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Hospach T, Kallinich T, Martin L, V Kalle T, Reichert F, Girschick HJ, Hedrich CM. [Arthritis and osteomyelitis in childhood and adolescence-Bacterial and nonbacterial]. Z Rheumatol 2024:10.1007/s00393-024-01504-z. [PMID: 38653784 DOI: 10.1007/s00393-024-01504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
Bacterial arthritis and osteomyelitis are usually acute diseases, which in this way differ from the often insidious course of nonbacterial osteomyelitis; however, there is often an overlap both in less acute courses of bacterial illnesses and also in nonbacterial osteitis. The overlapping clinical phenomena can be explained by similar pathophysiological processes. In bacteria-related illnesses the identification of the pathogen and empirical or targeted anti-infectious treatment are prioritized, whereas no triggering agent is known for nonbacterial diseases. The diagnostics are based on the exclusion of differential diagnoses, clinical scores and magnetic resonance imaging (MRI). An activity-adapted anti-inflammatory treatment is indicated.
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Affiliation(s)
- T Hospach
- Zentrum für Pädiatrische Rheumatologie, Olgahospital, Klinikum Stuttgart (ZEPRAS), Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - T Kallinich
- Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - L Martin
- Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - T V Kalle
- Radiologisches Institut, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland
| | - F Reichert
- Pädiatrische Infektiologie, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland
| | - H J Girschick
- Vivantes Klinikum Friedrichshain, Berlin, Deutschland
| | - C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, Großbritannien
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Großbritannien
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2
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Kašpárková N, Bártová E, Žákovská A, Budíková M, Sedlák K. Antibodies against Borrelia burgdorferi Sensu Lato in Clinically Healthy and Sick Horses: First Report from the Czech Republic. Microorganisms 2023; 11:1706. [PMID: 37512879 PMCID: PMC10386530 DOI: 10.3390/microorganisms11071706] [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: 04/25/2023] [Revised: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Lyme disease, caused by some strains of bacterial spirochetes Borrelia burgdorferi sensu lato (Bbsl), affects humans but also domestic animals including horses. The primary pathogens in horses in Europe are B. afzelii, B. garinii and B. burgdorferi sensu stricto. To our knowledge, there are no data available on the seropositivity of B. burgdorferi s.l. in horses from the Czech Republic. In this country, horses are mainly used for sport, breeding, and recreational riding in areas where vectors of B. burgdorferi s.l. are present, which is why they are frequently at risk of infection. The aim of the study was to detect anti-borrelia IgM and IgG antibodies in clinically healthy and sick horses from the Czech Republic and to evaluate the risk factors of infection. In total, sera of 262 horses (247 clinically healthy horses and 15 horses hospitalized due to symptoms of encephalitis/meningoencephalitis) were examined by an indirect sandwich enzyme-linked immunosorbent assay. Positivity of B. burgdorferi was 27% (66/247) in clinically healthy horses (21% IgM, 7% IgG and 3% IgM + IgG antibodies) and 20% (3/15) in horses with clinical signs (20% IgM, 7% IgG and 7% IgM + IgG). In the clinically healthy horses, positivity statistically differed (p ≤ 0.05) only in Pony and Warmblood breeds, being the most affected at 32% and 30%, respectively, while other characteristics (sex, age, usage and localities) had no effect on positivity. This is the first survey of antibodies to B. burgdorferi s.l. in Czech horses showing that horses are exposed to ticks infected with B. burgdorferi s.l. This should be taken into account when making differential diagnoses in patients with non-specific symptoms to start with adequate therapy.
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Affiliation(s)
- Nikola Kašpárková
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Eva Bártová
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Alena Žákovská
- Department of Experimental Biology, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Biology, Faculty of Education, Masaryk University, Poříčí 7/9, 625 00 Brno, Czech Republic
| | - Marie Budíková
- Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Kotlářská 267/2, 611 37 Brno, Czech Republic
| | - Kamil Sedlák
- State Veterinary Institute Prague, Sídlištní 136/24, 165 03 Prague, Czech Republic
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Sowula K, Szaleniec J, Stolcman K, Ceranowicz P, Kocoń S, Tomik J. Association between Sudden Sensorineural Hearing Loss and Lyme Disease. J Clin Med 2021; 10:jcm10051130. [PMID: 33800352 PMCID: PMC7962810 DOI: 10.3390/jcm10051130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives: Sudden sensorineural hearing loss (SSNHL) is defined as sensorineural hearing loss of 30 dB or more over at least three adjacent audiometric frequencies occurring within a 72-h period of time. One of the causes of SSNHL could be the progressive inflammatory state caused by an infection. The aim of this study was to assess the prevalence of SSNHL caused by various factors, most importantly those potentially related to Lyme disease. Material and Methods: The study includes a group of 86 patients between the ages of 20 and 70 who were hospitalized due to SSNHL between 2017 and 2018. All of these patients underwent a detailed medical interview and an otolaryngological examination, including audiological and diagnostic tests. Additionally, ELISA and Western blot tests were performed to confirm the diagnosis of Lyme disease. Results: In this group of 86 patients, nine patients presented with positive antibodies toward Borrelia burgdorferi sensu lato. This group was treated with antibiotics and experienced partial or complete regression of their deafness. This may suggest a relationship between SSNHL and Lyme disease. Conclusion: Infections caused by Borrelia burgdorferi may contribute to the development of inflammatory and angiopathic lesions, which are a possible cause of SSNHL. The longer the duration of the infection, the greater the likelihood of permanent and irreversible changes in the vessels of the cochlea or auditory nerve. Therefore, serological tests for Borrelia burgdorferi should be performed during the diagnosis of SSNHL as a possible cause of this illness.
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Affiliation(s)
- Klaudia Sowula
- ENT Department, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (K.S.); (J.S.); (K.S.); (S.K.)
| | - Joanna Szaleniec
- ENT Department, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (K.S.); (J.S.); (K.S.); (S.K.)
| | - Kamila Stolcman
- ENT Department, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (K.S.); (J.S.); (K.S.); (S.K.)
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16, 31-531 Krakow, Poland;
| | - Sebastian Kocoń
- ENT Department, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (K.S.); (J.S.); (K.S.); (S.K.)
| | - Jerzy Tomik
- ENT Department, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688 Krakow, Poland; (K.S.); (J.S.); (K.S.); (S.K.)
- Correspondence: ; Tel.: +48-603-877-201; Fax: +48-124-24-7925
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Anadure R, Saxena R, Sahu S, Kumar A, Praveen L. Bannwarth's syndrome and a surgical dilemma: An uncommon zoonosis with a rare presentation. Med J Armed Forces India 2021; 77:101-104. [PMID: 33487875 PMCID: PMC7809512 DOI: 10.1016/j.mjafi.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023] Open
Abstract
Lyme's disease also known as Erythema chronicum Migrans, is a multisystem infectious disease caused by the spirochete "Borrelia burgdorferi" which is transmitted by "Ixodes" tick, with both specific and nonspecific manifestations. Nervous system involvement occurs in 10%-15% of untreated patients and typically involves lymphocytic meningitis, cranial neuritis, and/or polyradiculitis. Here, we are reporting an interesting and challenging case of Neuro-Borreliosis in a young officer cadet, meeting the description for Bannwarth's syndrome and presenting initially as a surgical emergency followed by paraparesis. The diagnosis was finally clinched based on clinical profile of Chronic Myeloradiculopathy with focal myositis in the setting of recent outdoor camping, and confirmed by demonstrating high IgG antibody titres in serum and Cerebro spinal fluid (CSF). The officer cadet was treated successfully with a 6 week course of Ceftriaxone and Doxycycline, and went back to full training.
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Affiliation(s)
- R.K. Anadure
- Professor & Senior Adviser (Medicine & Neurology), Command Hospital (Air Force), Bengaluru, India
- Corresponding author.
| | - Rajeev Saxena
- Senior Adviser (Medicine & Neurology), Command Hospital (Air Force), Bengaluru, India
| | - Samaresh Sahu
- Senior Adviser (Radiology), Command Hospital (Air Force), Bengaluru, India
| | - Ameet Kumar
- Senior Adviser (Surgery & GI Surgery), Command Hospital (Air Force), Bengaluru, India
| | - L. Praveen
- Resident (Medicine), Command Hospital (Air Force), Bengaluru, India
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5
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Cytokine Expression Patterns and Single Nucleotide Polymorphisms (SNPs) in Patients with Chronic Borreliosis. Antibiotics (Basel) 2019; 8:antibiotics8030107. [PMID: 31366164 PMCID: PMC6784230 DOI: 10.3390/antibiotics8030107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/21/2019] [Accepted: 07/25/2019] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Genetically based hyperinflammation may play a role in pathogen defense. We here questioned whether alterations in circulating monocytes/macrophages, inflammatory biomarkers and a functional SNP (single nucleotide polymorphisms) of the Interleukin-6 (IL-6) promotor might play a role in patients with persistent, and treatment resistant borreliosis. (2) Methods: Leukocyte subpopulations were studied by flow cytometry; plasma cytokines were determined by a chemiluminescence based ELISA (Immulite®), and genotypes of the IL-6 promotor SNP rs1800795 were determined by pyrosequencing. (3) Results: In a cohort of n = 107 Lyme borreliosis patients, who concomitantly manifested either malignant diseases (group 1), autoimmune disorders (group 2), neurological diseases (group 3), or morbidities caused by multiple other infectious complications (group 4), we found decreased numbers of anti-inflammatory CD163-positive macrophages, elevated concentrations of inflammatory cytokines, and an imbalance of IL-6 promotor SNP rs1800795 genotypes. The most prominently upregulated cytokines were IL-1β, and IL-8. (4) Conclusions: Increased pro-inflammatory phenotypes identified by monocyte/macrophage subtypes and concomitantly increased cytokines appear to be valid to monitor disease activity in patients with persistent Lyme borreliosis. Patterns may vary by additional co-morbidities. In patients with autoimmune diseases, increased frequencies of a heterozygous IL-6 promotor SNP rs1800795 were identified. This functional SNP may guide chronic inflammation, impacting other cytokines to trigger trigger chronicity and therapeutic resistance in Lyme borreliosis.
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6
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Affiliation(s)
- Christine S. Kim
- Division of Otolaryngology, Albany Medical Center, Albany, New York
| | - Alexander G. Bien
- Division of Otolaryngology, Albany Medical Center, Albany, New York
- Albany ENT & Allergy Services, PC, Albany, New York
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Abstract
Given the variable clinical signs attributed to Borrelia burgdorferi, including infectious arthritis, neurologic disease, and behavioral changes, B burgdorferi is an important differential for decreased performance in sport horses. The primary vectors (Ixodes tick species) are expanding their range and thus Borrelia species are located in a wider area, making exposure more likely. Due to regionally high seroprevalence and vague clinical signs, diagnosis of Lyme disease in the horse is believed overestimated. Antibiotics are first-line treatment of confirmed Lyme disease. A single positive serologic test, by itself, is not conformation of Lyme disease but is evidence of current or past infection.
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8
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Shroff G, Hopf-Seidel P. A Novel Scoring System Approach to Assess Patients with Lyme Disease (Nutech Functional Score). J Glob Infect Dis 2018; 10:3-6. [PMID: 29563715 PMCID: PMC5850763 DOI: 10.4103/jgid.jgid_11_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: A bacterial infection by Borrelia burgdorferi referred to as Lyme disease (LD) or borreliosis is transmitted mostly by a bite of the tick Ixodes scapularis in the USA and Ixodes ricinus in Europe. Various tests are used for the diagnosis of LD, but their results are often unreliable. We compiled a list of clinically visible and patient-reported symptoms that are associated with LD. Based on this list, we developed a novel scoring system. Methodology: Nutech functional Score (NFS), which is a 43 point positional (every symptom is subgraded and each alternative gets some points according to its position) and directional (moves in direction bad to good) scoring system that assesses the patient's condition. Results: The grades of the scoring system have been converted into numeric values for conducting probability based studies. Each symptom is graded from 1 to 5 that runs in direction BAD → GOOD. Conclusion: NFS is a unique tool that can be used universally to assess the condition of patients with LD.
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Affiliation(s)
| | - Petra Hopf-Seidel
- Neurologist and Psychiatrist, Expert for Lyme Disease, Ansbach, Germany
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Divers TJ, Gardner RB, Madigan JE, Witonsky SG, Bertone JJ, Swinebroad EL, Schutzer SE, Johnson AL. Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement. J Vet Intern Med 2018; 32:617-632. [PMID: 29469222 PMCID: PMC5866975 DOI: 10.1111/jvim.15042] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022] Open
Abstract
Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and antigen detection. Treatment of Lyme disease in horses is similar to treatment of humans or small animals but treatment success might not be the same because of species differences in antimicrobial bioavailability and duration of infection before initiation of treatment. There are no approved equine label Lyme vaccines but there is strong evidence that proper vaccination could prevent infection in horses.
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Affiliation(s)
- T J Divers
- Department of Clinical Sciences, Cornell University, Ithaca, NY
| | | | - J E Madigan
- Department of Medicine and Epidemiology, University of California - Davis, CA
| | - S G Witonsky
- Department of Large Animal Clinical Sciences, Virginia-Maryland Region CVM, Blacksburg, VA
| | - J J Bertone
- CVMm Western University of Health Sciences, Pomona, CA
| | | | - S E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - A L Johnson
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, PA
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10
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Sharma A, Guleria S, Sharma R, Sharma A. Lyme Disease: A Case Report with Typical and Atypical Lesions. Indian Dermatol Online J 2017; 8:124-127. [PMID: 28405553 PMCID: PMC5372433 DOI: 10.4103/2229-5178.202271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lyme disease is a multisystem infectious disease caused by the spirochete “Borrelia burgdorferi,” which is transmitted by “Ixodes” tick, with skin being the most common and earliest organ to be affected. Diagnosis of erythema chronicum migrans (ECM), which is the characteristic lesion of early disease, may help in early treatment and prevention of complications. Here, we are reporting a case of Lyme disease in a 10-year-old young boy from a non-endemic zone of Himachal Pradesh, who presented with typical as well as atypical ECM lesions. The clinical diagnosis was confirmed serologically, and the child was treated successfully with doxycycline.
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Affiliation(s)
- Anuj Sharma
- Department of Dermatology, Regional Hospital, Bilaspur, Himachal Pradesh, India
| | - Sandesh Guleria
- Department of Paediatrics, Regional Hospital, Bilaspur, Himachal Pradesh, India
| | - Reena Sharma
- Department of Dermatology, Regional Hospital, Bilaspur, Himachal Pradesh, India
| | - Anita Sharma
- Department of Anaesthesiology, Indira Gandhi Medical College, Himachal Pradesh, India
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Vázquez-López ME, Díez-Morrondo C, Sánchez-Andrade A, Pego-Reigosa R, Díaz P, Castro-Gago M. Manifestaciones articulares en enfermos de Lyme. ACTA ACUST UNITED AC 2016; 12:327-330. [DOI: 10.1016/j.reuma.2015.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 11/24/2022]
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12
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Treatment with Doxycycline of Generalized Annular Elastolytic Giant Cell Granuloma Associated with Borrelia burgdorferi Infection. W INDIAN MED J 2015; 64:447-51. [PMID: 26624605 DOI: 10.7727/wimj.2014.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 11/18/2022]
Abstract
This is a case of generalized annular elastolytic giant cell granuloma (AEGCG) associated with borrelia infection and genes of p-30, p-31, p-39. A possible cross-mediated reaction from the T-cell type which might have induced the AEGCG is discussed from the concept of "heat-shock proteins (HSPs) and molecular mimicry".
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13
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[Diagnosis and treatment of Lyme arthritis. Recommendations of the Pharmacotherapy Commission of the Deutsche Gesellschaft für Rheumatologie (German Society for Rheumatology)]. Z Rheumatol 2015; 73:469-74. [PMID: 24924733 DOI: 10.1007/s00393-014-1370-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
These guidelines summarize the current evidence for diagnosis and treatment of Lyme arthritis and the most frequent skin manifestations of Borrelia burgdorferi infections. Lyme arthritis is a monoarticular or oligoarticular form of arthritis that typically involves the knee. A positive enzyme-linked immunosorbent assay (ELISA) for IgG antibodies should be followed by an IgG immunoblot. A positive PCR test from synovial fluid adds increased diagnostic certainty. Serum positivity for antibodies to Borrelia burgdorferi without typical symptoms does not justify antibiotic treatment. Oral antibiotic treatment for erythema migrans is recommended using doxycycline, 200 mg once per day for 10-21 days, alternative choices are amoxicillin, cefuroxime and azithromycin. For children below 8 years of age, amoxicillin is recommended.Lyme arthritis can usually be successfully treated with orally administered antimicrobial agents. Doxycycline, 1 × 200 or 2 × 100 mg for 30 days is the antibiotic agent of choice. Amoxicillin (3 × 500-1000 mg) can be alternatively chosen. Patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be treated intravenously. In this situation, ceftriaxone at 2 g per day for 14-21 days is recommended. There is no evidence to recommend long-term and combined treatments.
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14
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Lyme disease: sudden hearing loss as the sole presentation. The Journal of Laryngology & Otology 2015; 129:183-6. [PMID: 25619547 DOI: 10.1017/s0022215114003417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lyme disease is an uncommon tick-borne multisystemic infection caused by Borrelia burgdorferi. The most common clinical manifestation is erythema migrans. In this report, a very unusual presentation of this condition is described, in which sudden onset sensorineural hearing loss was the sole presenting symptom. METHODS Case report and review of English-language literature. RESULTS A patient presented with sensorineural hearing loss, with no other symptoms or signs. Acute Lyme infection was detected by laboratory tests. Magnetic resonance imaging showed signs of labyrinthitis of the same inner ear. After hyperbaric oxygen and systemic antibiotic treatment, the patient showed total hearing recovery, and magnetic resonance imaging showed complete resolution of the labyrinthitis. CONCLUSION To our knowledge, this is the first reported case of Lyme disease presenting only with sensorineural hearing loss. Borreliosis should be considered as an aetiological factor in sensorineural hearing loss. Adequate treatment may provide total recovery and prevent more severe forms of Lyme disease.
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15
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Suspected inflammatory cardiomyopathy. Herz 2014; 40 Suppl 1:91-5. [DOI: 10.1007/s00059-014-4118-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/16/2014] [Accepted: 05/14/2014] [Indexed: 12/22/2022]
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16
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Palmieri JR, King S, Case M, Santo A. Lyme disease: case report of persistent Lyme disease from Pulaski County, Virginia. Int Med Case Rep J 2013; 6:99-105. [PMID: 24353444 PMCID: PMC3862396 DOI: 10.2147/imcrj.s51240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 50-year-old woman from Pulaski, Virginia, presented to a local clinic with headaches, fever, generalized joint pain, excessive thirst and fluid intake, and a progressing rash on her back. On physical examination, she had a large circular red rash on her back with a bull’s-eye appearance, 16 × 18 cm in diameter. Serologic tests confirmed a diagnosis of Lyme disease. The patient could recall a walk through the woods 3 weeks prior, although she never noticed a tick on her body. Following a prolonged course of antibiotics, this case report presents a patient with ongoing symptoms consistent with post-treatment Lyme disease.
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Affiliation(s)
- James R Palmieri
- Department of Microbiology, Infectious and Emerging Diseases, Blacksburg, VA, USA
| | - Scott King
- Department of Microbiology, Infectious and Emerging Diseases, Blacksburg, VA, USA
| | - Matthew Case
- Department of Microbiology, Infectious and Emerging Diseases, Blacksburg, VA, USA
| | - Arben Santo
- Department of Pathology, Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA
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17
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Sprong H, Hofhuis A, Gassner F, Takken W, Jacobs F, van Vliet AJH, van Ballegooijen M, van der Giessen J, Takumi K. Circumstantial evidence for an increase in the total number and activity of Borrelia-infected Ixodes ricinus in the Netherlands. Parasit Vectors 2012; 5:294. [PMID: 23244453 PMCID: PMC3562265 DOI: 10.1186/1756-3305-5-294] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/09/2012] [Indexed: 11/15/2022] Open
Abstract
Background Between 1994 and 2009, a threefold increase has been observed in consultations of general practitioners for tick bites and Lyme disease in The Netherlands. The objective of this study was to determine whether an increase in the number of questing ticks infected with B. burgdorferi sensu lato is a potential cause of the rise in Lyme disease incidence. Methods Historic data on land usage, temperature and wildlife populations were collected and analyzed together with data from two longitudinal field studies on density of questing ticks. Effective population sizes of Borrelia burgdorferi s.l. were calculated. Results Long-term trend analyses indicated that the length of the annual tick questing season increased as well as the surface area of tick-suitable habitats in The Netherlands. The overall abundances of feeding and reproductive hosts also increased. Mathematical analysis of the data from the field studies demonstrated an increase in mean densities/activities of questing ticks, particularly of larvae between 2006 and 2009. No increase in infection rate of ticks with Borrelia burgdorferi sensu lato was found. Population genetic analysis of the collected Borrelia species points to an increase in B. afzelii and B. garinii populations. Conclusions Together, these findings indicate an increase in the total number of Borrelia-infected ticks, providing circumstantial evidence for an increase in the risk of acquiring a bite of a tick infected with B. burgdorferi s.l. Due to the high spatiotemporal variation of tick densities/activities, long-term longitudinal studies on population dynamics of I. ricinus are necessary to observe significant trends.
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Affiliation(s)
- Hein Sprong
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Divers T, Grice A, Mohammed H, Glaser A, Wagner B. Changes in Borrelia burgdorferi ELISA antibody over time in both antibiotic treated and untreated horses. Acta Vet Hung 2012; 60:421-9. [PMID: 23160024 DOI: 10.1556/avet.2012.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Changes in ELISA serology are frequently used to determine antibiotic treatment success for Lyme disease in horses. This concept was based upon a previous report showing a marked decline in ELISA values in experimentally infected and antibiotic-treated ponies. Changes in Lyme serology following antibiotic treatment in naturally infected horses have not been reported. The objective of this study was to compare Borrelia ELISA antibody concentrations in naturally exposed horses both before and following antibiotic treatment for Lyme disease. A retrospective study was performed comparing oxytetracycline- or doxycyclinetreated (n = 68) and untreated (n = 183) horses from a single equine practice and their change in Borrelia ELISA values over a similar time period. Antibiotictreated horses had a decline in ELISA values in comparison to control horses (P ≤ 0.05) and untreated horses were twice as likely to have their ELISA values increase (OR = 0.5; 95% C.I. = 0.3-0.9) compared to treated horses. The magnitude of the decline in ELISA units following treatments was small compared to that previously reported in experimentally infected and treated ponies. Field-exposed horses with high Borrelia burgdorferi ELISA values who are treated with either oxytetracycline or doxycycline can be expected to have only a small decline in ELISA values following treatment. Persistently high ELISA titres following appropriate treatments for Lyme disease may not, without appropriate clinical signs, be a reason for more prolonged treatment.
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Affiliation(s)
- Thomas Divers
- 1 Cornell University Department of Clinical Sciences Ithaca NY 14853 USA
| | - Amy Grice
- 3 Rhinebeck Equine 26 Losee Lane Rhinebeck NY USA
| | - Hussni Mohammed
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
| | - Amy Glaser
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
| | - Bettina Wagner
- 2 Cornell University Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Ithaca NY 14853 USA
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Tijsse-Klasen E, Jacobs JJ, Swart A, Fonville M, Reimerink JH, Brandenburg AH, van der Giessen JWB, Hofhuis A, Sprong H. Small risk of developing symptomatic tick-borne diseases following a tick bite in The Netherlands. Parasit Vectors 2011; 4:17. [PMID: 21310036 PMCID: PMC3050846 DOI: 10.1186/1756-3305-4-17] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/10/2011] [Indexed: 11/17/2022] Open
Abstract
Background In The Netherlands, the incidence of Lyme borreliosis is on the rise. Besides its causative agent, Borrelia burgdorferi s.l., other potential pathogens like Rickettsia, Babesia and Ehrlichia species are present in Ixodes ricinus ticks. The risk of disease associated with these microorganisms after tick-bites remains, however, largely unclear. A prospective study was performed to investigate how many persons with tick-bites develop localized or systemic symptoms and whether these are associated with tick-borne microorganisms. Results In total, 297 Ixodes ricinus ticks were collected from 246 study participants who consulted a general practitioner on the island of Ameland for tick bites. Ticks were subjected to PCR to detect DNA of Borrelia burgdorferi s.l., Rickettsia spp., Babesia spp. or Ehrlichia/Anaplasma spp.. Sixteen percent of the collected ticks were positive for Borrelia burgdorferi s.l., 19% for Rickettsia spp., 12% for Ehrlichia/Anaplasma spp. and 10% for Babesia spp.. At least six months after the tick bite, study participants were interviewed on symptoms by means of a standard questionnaire. 14 out of 193 participants (8.3%) reported reddening at the bite site and 6 participants (4.1%) reported systemic symptoms. No association between symptoms and tick-borne microorganisms was found. Attachment duration ≥24 h was positively associated with reddening at the bite site and systemic symptoms. Using logistic regression techniques, reddening was positively correlated with presence of Borrelia afzelii, and having 'any symptoms' was positively associated with attachment duration. Conclusion The risk of contracting acute Lyme borreliosis, rickettsiosis, babesiosis or ehrlichiosis from a single tick bite was <1% in this study population.
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Affiliation(s)
- Ellen Tijsse-Klasen
- Laboratory for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
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