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Önal U, Saraç-Pektaş F, Sağlık İ. Is There a Role for Dark Field Microscopy in the Diagnosis of Lyme Disease?A Narrative Review. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:281-286. [PMID: 38633860 PMCID: PMC10986710 DOI: 10.36519/idcm.2023.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 04/19/2024]
Abstract
The diagnosis of Lyme disease is becoming more common in Turkey. Nonetheless, some physicians are not aware of the diagnostic principles that should be followed when faced with a suspected patient and could use tests that are not recommended, such as darkfield microscopy. Dark field microscopy is a diagnostic technique to visualize the spirochetes that cause Lyme disease; however, it is not recommended for the diagnosis of Lyme disease. One of the main limitations of dark field microscopy is its low sensitivity. Another limitation is its high false-positivity rate, as other microorganisms and cellular debris can be mistaken for spirochetes, leading to a misdiagnosis thatmay result in unnecessary treatment. Therefore, this study aimed to review the literature on the role of dark field microscopy as a diagnostic method for Lyme disease and inform physicians about recommended approaches in line with the recommendations of national or international guidelines. An electronic search of Pubmed, Scopus, and Web of Science was performed using the following medical subject headings (MeSH) search terms: Lyme borreliosis, Lyme disease, Borrelia burgdorferi, diagnosis, and microscopy. With this narrative review, we aimed to inform physicians better and improve patient care for patients with suspected Lyme disease.
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Affiliation(s)
- Uğur Önal
- Department of Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Türkiye
| | - Fatma Saraç-Pektaş
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - İmran Sağlık
- Department of Microbiology, Uludağ University School of Medicine, Bursa, Türkiye
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Böhm S, Woudenberg T, Stark K, Böhmer MM, Katz K, Kuhnert R, Schlaud M, Wilking H, Fingerle V. Seroprevalence, seroconversion and seroreversion of Borrelia burgdorferi-specific IgG antibodies in two population-based studies in children and adolescents, Germany, 2003 to 2006 and 2014 to 2017. Euro Surveill 2023; 28:2200855. [PMID: 37616114 PMCID: PMC10451011 DOI: 10.2807/1560-7917.es.2023.28.34.2200855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/09/2023] [Indexed: 08/25/2023] Open
Abstract
BackgroundLyme borreliosis (LB), caused by Borrelia burgdorferi (Bb), is the most common tick-borne infection in Germany. Antibodies against Bb are prevalent in the general population but information on temporal changes of prevalence and estimates of seroconversion (seroincidence) and seroreversion are lacking, especially for children and adolescents.AimWe aimed at assessing antibodies against Bb and factors associated with seropositivity in children and adolescents in Germany.MethodsWe estimated seroprevalence via two consecutive cross-sectional surveys (2003-2006 and 2014-2017). Based on a longitudinal survey component, we estimated annual seroconversion/seroreversion rates.ResultsSeroprevalence was 4.4% (95% confidence interval (CI): 3.9-4.9%) from 2003 to 2006 and 4.1% (95% CI: 3.2-5.1%) from 2014 to 2017. Seroprevalence increased with age, was higher in male children, the south-eastern regions of Germany and among those with a high socioeconomic status. The annual seroconversion rate was 0.3% and the annual seroreversion rate 3.9%. Males were more likely to seroconvert compared with females. Low antibody levels were the main predictor of seroreversion.ConclusionWe did not detect a change in seroprevalence in children and adolescents in Germany over a period of 11 years. Potential long-term changes, for example due to climatic changes, need to be assessed in consecutive serosurveys. Seroconversion was more likely among children and adolescents than among adults, representing a target group for preventive measures. Seroreversion rates are over twice as high in children and adolescents compared with previous studies among adults. Thus, seroprevalence estimates and seroconversion rates in children are likely underestimated.
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Affiliation(s)
- Stefanie Böhm
- Bavarian Health and Food Safety Authority, Munich, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Tom Woudenberg
- Bavarian Health and Food Safety Authority, Munich, Germany
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Infectious Disease Epidemiology and Analytics Unit, Department of Global Health, Institut Pasteur, Paris, France
| | - Klaus Stark
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Merle M Böhmer
- Bavarian Health and Food Safety Authority, Munich, Germany
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, Magdeburg, Germany
| | - Katharina Katz
- Bavarian Health and Food Safety Authority, Munich, Germany
| | - Ronny Kuhnert
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Martin Schlaud
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hendrik Wilking
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- These authors contributed equally to the work and share the last authorship
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority, Munich, Germany
- German National Reference Centre for Borrelia, Oberschleißheim, Germany
- These authors contributed equally to the work and share the last authorship
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The evolving story of Borrelia burgdorferi sensu lato transmission in Europe. Parasitol Res 2022; 121:781-803. [PMID: 35122516 PMCID: PMC8816687 DOI: 10.1007/s00436-022-07445-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022]
Abstract
Beside mosquitoes, ticks are well-known vectors of different human pathogens. In the Northern Hemisphere, Lyme borreliosis (Eurasia, LB) or Lyme disease (North America, LD) is the most commonly occurring vector-borne infectious disease caused by bacteria of the genus Borrelia which are transmitted by hard ticks of the genus Ixodes. The reported incidence of LB in Europe is about 22.6 cases per 100,000 inhabitants annually with a broad range depending on the geographical area analyzed. However, the epidemiological data are largely incomplete, because LB is not notifiable in all European countries. Furthermore, not only differ reporting procedures between countries, there is also variation in case definitions and diagnostic procedures. Lyme borreliosis is caused by several species of the Borrelia (B.) burgdorferi sensu lato (s.l.) complex which are maintained in complex networks including ixodid ticks and different reservoir hosts. Vector and host influence each other and are affected by multiple factors including climate that have a major impact on their habitats and ecology. To classify factors that influence the risk of transmission of B. burgdorferi s.l. to their different vertebrate hosts as well as to humans, we briefly summarize the current knowledge about the pathogens including their astonishing ability to overcome various host immune responses, regarding the main vector in Europe Ixodes ricinus, and the disease caused by borreliae. The research shows, that a higher standardization of case definition, diagnostic procedures, and standardized, long-term surveillance systems across Europe is necessary to improve clinical and epidemiological data.
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van de Schoor FR, Baarsma ME, Leeflang MMG, Fingerle V, Margos G, Hovius JW, van Dam AP. Opinion: Methodological Shortcomings in the Study on a Prophage-based PCR Test for Lyme Borreliosis. Front Microbiol 2021; 12:802131. [PMID: 34966377 PMCID: PMC8710760 DOI: 10.3389/fmicb.2021.802131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Freek R van de Schoor
- Radboudumc, Department of Internal Medicine, Radboudumc Center for Infectious Diseases and Radboud Institute of Health Sciences, Nijmegen, Netherlands
| | - M E Baarsma
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mariska M G Leeflang
- Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Volker Fingerle
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
| | - Gabriele Margos
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
| | - Joppe W Hovius
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
| | - Alje P van Dam
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,ESCMID Study Group for Lyme Borreliosis, Basel, Switzerland
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Liebmann N, Sterker I, Sorge I, Opitz S, Merkenschlager A, Gburek-Augustat J. [Unusual Localisation of a Borrelia Lymphocytoma]. Klin Monbl Augenheilkd 2021. [PMID: 34911119 DOI: 10.1055/a-1686-9274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nora Liebmann
- Neuropädiatrie, Klinik und Poliklinik für Kinder und Jugendmedizin, Universitätsklinikum Leipzig, Deutschland
| | - Ina Sterker
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Deutschland
| | - Ina Sorge
- Abteilung für Kinderradiologie, Universitätsklinikum Leipzig, Deutschland
| | - Sabine Opitz
- Institut für Pathologie, Universitätsklinikum Leipzig, Deutschland
| | - Andreas Merkenschlager
- Neuropädiatrie, Klinik und Poliklinik für Kinder und Jugendmedizin, Universitätsklinikum Leipzig, Deutschland
| | - Janina Gburek-Augustat
- Neuropädiatrie, Klinik und Poliklinik für Kinder und Jugendmedizin, Universitätsklinikum Leipzig, Deutschland
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Böhmer MM, Ens K, Böhm S, Heinzinger S, Fingerle V. Epidemiological Surveillance of Lyme Borreliosis in Bavaria, Germany, 2013-2020. Microorganisms 2021; 9:microorganisms9091872. [PMID: 34576768 PMCID: PMC8467410 DOI: 10.3390/microorganisms9091872] [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: 07/27/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 01/12/2023] Open
Abstract
Lyme borreliosis (LB) is the most common tick-borne disease in Germany. Mandatory notification of acute LB manifestations (erythema migrans (EM), neuroborreliosis (NB), and Lyme arthritis (LA)) was implemented in Bavaria on 1 March 2013. We aimed to describe the epidemiological situation and to identify LB risk areas and populations. Therefore, we analyzed LB cases notified from March 2013 to December 2020 and calculated incidence (cases/100,000 inhabitants) by time, place, and person. Overall, 35,458 cases were reported during the study period (EM: 96.7%; NB: 1.7%; LA: 1.8%). The average incidence was 34.3/100,000, but annual incidence varied substantially (2015: 23.2; 2020: 47.4). Marked regional differences at the district level were observed (annual average incidence range: 4–154/100,000). The Bavarian Forest and parts of Franconia were identified as high-risk regions. Additionally, high risk for LB was found in 5–9-year-old males and in 60–69-year-old females. The first group also had the highest risk of a severe disease course. We were able to identify areas and populations in Bavaria with an increased LB risk, thereby providing a basis for targeted measures to prevent LB. Since LB vaccination is currently not available, such measures should comprise (i) avoiding tick bites, (ii) removing ticks rapidly after a bite, and (iii) treating LB early/adequately.
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Affiliation(s)
- Merle Margarete Böhmer
- Department for Infectious Disease Epidemiology, Taskforce Infectiology, Bavarian Health and Food Safety Authority, Lazarettstrasse 67, 80636 Munich, Germany
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-9131-6808-5634
| | - Katharina Ens
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich (LMU), 81377 Munich, Germany;
| | - Stefanie Böhm
- Bavarian Health and Food Safety Authority, 80636 Munich, Germany;
| | - Susanne Heinzinger
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (S.H.); (V.F.)
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany; (S.H.); (V.F.)
- National Reference Centre for Borrelia, 85764 Oberschleissheim, Germany
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Dolange V, Simon S, Morel N. Detection of Borrelia burgdorferi antigens in tissues and plasma during early infection in a mouse model. Sci Rep 2021; 11:17368. [PMID: 34462491 PMCID: PMC8405660 DOI: 10.1038/s41598-021-96861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Borrelia burgdorferi is the causative agent of Lyme borreliosis, which is the most common tick-borne human disease in Europe and North America. Currently, the diagnosis of Lyme borreliosis is based on serological tests allowing indirect detection of anti-Borrelia antibodies produced by patients. Their main drawback is a lack of sensitivity in the early phase of disease and an incapacity to prove an active infection. Direct diagnostic tests are clearly needed. The objectives of this study were to produce tools allowing sensitive detection of potential circulating Borrelia antigens and to evaluate them in a mouse model. We focused on two potential early bacterial makers, the highly variable OspC protein and the conserved protein FlaB. High-affinity monoclonal antibodies were produced and used to establish various immunoassays and western blot detection. A very good limit of detection for OspC as low as 17 pg/mL of sample was achieved with SPIE-IA. In infected mice, we were able to measure OspC in plasma with a mean value of 10 ng/mL at 7 days post-inoculation. This result suggests that OspC could be a good blood marker for diagnosis of Lyme borreliosis and that the tools developed during this study could be very useful.
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Affiliation(s)
- Victoria Dolange
- Paris-Saclay University, CEA, INRAE, Medicines and Healthcare Technologies Department (DMTS), SPI, 91191, Gif-sur-Yvette, France
| | - Stéphanie Simon
- Paris-Saclay University, CEA, INRAE, Medicines and Healthcare Technologies Department (DMTS), SPI, 91191, Gif-sur-Yvette, France
| | - Nathalie Morel
- Paris-Saclay University, CEA, INRAE, Medicines and Healthcare Technologies Department (DMTS), SPI, 91191, Gif-sur-Yvette, France.
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Methodological Quality Assessment with the AGREE II Scale and a Comparison of European and American Guidelines for the Treatment of Lyme Borreliosis: A Systematic Review. Pathogens 2021; 10:pathogens10080972. [PMID: 34451436 PMCID: PMC8399315 DOI: 10.3390/pathogens10080972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Most European and American countries recently updated their guidelines on Lyme borreliosis (LB). The aim of this study was to provide a comparative overview of existing guidelines on the treatment of LB in Europe and America and to assess the methodological quality of their elaboration. METHODS A systematic search was carried out in MEDLINE, Google Scholar, and the national databases of scientific societies from 2014 to 2020. Quality was assessed by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS Twelve guidelines were included. The scores for the AGREE II domains (median ± IQR) were: overall assessment 100 ± 22, scope and purpose 85 ± 46, stakeholder involvement 88 ± 48, rigour of development 67 ± 35, clarity of presentation 81 ± 36, applicability 73 ± 52 and editorial independence 79% ± 54%. Cohen's weighted kappa showed a high agreement (K = 0.90, 95%CI 0.84-0.96). Guidelines were quite homogeneous regarding the recommended molecules (mostly doxycycline in the first intention and ceftriaxone in the second intention), their duration (10 to 28 days), and their dosage. The differences were due to the lack of well-conducted comparative trials. The International Lyme and Associated Diseases Society (ILADS) guidelines were the only ones to suggest longer antibiotics based on an expert consensus. CONCLUSION European and American guidelines for the treatment of LB were quite homogeneous but based on moderate- to low-evidence studies. Well-conducted comparative trials are needed to assess the best molecules, the optimal duration and the most effective doses.
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Raffetin A, Barquin A, Nguala S, Paoletti G, Rabaud C, Chassany O, Caraux-Paz P, Covasso S, Partouche H. Perceptions, Representations, and Experiences of Patients Presenting Nonspecific Symptoms in the Context of Suspected Lyme Borreliosis. Microorganisms 2021; 9:microorganisms9071515. [PMID: 34361950 PMCID: PMC8304161 DOI: 10.3390/microorganisms9071515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Some subjective symptoms may be reported at all stages of Lyme borreliosis (LB) and may persist for several months after treatment. Nonspecific symptoms without any objective manifestation of LB are sometimes attributed by patients to a possible tick bite. The aim of our study was to explore the perceptions, representations, and experiences that these patients had of their disease and care paths. METHODS We performed a qualitative study through individual interviews (October 2017-May 2018), based on grounded theory, following the COREQ checklist. A balanced sample of patients with diverse profiles was recruited at consultations with general practitioners and infectious disease physicians. RESULTS Twelve patients were interviewed. Data saturation was reached at the twelfth interview. For codes, 293 were identified, and classified into 5 themes: (1) the experience of disabling nonspecific symptoms, especially pain, causing confusion and fear, (2) long and difficult care paths for the majority of the patients, experienced as an obstacle course, (3) a break with the previous state of health, causing a negative impact on every sphere of the patient's life, (4) empowerment of the patients and the self-management of their disease, and (5) the strong expression of a desire for change, with better listening, greater recognition of the symptoms, and simpler care paths. CONCLUSIONS This study allows for the understanding of a patient's behaviours and the obstacles encountered, the way they are perceived, and the necessary solutions. The patients' expectations identified here could help physicians better understand the doctor-patient relationship in these complex management situations, which would reduce the burden of the disease. The current development of specialised reference centres could help meet the patients' demands and those of family physicians.
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Affiliation(s)
- Alice Raffetin
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
- European Study Group for Lyme Borreliosis ESGBOR, ESCMID, Gerbergasse 14 3rd Floor, 4001 Basel, Switzerland
- Correspondence: ; Tel.: +33-143862068
| | - Aude Barquin
- Département de Médecine Générale, Paris University, Site Cochin 27, Rue du Fbg Saint-Jacques, CEDEX 14, 75679 Paris, France; (A.B.); (H.P.)
| | - Steve Nguala
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
| | - Giulia Paoletti
- Department of Psychiatry, Tick-Borne Diseases Reference Centre, Île-de-France/Hauts-de-France, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France;
| | - Christian Rabaud
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, East Region, CHRU Nancy, Bâtiment Philippe Canton, Hôpitaux de Brabois, Allée du Morvan, 54500 Vandoeuvre les Nancy, France;
| | - Olivier Chassany
- Health Economics Clinical Trial Unit (URC-ECO), Hôpital Hotel-Dieu, AP-HP, 1 Place du Parvis Notre Dame, 75004 Paris, France;
| | - Pauline Caraux-Paz
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
| | - Sarah Covasso
- Department of Infectious Diseases, Tick-Borne Diseases Reference Centre, North Region, CH Villeneuve Saint Georges, 40 Allée de la Source, 94190 Villeneuve-Saint-Georges, France; (S.N.); (P.C.-P.); (S.C.)
- Department of Anthropology, University Lyon II, UFR Anthropologie, Sociologie et Science Politique, Université Lumière Lyon 2, 5 Avenue Pierre Mendès France, 69676 Bron, France
| | - Henri Partouche
- Département de Médecine Générale, Paris University, Site Cochin 27, Rue du Fbg Saint-Jacques, CEDEX 14, 75679 Paris, France; (A.B.); (H.P.)
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Borrelia burgdorferi BmpA-BBK32 and BmpA-BBA64: New Recombinant Chimeric Proteins with Potential Diagnostic Value. Pathogens 2021; 10:pathogens10060767. [PMID: 34207025 PMCID: PMC8234703 DOI: 10.3390/pathogens10060767] [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: 05/27/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Currently, the diagnosis of Lyme disease is based mostly on two-tiered serologic testing. In the new generation of immunoenzymatic assays, antigens comprise whole-cell lysates of members of the Borrelia burgdorferi sensu lato (s.l.) species complex, with the addition of selected recombinant proteins. Due to the high diversity of members of the B. burgdorferi s.l. genospecies and the low degree of conservation among the amino acid sequences of their proteins, serodiagnostic methods currently in use are not sufficient for the correct diagnosis of borreliosis. Two divalent chimeric proteins (BmpA-BBK32 and BmpA-BBA64) were expressed in Escherichia coli. Following purification by one-step metal-affinity chromatography, preparations were obtained containing milligram levels of chimeric protein exhibiting electrophoretic purity in excess of 98%. Reactivity of the new chimeric proteins with specific human IgG antibodies was preliminarily determined by Western blot. For this purpose, 20 negative sera and 20 positive sera was used. The new chimeric proteins were highly reactive with IgG antibodies contained in the serum of patients suffering from borreliosis. Moreover, no immunoreactivity of chimeric proteins was observed with antibodies in the sera of healthy people. These promising results suggest that new chimeric proteins have the potential to discriminate between positive and negative sera.
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Lyme Neuroborreliosis in Children. Brain Sci 2021; 11:brainsci11060758. [PMID: 34200467 PMCID: PMC8226969 DOI: 10.3390/brainsci11060758] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 12/22/2022] Open
Abstract
Lyme neuroborreliosis (LNB) is an infectious disease, developing after a tick bite and the dissemination of Borrelia burgdorferi sensu lato spirochetes reach the nervous system. The infection occurs in children and adults but with different clinical courses. Adults complain of radicular pain and paresis, while among the pediatric population, the most common manifestations of LNB are facial nerve palsy and/or subacute meningitis. Moreover, atypical symptoms, such as fatigue, loss of appetite, or mood changes, may also occur. The awareness of the various clinical features existence presented by children with LNB suspicion remains to be of the greatest importance to diagnose and manage the disease.
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Scheerer C, Rüth M, Tizek L, Köberle M, Biedermann T, Zink A. Googling for Ticks and Borreliosis in Germany: Nationwide Google Search Analysis From 2015 to 2018. J Med Internet Res 2020; 22:e18581. [PMID: 33064086 PMCID: PMC7600002 DOI: 10.2196/18581] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Borreliosis is the most frequently transmitted tick-borne disease in Europe. It is difficult to estimate the incidence of tick bites and associated diseases in the German population due to the lack of an obligation to register across all 16 federal states of Germany. Objective The aim of this study is to show that Google data can be used to generate general trends of infectious diseases on the basis of borreliosis and tick bites. In addition, the possibility of using Google AdWord data to estimate incidences of infectious diseases, where there is inconsistency in the obligation to notify authorities, is investigated with the perspective to facilitate public health studies. Methods Google AdWords Keyword Planner was used to identify search terms related to ticks and borreliosis in Germany from January 2015 to December 2018. The search volume data from the identified search terms was assessed using Excel version 15.23. In addition, SPSS version 24.0 was used to calculate the correlation between search volumes, registered cases, and temperature. Results A total of 1999 tick-related and 542 borreliosis-related search terms were identified, with a total of 209,679,640 Google searches in all 16 German federal states in the period under review. The analysis showed a high correlation between temperature and borreliosis (r=0.88), and temperature and tick bite (r=0.83), and a very high correlation between borreliosis and tick bite (r=0.94). Furthermore, a high to very high correlation between Google searches and registered cases in each federal state was observed (Brandenburg r=0.80, Mecklenburg-West Pomerania r= 0.77, Saxony r= 0.74, and Saxony-Anhalt r=0.90; all P<.001). Conclusions Our study provides insight into annual trends concerning interest in ticks and borreliosis that are relevant to the German population exemplary in the data of a large internet search engine. Public health studies collecting incidence data may benefit from the results indicating a significant correlation between internet search data and incidences of infectious diseases.
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Affiliation(s)
- Cora Scheerer
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Melvin Rüth
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Linda Tizek
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Martin Köberle
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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A painless erythematous swelling of the external ear as a manifestation of Lyme disease: a case report. J Med Case Rep 2020; 14:48. [PMID: 32295641 PMCID: PMC7161252 DOI: 10.1186/s13256-020-02377-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background Lyme disease is the most common tick-borne illness in the USA, Canada, and Europe. Clinical manifestations vary greatly, with localized skin findings functioning as early signs of the disease, followed by disseminated disease. The rarest dermatologic presentation of Lyme is a borrelial lymphocytoma, occurring distinctly in Europe and caused typically by Borrelia afzelii. Case presentation We report a case of a Caucasian 5-year-old European-American boy with slowly progressing, painless edema and erythema of his right pinna. Travel history revealed significant exposure to ticks during a recent trip to Eastern Europe. Laboratory testing for Borrelia burgdorferi demonstrated mixed positivity. He was treated with a 21-day course of amoxicillin, with complete resolution of symptoms and no sign of secondary Lyme disease. Conclusions Borrelial lymphocytoma is a rare manifestation of Lyme disease in North America, although not uncommon in Europe. Diagnosis is made by the presence of a painless erythematous swelling typically found on the ear lobe, nipples, or testes. Laboratory tests are available but with low sensitivity, therefore, a high index of suspicion is necessary for a clinical diagnosis to be made. Treatment for isolated borrelial lymphocytoma is doxycycline 4 mg/kg up to 100 mg twice daily, whereas for children less than 8 years of age amoxicillin 50 mg/kg divided three times daily, for 3–4 weeks, is preferred.
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Abstract
These are cutaneous diseases caused by insects, worms, protozoa, or coelenterates which may or may not have a parasitic life. In this review the main ethological agents, clinical aspects, laboratory exams, and treatments of these dermatological diseases will be studied.
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Torbahn G, Hofmann H, Rücker G, Bischoff K, Freitag MH, Dersch R, Fingerle V, Motschall E, Meerpohl JJ, Schmucker C. Efficacy and Safety of Antibiotic Therapy in Early Cutaneous Lyme Borreliosis: A Network Meta-analysis. JAMA Dermatol 2019; 154:1292-1303. [PMID: 30285069 DOI: 10.1001/jamadermatol.2018.3186] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Controversies about the choice of antibiotic agent and treatment modality exist in the management of erythema migrans in early cutaneous Lyme borreliosis (LB). Objective To conduct a network meta-analysis (NMA) of all randomized clinical trials on various antibiotic agents and treatment modalities in early cutaneous LB. Data Sources Electronic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were conducted from inception until July 2017. The reference lists of the included studies were hand searched, authors were contacted, and ongoing trials were searched at ClinicalTrials.gov. Study Selection One reviewer screened the titles and abstracts of the 9975 reports identified by the electronic searches. Full-text copies of 161 potentially relevant articles were obtained, and 2 reviewers independently assessed those articles for inclusion. Adults with a physician-confirmed early localized skin infection who were treated with antibiotics of any dose or duration were included. Data Extraction and Synthesis Two reviewers independently extracted data on study, patient, and intervention characteristics. Network meta-analyses on treatment effects and adverse outcomes were calculated with a frequentist approach using the R package netmeta. The Grading of Recommendations Assessment, Development and Evaluation guidance for NMA was used to assess the certainty of evidence. Main Outcomes and Measures Treatment effects for response to treatment (resolution of symptoms) and treatment-related adverse events. Results Overall, 19 studies (2532 patients) were included. The mean patient age ranged between 37 and 56 years, and the percentage of female patients ranged from 36% to 60%. The antibiotics investigated were doxycycline, cefuroxime axetil, ceftriaxone, amoxicillin, azithromycin, penicillin V, and minocycline. Pooled effect sizes from NMAs did not suggest any significant differences in treatment response by antibiotic agent (eg, amoxicillin vs doxycycline odds ratio, 1.26; 95% CI, 0.41-3.87), dose, or duration (eg, doxycycline, 200 mg/d for 3 weeks, vs doxycycline, 200 mg/d for 2 weeks, odds ratio, 1.28; 95% CI, 0.49-3.34). Treatment failures were rare at both 2 months (4%; 95% CI, 2%-5%) and 12 months (2%, 95% CI, 1%-3%) after treatment initiation. There were also no differences in the effect sizes among antibiotic agents and treatment modalities for treatment-related adverse outcomes, which were generally mild to moderate. Certainty of evidence was categorized as low and very low mostly because of imprecision, indirectness, and study limitations (high risk of bias) of the included studies. Conclusions and Relevance This NMA suggests that neither the antibiotic agent nor treatment modality contributed to comparative effectiveness or drug-related adverse outcomes. This finding is relevant for physicians treating patients with LB and for patient decision making.
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Affiliation(s)
- Gabriel Torbahn
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heidelore Hofmann
- Department of Dermatology and Allergology, Technical University of Munich, München, Germany
| | - Gerta Rücker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Division of General Practice and Family Medicine, Department of Health Services Research, University of Oldenburg, Oldenburg, Germany
| | - Karin Bischoff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael H Freitag
- Department of Neurology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rick Dersch
- National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Volker Fingerle
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Edith Motschall
- Division of General Practice and Family Medicine, Department of Health Services Research, University of Oldenburg, Oldenburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Mixed Borrelia burgdorferi and Helicobacter pylori Biofilms in Morgellons Disease Dermatological Specimens. Healthcare (Basel) 2019; 7:healthcare7020070. [PMID: 31108976 PMCID: PMC6627092 DOI: 10.3390/healthcare7020070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/17/2019] [Accepted: 05/14/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Morgellons disease (MD) is a dermopathy that is associated with tick-borne illness. It is characterized by spontaneously developing skin lesions containing embedded or projecting filaments, and patients may also experience symptoms resembling those of Lyme disease (LD) including musculoskeletal, neurological and cardiovascular manifestations. Various species of Borrelia and co-infecting pathogens have been detected in body fluids and tissue specimens from MD patients. We sought to investigate the coexistence of Borrelia burgdorferi (Bb) and Helicobacter pylori (Hp) in skin specimens from MD subjects, and to characterize their association with mixed amyloid biofilm development. METHODS Testing for Bb and Hp was performed on dermatological specimens from 14 MD patients using tissue culture, immunohistochemical (IHC) staining, polymerase chain reaction (PCR) testing, fluorescent in situ hybridization (FISH) and confocal microscopy. Markers for amyloid and biofilm formation were investigated using histochemical and IHC staining. RESULTS Bb and Hp were detected in dermatological tissue taken from MD lesions. Bb and Hp tended to co-localize in foci within the epithelial tissue. Skin sections exhibiting foci of co-infecting Bb and Hp contained amyloid markers including β-amyloid protein, thioflavin and phosphorylated tau. The biofilm marker alginate was also found in the sections. CONCLUSIONS Mixed Bb and Hp biofilms containing β-amyloid and phosphorylated tau may play a role in the evolution of MD.
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Wendt S, Trawinski H, von Braun A, Lübbert C. Durch Zecken übertragbare Erkrankungen. CME (BERLIN, GERMANY) 2019; 16:53-71. [PMID: 32288719 PMCID: PMC7111815 DOI: 10.1007/s11298-019-6903-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Zecken sind Überträger einer Vielzahl humanpathogener Krankheitserreger mit einer großen Bandbreite klinischer Symptome. Das Verbreitungsgebiet der einzelnen Erreger ist vom Vorkommen der Vektoren und Wirte abhängig. Aufgrund verschiedener Faktoren ist es in den letzten Jahren zum Teil zu einer Ausdehnung der Endemiegebiete gekommen. Am weitesten verbreitet sind Zecken-übertragene Rickettsiosen, welche v.a. in der Reisemedizin eine Rolle spielen. Die häufigsten Zecken-übertragbaren Erkrankungen in Deutschland und Europa sind Lyme-Borreliose und Frühsommer-Meningoenzephalitis (FSME). Meist verlaufen die Infektionen mild oder sind — im Falle bakterieller Infektionen — gut behandelbar. Die wichtigsten präventiven Maßnahmen bei Aufenthalten in einem Risikogebiet sind der Schutz vor Zeckenstichen und im Falle der FSME die sehr gut wirksame Impfung.
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Affiliation(s)
- Sebastian Wendt
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Henning Trawinski
- Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Amrei von Braun
- Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christoph Lübbert
- Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, D-04103 Leipzig, Deutschland
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18
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Hauser U. Modified interpretation criteria significantly improve performance of commercially available confirmatory assays for the serodiagnosis of Lyme borreliosis: a case-control study with clinically defined serum samples. Eur J Clin Microbiol Infect Dis 2019; 38:529-539. [PMID: 30715667 PMCID: PMC6394730 DOI: 10.1007/s10096-018-03455-1] [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: 11/12/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
Case-control study for the evaluation of innovative test formats for second-tier testing for the serodiagnosis of Lyme borreliosis (LB). A head-to-head comparison was performed with the test systems ViraStripe, SeraSpot, ViraChip, and recomBead. Serum samples from 62 patients (21 erythema migrans, 33 Lyme neuroborreliosis, 8 late LB) and 91 controls (including 29 potentially cross-reacting sera) were tested. For ViraChip and recomBead, optimised interpretation criteria were developed for both IgG and IgM. The most important modification for the proposed interpretation criteria for ViraChip is the interpretation of strong (> 2.5-fold above cutoff) singular IgG reactions against VlsE as positive. This significantly improves sensitivity (32 to 85%, p < 0.0001) without significant changes in specificity (borderline reactions interpreted as negative). By application of our modified rules, specificity of ViraChip IgM is significantly increased (89 to 97%, p < 0.05; borderline results included to negatives), and sensitivities of recomBead IgG and IgM are also significantly improved (69 to 87%, p < 0.01, and 57 to 74%, p < 0.01, respectively; borderline results included to positives). Further improvement of sensitivity by the rating of strong singular IgG reactions against VlsE as positive can also be shown for recomBead. IgG/IgM result combinations must be interpreted as a function of the assumed disease stage, and the best combinations differ for the various assays. Application of our proposed interpretation criteria significantly improve the discriminatory abilities of two assays; however, this must be confirmed with other data sets. Recommendations from Scientific Societies should be updated as may be necessary.
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Affiliation(s)
- Ulrike Hauser
- SYNLAB MVZ Augsburg GmbH, Gubener Straße 39, 86156, Augsburg, Germany.
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Lohr B, Fingerle V, Norris DE, Hunfeld KP. Laboratory diagnosis of Lyme borreliosis: Current state of the art and future perspectives. Crit Rev Clin Lab Sci 2018; 55:219-245. [PMID: 29606016 DOI: 10.1080/10408363.2018.1450353] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review is directed at physicians and laboratory personnel in private practice and clinics who treat and diagnose Lyme borreliosis (LB) in patients as part of their daily work. A major objective of this paper is to bring together background information on Borrelia (B.) burgdorferi sensu lato (s.l.) and basic clinical knowledge of LB, which is one of the most frequently reported vector-borne diseases in the Northern Hemisphere. The goal is to provide practical guidance for clinicians and for laboratory physicians, and scientists for a better understanding of current achievements and ongoing obstacles in the laboratory diagnosis of LB, an infectious disease that still remains one of the diagnostic chameleons of modern clinical medicine. Moreover, in bringing together current scientific information from guidelines, reviews, and original papers, this review provides recommendations for selecting the appropriate tests in relation to the patient's stage of disease to achieve effective, stage-related application of current direct and indirect laboratory methods for the detection of B. burgdorferi s.l. Additionally, the review aims to discuss the current state of the art concerning the diagnostic potential and limitations of the assays and test methods currently in use to optimize LB patient management and provide insight into the possible future prospects of this rapidly changing area of laboratory medicine.
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Affiliation(s)
- Benedikt Lohr
- a Institute for Laboratory Medicine, Microbiology & Infection Control , Northwest Medical Centre, Medical Faculty, Goethe University , Frankfurt/Main , Germany
| | - Volker Fingerle
- b Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) , Oberschleissheim , Germany
| | - Douglas E Norris
- c W. Harry Feinstone Department of Molecular Microbiology & Immunology , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
| | - Klaus-Peter Hunfeld
- a Institute for Laboratory Medicine, Microbiology & Infection Control , Northwest Medical Centre, Medical Faculty, Goethe University , Frankfurt/Main , Germany
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