, but unlike this technique, the local control is independent of the stage. Brachytherapy should not always be performed in favour of mutilation for advanced tumours because the iatrogenic effects of brachytherapy are increased in these cases. An approach to the treatment of lymph nodes is proposed based on the authors' experience and the data of the literature.     

European Union Concerted Action on Risk Assessment in Lyme Borreliosis: clinical case definitions for Lyme borreliosis

The EU Concerted Action on Risk Assessment in Lyme Borreliosis (EUCALB) has consulted other clinicians and scientists in Europe to produce case definitions of the principal manifestations of European Lyme borreliosis. These case definitions will not only be helpful in supporting its own research interests, but are also intended to assist other clinicians in appropriate management and to support further studies aimed at determining the full clinical spectrum of the disease. The case definitions were achieved after a series of meetings organised by EUCALB with other expert clinicians and scientists from twelve European countries. The definitions and the diagnostic criteria presented thus represent the consensus reached at these meetings. The proposed case definitions consider skin, nervous system, cardiac and musculoskeletal presentations and the role of laboratory investigation in supporting diagnosis.