A vaccine consisting of recombinant Borrelia burgdorferi outer-surface protein A to prevent Lyme disease. Recombinant Outer-Surface Protein A Lyme Disease Vaccine Study Consortium

The purpose of this study was to determine whether infrared tympanic membrane thermometry can replace mercury-in-glass temperatures as an assessment tool for detecting fevers earlier and more reliably in a pediatric oncology outpatient setting. A total of 313 patient visits had infrared tympanic temperatures (obtained by using the LighTouch LTX Pedi-Q thermometer (Exergen; Watertown, MA) and axillary temperatures taken simultaneously (obtained by using mercury-in-glass thermometers). Those patients with a normal axillary temperature and an elevated tympanic measurement of 38 degrees C or higher had a follow-up axillary temperature conducted that evening to determine whether an elevated tympanic temperature predicted on coming fever or infection. The mean tympanic temperature was 37.5 degrees C and the mean axillary temperature was 36.8 degrees C, a difference of 0.7 degree C (P = .0001). Sixty-two (20%) patients had discrepant temperatures with a febrile tympanic and normal axillary measurement. Three (5%) of these patients were febrile at their follow-up axillary reading. Tympanic thermometry resulted in a significantly higher temperature reading than the axillary method. Elevated tympanic temperatures were not predictive of oncoming fever or infection. Fevers were not missed when using the tympanic method. To prevent unnecessary medical intervention, it is recommended that mercury-in-glass thermometers verify elevated tympanic temperatures.     

Prospects for the development of a vaccine against Helicobacter pylori

Over 50% of the world population is chronically infected by the gastric pathogen, Helicobacter pylori, which is responsible for most peptic ulcer disease and is closely associated with adenocarcinoma of the stomach. Current therapies for peptic ulcer disease include antibiotic eradication of H. pylori infection. While effective, the high cost, difficulty of patient compliance with the treatment regimens, and risks of selection for resistant strains make these therapies impractical on a large scale. Studies of the pathogenesis of H. pylori have led to the identification of bacterial antigens as candidates for inclusion in novel vaccines against this disease. Both prophylactic and therapeutic vaccination have been demonstrated in animal models of Helicobacter infection. Preclinical evaluations of several antigens are at present under way and trials of vaccination in humans are planned.     

Use of a live chlamydial vaccine to prevent ovine enzootic abortion

A lyophilised chlamydial vaccine was prepared from the 1B temperature-sensitive strain of ovine Chlamydia psittaci. Ewes inoculated with a low titre of the live vaccine four weeks before artificial insemination were challenged on day 70 of gestation with five UK field isolates of C psittaci, including strains A22 and S26/3 previously incorporated into a commercial inactivated vaccine. There was a significantly lower chlamydial abortion rate after challenge in the vaccinated group (7.1 per cent) than in the unvaccinated group (80 per cent). All the lambs born to the vaccinated ewes were viable and of good quality. The vaccine also reduced the number of infected ewes in the group and the severity of the infection. The compatibility of the chlamydial vaccine and a toxoplasma vaccine was also tested. The abortion rate of ewes vaccinated with the two vaccines at separate injection sites (16 per cent) was less than that of ewes vaccinated with both vaccines at one site (32 per cent).     

Lyme disease in children

In the recent years the number of diagnosed cases of Lyme Disease has tended to increase. This is due to the possibility of serological examinations. Between 1992-95 at the Neurological Department of 2nd Chair of Pediatrics Silesian Medical Academy in Katowice 7 children with Lyme Disease were hospitalized. The authors analysed the clinical course, important laboratory and serological data and treatment effects.     

Lyme disease in children

Lyme disease is becoming prevalent throughout the nation. This article will describe the etiology of Lyme disease, discuss ways of preventing the disease, and present methods for diagnosing and treating the disease.     

Subacute cerebellitis in Lyme disease

Cerebellitis is not a recognised manifestation of Lyme disease. We describe a patient with clinical features of subacute cerebellitis, cerebrospinal fluid (CSF) monocytic pleocytosis, positive CSF Borrelia burgdorferi antibodies, negative brain magnetic resonance imaging and a benign course after treatment with ceftriaxone. Possible earlier cases are discussed. Lyme disease should be considered in all cases of subacute cerebellitis.     

Sleep quality in Lyme disease

Complaints of chronic fatigue as well as sleep disturbances are prevalent in Lyme disease. We compared polysomnographic measures of sleep in patients with documented Lyme disease with those of a group of age-matched normal control subjects. Eleven patients meeting Centers for Disease Control criteria for late Lyme disease with serologic confirmation by enzyme-linked immunosorbent assay and Western blot without a history of other medical or psychiatric illness and 10 age-matched control subjects were studied. Lyme disease patients and controls underwent 2 nights of polysomnography. Multiple sleep latency testing (MSLT) was performed in the patients. Sleep was staged by standard criteria, and continuity of sleep was assessed for each stage of frequency analysis of consecutive epochs. All patients studied reported sleep-related complaints, including difficulty initiating sleep (27%), frequent nocturnal awakenings (27%), excessive daytime somnolence (73%) and restless legs/nocturnal leg jerking (9%). Greater sleep latency, decreased sleep efficiency and a greater arousal index were noted in Lyme patients. The median length of uninterrupted occurrences of stage 2 and stage 4 non-rapid eye movement (NREM) sleep was less in Lyme patients (6.3 +/- 3.0 epochs in patients vs. 11.4 +/- 4.4 epochs in controls for stage 2, p < 0.01, and 4.3 +/- 4.4 epochs in patients vs. 11.2 +/- 6.3 epochs in controls for stage 4, p < 0.01), indicating greater sleep fragmentation. Mean sleep onset latency during the MSLT was normal (12.7 +/- 5.6 minutes). Three patients demonstrated alpha-wave intrusion into NREM sleep. These sleep abnormalities may contribute to the fatigue and sleep complaints common in this disease.     

Platelet-activating-factor-mediated pathogenesis in Lyme disease

This study describes a role of platelet-activating factor (PAF) as a potential inducer of inflammation in infection with Borrelia burgdorferi. Two approaches were taken. The first involved the use of a PAF antagonist to show the lack of an inflammatory response in skin lesions. The second was to show that the PAF antagonist reduced platelet aggregation when the spirochetes were incubated with polymorphonuclear leukocytes.     

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.     

Searching for Lyme disease in Colombia: a preliminary study on the vector

Since ageing is accompanied by various alterations of the immune system, the aim of the present study was to investigate the effect of age on the expression of surface markers in peripheral blood monocytes. We studied 28 healthy young subjects and 28 elderly subjects fulfilling the criteria of the SENIEUR protocol. Peripheral blood mononuclear cells were isolated and the expression of various surface markers was analysed by double colour flow cytometry. The mean fluorescence intensity of the intercellular adhesion molecule- (CD54), CD29, CD45RO and CD32 was increased significantly in CD14+ cells of elderly people when compared with the young subjects. No significant differences were found in the expression of CD11a, CD11b, CD15, CD26, CD27, CD33, CD45RA, CD45RB, CD49d, HLA-DR and CD65. In summary, we demonstrated significant increase in four monocyte surface markers in subjects of old age; this finding may be related to certain immune phenomena observed in ageing subjects such as auto-immunity.     

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.     

Bacterial pathogenesis: a variation on variation in Lyme disease

The discovery of antigenic variation in Borrelia burgdorferi, the bacterium that causes Lyme disease, provides a potential explanation for the chronic nature of infection as well as new insights into the genetic structure of highly recombinogenic loci responsible for combinatorial genetic diversification.