Increased levels of sphingosine-1-phosphate in cerebrospinal fluid of patients diagnosed with tick-borne encephalitis

Background

Tick-borne encephalitis (TBE) is a serious acute central nervous system infection that can result in death or long-term neurological dysfunctions. We hypothesize that changes in sphingosine-1-phosphate (S1P) concentration occur during TBE development.

Methods

S1P and interleukin-6 (IL-6) concentrations in blood plasma and cerebrospinal fluid (CSF) were measured using HPLC and ELISA, respectively. The effects of S1P on cytoskeletal structure and IL-6 production were assessed using rat astrocyte primary cultures with and without addition of plasma gelsolin and the S1P receptor antagonist fingolimod phosphate (FTY720P).

Results

We report that acute inflammation due to TBE virus infection is associated with elevated levels of S1P and IL-6 in the CSF of infected patients. This elevated concentration is observed even at the earliest neurologic stage of disease, and may be controlled by glucocorticosteroid anti-inflammatory treatment, administered to patients unresponsive to antipyretic drugs and who suffer from a fever above 39°C. In vitro, treatment of confluent rat astrocyte monolayers with a high concentration of S1P (5 μM) results in cytoskeletal actin remodeling that can be prevented by the addition of recombinant plasma gelsolin, FTY720P, or their combination. Additionally, gelsolin and FTY720P significantly decreased S1P-induced release of IL-6.

Conclusions

TBE is associated with increased concentration of S1P and IL-6 in CSF, and this increase might promote development of inflammation. The consequences of increased extracellular S1P can be modulated by gelsolin and FTY720P. Therefore, blocking the inflammatory response at sites of infection by agents modulating S1P pathways might aid in developing new strategies for TBE treatment.

Depletion of plasma gelsolin in patients with tick-borne encephalitis and Lyme neuroborreliosis

BACKGROUND/AIMS

Cell damage during the course of inflammation results in cytoplasmic actin release, which if not eliminated by the extracellular actin scavenger system, composed of gelsolin and vitamin D binding protein, can cause dysfunction of hemostasis and toxicity towards surrounding cells. In this study, we test the hypothesis that an inflammatory reaction induced by central nervous system infections such as tick-borne encephalitis (TBE) or Lyme neuroborreliosis (LNB) will result in plasma gelsolin concentration changes in the blood and cerebrospinal fluid (CSF).

METHODS

Quantitative Western blot was used to determine gelsolin levels in 58 samples, which include: 29 patients without infection (diagnosed with conditions such as idiopathic cephalalgia, idiopathic Bell's facial nerve palsy and ischialgia due to discopathy in which standard CSF diagnostic tests show no abnormalities), 12 patients diagnosed with TBE, and 17 patients diagnosed with LNB sub forma meningitis.

RESULTS AND CONCLUSION

The gelsolin concentration in the blood of patients with TBE (163.2 ± 80.8 μg/ml) and LNB (113.6 ± 56.8 μg/ml) was significantly lower (p < 0.05 and p < 0.001, respectively) compared to the control group (226.3 ± 100.7 μg/ml). Furthermore, there was no statistically significant difference between the CSF gelsolin concentration in patients with TBE (3.9 ± 3.3 μg/ml), LNB (2.9 ± 1.2 μg/ml) and the control group (3.7 ± 3.3 μg/ml). An observed decrease in gelsolin concentration in the blood of TBE and LNB patients supports previous findings indicating the involvement of gelsolin in the pathophysiology of an inflammatory response. Therefore, evaluation of blood gelsolin concentration and administration of recombinant plasma gelsolin might provide a new tool to develop diagnostic and therapeutic strategies for TBE and LNB.

[Peripheral neuropathies in Lyme borreliosis]

Lyme borreliosis is a multisystem disease and when involves the nervous system it is termed neuroborreliosis. The symptomatology of peripheral neuroborreliosis is rich and varied. The early symptoms are asymmetric polyradiculopathies and paralysis of the cranial nerves (most commonly facial nerve). Thereafter, there are multifocal mononeuropathies and sensory-motorpolyneuropathies. Difficulties in making a correct diagnosis can result from the long time lag between tick bite and the occurrence of neurological symptoms. In the treatment the most important role play antibiotics.

CASE REPORTS

We report the cases of three patients with symptoms of damage to various structures of the peripheral nervous system in the course of Borrelia burgdorferi infection. In all cases, clinical improvement was obtained after treatment with antibiotics, which further confirms the diagnosis of neuroborreliosis.

CONCLUSIONS

About neuroborreliosis as a cause of peripheral neuropathy we should always think in the case of vague symptoms of peripheral nervous system lesions in patients with potential exposure to tick bites. Peripheral neuropathies may occur a long interval from the tick bite and are not always preceded by other forms of the disease.

[Presence of antibodies against gangliosides among patients with Lyme borreliosis--preliminary study]

THE AIM of the study was the evaluation of autoantibody reaction against endogenous gangliosides in the course of Lyme borreliosis.

MATERIAL AND METHODS

Antibodies against profile of gangliosides composed of GM1, GM2, GM3, GD1a,GD1b,GT1b, GQ1b were evaluated in serum patients with early disseminated (neuroborreliosis) Lyme disease (n = 16), patients with long lasting serologic response against Borrelia burgdorferi (n = 32) and in healthy subjects (n = 16). Immunoblot test for IgG was used.

RESULTS

Antibodies were detected in all evaluated groups. In group of neuroborreliosis (lymphocytic meningitis with cranial nerve invoIvement) there was no essential difference with control group. It was stated in group of forestry workers with serological features of infection B. burgdorferi lasting for years.

CONCLUSIONS

Results of the study do not support the thesis of participation of IgG autoantibodies against gangliosides in pathogenesis early disseminated Lyme borreliosis in form of lymphocytic meningitis with cranial nerves paresis. Antibodies against endogenous glicosfingolipides in Lyme borreliosis probably can lead to affecting nervous system (demielinisation and polineuropathy) but probably require long-term immunization, what is suggested by results of examined group of patients with the multi-annual serological features of infection.

[Transmission and circulation of tick borne pathogens (TBE and Lyme borreliosis) and the role of changing environment]

Ixodes ricinus is regarded as a species with great medical and veterinary meaning. Transmission of tick borne pathogens in mammals depends not only on systemic infection. Transmission of B. burgdorferi and tick-borne encephalitis virus in an infected organism differs, because of different location in tick, the differences in dissemination of the virus and bacteria (own motility) as well as mechanisms supporting bacterial infection. The mechanisms governing the transmission of these pathogens in nature have epidemiological importance and are essential in understanding the pathogenesis of diseases. The increase in the incidence of tick-borne encephalitis in recent years, is a marker of tick borne diseases. In the 90s, the number of cases among humans in many European countries remains at a higher level compared to the eighties. Similar observations consider to Lyme borreliosis. Natural environmental changes, mainly related to climate, as well as regional and local changes in distribution of the small rodents species, wild animals, anthropogenic factors (reforestation, drainage of swamps, increasing the reservoir of animals), and social change (increased human activities in forests, vaccinations) may have a significant impact on rates of tick-borne diseases.

[Long-term fever as a first symptom of neoplasmatic process in young patients--case reports]

Fever is a thermoregulation disorder with body temperature increased (above 38 degrees C). The most often accompanies infections, but it may also be a symptom of neoplasmatic disease.

CASE REPORTS

In our paper we described 2 patients, who were admitted to the Department of Infectious Diseases and Neuroinfections with fever as a main symptom. Laboratory tests excluded the infection as causative agents of a long term fever. Wide spectrum diagnosis in both cases led to diagnosis of neoplasmatic disease. Presented cases indicate that in patents with long term fever, even in young age, neoplasmatic process should be taken into consideration.

[Neuroradiologic imaging results suggestive of parasitic cysts in central nervous system in course of neoplastic disorders--cases report]

Cystic changes within CNS, revealed by computed tomography or magnetic resonance imaging, pose difficult diagnostic and therapeutic problem. We present two patients with primary diagnosis of parasitic cysts of CNS, in whom neoplastic etiology was finally confirmed. Differential diagnosis of cystic foci should from the beginning include not only parasitic infections, but also neoplastic diseases, which are much more frequent in Poland at present and in which prolonged diagnostic process and delayed treatment is highly unfavorable.

[Fractalkine--structure, functions and biological activity]

Although chemokines, as chemotactic factors, were already known in 70's of the past century, it was only the progress in molecular biology, genetics and immunology which occurred in the past few years that opened the way to discover new molecules, their chemical structure and biological functions. Fkn (fractalkine, CX3CL1) is a unique chemokine and the only representative of CX3C group. It exists as a membrane-bound and soluble form. It interacts with cells expressing CX3CR1, a G-coupled protein receptor. The polymorphism of CX3CR1 gene modulates Fkn affinity to its receptror, which influences the risk of development and progression of various diseases. Its unique character is determined by its functions. Fkn is not only a chemotactic factor, but it also participates in leukocyte trafficking, adhesion and cytotoxic activities, modulates expression of cytokines, adhesion molecules, free oxygen radicals, iNOS and influences apoptosis. Its elucidation should not only help understanding of molecular events occurring in many autoimmune inflammatory, neoplasmatic diseases, but would allow to use Fkn, its receptor, or anti-Fkn antibodies in treatment of those diseases.

[Transforming growth factor beta, metalloproteinase 2 and its tissue inhibitor 2 in the serum from patients with early and late boreliosis]

Boreliosis is an arthropod transmitted, bacterial infection, known for its complicated pathogenesis and prolonged course. Boreliosis can be divided into early, localized type, early generalized type as well as late type. Cytokines control homeostasis of the organism by transmitting signals between cells. TGF (transforming growth factor) beta is one of the cytokines that modulates cell differentiation, proliferation and angiogenesis. In larger concentrations it blocks the expression of IL-1 and TNF-alfa. TGF-beta stimulates production of selectin, collagen, fibrinoectin and integrin. It inhibits metalloproteinase that causes degradation of the above mentioned proteins.

THE AIM OF THE STUDY

We assessed a concentration of TGF-beta in the blood of patients presented with an early form of boreliosis Erythema Migrans (EM) as well as in patients with an advanced form of this disease Lyme arthritis (LA) In addition, levels of metalloproteinase (MMP-2), its tissue inhibitor (TIMP) was assessed. We attempted to analyze the effects of treatment by measuring specific markers of inflammation.

MATERIAL AND METHODS

We tested a group of 40 patients with Lyme disease. The first group included 20 patients with an early form--(EM), while the second group of 20 patients, had a chronic form of the disease--(LA). The control group consisted of 8 healthy blood donors. The serum levels of TGF beta, metalloproteinase (MMP-2) and its tissue inhibitor (TIMP-2) were obtained using ELISA. Levels were obtained prior to treatment and after 4 weeks of treatment with Doxycyclin or Rocephin (Ceftriaxon).

RESULTS

The results indicated that levels of TGF-beta were lower in the Lyme patients than in the healthy control. In the patients group, the early form of disease had higher levels of TGF-beta than in the chronic. Acute, early phase group had also higher serum levels of MMP-2 and TIMP-2 in comparison to the chronic stage group. LA group showed correlation between TGF-beta concentration and levels of MMP-2. It has not been the case in the acute stage of the disease. Both groups of patients had higher levels of IL-1-aRII and selectin E in comparison with control.

CONCLUSIONS

As suggested by the results, decreased levels of TGF-beta in patients with boreliosis can be due to increased levels of MMP-2 and TIMP. The above markers and their concentration can be useful in the monitoring of the effectiveness of provided therapy and suggest that inflammation can persist in spite of the normalization of the clinical picture. The results suggest extremely complicated pathophysiology of Lyme disease where pro and antiinflammatory cytokines are as important as the pathogen itself.

[Neuroborreliosis--some aspects of pathogenesis, diagnosis and treatment]

Chosen pathophysiological aspects of Lyme borreliosis influencing on neurological symptoms, difficulties in diagnosis of neuroborreliosis and current opinions about effectivness of treatment. European recomendations--results of EUCALB expert group, AAN-American Academy Neurology supported some important studies connected with duration of therapy are described.

[Comparison of test with antigen VlsE (C6) with tests with recombinant antigens in patients with Lyme borreliosis]

In diagnosis of Lyme borreliosis classic, recombinant antigens are used. Introduced recombinant antigen VlsE increases hope to improve sensibility of the tests.

AIM OF THE STUDY

Serological results detecting antibodies against Borrelia burgdorferi, recombinant antigens in both classes and test with VlsE were compared.

MATERIAL AND METHODS

Quick ELISA C6 Borrelia Assay Kit (U.S.A.) for both classes simultaneusly were compared with two tests composed of recombinant antigens Borrelia IgG recombinant, Borrelia IgM recombinant (Biomedica, Austria)separate for IgM i IgG antibodies. Patients with borreliosis as eryhtema migrans were evaluated (n=36) and group with chronic Lyme arthritis (n=68).

RESULTS

Statistical coincidence between results of test ELISA C6 and presence of antibodies IgM (p < 0.0001) and IgG (p < 0.0001) obtained in tests based on recombinant antigens in group erytema migrans. In group Lyme arthritis coincidence (p < 0.0002), with IgM antibodies was stated.

CONCLUSIONS

Test ELISA C6 (with protein VlsE-C6) in group of patients with Lyme borreliosis had statistically essential predictive values of presence antibodies in IgM i IgG class, stated in tests performed separately for IgM and IgG classes with recombinant antigens. Tests based on conservative part of protein VlsE (C6), detecting antibodies in both classes are very promising in diagnosis of early stages Lyme borreliosis.

[Clinical forms of neuroborreliosis among hospitalized patients in the years 2000-2005]

THE AIM OF THE STUDY

To evaluate the frequency of clinical forms as well as laboratory and neuroimaging results of patients with diagnosed neuroborreliosis in the years 2000-2005 due to neuroborreliosis.

MATERIAL AND METHODS

The records of 125 patients at the age of 21-83 (mean 49 years) treated in the years 2000-2005 in the Department of Infectious Diseases and Neuroinfections, Medical University, Bialystok were subject to retrospective analysis. Diagnosis was based on case history along with a clinical picture and presence of antibodies against Borrelia burgdorferi, using ELISA test (Borrelia IgM and Borrelia IgG recombinant Biomedica). The subject of the detailed analysis was demographic data, clinical symptoms as well as subjective complaints, results of neurological examinations, the results of cerebrospinal fluid (CSF) parameters and results of serologic tests.

RESULTS

The most frequent clinical symptoms observed were: headaches 71%, vertigo 44%, meningeal symptoms 22% and neurological paresis 27% (including facial palsy--23%). Inflammatory changes in CSF in the form of increased proteins concentration and pleocytosis were present among 34% of patients. In all cases the antibodies against B. burgdorferi were present in CSF in diagnostically significant titer. Serum presence of antibodies antiborrelia IgM was found with 55% of patients and anibodies antiborrelia IgG with 76% of patients. 17% of patients suffering from neuroborreliosis were also coinfected with tick-borne encephalitis virus. Along with the neurological symptoms, which were crucial to diagnosis, general symptoms coexisted, such as: weakness 35%, arthralgia 54% and nausea 17%. In the analyzed period of time neuroborreliosis was diagnosed in a 13% of hospitalized patient suffering from borreliosis.

CONCLUSIONS

Absence of erythema migrans does not exclude existence of neuroborreliosis. Symptoms that may suggest presence of neuroborreliosis are not only neurological symptoms such as facial palsy, but also memory and concentration disorders and general symptoms.

[Immunopathology of Lyme arthritis]

Lyme borreliosis (Lyme disease) is the most prevalent tick-borne disease caused by spirochaetes of the Borrelia species complex. Arthritis is one of the common manifestations of B. burgdorferi infection. The pathomechanism of articular changes in Lyme arthritis has not yet been elucidated. Histopathological studies of synovia and immunological changes are similar to rheumatoid arthritis. In the early stage of inflammation B. burgdorferi interact with polynuclear granulocytes and epithelial cells, triggering production of reactive oxygen species, lipid peroxidation products and other inflammatory mediators. The imbalance between anabolic and catabolic processes in inflamed joints results in the progressive destruction of articular cartilage and disintegration of extracellular matrix. Molecular mimicry between OspA (outer surface protein A) and adhesion molecule LFA-1alpha seems to be responsible for chronic arthritis.

[Cilliary neurotrophic factor in tick-borne encephalitis]

THE PURPOSE OF THIS STUDY

To evaluate concentrations of cilliary neutrophic factor (CNTF) in serum and cerebrospinal fluid of patients with tick-borne encephalitis (TBE) and bacterial meningitis.

MATERIAL AND METHODS

49 patients (14 females and 35 males), aged 19 to 62 were examined. Patients were divided into three groups: group I--23 patients (47%) with diagnosed TBE, group II--16 patients (33%) with bacterial meningitis and 10 (20%) healthy individuals as control group. The examination was performed twice before and after 4-weeks treatment. In achieved results CNTF concentration in serum from group I and II in both examinations was significantly higher compared to control group.

RESULTS

Patients with TBE showed higher serum CNTF concentration compared to group with bacterial meningitis in both examinations as well. In examination 1 cerebrospinal fluid CNTF concentration of both groups was significantly higher in comparison to control group. Examined cytokine CSF concentration was higher in group with bacterial meningitis. After treatment CNTF concentration decreased significantly in group I and II. In group I CNTF concentration was comparable to control group.

CONCLUSION

Concentration of CNTF in csf could be used as a marker of the inflammatory process in the central nervous system.

[Soluble CD40 and soluble CD40L concentrations in the serum and the cerebrospinal fluid of patients with tick borne encephalitis and neuroborreliosis]

BACKGROUND AND PURPOSE

The interaction between CD40 and CD40L is essential in generating of an immunological response also intrathecally. The aim of the study was estimation of a concentration soluble form of CD40, CD40L (CD154) in the bacterial and viral inflammation of the central nervous system in two compartments - blood circulation and intrathecally, before and after the treatment.

MATERIAL AND METHODS

sCD40 and sCD40L were tested twice before and after treatment in pairs serum and CSF of 40 patients treated in the Dept. of Infectious Diseases and Neuroinfections. Patients were divided in two groups: (n=20) patients with tick borne encephalitis (TBE) (group I, n=20) and patients with neuroborreliosis in the form of lymphocytic meningitis (group II, n=20). ELISA assays were performed.

RESULTS

Significantly increased concentrations of sCD40, sCD40L in CSF (higher in neuroborreliosis) were measured. We found also an increased concentration of sCD40L in inflammatory CSF in both tested groups (in neuroboreliosis lasting also after 4 weeks of treatment), compared with the control group (below the detection limit in normal CSF).

CONCLUSIONS

Results of estimation of the sCD40 and sCD40L concentrations indicate their role in the intrathecal inflammation process of bacterial and viral etiology. The increased serum concentration of sCD40L in TBE and CD40 in neuroborreliosis indicate that peripheral activation of the immunological system persists after cessation of treatment and after the clinical recovery. The defense mechanisms are more pronounced in neuroborreliosis than in tick borne encephalitis.

[Difficulties in early diagnosis of Herpes simplex encephalitis]

Herpes simplex virus infection of the central nervous system is still a significant cause of morbidity and often mortality at relatively young people. Changes of central nervous system are results of primary infection or activation of latent HSV-1, HSV-2. Neurological deficits often follow encephalitis herpetica. CT, MRI and SPECT are usefull tools in early recognition of herpes encephalitis. The aplication of PCR is prompt and specific diagnosis of herpes simplex virus infections of the brain. Advances in treatment Herpes simplex encephalitis with acyclovir have improved outcome.

[Serum and cerebrospinal concentrations of sICAM-1 sICAM-2, sICAM-3 in neuroborrellosis and tick borne encephalitis--preliminary report]

OBJECTIVE

The aim was to evaluate the concentrations of the soluble forms of ICAM-1, ICAM-2, ICAM-3 in the serum and cerebrospinal fluid (CSF) of patients with neuroborreliosis and thick borne encephalitis before and after therapy in comparison with the control group.

MATERIAL AND METHODS

We examined 30 patients, 10 in each group: neuroborreliosis-group I (NB), tick borne encephalitis--group II (TBE) and in the control group (group K). The diagnosis of neuroborreliosis and TBE based on the clinical features was confirmed by ELISA assays: FSME Virus/TBE Virus test (VIRION, Germany) for TBE and Borrelia IgM and IgG Recombinant (Biomedica Austria) for NB. The assays of sICAM-1, sICAM-2, sICAM-3 (ELISA, Bender Med System, USA) were performed twice in group I and II: before and after 3-4 weeks long treatment and once in control group.

RESULTS AND CONCLUSIONS

Increased concentration of soluble forms of ICAM-1, ICAM-2, ICAM-3 in CSF suggest their important role in inflammatory process of viral and bacterial origin. In NB group, the serum concentrations of sICAM-1, sICAM-2 were significantly increased before and after treatment in comparison with control as well as with the analogous test results in TBE group. It may suggest NB as the part of systemic inflammation. The CSF concentration of sICAM-2 decreases after treatment in NB group in comparison with the analogous test results of TBE group. The increased CSF concentration of sICAM-2 in TBE group when compared to the CSF concentration in NB group suggest slow recovery and still persisting immunological activation in this group, even when the neurological symptoms disappeared. Increased concentrations in CSF in both diseases indicate intrameningeal activity of lymphocytes and may be a useful marker of inflammation.

[Concentration of soluble CD4, CD8, CD25 receptors as well IFN-gamma and IL-4 released by lymphocyte of chronic Lyme patients cultured with 3 genotypes of Borrelia burgdorferi]

The aim of the study was the evaluation of sCD4, sCD8, sCD25, IFN-gamma and IL-4 released in the supernatant of lymphocyte cultures from patients with chronic Lyme stimulated by B. burgdorferi. Three genotypes of B. burgdorferi: sensu stricto B-31, B. garinii 20047 and B. afzelii--VS 46110 were used for stimulation. The study group consisted of 23 patients (13 males and 10 females). The control group (K) consisted of 10 healthy people. Peripheral blood mononuclear cells were incubated in atmosphere of 5% CO2 at 37 degrees C after the addition of spirochetes of B. afzelii (VS 46110), B. garinii (20047), B. burgdorferi sensu stricto (B-31) in the concentration of 10(8) spirochetes/well, for 5 days. The supernatants were analyzed for concentration of sCD4, sCD8, sCD25 and IL-4, IFN-gamma by means of ELISA method. The increase in sCD4, sCD8 and sCD25 concentrations indicates the activation of these lymphocytes with CD4, CD8, CD25 receptors in this group of patients. A significantly higher concentration of IFN-gamma shows the long-lasting cellular response with the advantage of Th1 type profile cytokines. All used strains had immunogenic properties but B. afzelii had the strongest in patients with chronic borreliosis.

[Severe acute respiratory syndrome (SARS)--new, unknown disease?]

Severe Acute Respiratory Syndrome (SARS) caused by new corona--virus SARS-Co-V was not identified at humans and animals up to this time. A characteristic feature of this disease is biphasic course. First high fever, parainfluenza syndrome followed by increasing respiratory distress. The main role in transmission is droplet way, things contaminated by excreta, blood transfusion is not excluded. Pathomorphological changes are: bronchial epithelial denudation, loss of cilia, squamous metaplasia, a giant cells infiltrate of macrophages in the alveoli, haemophagocytosis, atrophy white pulp of the spleen. Diagnosis is based on clinical picture and epidemiological data supported by positive serology, PCR or presence virus in cell culture. In treatment ribavirin, steroids and mechanical ventilation are used.

[Should ticks be regarded as a tularemia vector in habitants of North-Eastern Poland?]

BACKGROUND

A growing incidence of tick borne encephalitis and Lyme borreliosis in north-eastern Poland as well as an increasing number of Ixodes ricinus ticks in wooded areas and meadows have prompted the authors to evaluate the presence of antibodies against Francisella tularensis in serum of forest workers.

MATERIALS AND METHODS

Sera of 820 persons, including 765 healthy forest workers (group I) and 55 patients with lymphadenopathy (group II) admitted to the Department of Infectious and Neuroinfectious Diseases, Medical Academy, Białystok, were diagnosed for antibodies against F. tularensis. Agglutination test at 37 degrees C, with suspensed F. tularensis (Biomed, Kraków, Poland) were used. Simultaneously all sera were tested for the presence of antibodies against B. burgdorferi, using ELISA test, Borrelia IgM and Borrelia IgG recombinant (Biomedica, Austria).

RESULTS

Of the 765 forest workers (group I), 20 (2.06%), persons showed positive (1:20) result of agglutination test, including 8 persons with antibodies against B. burgdorferi in IgG, of these 1 in IgM and IgG. Twenty persons with positive agglutination test had no signs of present or past tularemia in physical examination. Nine persons with prior diagnosis of arthritic form of Lyme boreliosis had undergone repeated antibiotic therapy (two 30-days therapy courses with cefotaksym or doxycycline). In group II, sera of 55 patients were negative in the agglutination test with F. tularensis.

CONCLUSIONS

The results of our study show that in North-Eastern Poland, Ixodes ricinus is not essential in Francisella tularensis transmission in this region.

Apoptosis in Lyme borreliosis--a preliminary study

BACKGROUND

Apoptosis plays an important role in the control of the immune system, and its impairment may be associated with autoimmune responses. Different bacterial and viral pathogens interfere with the regulation of apoptosis. This may take place in Lyme borreliosis, in which pathological autoimmune reactions are likely to occur.

MATERIAL/METHODS

A study group consisted of 15 patients with erythema migrans (group I), 15 with Lyme arthritis (group II) and 9 with neuroborreliosis (group III); the control group consisted of 10 healthy subjects. The concentrations of the factors involved in apoptosis regulation--transforming growth factor-beta1 (TGF-beta 1), soluble Fas (sFas), soluble Fas ligand (sFasL) and protein bcl-2--were measured in serum before (examination 1) and after (examination 2) four weeks of antibiotic treatment.

RESULTS

The mean concentration of sFas was significantly higher in all study groups compared to controls in examination 1 and 2, and showed a tendency to increase during treatment. The concentration of sFasL was significantly increased in groups II and III in examination 1. The concentration of bcl-2 was elevated significantly in all groups in examination 1 and dropped during treatment, remaining significantly increased in group I. The concentration of TGF-beta 1 was not significantly elevated except for group II in examination 2.

CONCLUSIONS

The concentrations of soluble factors involved in the regulation of apoptosis were increased in serum of patients with different forms of Lyme borreliosis. Further studies are necessary to confirm if inappropriate apoptosis of immune cells may contribute to the pathogenesis of Lyme disease.

[Viral nosocomial infections: the problem of contemporary hospital management]

The most frequent viral pathogens which are the cause of nosocomial infections were presented. Influenza and parainfluenza viruses as well as RS virus affect frequently respiratory tract. So called enteric viruses which are rotaviruses, adenoviruses, small round viruses, astroviruses, caliciviruses, corona viruses, Coxackie, ECHO may be the agents of disorders in digestive tract in the form of intoxications. Viruses of viral hepatitis B, C, D and HIV, CMV, EBV may be the source of nosocomial viral infections transmitted by blood (transfusions).

Serum concentration of TNF-alpha and IL-1 beta in patients with chronic hepatitis C treated with interferon alpha--a preliminary report

The aim of the study was to evaluate the concentration of TNF-alpha and IL-1 beta in 14 chronic hepatitis C patients during interferon treatment in a correlation with biochemical indicators of hepatic cell damage, AspAT and ALAT activity. The study included the sera obtained every month (10-12 measurements) during 48-week therapy. IL-1 beta and TNF-alpha concentrations were determined by ELISA method. Statistic analysis were performed with AnStat program. The wide range of IL-1 beta and TNF-alpha concentration values may prove a differentiated response to immunomodulating treatment with INF-alpha. Concentrations of TNF-alpha, IL-1 beta, show decreasing tendency during therapy. A positive correlation between proinflammatory cytokines (IL-1 beta and TNF-alpha), ALAT and AspAT indicates the role of these cytokines and their relation to a necrotic-inflammatory process demonstrated by aminotransferases concentration.

[Pathogenetic-clinical problems of Lyme borreliosis]

In this article a short review of pathogenesis and clinical manifestations of Lyme disease is presented. As regards pathogenesis, attention was paid to the mosaic protein structure of the B. burgdorfieri spirochete, particularly of outer surface proteins (Osp) that influence the clinical course and diagnosis of the disease. The presence of various atypical spirochete forms: spheroplastic L (without cell walls), cystic, and granular "blebs" may lead to a chronic form of the disease and to a low efficacy of antibiotic therapy. An important part of the pathogenesis is epithelial damage, stimulating the production of inflammatory cytokines (mainly IL-1, TNF-alpha, IFN-gamma), adhesive molecules and acute-phase proteins. Moreover, in the course of the disease not only an impairment of phagocytosis and chemotaxis was found, but also B. burgdorfieri spirochete binding by antibodies into immunological complexes that may maintain chronic inflammation. In terms of the Asbrink classification, complaints predominating in the clinical picture of an early and late stage of the disease were presented, with an emphasis on neuroborreliosis.

[Effect of antibiotic therapy on levels of proinflammatory cytokines: interleukin IL-1, IL-6 and tumor necrosis factor TNF-alpha in serum of patients with Lyme borreliosis]

We estimated serum concentrations of cytokines: IL-1, IL-6, TNF-alpha in patients with diagnosed Lyme disease treated for 14 days with antibiotics. The detection of proinflammatory cytokines was performed by ELISA tests. The examination was carried out before and after the treatment. The comparison with control group stated statistically significant higher concentration of IL-1, IL-6 and TNF-alpha before and after the treatment. Comparing the concentrations of cytokines after treatment with control group showed normalization only in a few cases. In the majority of cases serum cytokines concentrations remained significantly higher. That is why we conclude that 14-day-therapy with antibiotic in patients with Lyme disease may not be sufficient.

[Echinococcosis in North-Easter Poland--epidemiological and clinical aspects]

The incidence was assessed of antibodies against E. granulosus and chosen biochemical parameters among the inhabitants of north-eastern Poland. Among 532 studied subjects, 110 were seropositive. Group I (n = 73) was pharmacologically treated. Group II was surgically treated. Control group consisted of 15 healthy persons. 20.6% seropositive inhabitants of north-east Poland indicate that echinococcosis is not rare. Mainly it was echinococcosis of the liver, only in 2.7% it was connected with other organs. Echinococcosis was diagnosed among women aged 47-70, living in town, in majority owners of a dog. The course of echinococcos in majority cases was without clinical signs. In the diagnosis USG and serological test were helpful. Laboratory findings were not characteristic of echinococcosis. If it is possible surgical treatment is recommended for removal of parasite, verification of preoperative tests. In majority of chirurgically removed cyst, antibodies against E. granulosus were found after 3.5 years on the average, what evidenced strong immunogenicity of the parasite.

[Estimation of platelet counts and their morphological parameters in patients infected by borrelia burgdorferi]

Platelet counts and their morphologic parameters in patients with Lyme borreliosis before and after antibiotic therapy (4 weeks of treatment) were estimated. 30 patients aged 17-60, x = 41 were evaluated: 7 with Erythema migrans, 3 patients with neuroborreliosis in the from Lymphocytic meningitis and 20 ones with Lyme arthritis. Control group consisted of 19 healthy persons aged 34-52, x = 43. Hematologic analyser Coulter MAXM was used for testing PLT, MPV, PCT and PDW. The results indicated that patients with Lyme boreliosis have decreasing platelet count with simultaneously increasing their volume in comparison with healthy control. It may result from the involement of platelets in defense mechanisms of infected host. The decrease of platelet count after the antibiotic treatment in comparison with the control group may be the reflection of influence of antibiotic treatment on thrombopoesis.

Analysis of some peripheral blood lymphocyte subsets in relation to Borrelia burgdorferi antibodies in patients with Lyme disease

The aim of our study was to evaluate the changes in T (CD3), B(CD19) lymphocytes, CD4 and CD8 subsets, activated CD3+ HLA-DR+ lymphocytes, lymphocytes with receptor for IL-2 (CD3+CD25), NK cells as well as the rate of CD4/CD8 in 30 patients with recognized Lyme disease, before and after antibiotic therapy. Patients were divided into the following groups: Group I n = 9--without detected specific antibodies against B. burgdorferi and with clinical recognition of EM(erythema migrans). Group II n = 10--with increased IgM production, with a clinical form of Lyme arthritis and neuroborreliosis. Group III n = 11--with increased IgG anti B. burgdorferi production, with clinical recognition of Lyme arthritis. The results were compared with the results obtained in the control group consisting of 90 healthy people. The measurements were performed in the flow cytometer COULTER EPI XL with Becton Dickinson antibodies. The antibodies against B. burgdorferi were detected by means of ELISA method using Dako, Biomedica and Biocom kits. The statistic analysis was performed with AnStat Program. The changes in lymphocyte subsets were characterised by the decrease in the percentage of CD4, CD8, NK and CD3+HLA-DR+ lymphocytes in peripheral blood before treatment with later tendency to increase. The results show that the lag phase of antibodies production coincides with high activity of lymphocytes (group I). The significant level of antibodies in IgM class induced by the collaboration of T and B cells was found in the group II. In the group III, in which antibodies in IgG class predominated, the changes in lymphocyte subsets were less intensive. The results of our investigations indicate that the immune response in Lyme disease develops mainly with the participation of both cellular and humoral response which is involved in both the defense against and the pathogenesis of the disease.

[Proinflammatory cytokines in humoral immune response]

Proinflammatory cytokines secreted by cells involved in inflammatory process play a key role in the regulation of immune responses, both cellular and humoral immune response. Through their influence on T-helper lymphocytes and antigen presenting cells including lymphocytes B, they induce secretion of secondary cytokines and, in cooperation with them, promote activation and proliferation of lymphocytes B and production of variety of classes of immunoglobulins. Cytokines interact with their specific receptors which usually occur both in membrane bound and soluble form. The purpose of this article was to evaluate the relationships between primary cytokines such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) and other cytokines, lymphocytes T-helper and lymphocytes B in the light of current opinions regarding this matter.

Role of reactive oxygen species (ROS) in patients with erythema migrans, an early manifestation of Lyme borreliosis

BACKGROUND

Lyme borreliosis is a tick-transmitted, chronic, zoogenous disease caused by Borrelia burgdorferi spirochete. The clinical picture of Lyme disease is characterized by the variety of tissue and organ involvement and differing severity of symptoms. One of the pathogenic symptoms of early Lyme disease is a skin lesion called erythema migrans.

MATERIAL AND METHODS

The purpose of our research was to estimate the parameters of the antioxidant system and the concentration of lipid peroxidation products in the plasma of patients with erythema migrans (EM). The parameters measured included the activity levels of superoxide dismutase (SOD) according to Sykes, gluthatione reductase (GSSG-R) according to Mize and Langdon, glutathione peroxidase (GSH-Px) according to Paglia and Valentine; the concentrations of malondialdehyde (MDA) were examined by means of a Bioxytech LPO-586 kit. The total sulphydryl groups (-SH) according to Ellman and reduced glutathione (GSH) were measured using a Bioxytech GSH-400 test in plasma samples collected from 20 patients with EM aged from 19 to 50, taken before (examination 1) and after (examination 2) therapy with amoxycycline. The control group consisted of 8 healthy people.

RESULTS

The results of our examinations prove that beta-lactamase antibiotic therapy brings non-enzymatic antioxidant parameters to control values, though the treatment causes no change in enzymatic antioxidant parameters, resulting in the further activation of free radicals.

CONCLUSIONS

In patients with Erythema migrans, the decreased capability to reduce lipid superoxidants leads to maintaining a high concentration of membrane lipid peroxidation products.

[Epidemiologic aspect of lyme borreliosis among the inhabitants of Podlasie Province]

The aim of this study was to evaluate Lyme borreliosis morbidity among the inhabitants of Podlasie Province in the years of 1996-2000.

MATERIAL AND METHODS

The new cases of Lyme borreliosis reported in the years of 1996-2000 in Podlasie Province were analyzed. The analysis included the data from Mz-56 and Mz-57 forms and the information from epidemiologic investigations sent to Regional Sanitary and Epidemiologic Station in Bialystok. In 1996-2000, screening examinations were carried out in the same group of 358 forestry workers including 44 (12.29%) females and 314 (87.71%) males aged from 21 to 64 (x = 41.2) years. Immunoenzymatic test of ELISA Borrelia recombinant IgM and IgG by Biomedica firm (Austria) were used to detect B. burgdorferi antibodies.

RESULTS

In 1996-2000, 4933 of borreliosis cases were registered in Poland including 1377 (27.91%) in Podlasie Province. The morbidity rate in Podlasie province ranged from 15.05% in 1996 year to 21.29% in 2000 year of the whole country morbidity. At the same time, the incidence rate in Podlasie Province ranged from 9.09 in 1996 to 32.2 in 2000 year and was 6.72-fold higher than the incidence rate in the whole country. In Eastern and Central region of the province, 80.54% of cases were registered whereas, 14.09% by the Lakeside of Augustów and Suwalki only 5.37% in the western region of the province. It was proved that the morbidity increased in proportion to the age of patients (41.39% of patients were at the age of 30-49) and it decreased only above the age of 60. Thus, Lyme borreliosis affects mainly people at working age. The increase in B. burgdorferi antibody detectability was noticed in the population of forestry workers; it was detected in 38.55% in 1995 and in 2000 in 43.56% of the examined. Interestingly, 81 people infected with B.b in 1995-2000 included 74 men and only 7 women, supporting the statement that B.b infection affects mainly working professionals and the risk increases with the practice.

CONCLUSIONS

Our studies indicate that Lyme borreliosis is a serious health problem among the inhabitants of Podlasie Province which is an endemic area for Ixodes ricinus ticks infected with B. burgdorferi spirochete.

[Selected aspects of immunopathogenesis in Lyme disease]

Abilities of B. burgdorferi to infect and induce illness is connected with immunopathogenic factors as: immunomodulatory elements of tick saliva abilities of B. burgdorferi to move in extracellular matrix, connecting and activation of proteolitic zymogen, inducing endothelium to production of adhesive molecules, chemokines and acute phase proteins. Important elements in pathogenesis and course of Lyme disease are organ tropism, producing by lymphocytes T proinflammatory cytokines (Th1 and Th2 profile), phagocytic abilities of infected organisms. In pathogenesis of chronic and recurrent cases difficult to treat is essential is survive of metabolic inactive bacteria, antigens B. burgdorferi as form "blebs", cystic L-form or insoluble complexes antigen-antibody or possibility of intracellular survive of B. burgdorferi. Tissue and organs damage is caused not only directly by B. burgdorferi antigens. Undoubtedly in the late stages there are immunologic disregulation and molecular mimicry. In some cases important are concommitant other infections. All this factors and results of therapy have influence on prognosis of Lyme disease. Knowledge of pathogenesis of Lyme disease has an important meaning in interpretation of laboratory tests and estimation of clinical signs and choosing of treatment.

[Neurologic syndromes in Lyme disease]

Lyme borreliosis, multisystem disease, when involve neurologic system is named neuroborrelosis. Symptomatology of neuroborreliosis is rich and various. Difficulties in recognition are connected usually with long period from tick bite to late neurological signs. Any headache and psychiatric disorder in the course of Lyme disease could be an early manifestation of invasion of the CNS by the spirochaetes. Each part of neurologic system could be involved. The most common clinical picture of neuroborreliosis is meningitis with cranial or peripheral neuropathies connected with radiculalgia, less common are encephalitis and myelitis, neuropathies and polyneuropathies, encephalopathies. Encephalomyelitis is the most serious form of neuroborreliosis. From the pathophysiologic point of view all cranial and peripheral neuropathies are forms of mononeuritis multiplex. Vasculitis and autoimmunology processes are present. Encephalopathy is due to neuroimmunomodulators, like lymphokines and by toxico-metabolic effect could be connected with each form of systemic borreliosis. Spheroplast L-form of borrelia could be responsible for difficulties with their eradication. Diagnosis of neuroborreliosis is based on culturing of B. burgdorferi from CSF, detection of specific antispirochaetal antibodies produced in subarachnoid space, detection of activated lymphocytes, other antigens detection in CSF (also after dissociation of complexes) or borrelial DNA sequences.

Subpopulations of the peripheral lymphocytes in the early clinical forms of Lyme disease

The evaluation of the changes of lymphocytes: T(CD3), B (CD19), subpopulations CD4, CD8, active lymphocytes CD3 + HLA-DR+, lymphocytes with the receptor for IL2(CD3 + CD25+), NK cells as well as the CD4/CD8 ratio in 30 patients with the early localized (group I n = 7) and early disseminated (group II n = 23) type of Lyme disease, before (examination 1) and after the antibiotic therapy (examination 2) was performed. Group III was composed of 90 healthy people. Measurements were carried out in an COULTER EPIC XL cytoflowmeter, using Becton Dickinson antibodies. Statistical analysis was performed using AnStat software. In the examined groups, a decrease of the subpopulations of CD4, CD8 lymphocytes in comparison with healthy subjects was revealed, as well as a decrease of the CD4/CD8 ratio after treatment. A considerably lower percentage value of active lymphocytes CD3 + HLA-DR+ in both groups and the reduction of the NK subpopulation before and after treatment of early disseminated Lyme disease in comparison with healthy people was observed. The higher percentage values of the lymphocytes with IL-2 receptor were not statistically significant. The indicated essential changes in the subpopulations of T lymphocytes, characterized by a decrease before the antibiotic therapy and by the tendency towards an increase after that therapy of the percentage of CD4, CD8, NK and CD3 + HLA-DR+ lymphocytes in peripheral blood, point out their role in the immunopathogenesis of the Lyme disease. The absence of the complete normalization of the examined parameters after the treatment, on the one hand, may provide evidence for some inertia of the elements of the immune system, on the other hand can also result from too short antibiotic therapy and maintenance of the antigenic stimulation.

[Actual diagnostic possibilities of Lyme borreliosis]

Recognising of Lyme disease is based on epidemiology investigation, clinical manifestation of disease and results of diagnostic laboratory tests. Direct methods as isolation and culturing of Borrelia burgdorferi are very difficult and expensive. Depends on clinical stage PCR could be very useful but not often used. The other methods are based on detection of specific antispirochaetal antibodies produced in compartments or detection of antigens B. burgdorferi.

[Mental disorders in the course of neuroborreliosis: own observation]

Three cases of psychic disorders in the course of Lyme borreliosis were described. Two cases were connected with Lyme meningitis, one of them with chronic Lyme arthritis. These cases were described to discuss the possible occurrence of mental disturbances in the course of Lyme borreliosis, directly or indirectly connected with the central nervous system.

[Levels of proinflammatory cytokines: IL-1, IL-6, IL-8, TNF-alpha and receptor IL-6R in Lyme borreliosis]

We estimated serum concentrations of cytokines IL-1, IL-6, IL-8, TNF-alfa and IL-6R of patients with diagnosed Lyme disease treated with beta-lactam antibiotics. Detection of proinflammatory cytokines was performed in ELISA tests. The examination was performed before and after treatment. Comparison with control group stated statistically significant higher concentration of IL-1 and IL-6 before and after treatment. There were no differences in concentration of TNF-alfa, IL-8 and IL-6R. Comparing concentrations of cytokines before and after treatment there was no differences either. Lack of changes in concentration of proinflammatory cytokines during beta-lactam therapy could be explained by too short period of therapy or immunologic background of inflammatory process in Lyme disease which was only initiated by spirochete Borrelia burgdorferi.

[Herpes simplex encephalitis]

Herpes simplex virus infection of the central nervous system is still a significant cause of morbidity and often mortality. Changes of central nervous system are results of primary infection or activation of latent HSV-1, HSV-2. Neurological deficits often follow encephalitis herpetica. The application of PCR is prompt and specific diagnosis of herpes simplex virus infections of the brain. Advances in treatment herpes simplex encephalitis with acyclovir have improved outcome.

[Selected lymphocyte subsets in Lime borreliosis: a preliminary study]

Observation of percentages changes of lymphocytes (CD19), T(CD3), subsets CD4, CD8, NK cells, activated lymphocytes with fenotype CD3+HLA-DR, CD4/CD8 rate in Lyme borreliosis was carried out before (I examination) and after antibioticotherapy (II examination). 30 patients in aged 17-60 (x = 41) with recognition of erythema migrans(EM), Lyme arthritis(LA) and neuroborreliosis(NB) were examined. Epidemiological, clinical diagnosis was confirm by the presence of antibodies in ELISA test. Lymphocytes and their subsets, NK cells were signed and measured by flow cytometric immunophenotyping in Coulter EPIX XL with Becton-Dickinson antibodies twice: before and after treatment. Ampicillin, ceftriaxon or cefotaxim was applied during 4 weeks. AnStat program was used in statistic analysis. Value CD3 (x = 72.54) in I test was higher than control (x = 69.3), but CD19 (x = 13.2) was lower than control (x = 12.9). In II examination we stated CD19 (x = 9.48) progressive significant decreased in comparison to I examination. Percentage CD4 in II examination (x = 42) was lower than control (x = 45.8). Subset of CD8 had lower value in I examination (x = 28.03), as in II (x = 30.72) in comparison with control (x = 34.2). We showed lower CD4/CD8 (x = 1.40) rate after treatment than control (x = 2.67). We showed lower percentage NK cells after treatment (x = 13.5) than control. We also found lower percentage activated subsets T cells with phenotype CD3+HLA-DR before (x = 4.78) and after treatment (x = 4.03) compared with control (x = 7.27). No statistical changes in subsets with receptor for IL-2 before and after treatment was shown. In the course of active infection B.burgdorferi essential changes in lymphocytes subsets are observed. Decreased percentages of CD4, CD8, NK and CD3+HLA-DR+ in whole blood indicate their important role in immunopathogenesis of Lyme borreliosis. Lack of normalization of investigated parameters after treatment can be caused by inertion of elements immunologic system, as well as too short antibioticotherapies.

[Otoneurologic state estimation 2 years after tick-borne encephalitis]

In this paper an attempt is described to estimate the incidence and frequency of neurologic and otologic symptoms among patients two years after TBE. We examined 43 persons of both sexes aged 17-58. The most frequent complaints were: headache--34.9%, equilibrium problems--37.2%, buzzing in the ears--27.9%, hearing problems--23.3%, memory problems--25.6%. Decrease of throat reflexes was stated in 3 (7%) and pseudobulbaris symptoms in 2 (4.6%), weakness of muscles in 4 (9.3%). In audiometric examination decrease of hearing was stated in 8 persons (18.5%). We registered nystagmus: spontaneous--4.6-7%, gaze--13.9-18.6%, positional-T, mainly Nylen I and III type-18.6-25.6%. Pathologic recording in the eye-tracking pattern test was shown in 7 (16.3%) persons. Asymmetry of optokinetic nystagmus was stated in 6 (13.9%) examined persons. Asymmetry in caloric test was proved in 25.5% of examined persons.

[The time of maintainance of positive serologic results among patients operated on echinococcal liver cysts]

The purpose of this work was to analyse results of serologie examinations and complaints reported by patients who were operated on echinococcal liver cysts. The analysis was conducted on patients who were qualified to surgical removal of echionococcal liver cysts. Persons who were analysed answered the questionaires and 11 of them send sera for serologie examination. The questionaires consisted of questions about time since operation, complaints before and after operation abdomen pains, distensions, vomits, exanthema, weakness, headaches). Results showed that patient were from 1 to 6 years after operation. Among 11 who send sera 18% results were negative (2 and 6 years after operation) and 82% was positive. Analysis of 15 questionnaires showed that majority of patients still had the complaints that were present before operation.

[Lymphocytic meningitis with the involvement of the skull in the course of spinal cord neoplasm simulating neuroborreliosis. Case report]

We describe a case of 48 year old male patient treated in the Department of Parasitic Diseases and Neuroinfections AMB with suspected neuroborreliosis.

CLINICAL SYMPTOMS

lymphocytic meningitis with cranial neuropathies n. VII palsy and radiculitis after numerous tick bites in endemic area--indicated neuroborreliosis. Because there was no effect of antibiotic therapy and lack antibodies against B-burgdorferi in serum and CSF we excluded neuroborreliosis. Developing neuropathies III-XII, increasing cytosis and protein concentration, radiculalgia and difficulties in walking, cachexia made us think of tbc etiology. Patient failed to improve after anti-tbc treatment. CT and MR showed presence of neoplasmatic masses in spinal canal. In cytologic examination "neoplasma malignum male differentiatum probabiliter metastaticum" was found. Primary focus of neoplasmatic process was not found.

[Lasting hearing loss in the course of neuro-borreliosis]

Lyme borreliosis is spirochetal disease that frequently affects the nervous system months or years after infection giving rise to a varied clinical picture named neuro-borreliosis. We report a case of 47 year old female with progressing hearing loss, tinnitus, paraparesis and ataxia. The disease was beginning six month earlier by weakness of the lower limbs associated with hearing loss. The patient did not remember to be exposed to ticks and did not recall the presence of erythema migrans, arthritis or other systemic signs. CSF was with mononuclear pleocytosis and protein concentration over 600 mg%. Firstly patient was unsuccessfully treated like encephalomeningitis with tbc etiology. Next cerebrospinal fluid analysis showed presence of antibodies against Borrelia burgdorferi in IgG and IgM class. IgG antibodies in serum were founded. Audiometry electric responses from brain stem showed sensorineural hearing loss. Therapy with ceftriaxone was successful. Because negative tick bile history and many signs from different parts of CNS, relationship of this spirochetal infection and severe otolaryngological and neurological disease was firstly difficult to recognition.

[Neurologic borreliosis]

Any headache in the course of Lyme disease could be an early manifestation of invasion of the CNS by spirochaetes. The most characteristic symptoms of early neuroborreliosis are meningitis with cranial or peripheral neuropathies connected with radiculopathies, less common are encephalitis and myelitis, neuropathies, polyneuropathies, encephalopathies. Encephalomyelitis is the most serious form of neuroborreliosis. From the pathophysiologic point of view all cranial and peripheral neuropathies are forms of mononeuritis multiplex. Encephalopathy is due to neuroimmunomodulators, like lymphokins and or by toxico-metabolic effect could be connected with each form of systemic borreliosis. Certain diagnosis of neuroborreliosis is based on culturing of B. burgdorferi from CSF, detection of specific antispirochaetal antibodies produced in the subarachnoid space, detection of activated lymphocytes B producing specific antibodies, detection in CSF of other antigens of B. burgdorferi or DNA sequences.

[Albumin and immunoglobulin levels in cerebrospinal fluid and serum in tick borne meningoencephalitis]

The levels of albumin and immunoglobulins G, A, M were determined by using nephelometry technique in the cerebrospinal fluid and serum in 14 adults with tick borne meningoencephalitis at the beginning and after four weeks of disease. Intra blood-brain synthesis of IgG, IgA, IgM was evaluated by indexes of synthesis (Tibbling formula). The blood-brain integrity was estimated by CSF/serum albumin ratio. Increased albumin and immunoglobulins G, A, M levels were demonstrated in first examination and only elevated levels of albumin and immunoglobulin M lasted after four weeks. Albumin level in cerebrospinal fluid and albumin ratio were elevated in both examinations. The serum levels of albumin and immunoglobulins were similar in first and second examination. On the basis these results we conclude that in tested patients blood-brain integrity was disturbed still after four weeks of disease.

[Encephalitis with cerebellar syndrome as rare complication of varicella]

A 17-years old patient with severe encephalitis during chicken-pox is presented. The authors discuss the efficacy of used corticosteroid therapy.