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Nik Kamarudin NAA, Mawang CI, Ahamad M. Direct Detection of Lyme Borrelia: Recent Advancement and Use of Aptamer Technology. Biomedicines 2023; 11:2818. [PMID: 37893191 PMCID: PMC10604176 DOI: 10.3390/biomedicines11102818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Borrelia burgdorferi sensu lato (B. burgdorferi s.l.), which is predominantly spread by ticks, is the cause of Lyme disease (LD), also known as Lyme borreliosis, one of the zoonotic diseases affecting people. In recent years, LD has become more prevalent worldwide, even in countries with no prior records. Currently, Lyme Borrelia detection is achieved through nucleic acid amplification, antigen detection, microscopy, and in vitro culture. Nevertheless, these methods lack sensitivity in the early phase of the disease and, thus, are unable to confirm active infection. This review briefly discusses the existing direct detection methods of LD. Furthermore, this review also introduces the use of aptamer technology integrated with biosensor platforms to detect the Borrelia antigen. This aptamer technology could be explored using other biosensor platforms targeting whole Borrelia cells or specific molecules to enhance Borrelia detection in the future.
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Affiliation(s)
- Nik Abdul Aziz Nik Kamarudin
- Acarology Unit, Infectious Disease Research Center, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia; (C.I.M.); (M.A.)
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2
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Bobeica C, Niculet E, Craescu M, Parapiru EL, Corduneanu-Luca AM, Debita M, Pelin AM, Tiutiuca C, Vasile CI, Nicolescu AC, Miulescu M, Balan G, Tatu AL. Immunologic and nonimmunologic sclerodermal skin conditions - review. Front Immunol 2023; 14:1180221. [PMID: 37600771 PMCID: PMC10432860 DOI: 10.3389/fimmu.2023.1180221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/16/2023] [Indexed: 08/22/2023] Open
Abstract
Scleroderma-like cutaneous lesions have been found in many pathological conditions and they have the clinical appearance of sclerotic or scleroatrophic lesions. Affected skin biopsies described histopathological changes similar to those of scleroderma located strictly on the skin or those of systemic sclerosis. These skin lesions can be found in inflammatory diseases with autoimmune substrate (generalized morphea, chronic graft versus host disease, eosinophilic fasciitis), tissue storage diseases (scleredema, scleromyxedema, nephrogenyc systemic fibrosis, systemic amyloidosis), metabolic diseases (porphyrya cutanea tarda, phenylketonuria, hypothyroidism, scleredema diabeticorum), progeroid syndromes. Given the multiple etiologies of sclerodermal lesions, a correct differential diagnosis is necessary to establish the appropriate treatment.
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Affiliation(s)
- Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Elena-Laura Parapiru
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | | | - Mihaela Debita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Ana Maria Pelin
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Carmen Tiutiuca
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Codrut Nicolescu
- Dermatology Department “Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
| | - Magdalena Miulescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galaţi, Romania
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3
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Kim S, Samanta K, Nguyen BT, Mata-Robles S, Richer L, Yoon JY, Gomes-Solecki M. A portable immunosensor provides sensitive and rapid detection of Borrelia burgdorferi antigen in spiked blood. Sci Rep 2023; 13:7546. [PMID: 37161039 PMCID: PMC10170079 DOI: 10.1038/s41598-023-34108-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
There are no assays for detecting B. burgdorferi antigen in blood of infected Lyme disease individuals. Here, we provide proof-of-principle evidence that we can quantify B. burgdorferi antigen in spiked blood using a portable smartphone-based fluorescence microscope that measures immunoagglutination on a paper microfluidic chip. We targeted B. burgdorferi OspA to develop a working prototype and added examples of two antigens (OspC and VlsE) that have diagnostic value for discrimination of Lyme disease stage. Using an extensively validated monoclonal antibody to OspA (LA-2), detection of OspA antigen had a broad linear range up to 100 pg/mL in 1% blood and the limit of detection (LOD) was 100 fg/mL (= 10 pg/mL in undiluted blood), which was 1000 times lower than our target of 10 ng/mL. Analysis of the two other targets was done using polyclonal and monoclonal antibodies. OspC antigen was detected at LOD 100 pg/mL (= 10 ng/mL of undiluted blood) and VlsE antigen was detected at LOD 1-10 pg/mL (= 0.1-1 ng/mL of undiluted blood). The method is accurate and was performed in 20 min from sample to answer. When optimized for detecting several B. burgdorferi antigens, this assay may differentiate active from past infections and facilitate diagnosis of Lyme disease in the initial weeks of infection, when antibody presence is typically below the threshold to be detected by serologic methods.
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Affiliation(s)
- Sangsik Kim
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA
| | - Kamalika Samanta
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Merck & Co., West Point, PA, 19486, USA
- Immuno Technologies, Inc, Memphis, TN, 38103, USA
| | - Brandon T Nguyen
- College of Medicine, The University of Arizona, Tucson, AZ, 85724, USA
| | - Samantha Mata-Robles
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA
| | - Luciana Richer
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Immuno Technologies, Inc, Memphis, TN, 38103, USA
- US Biologic, Inc, Memphis, TN, 38103, USA
| | - Jeong-Yeol Yoon
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, USA.
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
- Immuno Technologies, Inc, Memphis, TN, 38103, USA.
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Bruinsma RA, Zomer TP, Skogman BH, van Hensbroek MB, Hovius JW. Clinical manifestations of Lyme neuroborreliosis in children: a review. Eur J Pediatr 2023; 182:1965-1976. [PMID: 36856886 DOI: 10.1007/s00431-023-04811-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
Lyme neuroborreliosis (LNB) is a manifestation of Lyme disease involving the central and peripheral nervous system. It is caused by the spirochete Borrelia burgdorferi, transmitted by tick bites to a human host. Clinical signs of LNB develop after the dissemination of the pathogen to the nervous system. The infection occurs in children and adults, but the clinical manifestations differ. In adults, painful meningoradicultis is the most common manifestation of LNB, while children often present with facial nerve palsy and/or subacute meningitis. Subacute headache can be the only manifestation of LNB in children, especially during the summer months in Lyme disease-endemic regions. Non-specific symptoms, such as loss of appetite, fatigue or mood changes, may also occur, especially in young children. A high level of suspicion and early recognition of the various clinical manifestations presented by children with LNB is essential to minimize delay in diagnosis and optimize management. This review provides an overview of the spectrum of clinical manifestations, and discusses diagnosis, antibiotic treatment, and clinical outcome of LNB in children.
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Affiliation(s)
- R A Bruinsma
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.,Department of Pediatrics, Gelre Hospital, Apeldoorn, the Netherlands
| | - T P Zomer
- Lyme Center Apeldoorn, Gelre Hospital, Apeldoorn, P.O. Box 9014, 7300 DS, the Netherlands.
| | - B H Skogman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - M Boele van Hensbroek
- Department of Pediatrics, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J W Hovius
- Amsterdam UMC Multidisciplinary Lyme borreliosis Center, Amsterdam UMC Medical Centers, location AMC, University of Amsterdam, Amsterdam, the Netherlands
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Maxwell SP, Brooks C, McNeely CL, Thomas KC. Neurological Pain, Psychological Symptoms, and Diagnostic Struggles among Patients with Tick-Borne Diseases. Healthcare (Basel) 2022; 10:healthcare10071178. [PMID: 35885705 PMCID: PMC9323096 DOI: 10.3390/healthcare10071178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Public health reports contain limited information regarding the psychological and neurological symptoms of tick-borne diseases (TBDs). Employing a mixed-method approach, this analysis triangulates three sources of symptomology and provides a comparison of official public health information, case reports, medical literature, and the self-reported symptoms of patients with Lyme disease and other TBDs. Out of the fifteen neuropsychiatric symptoms reported in the medical literature for common TBDs, headaches and fatigue and/or malaise are the only two symptoms fully recognized by public health officials. Of TBDs, Lyme disease is the least recognized by public health officials for presenting with neuropsychiatric symptoms; only headaches and fatigue are recognized as overlapping symptoms of Lyme disease. Comparisons from a patient symptoms survey indicate that self-reports of TBDs and the associated symptoms align with medical and case reports. Anxiety, depression, panic attacks, hallucinations, delusions, and pain—ranging from headaches to neck stiffness and arthritis—are common among patients who report a TBD diagnosis. Given the multitude of non-specific patient symptoms, and the number and range of neuropsychiatric presentations that do not align with public health guidance, this study indicates the need for a revised approach to TBD diagnosis and for improved communication from official public health sources regarding the wide range of associated symptoms.
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Affiliation(s)
- Sarah P. Maxwell
- School of Economic, Political & Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA
- Correspondence:
| | - Chris Brooks
- Laboratory for Human Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA; (C.B.); (K.C.T.)
| | - Connie L. McNeely
- Center for Science, Technology, and Innovation Policy, George Mason University, Fairfax, VA 22030, USA;
| | - Kevin C. Thomas
- Laboratory for Human Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA; (C.B.); (K.C.T.)
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Abstract
Lyme disease (LD), also known as Lyme borreliosis, is a zoonotic disease caused by the Gram-negative bacteria Borrelia burgdorferi sensu lato belonging to the Spirochaetaceae family. Differentiating LD from other systemic disorders that present with musculoskeletal symptoms is challenging, and the presence of antibodies to borrelia in the general population may contribute to misdiagnosis. Moreover, long-term exposure of the host's immune system to spirochetes can contribute to the development of chronic autoimmune disease de novo. We report a 35-year-old woman with a combination of LD and systemic lupus erythematosus (SLE), and in this case, LD was the most likely trigger for SLE. We also performed a literature review and summarized the previously reported cases with a combination of LD and autoimmune disease.
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Affiliation(s)
| | - Svitlana Trypilka
- Rheumatologist Policlinic, Communal Non-Commercial Enterprise of Kharkov Regional Council "Regional Clinical Hospital", Kharkiv, UKR
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Savasta S, Fiorito I, Foiadelli T, Pichiecchio A, Cambieri P, Mariani B, Marone P, Marseglia G. Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature. Ital J Pediatr 2020; 46:172. [PMID: 33228741 PMCID: PMC7684897 DOI: 10.1186/s13052-020-00936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background Lyme neuroborreliosis can cause a variety of neurological manifestations. European children usually present facial nerve palsy, other cranial nerve palsies and aseptic meningitis. Case presentation We hereby report a case of Lyme neuroborreliosis in a 9-year-old boy with abdominal pain as first symptom and subsequent onset of attention deficit and ataxia. Diagnosis was made by detection of specific antibody in both serum and cerebrospinal fluid with neuro-radiological images suggestive for this infectious disease. A 12-months follow-up was performed during which no relevant neurological sequelae were revealed. Conclusion This case report shows that abdominal radiculitis, although extremely rare, could be the first manifestation of early Lyme neuroborreliosis in pediatric patients. Pediatricians must consider Lyme disease in the differential diagnosis of abdominal pain of unknown origin in children, especially in countries where the infection is endemic.
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Affiliation(s)
| | - Ivan Fiorito
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Neuroradiology Department, Foundation Casimiro Mondino, Pavia, Italy
| | | | - Bianca Mariani
- Virology Department, Foundation Policlinic San Matteo, Pavia, Italy
| | - Piero Marone
- Virology Department, Foundation Policlinic San Matteo, Pavia, Italy
| | - Gianluigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Lee S, Lee H, Park JW, Yoon SS, Seo HJ, Noh J, Yoo MS, Kim KH, Park Y, Cho YS, So BJ. Prevalence of antibodies against Anaplasma spp., Borrelia burgdorferi sensu lato, Babesia gibsoni, and Ehrlichia spp. in dogs in the Republic of Korea. Ticks Tick Borne Dis 2020; 11:101412. [PMID: 32173299 DOI: 10.1016/j.ttbdis.2020.101412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 12/20/2019] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
Abstract
There is a lack of comprehensive studies on the seroprevalence of tick-borne pathogens in the Republic of Korea. Therefore, the aim of this study was to investigate the seroprevalences of Anaplasma spp. (A. phagocytophilum/A. platys), Borrelia burgdorferi sensu lato, Babesia gibsoni, Ehrlichia spp. (E. canis/E. ewingii), and Ehrlichia chaffeensis in dogs across the Republic of Korea in 2017 and 2018. A total of 2215 serum samples collected from 938 companion dogs, 969 shelter dogs, and 308 military working dogs were examined using commercial enzyme-linked immunosorbent assay (ELISA) and indirect fluorescence immunoassay (IFA) kits. Data collected for each animal, including breed, sex, age, region, season, and dog type, were used for statistical analysis. The overall seroprevalence was highest for Anaplasma spp. (15.1 %), followed by Ehrlichia spp. (10.3 %), B. burgdorferi sensu lato (6.4 %), E. chaffeensis (2.3 %), and B. gibsoni (1.7 %). One hundred and sixty-one dogs had antibodies against two or three different pathogens. The most common combinations were Anaplasma spp. - Ehrlichia spp. (2.1 %), Anaplasma spp. - E. chaffeensis (1.4 %), and Anaplasma spp. - B. burgdorferi sensu lato (1.2 %). Season was significantly associated with the seroprevalences of B. burgdorferi sensu lato and Ehrlichia spp., with dogs presenting the highest percentage of positive results during summer. Anaplasma spp. and B. gibsoni were significantly more prevalent in the northern and southern regions, respectively. The seroprevalences of Anaplasma spp., B. burgdorferi sensu lato, and Ehrlichia spp. were significantly higher in military working dogs, while the seroprevalence of E. chaffeensis was higher in companion dogs. The current findings are important for future surveillance of canine tick-borne pathogens and designing appropriate approaches for the diagnosis and control of these pathogens in the Republic of Korea.
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Affiliation(s)
- Seunghee Lee
- Pathologic Diagnostic Laboratory, Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Hyunkyoung Lee
- Pathologic Diagnostic Laboratory, Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Jung-Won Park
- Pathologic Diagnostic Laboratory, Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Soon-Seek Yoon
- Pathologic Diagnostic Laboratory, Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Hyun-Ji Seo
- Parasitic and Insect Disease Laboratory, Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Jinhyeong Noh
- Parasitic and Insect Disease Laboratory, Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Mi-Sun Yoo
- Parasitic and Insect Disease Laboratory, Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Keun-Ho Kim
- Parasitic and Insect Disease Laboratory, Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Yeojin Park
- Parasitic and Insect Disease Laboratory, Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Yun Sang Cho
- Parasitic and Insect Disease Laboratory, Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
| | - Byung Jae So
- Pathologic Diagnostic Laboratory, Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Republic of Korea.
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Zawada SG, von Fricken ME, Weppelmann TA, Sikaroodi M, Gillevet PM. Optimization of tissue sampling for Borrelia burgdorferi in white-footed mice (Peromyscus leucopus). PLoS One 2020; 15:e0226798. [PMID: 31978068 PMCID: PMC6980393 DOI: 10.1371/journal.pone.0226798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
Peromyscus leucopus (the white-footed mouse) is a known reservoir of the Lyme disease spirochete Borrelia burgdorferi. Sampling of white-footed mice allows for year-round B. burgdorferi surveillance as well as opportunities to establish the diversity of the different variants in a geographic region. This study explores the prevalence of B. burgdorferi infections in the tissues of white-footed mice, investigates the correlations between B. burgdorferi infected tissues, and determines the optimum field methods for surveillance of B. burgdorferi in P. leucopus. A total of 90 mice and 573 tissues (spleen, liver, ear, tongue, tail, heart, and kidney) were screened via nested PCR for B. burgdorferi infections. A large number of infections were found in the 90 mice as well as multiple infections within individual mice. Infections in a single mouse tissue (spleen, liver, ear, tongue and tail) were predictive of concurrent infection in other tissues of the same mouse at a statistically significant level. Ear tissue accounted for 68.4% of detected infections, which increased to 78.9% of the infected mice with the inclusion of tail samples. The use of ear punch or tail snip samples (used individually or in tandem) have multiple advantages over current Lyme disease ecological studies and surveillance methodologies, including lower associated costs, minimization of delays, year-round B. burgdorferi testing opportunities, as well as longitudinal monitoring of B. burgdorferi in defined geographic regions. In the absence of an effective vaccine, personal prevention measures are currently the most effective way to reduce Lyme disease transmission to humans. Thus, the identification and monitoring of environmental reservoirs to inform at-risk populations remains a priority. The sampling methods proposed in this study provide a reasonable estimate of B. burgdorferi in white-footed mice in a timely and cost-effective manner.
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Affiliation(s)
- Sonya G. Zawada
- Department of Environmental Science & Public Policy, George Mason University, Fairfax, Virginia, United States of America
- Department of Biology, University of Mary Washington, Fredericksburg, Virginia, United States of America
- * E-mail:
| | - Michael E. von Fricken
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, United States of America
| | - Thomas A. Weppelmann
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Masoumeh Sikaroodi
- Department of Biology, George Mason University, Fairfax, Virginia, United States of America
| | - Patrick M. Gillevet
- Department of Biology, George Mason University, Fairfax, Virginia, United States of America
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Conforti C, Vezzoni R, Retrosi C, Longone M, Corneli P, Magaton Rizzi G, Nan K, Di Meo N, Zalaudek I. Overview on the treatment of Lyme disease in pregnancy. GIORN ITAL DERMAT V 2019; 155:220-222. [PMID: 31210468 DOI: 10.23736/s0392-0488.19.06396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lyme disease is a tick-borne illness, which is typically caused by Borrelia Burgdoferi. Over time, a typical Borreliosis skin reaction takes shape, i.e. the formation of an annular erythema that tends to expand centrifugally with erythematous edges whose diameter can reach up to 20 cm. The symptoms of Lyme disease are not only cutaneous but there may be a systemic involvement. Obviously, this disease can also affect pregnant women and for this reason this review aims to summarize the main ways of treatment to avoid worsening of the clinical condition in the mother and an eventual, albeit rare, involvement of the fetus.
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Affiliation(s)
- Claudio Conforti
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Roberta Vezzoni
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Chiara Retrosi
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy -
| | - Michela Longone
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paola Corneli
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | - Katiuscia Nan
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Nicola Di Meo
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Clinic of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
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11
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Lyme neuroborreliosis in children: Report of nine cases and a review of the literature. Arch Pediatr 2019; 26:133-137. [DOI: 10.1016/j.arcped.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/07/2019] [Accepted: 02/09/2019] [Indexed: 11/19/2022]
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Novak P, Felsenstein D, Mao C, Octavien NR, Zubcevik N. Association of small fiber neuropathy and post treatment Lyme disease syndrome. PLoS One 2019; 14:e0212222. [PMID: 30753241 PMCID: PMC6372188 DOI: 10.1371/journal.pone.0212222] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To examine whether post-treatment Lyme disease syndrome (PTLDS) defined by fatigue, cognitive complaints and widespread pain following the treatment of Lyme disease is associated with small fiber neuropathy (SFN) manifesting as autonomic and sensory dysfunction. METHODS This single center, retrospective study evaluated subjects with PTLDS. Skin biopsies for assessment of epidermal nerve fiber density (ENFD), sweat gland nerve fiber density (SGNFD) and functional autonomic testing (deep breathing, Valsalva maneuver and tilt test) were performed to assess SFN, severity of dysautonomia and cerebral blood flow abnormalities. Heart rate, end tidal CO2, blood pressure, and cerebral blood flow velocity (CBFv) from middle cerebral artery using transcranial Doppler were monitored. RESULTS 10 participants, 5/5 women/men, age 51.3 ± 14.7 years, BMI 27.6 ± 7.3 were analyzed. All participants were positive for Lyme infection by CDC criteria. At least one skin biopsy was abnormal in all ten participants. Abnormal ENFD was found in 9 participants, abnormal SGNFD in 5 participants, and both abnormal ENFD and SGNFD were detected in 4 participants. Parasympathetic failure was found in 7 participants and mild or moderate sympathetic adrenergic failure in all participants. Abnormal total CBFv score was found in all ten participants. Low orthostatic CBFv was found in 7 participants, three additional participants had abnormally reduced supine CBFv. CONCLUSIONS SFN appears to be associated with PTLDS and may be responsible for certain sensory symptoms. In addition, dysautonomia related to SFN and abnormal CBFv also seem to be linked to PTLDS. Reduced orthostatic CBFv can be associated with cerebral hypoperfusion and may lead to cognitive dysfunction. Autonomic failure detected in PTLDS is mild to moderate. SFN evaluation may be useful in PTLDS.
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Affiliation(s)
- Peter Novak
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Donna Felsenstein
- Department of Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Charlotte Mao
- Dean Center for Tick Borne Illness, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America
| | - Nadlyne R. Octavien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America
| | - Nevena Zubcevik
- Dean Center for Tick Borne Illness, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Dumic I, Severnini E. "Ticking Bomb": The Impact of Climate Change on the Incidence of Lyme Disease. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2018; 2018:5719081. [PMID: 30473737 PMCID: PMC6220411 DOI: 10.1155/2018/5719081] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/16/2018] [Indexed: 11/17/2022]
Abstract
Lyme disease (LD) is the most common tick-borne disease in North America. It is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks, Ixodes scapularis. The life cycle of the LD vector, I. scapularis, usually takes two to three years to complete and goes through three stages, all of which are dependent on environmental factors. Increases in daily average temperatures, a manifestation of climate change, might have contributed to an increase in tick abundance via higher rates of tick survival. Additionally, these environmental changes might have contributed to better host availability, which is necessary for tick feeding and life cycle completion. In fact, it has been shown that both tick activity and survival depend on temperature and humidity. In this study, we have examined the relationship between those climatic variables and the reported incidence of LD in 15 states that contribute to more than 95% of reported cases within the Unites States. Using fixed effects analysis for a panel of 468 U.S. counties from those high-incidence states with annual data available for the period 2000-2016, we have found sizable impacts of temperature on the incidence of LD. Those impacts can be described approximately by an inverted U-shaped relationship, consistent with patterns of tick survival and host-seeking behavior. Assuming a 2°C increase in annual average temperature-in line with mid-century (2036-2065) projections from the latest U.S. National Climate Assessment (NCA4)-we have predicted that the number of LD cases in the United States will increase by over 20 percent in the coming decades. These findings may help improving preparedness and response by clinicians, public health professionals, and policy makers, as well as raising public awareness of the importance of being cautious when engaging in outdoor activities.
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Affiliation(s)
- Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Edson Severnini
- Carnegie Mellon University, Heinz College, 4800 Forbes Ave., Pittsburgh, PA, USA
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14
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Mavin S, Evans R, Cornulier T, Bowman AS. The development of an IgG avidity Western blot with potential to differentiate patients with active Lyme borreliosis from those with past infection. J Microbiol Methods 2018; 146:71-76. [PMID: 29421691 DOI: 10.1016/j.mimet.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/02/2018] [Accepted: 02/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Current serological methods cannot distinguish active from past infection with Borrelia burgdorferi sensu lato. The aim of this study was to develop an IgG avidity Western blot and assess its potential to differentiate patients with early and late Lyme borreliosis (LB) i.e. active disease, from those infected in the past. METHODS An IgG avidity Western blot was developed. Penalized linear discriminant analysis (PLDA) was employed to compare the Western blot/avidity Western blot profiles of an evaluation panel consisting of 75 sera from patients with early (n = 26) and late (n = 24) LB and past infection (n = 25). The PLDA models produced were used to predict infection stage for 20 well characterised sera from the Centers for Disease Control and Prevention (CDC) Lyme disease serum repository and 112 routine seropositive sera (disease stage unknown), to validate and assess the usefulness of the avidity Western blot/avidity Western blot and PLDA approach. RESULTS PLDA correctly classified 40/51 (78%) of patients when early LB and past infection groups in the evaluation panel were compared. Likewise, when late LB and past infection groups were compared, 34/49 (69%) were correct. The resultant PLDA models correctly predicted infection stage for 18/20 (90%) of the CDC sera, validating the use of the avidity Western blot/avidity Western blot and PLDA approach. When tested with the routine sera, 21/29 (72%) tested with the early LB vs. past infection model were correct but only 32/83 (39%) with the late LB vs. past infection model. Past infection was predicted for 40/112 (35%) of the routine sera, 80% of which correlated with the clinical picture. CONCLUSION The Western blot/avidity Western blot with PLDA approach shows exciting potential for being able to predict disease stage in some patients with LB, which could improve patient management.
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Affiliation(s)
- Sally Mavin
- Raigmore Hospital, Inverness, UK; University of Aberdeen, Aberdeen, UK.
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15
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Rozwadowska B, Albertyńska M, Okła H, Jasik KP, Swinarew AS, Mazurek U, Dudek S, Urbańska-Jasik D, Poprawa I. Induction of Apoptosis in Normal Human Dermal Fibroblasts Infected withBorrelia burgdorferiSensu Lato. Vector Borne Zoonotic Dis 2017; 17:237-242. [DOI: 10.1089/vbz.2016.2057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Beata Rozwadowska
- Department of Skin Structural Studies, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Poland
| | - Marta Albertyńska
- Department of Skin Structural Studies, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Poland
| | - Hubert Okła
- Department of Skin Structural Studies, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Poland
- Institute of Materials Science, Faculty of Computer Science and Materials Science, University of Silesia in Katowice, Poland
| | - Krzysztof P. Jasik
- Department of Skin Structural Studies, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Poland
| | - Andrzej S. Swinarew
- Institute of Materials Science, Faculty of Computer Science and Materials Science, University of Silesia in Katowice, Poland
| | - Urszula Mazurek
- Department of Molecular Biology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Poland
| | - Sławomir Dudek
- Department of Pharmacognosy and Phytochemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Poland
| | - Danuta Urbańska-Jasik
- Department of Animal Histology and Embryology, Faculty of Biology and Environmental Protection, University of Silesia in Katowice, Poland
| | - Izabela Poprawa
- Department of Animal Histology and Embryology, Faculty of Biology and Environmental Protection, University of Silesia in Katowice, Poland
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16
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Potkonjak A, Kleinerman G, Gutiérrez R, Savić S, Vračar V, Nachum-Biala Y, Jurišić A, Rojas A, Petrović A, Ivanović I, Harrus S, Baneth G. Occurrence of Borrelia burgdorferi Sensu Lato in Ixodes ricinus Ticks with First Identification of Borrelia miyamotoi in Vojvodina, Serbia. Vector Borne Zoonotic Dis 2016; 16:631-5. [PMID: 27574731 DOI: 10.1089/vbz.2016.2008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Lyme borreliosis is the most common tick-borne infectious disease in Eurasia. Borrelia miyamotoi is the only known relapsing fever Borrelia group spirochete transmitted by Ixodes species. The aim of this study was to investigate the presence of Lyme Borrelia spp. and relapsing fever Borrelia spp. in Ixodes ricinus ticks collected from dogs and the vegetation from different parts of Vojvodina, Serbia. A total of 71 Ixodes ricinus ticks were collected and screened for the presence of Lyme Borrelia spp. group and relapsing fever Borrelia spp. by real-time PCR for the Borrelia flagellin B (flaB) gene followed by DNA sequencing of PCR products. Species identification was verified by PCR of the outer surface protein A (ospA) gene for Lyme Disease Borrelia spp. and by PCR of the glycerophosphodiester phosphodiesterase (glpQ) gene for relapsing fever Borrelia spp. Lyme Borrelia spp. were found in 15/71 (21.13%) of the ticks evaluated and included B. luisitaniae (11.3%), B. afzelii (7%), B. valaisiana (1.4%), and B. garinii (1.4%). Borrelia miyamotoi, from the relapsing fever Borrelia complex, was found, for the first time in Serbia, in one (1.4%) nymph collected from the environment. Co-infections between Borrelia species in ticks were not detected. These results suggest that the dominance of species within B. burgdorferi s.l. complex in I. ricinus ticks may vary over time and in different geographic regions. Further systematic studies of Borrelia species in vectors and reservoir hosts are needed to understand eco-epidemiology of these zoonotic infections and how to prevent human infection in the best way.
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Affiliation(s)
- Aleksandar Potkonjak
- 1 Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad , Novi Sad, Serbia
| | - Gabriela Kleinerman
- 2 Koret School of Veterinary Medicine, The Hebrew University of Jerusalem , Rehovot, Israel
| | - Ricardo Gutiérrez
- 2 Koret School of Veterinary Medicine, The Hebrew University of Jerusalem , Rehovot, Israel
| | - Sara Savić
- 3 Scientific Veterinary Institute "Novi Sad ," Novi Sad, Serbia
| | - Vuk Vračar
- 1 Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad , Novi Sad, Serbia
| | - Yaarit Nachum-Biala
- 2 Koret School of Veterinary Medicine, The Hebrew University of Jerusalem , Rehovot, Israel
| | - Aleksandar Jurišić
- 4 Department of Environmental and Plant Protection, Faculty of Agriculture, University of Novi Sad , Novi Sad, Serbia
| | - Alicia Rojas
- 2 Koret School of Veterinary Medicine, The Hebrew University of Jerusalem , Rehovot, Israel
| | - Aleksandra Petrović
- 4 Department of Environmental and Plant Protection, Faculty of Agriculture, University of Novi Sad , Novi Sad, Serbia
| | - Ivana Ivanović
- 4 Department of Environmental and Plant Protection, Faculty of Agriculture, University of Novi Sad , Novi Sad, Serbia
| | - Shimon Harrus
- 2 Koret School of Veterinary Medicine, The Hebrew University of Jerusalem , Rehovot, Israel
| | - Gad Baneth
- 2 Koret School of Veterinary Medicine, The Hebrew University of Jerusalem , Rehovot, Israel
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Jasik KP, Okła H, Słodki J, Rozwadowska B, Słodki A, Rupik W. Congenital Tick Borne Diseases: Is This An Alternative Route of Transmission of Tick-Borne Pathogens In Mammals? Vector Borne Zoonotic Dis 2016; 15:637-44. [PMID: 26565770 DOI: 10.1089/vbz.2015.1815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Tick-borne diseases (TBDs) have become a popular topic in many medical journals. Besides the obvious participation of ticks in the transmission of pathogens that cause TBD, little is written about alternative methods of their spread. An important role is played in this process by mammals, which serve as reservoirs. Transplacental transfer also plays important role in the spread of some TBD etiological agents. Reservoir species take part in the spread of pathogens, a phenomenon that has extreme importance in synanthropic environments. Animals that accompany humans and animals migrating from wild lands to urban areas increase the probability of pathogen infections by ticks This article provides an overview of TBDs, such as tick-borne encephalitis virus (TBEV), and TBDs caused by spirochetes, α-proteobacteria, γ-proteobacteria, and Apicomplexa, with particular attention to reports about their potential to cross the maternal placenta. For each disease, the method of propagation, symptoms of acute and chronic phase, and complications of their course in adults, children, and animals are described in detail. Additional information about transplacental transfer of these pathogens, effects of congenital diseases caused by them, and the possible effects of maternal infection to the fetus are also discussed. The problem of vertical transmission of pathogens presents a new challenge for medicine. Transfer of pathogens through the placenta may lead not only to propagation of diseases in the population, but also constitute a direct threat to health and fetal development. For this reason, the problem of vertical transmission requires more attention and an estimation of the impact of placental transfer for each of listed pathogens.
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Affiliation(s)
- Krzysztof P Jasik
- 1 Department of Skin Structural Studies, Medical University of Silesia in Katowice , School of Pharmacy with Division of Laboratory Medicine in Sosnowiec, Sosnowiec, Poland
| | - Hubert Okła
- 1 Department of Skin Structural Studies, Medical University of Silesia in Katowice , School of Pharmacy with Division of Laboratory Medicine in Sosnowiec, Sosnowiec, Poland .,2 University of Silesia in Katowice, Faculty of Computer Science and Material Science, Institute of Material Science , Katowice, Poland
| | - Jan Słodki
- 1 Department of Skin Structural Studies, Medical University of Silesia in Katowice , School of Pharmacy with Division of Laboratory Medicine in Sosnowiec, Sosnowiec, Poland
| | - Beata Rozwadowska
- 1 Department of Skin Structural Studies, Medical University of Silesia in Katowice , School of Pharmacy with Division of Laboratory Medicine in Sosnowiec, Sosnowiec, Poland .,3 Provincial Sanitary and Epidemiological Station in Katowice , Katowice, Poland
| | - Aleksandra Słodki
- 1 Department of Skin Structural Studies, Medical University of Silesia in Katowice , School of Pharmacy with Division of Laboratory Medicine in Sosnowiec, Sosnowiec, Poland
| | - Weronika Rupik
- 4 Department of Animal Histology and Embryology, University of Silesia in Katowice , Faculty of Biology and Environmental Protection, Katowice, Poland
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18
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Facial nerve palsy including Bell's palsy: Case definitions and guidelines for collection, analysis, and presentation of immunisation safety data. Vaccine 2016; 35:1972-1983. [PMID: 27235092 DOI: 10.1016/j.vaccine.2016.05.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
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Skogman BH, Sjöwall J, Lindgren PE. The NeBoP score - a clinical prediction test for evaluation of children with Lyme Neuroborreliosis in Europe. BMC Pediatr 2015; 15:214. [PMID: 26678681 PMCID: PMC4682231 DOI: 10.1186/s12887-015-0537-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/12/2015] [Indexed: 11/25/2022] Open
Abstract
Background The diagnosis of Lyme neuroborreliosis (LNB) in Europe is based on clinical symptoms and laboratory data, such as pleocytosis and anti-Borrelia antibodies in serum and CSF according to guidelines. However, the decision to start antibiotic treatment on admission cannot be based on Borrelia serology since results are not available at the time of lumbar puncture. Therefore, an early prediction test would be useful in clinical practice. The aim of the study was to develop and evaluate a clinical prediction test for children with LNB in a relevant European setting. Method Clinical and laboratory data were collected retrospectively from a cohort of children being evaluated for LNB in Southeast Sweden. A clinical neuroborreliosis prediction test, the NeBoP score, was designed to differentiate between a high and a low risk of having LNB. The NeBoP score was then prospectively validated in a cohort of children being evaluated for LNB in Central and Southeast Sweden (n = 190) and controls with other specific diagnoses (n = 49). Results The sensitivity of the NeBoP score was 90 % (CI 95 %; 82–99 %) and the specificity was 90 % (CI 95 %; 85–96 %). Thus, the diagnostic accuracy (i.e. how the test correctly discriminates patients from controls) was 90 % and the area under the curve in a ROC analysis was 0.95. The positive predictive value (PPV) was 0.83 (CI 95 %; 0.75–0.93) and the negative predictive value (NPV) was 0.95 (CI 95 %; 0.90–0.99). Conclusion The overall diagnostic performance of the NeBoP score is high (90 %) and the test is suggested to be useful for decision-making about early antibiotic treatment in children being evaluated for LNB in European Lyme endemic areas. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0537-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barbro H Skogman
- Paediatric clinic, Falun General Hospital, Nissers väg 3, S-791 82, Falun, Sweden. .,Center for Clinical Research (CKF) Dalarna-Uppsala University, S-791 31, Falun, Sweden.
| | - Johanna Sjöwall
- Clinic of Infectious Diseases, Linköping University Hospital, S-581 85, Linköping, Sweden.
| | - Per-Eric Lindgren
- Department of Clinical and Experimental Medicine, Medical Microbiology, Linköping University, S-581 85, Linköping, Sweden. .,Microbiological Laboratory, Medical Services, County Hospital Ryhov, S-551 85, Jönköping, Sweden.
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Admani S, Jinna S, Friedlander SF, Sloan B. Cutaneous infectious diseases: Kids are not just little people. Clin Dermatol 2015; 33:657-71. [PMID: 26686017 DOI: 10.1016/j.clindermatol.2015.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The changes in immune response that occur with age play a significant role in disease presentation and patient management. Evolution of the innate and adaptive immune systems throughout life, influenced partly by hormonal changes associated with puberty, plays a role in the differences between pediatric and adult response to disease. We review a series of manifestations of dermatologic infectious diseases spanning bacterial, viral, and fungal origins that can be seen in both pediatric and adult age groups and highlight similarities and differences in presentation and disease course. Therapeutic options are also discussed for these infectious diseases, with particular attention to variations in management between these population subgroups, given differences in pharmacokinetics and side effect profiles.
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Affiliation(s)
- Shehla Admani
- Department of Pediatric Dermatology, University of California at San Diego School of Medicine, San Diego, CA
| | - Sphoorthi Jinna
- Department of Dermatology, University of Connecticut Health Sciences, 21 South Road, Farmington, CT, 06032
| | - Sheila Fallon Friedlander
- Fellowship Training Program, Rady Children's Hospital, Department of Clinical Pediatrics & Medicine, University of California at San Diego School of Medicine, 8010 Frost Street, Suite 602, San Diego, CA 92123
| | - Brett Sloan
- Department of Dermatology, University of Connecticut Health Sciences, 21 South Road, Farmington, CT, 06032.
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Abstract
Monoarthritis, defined as inflammation of a single joint, requires a thorough physical examination in children, as pain may be lacking in 10% to 30% of cases and joint stiffness may be the only symptom. Joint aspiration is a crucial diagnostic tool that remains markedly underused. Joint aspiration may be unnecessary, however, when the family history or other investigations provide the diagnosis. Radiographs of the involved joint may supply information on the severity of the lesions. In doubtful cases and in patients with arthralgia, B-mode and Doppler ultrasound or magnetic resonance imaging (MRI) may confirm the presence of synovitis. Although suspected septic arthritis is an emergency and occurs frequently, particularly before 2 years of age, acute monoarthritis is often a post-infectious manifestation and therefore associated with a good outcome. Lyme disease should be sought, particularly when a lower limb joint is involved, as tick bites often go unnoticed. Chronic monoarthritis is very often a manifestation of juvenile idiopathic arthritis (JIA), which exists as several variants. Oligoarthritis is a specifically pediatric joint disease, whereas the other patterns of JIA have corresponding forms in adults, despite a number of specific features due to their onset during childhood. Tests for antinuclear antibodies should be performed routinely in children with monoarthritis persisting longer than 3 weeks. A decline in general health or a fever should suggest arthritis revealing a malignancy, which is a hematological disease in most cases. Finally, suggestive symptoms are often present in patients with less common causes such as auto-inflammatory diseases and connective tissue diseases.
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Leroux J, Vivier PH, Grall M, Foulongne E, Ould Slimane M, Abu Amara S, Lechevallier J. Arthrite de Lyme chez l’enfant : un piège diagnostique. Arch Pediatr 2013; 20:1139-42. [DOI: 10.1016/j.arcped.2013.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/24/2013] [Accepted: 07/13/2013] [Indexed: 11/28/2022]
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Esposito S, Bosis S, Sabatini C, Tagliaferri L, Principi N. Borrelia burgdorferi infection and Lyme disease in children. Int J Infect Dis 2013; 17:e153-8. [DOI: 10.1016/j.ijid.2012.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/26/2012] [Indexed: 12/01/2022] Open
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Management of paediatric Lyme disease in non-endemic and endemic areas: data from the Registry of the Italian Society for Pediatric Infectious Diseases. Eur J Clin Microbiol Infect Dis 2012; 32:523-9. [DOI: 10.1007/s10096-012-1768-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
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Ear presentation of Lyme borreliosis in a child. The Journal of Laryngology & Otology 2012; 126:1176-8. [PMID: 22906364 DOI: 10.1017/s0022215112001582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This case report aims to raise awareness amongst clinicians of ear presentation of cutaneous borrelia. CASE REPORT We report a recent case of borrelia lymphocytoma cutis benigna in a child presenting with unilateral earlobe swelling, who was otherwise well. A review of the English language literature, including management of the disease, is also presented. CONCLUSION This case highlights the fact that borrelia lymphocytoma should be included in the differential diagnosis of a persistent, unilateral, inflamed, swollen earlobe in an otherwise healthy child.
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Santos M, Haddad Júnior V, Ribeiro-Rodrigues R, Talhari S. Lyme borreliosis. An Bras Dermatol 2011; 85:930-8. [PMID: 21308327 DOI: 10.1590/s0365-05962010000600029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Indexed: 11/22/2022] Open
Abstract
Borreliosis is an infectious disease caused by spirochetes of the genus Borrelia. Lyme borreliosis, also known as Lyme disease, is a non-contagious infectious disease caused by spirochetes belonging to the complex Borrelia burgdorferi sensu lato and more often transmitted by the bite of infected ticks of the genus Ixodes.The disease is characterized by a varied clinical profile, which can trigger cutaneous, articular, neurological and cardiac manifestations.
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Affiliation(s)
- Mônica Santos
- Tropical Medicine Foundation of Amazonas, State University of Amazonas, Manaus, AM, Brazil
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Abstract
BACKGROUND AND PURPOSE Lyme disease is well documented in the literature; however, specific physical therapy interventions for the pediatric population with residual effects of Lyme disease have not been addressed. The purposes of this retrospective case report are: (1) to present an example of a therapeutic intervention for a pediatric patient in the late stages of Lyme disease with related musculoskeletal dysfunction and severely impaired quality of life, (2) to report the patient's functional outcomes from treatment, and (3) to discuss implications for treatment of patients with musculoskeletal dysfunction in the late stages of Lyme disease. CASE DESCRIPTION The patient was a 14-year old girl who had contracted Lyme disease 1 year prior to initiation of physical therapy. She was unable to participate with her peers in school, church, and sporting events due to significant impairments in strength (force-generating capacity), endurance, and gait; fatigue; pain; and total body tremor. Therapeutic exercise and gait training were used for treatment. The patient actively participated in managing her care by providing feedback during interventions and setting goals. OUTCOMES After 18 weeks of treatment, the patient achieved 96.7% of her predicted distance on the Six-Minute Walk Test with normal gait mechanics and returned to playing high school sports. She had a manual muscle test grade of 4/5 or greater in major extremity muscle groups. She returned to school and church participation with minimal total body tremor when fatigued and daily pain rated 0 to 3/10. DISCUSSION Therapeutic exercise and gait training may facilitate return to function in an adolescent patient with late effects of Lyme disease. Further investigation is advised to establish treatment effects in a broader population.
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Mc Causland FR, Niedermaier S, Bijol V, Rennke HG, Choi ME, Forman JP. Lyme disease-associated glomerulonephritis. Nephrol Dial Transplant 2011; 26:3054-6. [DOI: 10.1093/ndt/gfr335] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Fossati-Bellani MR, Steele RW. A 4-year-old with a "pirate face". Clin Pediatr (Phila) 2011; 50:567-9. [PMID: 21138849 DOI: 10.1177/0009922810389173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marco R Fossati-Bellani
- Ochsner Children's Health Center and Tulane University School of Medicine, New Orleans, LA, USA.
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Sharma A, Jaimungal S, Basdeo-Maharaj K, Chalapathi Rao AV, Teelucksingh S. Erythema migrans-like illness among Caribbean islanders. Emerg Infect Dis 2011; 16:1615-7. [PMID: 20875293 PMCID: PMC3294399 DOI: 10.3201/eid1610.100587] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Erythema migrans is the skin manifestation of Lyme disease and southern tick-associated rash illness. Neither disease is found in the Caribbean. We report 4 cases of erythema migrans of a possible emerging clinical entity, Caribbean erythma migrans–like illness.
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Affiliation(s)
- Anu Sharma
- University of the West Indies, St. Augustine, Trinidad and Tobago.
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32
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Knowledge on Lyme disease among foresters. Int J Occup Med Environ Health 2011; 24:78-93. [DOI: 10.2478/s13382-011-0001-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 09/28/2010] [Indexed: 11/20/2022] Open
Abstract
Abstract
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Cotté V, Bonnet S, Cote M, Vayssier-Taussat M. Prevalence of Five Pathogenic Agents in QuestingIxodes ricinusTicks from Western France. Vector Borne Zoonotic Dis 2010; 10:723-30. [DOI: 10.1089/vbz.2009.0066] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Violaine Cotté
- UMR 956 INRA/AFSSA/ENVA/UPVM, AFSSA, Maisons-Alfort, France
| | - Sarah Bonnet
- UMR 956 INRA/AFSSA/ENVA/UPVM, AFSSA, Maisons-Alfort, France
- UMR BIOEPAR, Atlanpole, La Chantrerie, Nantes, France
| | - Martine Cote
- UMR 956 INRA/AFSSA/ENVA/UPVM, AFSSA, Maisons-Alfort, France
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McKay G, Gill I, Chauhan S. Lyme disease: an unusual case of peripheral nerve palsy. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2010; 92:713-715. [PMID: 20436011 DOI: 10.1302/0301-620x.92b5.23345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Lyme disease is a vector-borne multisystem inflammatory disease caused by the spirochete Borrelia burgdorferi sensu lato. This disease is frequently seen in North America and to a lesser degree in Europe. However, its presence in England is uncommon and we present a case in which the patient developed a palsy of the common peroneal nerve.
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Affiliation(s)
- G McKay
- Trauma and Orthopaedic Department Royal Sussex County Hospital, BSUH NHS Trust, Eastern Road, Brighton, N2 5BE, UK
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Lim S, Irwin PJ, Lee S, Oh M, Ahn K, Myung B, Shin S. Comparison of selected canine vector-borne diseases between urban animal shelter and rural hunting dogs in Korea. Parasit Vectors 2010; 3:32. [PMID: 20377869 PMCID: PMC2860352 DOI: 10.1186/1756-3305-3-32] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/08/2010] [Indexed: 12/02/2022] Open
Abstract
A serological survey for Dirofilaria immitis, Anaplasma phagocytophilum, Ehrlichia canis, and Borrelia burgdorferi infections in rural hunting and urban shelter dogs mainly from southwestern regions of the Republic of Korea (South Korea) was conducted. From a total of 229 wild boar or pheasant hunting dogs, the number of serologically positive dogs for any of the four pathogens was 93 (40.6%). The highest prevalence observed was D. immitis (22.3%), followed by A. phagocytophilum (18.8%), E. canis (6.1%) and the lowest prevalence was B. burgdorferi (2.2%). In contrast, stray dogs found within the city limits of Gwangju showed seropositivity only to D. immitis (14.6%), and none of the 692 dogs responded positive for A. phagocytophilum, E. canis or B. burgdorferi antibodies. This study indicates that the risk of exposure to vector-borne diseases in rural hunting dogs can be quite high in Korea, while the urban environment may not be suitable for tick infestation on dogs, as evidenced by the low infection status of tick-borne pathogens in stray dogs.
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Affiliation(s)
- Sun Lim
- College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, Korea.
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Abstract
Lyme disease, caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States. The clinical presentation varies depending on the stage of the illness: early disease includes erthyma migrans, early disseminated disease includes multiple erythema migrans, meningitis, cranial nerve palsies, and carditis; late disease is primarily arthritis. The symptoms and signs of infection resolve in most patients after treatment with appropriate antimicrobials for 2 to 4 weeks. Serologic testing should be used judiciously as it often results in misdiagnosis when performed on blood from patients with a low prior probability of disease and those with only nonspecific symptoms such as fatigue or arthralgia without objective signs of infection.
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Affiliation(s)
- Thomas S. Murray
- Associate Research Scientist of Pediatrics and Laboratory Medicine, Yale University School of Medicine
| | - Eugene D. Shapiro
- Professor of Pediatrics, Epidemiology and Public Health and Investigative Medicine, Yale University School of Medicine
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Medrano MS, Policastro PF, Schwan TG, Coburn J. Interaction of Borrelia burgdorferi Hbb with the p66 promoter. Nucleic Acids Res 2009; 38:414-27. [PMID: 19910373 PMCID: PMC2811001 DOI: 10.1093/nar/gkp1027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Borrelia burgdorferi, an agent of Lyme disease, encodes the β3-chain integrin ligand P66. P66 is expressed by B. burgdorferi in the mammal, in laboratory media, and as the bacteria are acquired or transmitted by the tick, but is not expressed by the bacterium in unfed ticks. Attempts to reveal factors influencing expression revealed that P66 was expressed in all in vitro conditions investigated. Candidate regulators identified in a search of the B. burgdorferi genome for homologs to other bacterial transcription factors were cloned and introduced into E. coli carrying a p66 promoter-signal sequence-phoA (alkaline phosphatase, or AP) fusion. Three candidate transcription factors—two that decreased AP activity (Hbb and BB0527), and one that increased AP activity (BBA23)—were identified. BBA23 and BB0527 did not bind to the p66 promoter at physiologically relevant concentrations. In contrast, several promoter fragments, including p66, were bound by Hbb (BB0232), with slightly different affinities. Consistent with results from other laboratories, Hbb appears to recognize multiple DNA sequences. Changes in the expression of p66 and bb0232 in the tick at various points with respect to feeding on mice, along with the results of the reporter experiment in the surrogate host E. coli, are consistent with Hbb/BB0232 being involved in regulating p66 expression.
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Affiliation(s)
- Melisa S Medrano
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA 02111, USA
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Miklossy J, Kasas S, Zurn AD, McCall S, Yu S, McGeer PL. Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis. J Neuroinflammation 2008; 5:40. [PMID: 18817547 PMCID: PMC2564911 DOI: 10.1186/1742-2094-5-40] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 09/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long latent stage seen in syphilis, followed by chronic central nervous system infection and inflammation, can be explained by the persistence of atypical cystic and granular forms of Treponema pallidum. We investigated whether a similar situation may occur in Lyme neuroborreliosis. METHOD Atypical forms of Borrelia burgdorferi spirochetes were induced exposing cultures of Borrelia burgdorferi (strains B31 and ADB1) to such unfavorable conditions as osmotic and heat shock, and exposure to the binding agents Thioflavin S and Congo red. We also analyzed whether these forms may be induced in vitro, following infection of primary chicken and rat neurons, as well as rat and human astrocytes. We further analyzed whether atypical forms similar to those induced in vitro may also occur in vivo, in brains of three patients with Lyme neuroborreliosis. We used immunohistochemical methods to detect evidence of neuroinflammation in the form of reactive microglia and astrocytes. RESULTS Under these conditions we observed atypical cystic, rolled and granular forms of these spirochetes. We characterized these abnormal forms by histochemical, immunohistochemical, dark field and atomic force microscopy (AFM) methods. The atypical and cystic forms found in the brains of three patients with neuropathologically confirmed Lyme neuroborreliosis were identical to those induced in vitro. We also observed nuclear fragmentation of the infected astrocytes using the TUNEL method. Abundant HLA-DR positive microglia and GFAP positive reactive astrocytes were present in the cerebral cortex. CONCLUSION The results indicate that atypical extra- and intracellular pleomorphic and cystic forms of Borrelia burgdorferi and local neuroinflammation occur in the brain in chronic Lyme neuroborreliosis. The persistence of these more resistant spirochete forms, and their intracellular location in neurons and glial cells, may explain the long latent stage and persistence of Borrelia infection. The results also suggest that Borrelia burgdorferi may induce cellular dysfunction and apoptosis. The detection and recognition of atypical, cystic and granular forms in infected tissues is essential for the diagnosis and the treatment as they can occur in the absence of the typical spiral Borrelia form.
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Affiliation(s)
- Judith Miklossy
- Kinsmen Laboratory of Neurological Research, University of British Columbia, 2255 Wesbrook Mall, Vancouver, B.C. V6T1Z3, Canada
| | - Sandor Kasas
- Laboratoire de Physique de la Matière Vivante, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland and Département de Biologie Cellulaire et de Morphologie, Université de Lausanne, 1005 Lausanne, Switzerland
| | - Anne D Zurn
- Department of Experimental Surgery, Lausanne University Hospital, CH-1011 Lausanne, Switzerland
| | - Sherman McCall
- Pathology Laboratory, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter St., Ft. Detrick, MD 21702-5011, USA
| | - Sheng Yu
- Kinsmen Laboratory of Neurological Research, University of British Columbia, 2255 Wesbrook Mall, Vancouver, B.C. V6T1Z3, Canada
| | - Patrick L McGeer
- Kinsmen Laboratory of Neurological Research, University of British Columbia, 2255 Wesbrook Mall, Vancouver, B.C. V6T1Z3, Canada
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Blaho VA, Mitchell WJ, Brown CR. Arthritis develops but fails to resolve during inhibition of cyclooxygenase 2 in a murine model of Lyme disease. ACTA ACUST UNITED AC 2008; 58:1485-95. [PMID: 18438879 DOI: 10.1002/art.23371] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recent studies have implicated products of cyclooxygenase 2 (COX-2) in not only induction but also resolution of the inflammatory response; however, the contribution of COX-2 products to the in vivo response to infection is unknown. The aim of this study was to determine the contribution of COX-2 to temporal regulation of the inflammatory response to infection in a murine model of Lyme arthritis. METHODS Experimental Lyme disease was induced in both arthritis-resistant DBA/2J and arthritis-susceptible C3H/HeJ mice by inoculation in the hind footpads with Borrelia burgdorferi. COX-2 inhibitors were administered daily, and their effect on arthritis pathology was assessed at various time points postinfection. The COX-2 deficiency was also backcrossed onto both DBA and C3H backgrounds to confirm the findings from COX-2 inhibitor-treated mice. RESULTS In COX-2 inhibitor-treated or COX-2-/- C3H mice, arthritis developed normally but did not resolve. Cessation of COX-2 inhibitor treatment on day 14 postinfection did not induce resolution of arthritis, indicating an early onset for the molecular mechanisms governing resolution. The lack of resolution of arthritis correlated with altered COX-2 and cytosolic phospholipase A2 messenger RNA levels in the joints of C3H mice. In addition, the proresolution lipid molecule 15-deoxy-Delta12,14-prostaglandin J2 was produced in response to B burgdorferi infection, and its production was attenuated by the inhibition of COX-2. CONCLUSION Our results demonstrate that early production of COX-2 products is necessary for resolution of the inflammatory arthritis induced by Borrelia infection, and that COX-2 inhibition may result in prolonged inflammatory states, possibly by inhibition of proresolution eicosanoids.
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Miklossy J. Biology and neuropathology of dementia in syphilis and Lyme disease. HANDBOOK OF CLINICAL NEUROLOGY 2008; 89:825-44. [PMID: 18631798 DOI: 10.1016/s0072-9752(07)01272-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Judith Miklossy
- University of British Columbia, Kinsmen Laboratory of Neurological Research, Vancouver, BC, Canada.
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Rath B, Linder T, Cornblath D, Hudson M, Fernandopulle R, Hartmann K, Heininger U, Izurieta H, Killion L, Kokotis P, Oleske J, Vajdy M, Wong V. “All that palsies is not Bell's [1]”—The need to define Bell's palsy as an adverse event following immunization. Vaccine 2007; 26:1-14. [DOI: 10.1016/j.vaccine.2007.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/16/2007] [Accepted: 10/18/2007] [Indexed: 12/01/2022]
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Patey O. [Lyme disease: prophylaxis after tick bite]. Med Mal Infect 2007; 37:446-55. [PMID: 17399928 DOI: 10.1016/j.medmal.2006.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 11/25/2022]
Abstract
Lyme disease is a bacterial infection caused by Borrelia burgdorferi, which is transmitted by infected ticks. The transmission depends on several factors, especially on the duration of the tick's presence in the host body (the nymph which is smaller than the adults and thus less visible, is in this case the most frequently involved) and on whether the tick is infected or not. The interpretation of results in the few available studies is made difficult by the lack of information obtained (due to difficulty to collect information and examination costs). The comparison is made even more difficult by the difference between Borrelia ticks species in various regions. Today, the best methods are preventive: protective clothing, tick repellents, checking and removal of ticks after a journey in an endemic zone, and in case of tick bite, regular examination of the bite site during the following weeks in order to initiate an early curative treatment if ECM is diagnosed. The currently available data seems to be insufficient to suggest systematic antimicrobial prophylaxis in case of tick bite.
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Affiliation(s)
- O Patey
- Service des maladies infectieuses et tropicales, groupe études épidémiologique et prophylactique, CHI de Villeneuve-Saint-Georges, 94195 Villeneuve-Saint-Georges, France.
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Torres Claveras S, Duplá Arenaz M, García Jiménez MC. Borreliosis. A propósito de un caso de enfermedad de Lyme. An Pediatr (Barc) 2006; 64:500-1. [PMID: 16756899 DOI: 10.1157/13087886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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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Shoemaker RC, Hudnell HK, House DE, Van Kempen A, Pakes GE. Atovaquone plus cholestyramine in patients coinfected with Babesia microti and Borrelia burgdorferi refractory to other treatment. Adv Ther 2006; 23:1-11. [PMID: 16644602 DOI: 10.1007/bf02850341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ten percent of US patients with Lyme disease are coinfected with Babesia microti. A double-blind, placebo-controlled, crossover trial enrolled 25 patients with confirmed Borrelia burgdorferi/B microti coinfection, abnormal visual contrast sensitivity (VCS), and persistent symptoms despite prior treatment with atovaquone and azithromycin. Patients were randomly assigned to atovaquone suspension or placebo plus cholestyramine for 3 weeks, were crossed over for 3 weeks, and then received open-label atovaquone and cholestyramine for 6 weeks. Symptoms and VCS scores were recorded at baseline and after weeks 3, 6, 9, and 12. Improvements in symptoms and VCS deficits were observed only after at least 9 weeks of treatment. At week 12, 5 patients were asymptomatic, and 16 had a notable reduction in the number of symptoms. The entire cohort demonstrated significant increases in VCS scores. Adverse effects were rare. Patients coinfected with B burgdorferi and B microti derive measurable clinical benefit from prolonged treatment with atovaquone and cholestyramine. Longer-term combination therapy may be indicated.
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Affiliation(s)
- Ritchie C Shoemaker
- Center for Research on Biotoxin-Associated Illnesses Pocomoke City, Maryland 21851, USA
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Abstract
Lyme borreliosis (Lyme disease) is the most common tick-borne bacterial infection and the incidence is increasing in parts of Europe and the USA. Prompt antimicrobial therapy using oral agents such as doxycycline or amoxicillin is successful among more than 90% of patients. Inadequate penetration of oral agents into the CNS may result in the development of overt neuroborreliosis. The parenteral agent ceftriaxone is the drug of choice for severe acute and chronic infections, due to good penetration into CSF, convenient single daily dosage regimen and proven high efficacy in clinical trials involving a wide variety of disseminated infections. Regardless of therapeutic agent, there appears to a small minority of patients (<10%) who do not respond; such cases may be due to long-term persistence of borrelial cysts and to misdiagnoses based solely on seropositivity. Several adjunct therapies are available, including hyperbaric oxygen therapy and immune system supplements, but clinical trials have yet to be conducted.
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Weissenbacher S, Ring J, Hofmann H. Gabapentin for the Symptomatic Treatment of Chronic Neuropathic Pain in Patients with Late-Stage Lyme Borreliosis: A Pilot Study. Dermatology 2005; 211:123-7. [PMID: 16088158 DOI: 10.1159/000086441] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 10/08/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic neuropathic pain occurs in 10-15% of patients with neuroborreliosis and is difficult to treat. OBJECTIVE We evaluated the effect of gabapentin monotherapy on residual pain in patients with neuroborreliosis after intravenous ceftriaxone treatment. METHODS Ten patients with neuroborreliosis and a long-lasting history of neurologic symptoms were treated with gabapentin, starting with 300 mg/day. Doses were raised over a period of 4-12 weeks to the individually effective and tolerated maximum dose (500-1,200 mg). Treatment was maintained until pain disappeared and then gradually reduced in dose over weeks. If symptoms recurred, the doses were raised again. Therapy was maintained over an average of 1-2 years. RESULTS Pain quality and pain quantity were evaluated using the McGill pain questionnaire and a visual analogue scale. There was an improvement of 'crawling' and 'burning' pain sensations, neck and radiating lumbar pain in 9/10 (90%) patients as well as a positive effect on mood, general feeling of health and quality of sleep in 5/10 (50%) patients. The average dose leading to a clear-cut pain reduction was 700 mg. CONCLUSIONS In an open pilot study (10 patients), gabapentin monotherapy which has to our knowledge not been published as treatment of chronic neuropathic pain in patients with late Lyme borreliosis is efficacious in treating pain associated with neuroborreliosis and can thus improve quality of life in these patients.
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Affiliation(s)
- S Weissenbacher
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
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Abstract
Bone and joint infections are a significant cause of morbidity in infants and young children. Although many principles regarding pathogenesis, diagnosis, and treatment of infection have remained constant over the years, other aspects of this important pediatric diagnosis are continuing to evolve. This article reviews current information regarding pathogenesis, epidemiology, and microbiology of pediatric bone and joint infections and the clinical presentation, diagnosis, and treatment of these infections.
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Affiliation(s)
- Kathleen Gutierrez
- Department of Pediatrics, Division of Pediatric Infectious Disease, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Kadz B, Putteman A, Verougstraete C, Caspers L. La maladie de Lyme du point de vue de l’ophtalmologue. J Fr Ophtalmol 2005; 28:218-23. [PMID: 15851957 DOI: 10.1016/s0181-5512(05)81046-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The first case of Lyme disease was described more than 25 years ago in the city of Lyme, Connecticut (USA) and although the responsible pathogenic organism is known (Borrelia Burgdorferi) as well as its vector (a tick from the Ixode genus), it is still underdiagnosed and often poorly known by practitioners. The symptomatology is classically divided into three phases depending on the time between the tick bite and the first symptoms. However, in a number of cases this clinical division of the disease is not easily applied. We describe three cases of atypical ocular manifestations to illustrate this problem. Recently developed laboratory tests help confirm the diagnosis but should not be used without a good knowledge of the disease. This study aims to emphasize the difficulty of diagnosis and the importance of appropriate treatment and to avoid potentially permanent complications.
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Affiliation(s)
- B Kadz
- Service d'Ophtalmologie, CHU Saint Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Bruxelles, Belgique.
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