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Buchanan WW, Kean CA, Rainsford KD, Kean WF. Spondyloarthropathies and arthritis post-infection: a historical perspective. Inflammopharmacology 2024; 32:73-81. [PMID: 37676415 DOI: 10.1007/s10787-023-01331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
The spondyloarthropathies are a group of conditions characterised by spinal joint pain and have related clinical, epidemiological and genetic-related features. Ankylosing spondylitis, reactive arthritis, the spinal form of psoriatic arthritis and Crohn's and colitis enteropathic arthritis are the major clinical entities of the spondyloarthropathies, and principally occur in HLA-B27 positive individuals. Ankylosing spondylitis is much more common in males than females. Patients are usually seronegative for rheumatoid factor, and extra-articular features including iridocyclitis, mucous membrane and skin lesions: aortitis, may occur in some patients. The reactive arthritis form classically occurs following an infection of the gastrointestinal or genitourinary tract. The Crohn's and colitis enteropathic arthritis forms often have an associated large joint asymmetrical arthritis. Also discussed are acute rheumatic fever and Lyme disease which are conditions where the individual develops arthritis after an infection.
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Affiliation(s)
- W Watson Buchanan
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Colin A Kean
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada
| | | | - Walter F Kean
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada.
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Murison K, Wilson CH, Clow KM, Gasmi S, Hatchette TF, Bourgeois AC, Evans GA, Koffi JK. Epidemiology and clinical manifestations of reported Lyme disease cases: Data from the Canadian Lyme disease enhanced surveillance system. PLoS One 2023; 18:e0295909. [PMID: 38100405 PMCID: PMC10723709 DOI: 10.1371/journal.pone.0295909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Lyme disease cases reported in seven Canadian provinces from 2009 to 2019 through the Lyme Disease Enhanced Surveillance System are described herein by demographic, geography, time and season. The proportion of males was greater than females. Bimodal peaks in incidence were observed in children and older adults (≥60 years of age) for all clinical signs except cardiac manifestations, which were more evenly distributed across age groups. Proportions of disease stages varied between provinces: Atlantic provinces reported mainly early Lyme disease, while Ontario reported equal proportions of early and late-stage Lyme disease. Early Lyme disease cases were mainly reported between May through November, whereas late Lyme disease were reported in December through April. Increased awareness over time may have contributed to a decrease in the proportion of cases reporting late disseminated Lyme disease. These analyses help better describe clinical features of reported Lyme disease cases in Canada.
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Affiliation(s)
- Kiera Murison
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Christy H. Wilson
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Katie M. Clow
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Salima Gasmi
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
| | - Todd F. Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Departments of Pathology, Immunology and Microbiology, Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annie-Claude Bourgeois
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Gerald A. Evans
- Infection Prevention & Control, Kingston Health Sciences Centre, Biomedical & Molecular Sciences and Pathology & Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Jules K. Koffi
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
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Chen C, Chen A, Yang Y. A diversified role for γδT cells in vector-borne diseases. Front Immunol 2022; 13:965503. [PMID: 36052077 PMCID: PMC9424759 DOI: 10.3389/fimmu.2022.965503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Vector-borne diseases have high morbidity and mortality and are major health threats worldwide. γδT cells represent a small but essential subpopulation of T cells. They reside in most human tissues and exert important functions in both natural and adaptive immune responses. Emerging evidence have shown that the activation and expansion of γδT cells invoked by pathogens play a diversified role in the regulation of host-pathogen interactions and disease progression. A better understanding of such a role for γδT cells may contribute significantly to developing novel preventative and therapeutic strategies. Herein, we summarize recent exciting findings in the field, with a focus on the role of γδT cells in the infection of vector-borne pathogens.
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Affiliation(s)
- Chen Chen
- Department of Microbiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- *Correspondence: Chen Chen, ; Yanan Yang,
| | - Aibao Chen
- Department of Cell Biology, School of Life Sciences, Anhui Medical University, Hefei, China
| | - Yanan Yang
- Department of Immunology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
- *Correspondence: Chen Chen, ; Yanan Yang,
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Ostfeld RS, Brisson D, Oggenfuss K, Devine J, Levy MZ, Keesing F. Effects of a zoonotic pathogen, Borrelia burgdorferi, on the behavior of a key reservoir host. Ecol Evol 2018; 8:4074-4083. [PMID: 29721281 PMCID: PMC5916280 DOI: 10.1002/ece3.3961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 01/23/2023] Open
Abstract
Most emerging infectious diseases of humans are transmitted to humans from other animals. The transmission of these “zoonotic” pathogens is affected by the abundance and behavior of their wildlife hosts. However, the effects of infection with zoonotic pathogens on behavior of wildlife hosts, particularly those that might propagate through ecological communities, are not well understood. Borrelia burgdorferi is a bacterium that causes Lyme disease, the most common vector‐borne disease in the USA and Europe. In its North American range, the pathogen is most frequently transmitted among hosts through the bite of infected blacklegged ticks (Ixodes scapularis). Using sham and true vaccines, we experimentally manipulated infection load with this zoonotic pathogen in its most competent wildlife reservoir host, the white‐footed mouse, Peromyscus leucopus, and quantified the effects of infection on mouse foraging behavior, as well as levels of mouse infestation with ticks. Mice treated with the true vaccine had 20% fewer larval blacklegged ticks infesting them compared to mice treated with the sham vaccine, a significant difference. We observed a nonsignificant trend for mice treated with the true vaccine to be more likely to visit experimental foraging trays (20%–30% effect size) and to prey on gypsy moth pupae (5%–20% effect size) compared to mice treated with the sham vaccine. We observed no difference between mice on true‐ versus sham‐vaccinated grids in risk‐averse foraging. Infection with this zoonotic pathogen appears to elicit behavioral changes that might reduce self‐grooming, but other behaviors were affected subtly or not at all. High titers of B. burgdorferi in mice could elicit a self‐reinforcing feedback loop in which reduced grooming increases tick burdens and hence exposure to tick‐borne pathogens.
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Affiliation(s)
| | | | | | - Jill Devine
- University of Pennsylvania Philadelphia PA USA
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Brock CM, Bañó-Polo M, Garcia-Murria MJ, Mingarro I, Esteve-Gasent M. Characterization of the inner membrane protein BB0173 from Borrelia burgdorferi. BMC Microbiol 2017; 17:219. [PMID: 29166863 PMCID: PMC5700661 DOI: 10.1186/s12866-017-1127-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The bacterial spirochete Borrelia burgdorferi is the causative agent of the most commonly reported arthropod-borne illness in the United States, Lyme disease. A family of proteins containing von Willebrand Factor A (VWFA) domains adjacent to a MoxR AAA+ ATPase have been found to be highly conserved in the genus Borrelia. Previously, a VWFA domain containing protein of B. burgdorferi, BB0172, was determined to be an outer membrane protein capable of binding integrin α3β1. In this study, the characterization of a new VWFA domain containing membrane protein, BB0173, is evaluated in order to define the location and topology of this multi-spanning membrane protein. In addition, functional predictions are made. RESULTS Our results show that BB0173, in contrast to BB0172, is an inner membrane protein, in which the VWFA domain is exposed to the periplasmic space. Further, BB0173 was predicted to have an aerotolerance regulator domain, and expression of BB0173 and the surrounding genes was evaluated under aerobic and microaerophilic conditions, revealing that these genes are downregulated under aerobic conditions. Since the VWFA domain containing proteins of B. burgdorferi are highly conserved, they are likely required for survival of the pathogen through sensing diverse environmental oxygen conditions. CONCLUSIONS Presently, the complex mechanisms that B. burgdorferi uses to detect and respond to environmental changes are not completely understood. However, studying the mechanisms that allow B. burgdorferi to survive in the highly disparate environments of the tick vector and mammalian host could allow for the development of novel methods of preventing acquisition, survival, or transmission of the spirochete. In this regard, a putative membrane protein, BB0173, was characterized. BB0173 was found to be highly conserved across pathogenic Borrelia, and additionally contains several truly transmembrane domains, and a Bacteroides aerotolerance-like domain. The presence of these functional domains and the highly conserved nature of this protein, strongly suggests a required function of BB0173 in the survival of B. burgdorferi.
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Affiliation(s)
- Christina M Brock
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, TAMU-4467, College Station, TX, 77843, USA.,Current affiliation: Department of Entomology, College of Agricultural and Life Sciences, Texas A&M University, College Station, USA
| | - Manuel Bañó-Polo
- Department of Biochemistry and Molecular Biology, Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BioTecMed), Faculty of Biology, University of Valencia, E-46100, Burjassot, Valencia, Spain
| | - Maria J Garcia-Murria
- Department of Biochemistry and Molecular Biology, Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BioTecMed), Faculty of Biology, University of Valencia, E-46100, Burjassot, Valencia, Spain
| | - Ismael Mingarro
- Department of Biochemistry and Molecular Biology, Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BioTecMed), Faculty of Biology, University of Valencia, E-46100, Burjassot, Valencia, Spain
| | - Maria Esteve-Gasent
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, TAMU-4467, College Station, TX, 77843, USA.
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Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther 2014; 12:1103-35. [PMID: 25077519 PMCID: PMC4196523 DOI: 10.1586/14787210.2014.940900] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.
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Affiliation(s)
- Daniel J Cameron
- International Lyme and Associated Diseases Society,PO Box 341461, Bethesda MD, 20827-1461,USA
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Lledó L, Gegúndez MI, Giménez-Pardo C, Álamo R, Fernández-Soto P, Nuncio MS, Saz JV. A seventeen-year epidemiological surveillance study of Borrelia burgdorferi infections in two provinces of northern Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1661-72. [PMID: 24487455 PMCID: PMC3945560 DOI: 10.3390/ijerph110201661] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/15/2014] [Accepted: 01/26/2014] [Indexed: 11/17/2022]
Abstract
This paper reports a 17-year seroepidemiological surveillance study of Borrelia burgdorferi infection, performed with the aim of improving our knowledge of the epidemiology of this pathogen. Serum samples (1,179) from patients (623, stratified with respect to age, sex, season, area of residence and occupation) bitten by ticks in two regions of northern Spain were IFA-tested for B. burgdorferi antibodies. Positive results were confirmed by western blotting. Antibodies specific for B. burgdorferi were found in 13.3% of the patients; 7.8% were IgM positive, 9.6% were IgG positive, and 4.33% were both IgM and IgG positive. Five species of ticks were identified in the seropositive patients: Dermacentor marginatus (41.17% of such patients) Dermacentor reticulatus (11.76%), Rhiphicephalus sanguineus (17.64%), Rhiphicephalus turanicus (5.88%) and Ixodes ricinus (23.52%). B. burgdorferi DNA was sought by PCR in ticks when available. One tick, a D. reticulatus male, was found carrying the pathogen. The seroprevalence found was similar to the previously demonstrated in similar studies in Spain and other European countries.
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Affiliation(s)
- Lourdes Lledó
- Department of Biomedicine and Biotecnology, Alcalá University, 28871 Alcalá de Henares, Spain; E-Mails: (M.I.G.); (C.G.-P.); (J.V.S.)
| | - María Isabel Gegúndez
- Department of Biomedicine and Biotecnology, Alcalá University, 28871 Alcalá de Henares, Spain; E-Mails: (M.I.G.); (C.G.-P.); (J.V.S.)
| | - Consuelo Giménez-Pardo
- Department of Biomedicine and Biotecnology, Alcalá University, 28871 Alcalá de Henares, Spain; E-Mails: (M.I.G.); (C.G.-P.); (J.V.S.)
| | - Rufino Álamo
- Territorial Health Service and Social Welfare of the Junta de Castilla y León, 47003 Valladolid, Spain; E-Mail:
| | - Pedro Fernández-Soto
- Department of Parasitology, Salamanca University, 37008 Salamanca, Spain; E-Mail:
| | - María Sofia Nuncio
- Centre for Vectors and Infectious Diseases Research, Instituto Nacional de Saúde Dr. Ricardo Jorge (National Institute of Health), 2965-575 Aguas de Moura, Portugal; E-Mail:
| | - José Vicente Saz
- Department of Biomedicine and Biotecnology, Alcalá University, 28871 Alcalá de Henares, Spain; E-Mails: (M.I.G.); (C.G.-P.); (J.V.S.)
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9
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Tsai JH, Chao JR, Rao NA. Syphilitic and Other Spirochetal Uveitis. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Collins C, Shi C, Russell JQ, Fortner KA, Budd RC. Activation of gamma delta T cells by Borrelia burgdorferi is indirect via a TLR- and caspase-dependent pathway. THE JOURNAL OF IMMUNOLOGY 2008; 181:2392-8. [PMID: 18684928 DOI: 10.4049/jimmunol.181.4.2392] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Activation of the innate immune system typically precedes engagement of adaptive immunity. Cells at the interface between these two arms of the immune response are thus critical to provide full engagement of host defense. Among the innate T cells at this interface are gammadelta T cells. gammadelta T cells contribute to the defense from a variety of infectious organisms, yet little is understood regarding how they are activated. We have previously observed that human gammadelta T cells of the Vdelta1 subset accumulate in inflamed joints in Lyme arthritis and proliferate in response to stimulation with the causative spirochete, Borrelia burgdorferi. We now observe that murine gammadelta T cells are also activated by B. burgdorferi and that in both cases the activation is indirect via TLR stimulation on dendritic cells or monocytes. Furthermore, B. burgdorferi stimulation of monocytes via TLR, and secondary activation of gammadelta T cells, are both caspase-dependent.
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Affiliation(s)
- Cheryl Collins
- Immunobiology Program, Department of Medicine, The University of Vermont College of Medicine, Burlington, VT 50405, USA
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Acceptance and Commitment Therapy in the Rehabilitation of a Girl With Chronic Idiopathic Pain: Are We Breaking New Ground? COGNITIVE AND BEHAVIORAL PRACTICE 2006. [DOI: 10.1016/j.cbpra.2006.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shi C, Wolfe J, Russell JQ, Fortner K, Hardin N, Anguita J, Budd RC. Fas ligand deficiency impairs host inflammatory response against infection with the spirochete Borrelia burgdorferi. Infect Immun 2006; 74:1156-60. [PMID: 16428764 PMCID: PMC1360353 DOI: 10.1128/iai.74.2.1156-1160.2006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lyme disease represents a complex response to Borrelia burgdorferi that involves both bacterial factors as well as host responses. This results in an inflammatory reaction at several sites, including the synovial lining of joints. Synovial tissues of inflamed joints contain cells expressing high levels of Fas and Fas ligand (FasL). Although Fas stimulation is typically associated with cell death, it can also transmit stimulatory signals to certain cell types. Among these are dendritic cells and macrophages, which are abundant in inflamed synovium. To better assess the role of FasL in the pathogenesis of Lyme arthritis, we evaluated the response to B. burgdorferi infection in C3H/HeJgld mice that bear a nonfunctional mutation in FasL. Compared to wild-type C3H+/+ mice, C3Hgld mice had a similar bacterial burden and antibody response 2 weeks and 4 weeks following infection, but they manifested a significantly reduced Borrelia-specific cytokine response. In addition, C3Hgld mice developed a greatly reduced incidence and severity of arthritis. The findings document a contribution of FasL to the host inflammatory response to B. burgdorferi.
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Affiliation(s)
- Cuixia Shi
- Immunobiology Program, The University of Vermont College of Medicine, Given Medical Building, Burlington, VT 05405-0068, USA
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Abstract
Tick-borne encephalopathies constitute a broad range of infectious diseases affecting the brain and other parts of the CNS. The causative agents are both viral and bacterial. This review focuses on the current most important tick-borne human diseases: tick-borne encephalitis (TBE; including Powassan encephalitis) and Lyme borreliosis. Rocky Mountain spotted fever (RMSF) and Colorado tick fever (CTF), less common tick-borne diseases associated with encephalopathy, are also discussed. TBE is the most important flaviviral infection of the CNS in Europe and Russia, with 10 000-12 000 people diagnosed annually. The lethality of TBE in Europe is 0.5% and a post-encephalitic syndrome is seen in over 40% of affected patients, often producing a pronounced impairment in quality of life. There is no specific treatment for TBE. Two vaccines are available to prevent infection. Although these have a good protection rate and good efficacy, there are few data on long-term immunity. Lyme borreliosis is the most prevalent tick-borne disease in Europe and North America, with >50 000 cases annually. Localised early disease can be treated with oral phenoxymethylpenicillin (penicillin V), doxycycline or amoxicillin. The later manifestations of meningitis, arthritis or acrodermatitis can be treated with oral doxycycline, oral amoxicillin or intravenous ceftriaxone; intravenous benzylpenicillin (penicillin G) or cefotaxime can be used as alternatives. The current use of vaccines against Lyme borreliosis in North America is under discussion, as the LYMErix vaccine has been withdrawn from the market because of possible adverse effects, for example, arthritis. RMSF and CTF appear only in North America. RMSF is an important rickettsial disease and is effectively treated with doxycycline. There is no treatment or preventative measure available for CTF.
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Affiliation(s)
- Göran Günther
- Infectious Diseases, Department of Medical Sciences, Akademiska Sjukhuset, Uppsala University Hospital, Uppsala, Sweden.
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Renaud I, Cachin C, Gerster JC. Good outcomes of Lyme arthritis in 24 patients in an endemic area of Switzerland. Joint Bone Spine 2004; 71:39-43. [PMID: 14769519 DOI: 10.1016/s1297-319x(03)00160-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Accepted: 07/10/2003] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe outcomes of treated Lyme arthritis in an endemic area of western Switzerland, where some of the first cases of Lyme disease outside the United States were reported. PATIENTS AND METHODS We retrospectively studied 24 patients (15 males and nine females, mean age 38.7 years) managed by rheumatologists between 1994 and 1999 for Borrelia burgdorferi arthritis manifesting as monoarthritis (n = 20), oligoarthritis (n = 3), or polyarthritis (n = 1). The knee was affected in 20 (85%) patients. Nine patients reported a history of tick bite and four of erythema chronicum migrans. All the patients but one had a high titer of antibodies to B. burgdorferi by ELISA and all but two had a positive immunoblot test (22 positive for all three types of B. burgdorferi found in Switzerland and one positive only for B. burgdorferi sensu stricto). Joint fluid PCR for B. burgdorferi was done in nine patients and was positive in six. RESULTS All 24 patients received antibiotic therapy, orally (n = 10) or parenterally (n = 14). A second course of antibiotic therapy was used in four patients with persistent arthritis. A rapid response was noted in 13 patients. Intraarticular glucocorticoid therapy or a synoviorthesis was required in nine patients. After a mean follow-up of 40 months (range, 6-84 months), none of the patients had chronic arthritis but two reported persistent muscle or joint pain. CONCLUSION Recurrent or chronic arthritis, which has been reported in treated patients in the United States, did not occur in our series. This may be ascribable to differences in B. burgdorferi subtypes, as in the United States only B. burgdorferi sensu stricto is found.
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Affiliation(s)
- Isabelle Renaud
- Internal Medicine Department, CHUV, 1011 Lausanne, Switzerland
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15
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Taylor-Robinson D, Keat A. How can a causal role for small bacteria in chronic inflammatory arthritides be established or refuted? Ann Rheum Dis 2001; 60:177-84. [PMID: 11171674 PMCID: PMC1753580 DOI: 10.1136/ard.60.3.177] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D Taylor-Robinson
- Department of Genitourinary Medicine, Imperial College School of Medicine, St Mary's Campus, London W2 1NY, UK
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16
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Pollina DA, Elkins LE, Squires NK, Scheffer SR, Krupp LB. Does Process-Specific Slowing Account for Cognitive Deficits in Lyme Disease? ACTA ACUST UNITED AC 1999; 6:27-32. [PMID: 10382568 DOI: 10.1207/s15324826an0601_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Although several studies have suggested that cognitive slowing is a symptom in Lyme disease, it is not clear whether this slowing is general or relates to specific cognitive tasks. This study examined cognitive speed in 25 Lyme disease patients using a mental arithmetic task. These patients showed significant impairments when initiating the cognitive processes involved in counting, but performed as well as healthy participants (n = 23) when the number of counting increments increased. Lyme patients also performed a speeded perceptual-motor matching task as well as healthy participants. Lyme-related initiation speed deficits were significantly correlated with performance on standardized neuropsychological tests, including the Trail Making Test and the Digit Symbol Test, but not with self-reported depression. These results suggest that the cognitive deficits seen on speeded tasks are process specific in the Lyme patient group, and are not the result of generalized slowing.
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Affiliation(s)
- D A Pollina
- Department of Neurology, State University of New York at Stony Brook 11794-8121, USA
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 19-1998. A 70-year-old man with diarrhea, polyarthritis, and a history of Reiter's syndrome. N Engl J Med 1998; 338:1830-6. [PMID: 9634361 DOI: 10.1056/nejm199806183382508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dattwyler RJ, Luft BJ, Kunkel MJ, Finkel MF, Wormser GP, Rush TJ, Grunwaldt E, Agger WA, Franklin M, Oswald D, Cockey L, Maladorno D. Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease. N Engl J Med 1997; 337:289-94. [PMID: 9233865 DOI: 10.1056/nejm199707313370501] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Localized Lyme disease, manifested by erythema migrans, is usually treated with oral doxycycline or amoxicillin. Whether acute disseminated Borrelia burgdorferi infection should be treated differently from localized infection is unknown. METHODS We conducted a prospective, open-label, randomized, multicenter study comparing parenteral ceftriaxone (2 g once daily for 14 days) with oral doxycycline (100 mg twice daily for 21 days) in patients with acute disseminated B. burgdorferi infection but without meningitis. The erythema migrans skin lesion was required for study entry, and disseminated disease had to be indicated by either multiple erythema migrans lesions or objective evidence of organ involvement. RESULTS Of 140 patients enrolled, 133 had multiple erythema migrans lesions. Both treatments were highly effective. Rates of clinical cure at the last evaluation were similar among the patients treated with ceftriaxone (85 percent) and those treated with doxycycline (88 percent); treatment was considered to have failed in only one patient in each group. Among patients whose infections were cured, 18 of 67 patients in the ceftriaxone group (27 percent) reported one or more residual symptoms at the last follow-up visit, as did 10 of 71 patients in the doxycycline group (14 percent, P > or = 0.05). Mild arthralgia was the most common persistent symptom. Both regimens were well tolerated; only four patients (6 percent) in each group withdrew because of adverse events. CONCLUSIONS In patients with acute disseminated Lyme disease but without meningitis, oral doxycycline and parenterally administered ceftriaxone were equally effective in preventing the late manifestations of disease.
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Affiliation(s)
- R J Dattwyler
- Department of Medicine, State University of New York, Stony Brook, 11794-8161, USA
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19
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Abstract
Congenital infections remain an important source of neurologic, ophthalmologic, and audiologic disability for thousands of children throughout the world. This review summarizes the clinical features and describes contemporary approaches to the microbiologic diagnosis of congenital infections. In particular, this review emphasizes the important roles that molecular methods, especially the polymerase chain reaction, have in detecting the many infectious agents capable of damaging the developing nervous system.
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Affiliation(s)
- I E Souza
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, USA
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20
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Liveris D, Gazumyan A, Schwartz I. Molecular typing of Borrelia burgdorferi sensu lato by PCR-restriction fragment length polymorphism analysis. J Clin Microbiol 1995; 33:589-95. [PMID: 7751362 PMCID: PMC227995 DOI: 10.1128/jcm.33.3.589-595.1995] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The etiologic agent of Lyme borreliosis, Borrelia burgdorferi sensu lato, has been isolated from many biologic sources in North America and Eurasia, and isolates have been divided into three distinct genospecies (B. burgdorferi sensu stricto, Borrelia garinii, and Borrelia afzelii). In order to explore the possible association of genospecies with disease manifestation, 60 isolates of B. burgdorferi sensu lato were subjected to 5S rDNA-linked restriction fragment length polymorphism (RFLP) analysis. The results confirmed earlier studies which indicated that virtually all North American isolates are B. burgdorferi sensu stricto, whereas Eurasian strains fall into all three genospecies. Thirty-five isolates were further characterized by PCR amplification of a region of the 16S-23S rDNA spacer and HinfI digestion of the products. This method resulted in the subdivision of B. burgdorferi sensu stricto into two distinct PCR-RFLP types. In contrast, B. garinii isolates all displayed an identical pattern. Additionally, a number of previously unclassified North American isolates (25015, DN127, 19857, 24330) showed distinctively different PCR-RFLP patterns. The application of this method for the typing of uncultured B. burgdorferi directly in biologic samples was demonstrated by analysis of several field-collected Ixodes scapularis tick specimens. The described PCR-RFLP technique should allow for the direct and rapid molecular typing of B. burgdorferi-containing samples and facilitate studies of the relationship between spirochete genotype and clinical disease.
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Affiliation(s)
- D Liveris
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla 10595, USA
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21
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Affiliation(s)
- S O'Connell
- Department of Microbiology and Public Health Laboratory, Southampton General Hospital
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22
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Moody KD, Adams RL, Barthold SW. Effectiveness of antimicrobial treatment against Borrelia burgdorferi infection in mice. Antimicrob Agents Chemother 1994; 38:1567-72. [PMID: 7979290 PMCID: PMC284594 DOI: 10.1128/aac.38.7.1567] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Although antimicrobial agents are effective therapy for early Lyme disease, optimal treatment schedules have not been conclusively established. The efficacy of various dosages of eight antibiotics used for borreliosis treatment was evaluated for C3H/HeNCrIBR mice, which reproducibly develop persistent infection, arthritis, and carditis when inoculated with Borrelia burgdorferi. Amoxicillin-clavulanic acid, ceftriaxone, and high-dose penicillin G effectively eliminated infection and disease. Oxytetracycline, doxycycline, chloramphenicol, erythromycin, and azithromycin failed to cure infected mice. There was a correlation between peak serum antibiotic concentrations in mice, as determined by agar well diffusion bioassays, and therapeutic levels in humans. When experimentally inoculated mice were treated at 1 week postinfection with ceftriaxone (16 mg/kg of body weight twice daily for 5 days) and monitored for up to 90 days, all treated mice were free of spirochetes and had no gross or histologic lesions. This antibiotic regimen at days 7 to 11 postinoculation eliminated the spirochetes so that there were no relapses during the 90-day observation period. For experimentally inoculated mice treated with ceftriaxone at 7 or 14 days postinfection, arthritis, carditis, and infection were eliminated. When treatment began at 30 and 90 days after inoculation, infection and active cardiac and arthritic lesions were eradicated; however, residual mild synovitis and vasculitis persisted in some mice. In comparison with inoculated, untreated mice, ceftriaxone therapy at 7, 14, 30, and 90 days postinfection abrogated the development of antibody titers against B. burgdorferi. Having the potential to determine the presence of the spirochete through culture and histologic lesions makes the B. burgdorferi-inoculated C3H mouse model a valuable adjunct in evaluating chemotherapeutic options for Lyme disease.
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Affiliation(s)
- K D Moody
- Section of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut 06510
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23
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Nohlmans MK, Blaauw AA, van den Bogaard AE, van Boven CP. Evaluation of nine serological tests for diagnosis of Lyme borreliosis. Eur J Clin Microbiol Infect Dis 1994; 13:394-400. [PMID: 8070452 DOI: 10.1007/bf01971996] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two hundred serum specimens including 13 sera from patients with early Lyme borreliosis, 21 patients with late Lyme borreliosis, 15 rheumatoid factor positive sera, 31 sera from patients with syphilis and 84 sera from healthy controls were used to evaluate the following assays for the detection of antibodies to Borrelia burgdorferi: two in-house enzyme immunoassays (EIAs), two in-house immunofluorescent antibody assays (IFAs), a commercial haemagglutination assay (HA) (Diagast) and four commercial EIAs (Diagast, Dako, Diamedix, Whittaker Bioproducts). In early and late Lyme borreliosis sera sensitivity ranged from 8% to 62% and from 62% to 86% respectively. With the exception of the Dako EIA, which was signifcantly more sensitive in early Lyme borreliosis (62%) than the Diagast HA (8%) (p = 0.05), differences in sensitivity were not significant. In healthy controls the specificity was > or = 95% for all tests. Taking into account sensitivity, specificity, intra-test and inter-test precision, ease of performance and cost, the Dako EIA and Diamedix EIA were shown to be good alternatives to the in-house EIA and in-house IFA. Because of its low sensitivity in diagnosis of both early and late Lyme borreliosis, use of the Diagast HA should be discouraged.
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Affiliation(s)
- M K Nohlmans
- Department of Medical Microbiology, State University of Limburg, Maastricht, The Netherlands
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25
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Sigal LH. Persisting complaints attributed to chronic Lyme disease: possible mechanisms and implications for management. Am J Med 1994; 96:365-74. [PMID: 8166157 DOI: 10.1016/0002-9343(94)90068-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A better understanding of the natural history of Lyme disease and of possible causes for persisting symptoms other than active infection is needed to optimize management of patients with persistent symptoms. Review of patients seen at a Lyme disease referral center and of the immunologic and clinical literature on Lyme disease suggests most symptoms that persist after therapy can be explained by one or more of seven proposed pathogenetic mechanisms, only one of which includes active ongoing infection. Individualization of care and reanalysis of patients problems are crucial if misdiagnosis and overtreatment of Lyme disease are to be avoided.
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Affiliation(s)
- L H Sigal
- Department of Medicine, University of Medicine and Dentistry, Robert Wood Johnson Medical School, New Brunswick, NJ
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26
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Affiliation(s)
- R S Pinals
- Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick
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27
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Abstract
Borrelia burgdorferi adhere to mammalian cells in vitro but neither the ligand(s) nor the receptor(s) has (have) been clearly established. Using an in vitro attachment-inhibition assay, a B. burgdorferi attachment mechanism has been identified. Heparin, heparan sulfate, and dermatan sulfate reduced the attachment of virulent B. burgdorferi strain 297 to HeLa cells by approximately 60%. In addition, virulent, but not avirulent, B. burgdorferi strains B31, N40, and HB19 demonstrated heparin attachment-inhibition. Attachment to Chinese hamster ovary cells deficient in heparan sulfate proteoglycans was reduced by 68% compared to attachment to wild-type cells and was identical to attachment at maximum heparin inhibition to the wild-type cells. Pretreatment of HeLa cell monolayers with heparitinase, heparinase, and chondroitinase ABC, but not with chondroitinase AC, reduced borrelial attachment by approximately 50%. A moderately high affinity, low copy number, promiscuous B. burgdorferi glycosaminoglycan receptor was demonstrated by equilibrium binding studies. A 39-kD polypeptide, purified by heparin affinity chromatography from Triton X-100 extracts derived from virulent borrelia, was a candidate for this receptor. These studies indicate that one mode of B. burgdorferi attachment to eukaryotic cells is mediated by a borrelial glycosaminoglycan receptor attaching to surface-exposed proteoglycans on mammalian cells.
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Affiliation(s)
- R D Isaacs
- Department of Medicine, Department of Veterans Affairs Medical Center, Jackson, Mississippi 39216
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28
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Sheeler RD. Lyme Disease. Fam Med 1994. [DOI: 10.1007/978-1-4757-4005-9_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schwartz I, Bittker S, Bowen SL, Cooper D, Pavia C, Wormser GP. Polymerase chain reaction amplification of culture supernatants for rapid detection of Borrelia burgdorferi. Eur J Clin Microbiol Infect Dis 1993; 12:879-82. [PMID: 8112365 DOI: 10.1007/bf02000415] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A combination of culture and polymerase chain reaction (PCR) amplification was employed to detect Borrelia burgdorferi in in vitro cultures of skin biopsy specimens. Spirochetes were observed by microscopic examination in 56% (20/36) of the cultures from patients with erythema migrans who had not received prior antibiotic treatment. No growth of Borrelia burgdorferi was detected in control cultures or those from patients who had received antibiotics. PCR analysis of culture supernatants agreed with microscopic evaluation in 50/51 evaluable cultures tested (both positive and negative). At two weeks of incubation Borrelia burgdorferi could be detected by PCR in 19/20 cultures (95%) compared to 14/20 (70%) by visual inspection. This study indicates that a combined culture-PCR test for detection of Borrelia burgdorferi is more rapid and specific than culture alone.
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Affiliation(s)
- I Schwartz
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla 10595
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30
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Liebling MR, Nishio MJ, Rodriguez A, Sigal LH, Jin T, Louie JS. The polymerase chain reaction for the detection of Borrelia burgdorferi in human body fluids. ARTHRITIS AND RHEUMATISM 1993; 36:665-75. [PMID: 8489545 DOI: 10.1002/art.1780360514] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To analyze clinical fluids for the presence of Borrelia burgdorferi DNA using the polymerase chain reaction (PCR). METHODS We utilized a modified, nested PCR to detect the presence of Borrelia DNA in 99 samples of serum, urine, cerebrospinal fluid (CSF), or synovial fluid obtained from 44 patients with various stages of Lyme disease and 47 control subjects. Primer specificity was corroborated by examining 2 DNA data banks, testing against DNA from other organisms, and confirming results with a second set of nested primers. RESULTS Nested PCR was capable of detecting DNA from fewer than 10 organisms in 1 ml of fluid. The specificity of this technique was 96.4%, with a sensitivity of 76.7%. Although the specificity was uniformly high, the sensitivity was dependent upon the body fluid being tested: CSF 100%, urine 100%, synovial fluid 80%, and serum 59%. The rate of false-positive results was 3.6%. CONCLUSION These data demonstrate the potential utility of PCR in confirming the clinical diagnosis of Lyme disease as well as providing insight into the pathogenesis of various stages of this disorder.
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Affiliation(s)
- M R Liebling
- Division of Rheumatology, Harbor-University of California, Los Angeles Medical Center, Torrance 90509
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31
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Schwartz I, Wormser GP, Schwartz JJ, Cooper D, Weissensee P, Gazumyan A, Zimmermann E, Goldberg NS, Bittker S, Campbell GL, Pavia CS. Diagnosis of early Lyme disease by polymerase chain reaction amplification and culture of skin biopsies from erythema migrans lesions. J Clin Microbiol 1992; 30:3082-8. [PMID: 1452688 PMCID: PMC270592 DOI: 10.1128/jcm.30.12.3082-3088.1992] [Citation(s) in RCA: 166] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Current laboratory diagnosis of Lyme disease relies on tests for the detection of antibodies to Borrelia burgdorferi, the etiologic agent of the disease. These tests are often unreliable because of a lack of sensitivity and specificity and test-to-test variability. The purpose of this study was to evaluate the sensitivity and specificity of polymerase chain reaction (PCR) amplification for detection of B. burgdorferi in skin biopsy specimens. Forty-six 2-mm skin biopsy samples were obtained from 44 patients with a clinical diagnosis of erythema migrans, 9 of whom were receiving antibiotic therapy at the time of biopsy. Specimens were ground in BSK medium with separate aliquots taken for culture and PCR. Of the specimens from the untreated group, 57% (21 of 37) were positive by culture and 22% (8 of 37) were culture negative; 22% (8 of 37) of the cultures were uninformative because of contamination. By comparison, 22 (59%) of 37 specimens were positive by PCR amplification. Of 21 culture-positive samples, 13 (62%) were also positive by PCR analysis. Thus, the sensitivity of the PCR was 59 to 62%, based on either a clinical or cultural diagnosis of untreated Lyme disease. None of the nine specimens from antibiotic-treated patients grew in culture, whereas two of the nine were positive by PCR analysis. Given the complexity and time required for culture, PCR is a promising technique for the diagnosis of early Lyme disease.
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Affiliation(s)
- I Schwartz
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla 10595
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33
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Schwartz JJ, Gazumyan A, Schwartz I. rRNA gene organization in the Lyme disease spirochete, Borrelia burgdorferi. J Bacteriol 1992; 174:3757-65. [PMID: 1350586 PMCID: PMC206066 DOI: 10.1128/jb.174.11.3757-3765.1992] [Citation(s) in RCA: 140] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lyme disease is the most common vector-borne disease in the United States. The causative agent is the spirochete Borrelia burgdorferi. The copy number and organization of the genes encoding the rRNAs of this organism were determined. There is a single gene for 16S rRNA and two copies each of the 23S rRNA and 5S rRNA genes. All of the genes are located within a chromosomal fragment of approximately 9.5 to 10.0 kb. The 23S and 5S rRNA genes are tandemly duplicated in the order 23S-5S-23S-5S and are apparently not linked to the 16S rRNA gene, which is situated over 2 kb upstream from the 23S-5S duplication. The individual copies of the 23S-5S duplication are separated by a 182-bp spacer. Within each 23S-5S unit, an identical 22-bp spacer separates the 23S and 5S rRNA sequences from each other. The genome organization of the 23S-5S gene cluster in a number of different B. burgdorferi isolates obtained at a number of different geographical locations, as well as in several other species of Borrelia, was investigated. All isolates of B. burgdorferi tested displayed the tandem duplication, whereas the closely related species B. hermsii, B. anserina, and B. turicatae all contained a single copy of each of the genes. In addition, different geographical isolates of B. burgdorferi can be differentiated on the basis of a restriction fragment length polymorphism associated with the 23S-5S gene cluster. This polymorphism can be a useful tool for the determination of genetic relatedness between different isolates of B. burgdorferi.
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MESH Headings
- Base Sequence
- Borrelia burgdorferi
- Borrelia burgdorferi Group/genetics
- Chromosome Mapping
- DNA Probes
- Genetic Variation
- Molecular Sequence Data
- Multigene Family
- Nucleic Acid Conformation
- Oligonucleotide Probes
- Polymorphism, Restriction Fragment Length
- RNA Processing, Post-Transcriptional
- RNA, Ribosomal/genetics
- RNA, Ribosomal, 16S/genetics
- RNA, Ribosomal, 23S/genetics
- RNA, Ribosomal, 5S/genetics
- Sequence Homology, Nucleic Acid
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Affiliation(s)
- J J Schwartz
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla 10595
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Abstract
Although laboratory testing is likely to have a greater role in diagnosis and monitoring of treatment of Lyme disease in the future, at present physicians must rely on a combination of history taking, clinical manifestations, and laboratory results. Unwarranted antibiotic therapy is to be avoided. Asymptomatic persons with positive serologic results who live in an endemic area present a challenge, and borderline serologic results in patients with manifestations of late Lyme disease are also troubling. All relevant clinical information must be considered before treatment is undertaken, until more specific and sensitive tests are available.
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Affiliation(s)
- D C Zoschke
- University of Minnesota School of Medicine, Minneapolis
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35
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Schned ES, Williams DN. Special concerns in Lyme disease. Seropositivity with vague symptoms and development of fibrositis. Postgrad Med 1992; 91:65-8, 70. [PMID: 1589369 DOI: 10.1080/00325481.1992.11701344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fear of Lyme disease may be as powerful as the disease itself. Patients may insist on being tested for infection although little evidence of it exists, and a positive result in the face of vague symptoms can add to the problem. Physicians should explain to these patients the differences in "background" seropositivity in various geographic locations and the drawbacks of instituting unnecessary treatment. Fibrositis may evolve over time after Lyme disease infection. Many factors may trigger this disorder, but some investigators propose that it is a result of musculoskeletal pain, sleep disturbance, and anxiety over the disease.
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Affiliation(s)
- E S Schned
- Park Nicollet Medical Center, Minneapolis, MN 55416
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