[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.

[Re-infection with Borrelia burgdorferi s.l in a patient with a history of neuroborreliosis--case report]

Reinfection with Borrelia burgdorferi s.l., which is likely in highly exposed persons, has not been described in Poland so far. Symptoms of Lyme arthritis, preceded by typical skin lesion (erythema migrans) appeared in 46 years old women 5 years after successful treatment of borrelial meningitis. Re-appearance of symptoms of Lyme borreliosis following localized skin lesion, after a long asymptomatic period, as well as accompanying increase in specific antibodies, point to reinfection with Borrelia burgdorferi sensu lato. Different localization of systemic symptoms during two episodes of Lyme disease suggests infection with distinct genospecies of B. burgdorferi s.l. This case confirms risk of recurrent infections with different B. burgdorferi s.l. genospecies in inhabitants of highly endemic areas in the north-east of Poland, which may pose necessity of repeated antibiotic treatment.

[Reinfection in Lyme borreliosis]

Persons exposed to tick bites in endemic areas of Lyme borreliosis are at high risk of repeated infections with Borrelia burgdorferi s.l. Typically, recurrent episodes of Lyme borreliosis present as erythema migrans, but systemic manifestations, like borrelial arthritis and meningitis, have been described. Differentiating reinfection from relapse or chronic sequelae of primary infection should be possible on the basis of epidemiological data, clinical course and careful interpretation of serologic tests results. In case of reinfection, antibiotic treatment should be administered.

[Serum and cerebrospinal fluid concentration of vitamins A, E and C in patients with tick-borne encephalitis]

We included in our study 18 patients hospitalized because of tick borne encephalitis (tbc) at the Departament of Infectious Diseases and Neuroinfections of Medical University of Bialystok. In this group, concentration of vitamins A, E and C in serum and cerebrospinal fluid (CSF) was measured before and after treatment. The control group consisted of 11 patients with no inflammatory changes in CSF were observed. We did not observe significant differences in concentration of vitamins in serum and CSF before and after treatment comparing to controls. However, we showed significant increase in concentration of vitamin E before and after treatment in both serum and CSF in patients with tbc in comparison with control group.

[Examination of intrathecal immunological response to Borrelia burgdorferi antigens in patients with suspected neuroborreliosis--a preliminary communication]

10 persons with suspected neuroborreliosis (in accordance with EUCALB recommendations), inpatients of Departament of Infectious Diseases and Neuroinfections were evaluated. Antibodies of IgM and IgG in CSF and serum against B. burgdorferi were tested with Western blot kits (Mikrogen, Germany). 3 of 10 tested CSF showed presence of additional bands in comparison with serum. Simultanously evaluation antibodies against B. burgdorferi in CSF and serum with Western blot kits patients with suspected neuroborreliosis is usefull to estimate intrathecal immunological response, with showing the differences between CSF and serum. Estimation of immunological response is Essentials in both classes especially in Elary phase of disease.

[Anti Yersinia enterocolitica antybodies titer in serum in patients with chronic Lyme arthritis]

Yersiniosis is an acute infectious disease, which course may differ in dependence to age at which patient was infected. It may cause reactive arthritis in adults and seldom in children. The aim of the study was evaluation of anti Yersinia enterocolitica antibodies titer in group of patients with previously diagnosed Lyme disease. The subject of the study was group of 76 males, foresters from north-eastern Poland at the age of 26 to 60 years (x = 41), with long term history of Lyme disease. In 10% of examined patients positive anti Yersinia enterocolitica antibodies titer was observed.

[Activity of the caspase-3 in the culture of peripheral blood mononuclear cells stimulated with Borrelia burgdorferi antigens]

OBJECTIVE

To investigate whether the decreased rate of apoptosis of peripheral blood mononuclear cells occurs in patients with chronic Lyme arthritis (LA), which could contribute to persistent inflammation in those patients.

METHODS

PBMC from 7 patients with LA and 6 healthy persons (control--C) were incubated for 48 hours without stimulation (negative control) or under antigenic stimulation with Borrelia burgdorferi s.l. spirochetes: Borrelia afzelii VS46110 (B.a.), B. garinii 20047 (B.g.) or B. burgdorferi sensu stricte B-31 (B.ss.). Concentration of the apoptosis mediator active caspase-3, was measured by ELISA in the culture homogenate.

RESULTS

Mean active caspase-3 concentration was higher in LA than in C in unstimulated culture. Increase of active caspase-3 concentration under antigenic stimulation occurred in C (significant for B.g.), but not in LA.

CONCLUSIONS

1) apoptosis rate of PBMC increases in presence of B. burgdorferi s.l., which may be a defense mechanism of this pathogen; 2) in late LA there is increased baseline susceptibility of PBMC to apoptosis, but exposition to B. burgdorferi s.l. seem not to exert further pro-apoptotic effect. This altered response to pro-apoptotic stimuli may be related to persistent inflammatory pathology in this group of patients.

[Detection of anti-hantavirus antibodies in forest workers in the north-east of Poland]

OBJECTIVE

To estimate exposition to hantaviruses in a high-risk population (forest workers) in the north-east of Poland.

METHODS

IgG antibodies against virus Puumala (PUUV) and Hantaan (HTNV) were detected by ELISA in sera of 59 forest workers from Podlaskie and Warmińsko-Mazurskie provinces (group I), as well as in 10 employees of Regional Forest Administration in Białystok (group II).

MAIN OBSERVATIONS

Anti-PUUV IgG antibodies were detected in 3 persons in group I and 1 in group II. Anti-HTNV IgG were present in 1 person in group I and 2 in group II, in one case accompanying strong reactivity towards PUUV.

RESULTS

Anti-PUUV IgG, suggestive of the history of non-diagnosed PUUV infection, were detected in 4 persons of 69 (5,7%). Isolated anti-HTNV IgG, which could indicate past infection with Saaremaa virus, antigenically related to HTNV, were present in 2 subjects (2,9%).

CONCLUSIONS

Non-diagnosed infections with Puumala and Saaremaa viruses seem to occur in the high risk groups in the north-east of Poland, with frequency comparable to other European countries. Most infections are probably mild or asymptomatic.

[Concentration of soluble forms of selectins in serum and in cerebrospinal fluid in group of patients with neuroborreliosis--a preliminary study]

The results of the research already done, suggest an important role of selectins in inflammatory process of various etiology. Lack of selectins or their ligands causes severe complications, such as chronic inflammatory processes. The aim of this study was to analyze the role of selectins sL, sE and sP in the development and course of neuroborreliosis in the form of meningitis. We have also analyzed the influence of treatment on changes of selectins' concentration in serum and cerebrospinal fluid.

MATERIAL AND METHODS

We have analyzed 17 patients with neuroborreliosis presenting as meningitis, in whom we measured by immunoenzymatic method concentration of selectins sL, sP and sE in blood and cerebrospinal fluid before and after 4-week therapy with cefotaxim. We used Human sL-selectin, Human sE-selectin and Human sP-selectin kits produced by Bender Med. Systems, Austria. Control group for measurement of concentration of selectins in serum consisted of 8 healthy patients. Control group for measurement of concentration of selectins in cerebrospinal fluid consisted of 8 patients, in whom lumbar puncture excluded inflammatory disease of the central nervous system.

RESULTS

In serum concentration of selectins sL and sP was significantly higher comparing to control group. After treatment concentration of these selectins decreased, but still was significantly higher than in control group. Only concentration of selectin sE was significantly lower than in control group and after treatment decreased further remaining lower comparing to control group. In cerebrospinal fluid concentration of selectin sL was significantly higher comparing to control group and increased after treatment. Concentration of selectins sE and sP increased before treatment and decreased after treatment, but still remained elevated comparing to control group.

CONCLUSIONS

Persistence of increased concentration of selectins sP and sL in serum and also of selectin sE in cerebrospinal fluid in patients with neuroborreliosis after completed antibiotic therapy and regression of clinical symptoms can suggest permanence of chronic inflammatory state in consequence of survival of B. burgdorferi spirochetes in affected tissues.

[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.

[The evaluation of serum presence of antibodies reacting with West Nile Fever virus (WNV) antigens among inhabitants from Podlaskie and Swietokrzyskie region]

Up to now there was no information about WNV infection of humans in Poland. Although specific diagnostic procedure has not been used and uncharacteristic clinical picture of infection might be mislead with other viral infections. 75 patient with acute febrile episodes were diagnosed for serum IgM antibodies reacting with WNV antigens. 93 sera of forestry workers (52 from świetokrzyskie region and 41 from podlaskie region) were tested for IgG antibodies reacting with WNV. All sera weretested using ELISA method, and all positive results were examined by immunofluorescent assay (IFA) based on virus stains isolated in Hungary. The analysis of both methods confirmed presence of IgG antibodies reacting with WNV antigens among 5 (17.24%) of 29 sera showing positive results in ELISA method. It can be presumed that Poland is the country where West Nile virus might be present and transmitted by mosquitos. WNV infection might be considered in diagnosis of fevers and meningitis.

[Concentration of sFas and sFasL in the supernatant of PBMC culture from the patients with late lyme borreliosis]

OBJECTIVE

Persistent, inadequate inflammatory response present in late Lyme borreliosis may be driven by activated T lymphocytes. We estimated synthesis of extracellular proteins: soluble Fas receptor (sFas) and its ligand (sFasL), which might protect T lymphocytes from physiologic apoptosis, in the peripheral blood mononuclear cell (PBMC) culture from patients with late borreliosis.

METHODS

Lyme borreliosis group (LB) consisted of 20 patients with Lyme borreliosis present for >6 months. Six patients without any active infection constituted the control group (K). PBMC were incubated for 7 days with phytohemaglutinine or suspension of Borrelia afzeli (Ba), B. garinii (Bg) and B. burgdorferi sensu stricto (Bss) spirochetes. sFas and sFasL concentrations were measured in the culture supernatant with ELISA.

RESULTS

In LB mean sFasL concentration was increased significantly under stimulation with phytohemaglutinine, Ba and Bg, and, with borderline significance, with Bss, in comparison with unstimulated culture. sFas also tended to increase, which was significant with phytohemaglutinine and borderline with Bg. In K sFas and sFasL was not significantly increased under antigenic stimulation.

CONCLUSIONS

Increased synthesis of antiapoptotic factors by PBMC from patients with late borreliosis incubated with B. burgdorferi antigens may suggest impaired apoptosis of T lymphocytes contributing to persistent inflammatory response in this patients.

Molecular and serological diagnosis of Borrelia burgdorferi infection among patients with diagnosed Erythema migrans

The aim of the study was to assess the frequency of Borrelia burgdorferi DNA detection in the blood and urine of patients diagnosed with erythema migrans, and compare the results of PCR-based methods with ELISA methodology. The latter was used to detect serum antibodies against Borrelia burgdorferi of the IgM and IgG classes, before and after antibiotic therapy. The study included 86 patients hospitalized in the Department of Infectious Diseases and Neuroinfections in the Medical Academy in Białystok, diagnosed with the erythema migrans phase of Lyme borreliosis. Examinations were carried out twice: the first at the moment of diagnosis (Trial 1), the second after 4 weeks of antibiotic therapy. The study showed that antibiotic therapy in the early phase of borreliosis does not decrease the sensitivity of PCR and that after 4 weeks of therapy (Trial 2), spirochete DNA is still detectable in most patients (45/86). There was no correlation between detectability of spirochete DNA and the presence of antibodies against B. burgdorferi s.l. (assessed by ELISA) during the course of erythema migrans. The largest percentage of positive results in the detection of B. burgdorferi s.l. DNA was observed in patients who simultaneously possessed IgM and IgG antibodies against B. burgdorferi, while the lowest percentage of PCR positive results was among patients with only IgM antibodies.

Concentration of TGF-beta1 in the supernatant of peripheral blood mononuclear cells cultures from patients with early disseminated and chronic lyme borreliosis

PURPOSE

The aberrant inflammatory response is probably involved in the pathogenesis of chronic Lyme borreliosis, including chronic Lyme arthritis and neuroborreliosis. Transforming growth factor-beta 1 (TGF-beta1) is an important anti-inflammatory and immunomodulatory cytokine and its deficient synthesis is linked to exaggerated inflammation and immune response.

MATERIAL AND METHODS

Peripheral blood mononuclear cells (PBMC) from 25 patients with Lyme borreliosis and 6 controls were incubated for 7 days with suspension of Borrelia afzeli, B. garinii and B. burgdorferi sensu stricto spirochetes. TGF-beta1 concentration in culture supernatants was measured with ELISA. Results were analyzed according to disease duration (group I--chronic borreliosis, n=20; group II--early borreliosis, n=5) and clinical form (LA--arthritis, NB--neuroborreliosis).

RESULTS

TGF-beta1 concentration was increased in supernatants of PBMC cultures of patients with early neuroborreliosis, in comparison with chronic borreliosis and controls. In chronic, but not in early borreliosis, there was a tendency for decrease of TGF-beta1 synthesis under stimulation with B. burgdorferi spirochetes.

CONCLUSIONS

Impaired synthesis of TGF-beta1 by mononuclear cells seems to be present in patients with chronic forms of Lyme borreliosis when compared to those with early stage of the disease. It may be a factor contributing to the persistence of inadequate inflammatory response in patients in whom chronic form of the disease develops.

[Concentration of interleukin 6 and 10 in tick-borne and purulend encephalomeningitis]

The aim of the study was to evaluate concentrations of interleukin 6 (IL-6) and interleukin (IL-10) in serum and cerebrospinal fluid (csf) of patients with tick-borne encephalitis (tbe) and purulent meningitis before and after 4 weeks of treatment.

MATERIAL AND METHODS

Group I consisted of 23 patients with tbe and group II - 16 patients with bacterial meningitis. Group III (control) consisted of 10 healthy men.

RESULTS AND CONCLUSIONS

In patients with tbe and purulent meningitis concentrations of IL-6 and IL-10 in serum and csf were initially increased and tended to remain increased after 4 weeks of treatment. It suggests significant role of IL-6 and IL-10 in inflammatory process within cns. Higher concentrations of IL-6 than IL-10 in csf than in serum suggests their local synthesis within cns and tendency to the limitation of the inflammatory response to the intratecal compartment. Concentrations of both IL-6 and IL-10 in csf and serum remained sgnificantly higher in patints with purulent meningits than in tbe, both before and after treatment. This observation may be helpful in diagnosing the ethiology of meningitis and meningoencephalitis and monitoring the course of the disease.

Serum Levels of Interleukin-18 (IL-18), Interleukin-1β (IL-1β), its Soluble Receptor sIL-1RII and C-reactive Protein (CRP) in Patients with Lyme Arthritis

BACKGROUND

In recent years, the role of pro- and antiinflammatory cytokines in the development of Lyme arthritis (LA) has been widely discussed. The purpose of the present study was to determine the concentration of interleukin-18 (IL-18), interleukin-1beta (IL-beta) and its soluble receptor sIL-1RII in serum of patients with LA as well as the usefulness of serum C-reactive protein (CRP) determination in LA diagnosis and monitoring of its treatment.

PATIENTS AND METHODS

The study group consisted of 20 patients with LA. Before and after antibiotic treatment, the serum levels of IL-18, IL-1beta and sIL-1RII were measured immunoenzymatically using standard kits and the CRP level was measured by immunoturbidimetric method.

RESULTS

Before treatment, the serum levels of IL-18, IL-1beta and sIL-1RII were significantly higher than in control group and after treatment the concentrations of IL-18, IL-1beta and sIL-1RII decreased significantly, but the level of IL-18 and sIL-1RII still remained higher than in control group. The elevated serum level of CRP was detected only in 6 of 20 patients and in 5 of them it returned to the baseline after treatment.

CONCLUSION

The results of our study suggest that IL-18, IL-1beta and sIL-1RII might be involved in the development of LA. CRP may be useful in differential diagnosis in patients with suspicion of Lyme arthritis.

[Concentration of the beta-chemokine CCL5 (RANTES) in cerebrospinal fluid in patients with tick-borne encephalitis]

BACKGROUND AND PURPOSE

In tick-borne encephalitis (TBE), perivascular infiltrates are formed within the central nervous system (CNS) and are accompanied by pleocytosis with a predominance of T CD4+ lymphocytes in cerebrospinal fluid (CSF). Factors responsible for leukocyte flow into CNS in TBE have not been investigated. We evaluated the concentration of the chemotactic factor for lymphocytes, chemokine CCL5 (RANTES, Regulated upon Activation, Normal T cell Expressed and Secreted) in CSF and serum of patients with TBE and assessed its correlation with CSF pleocytosis.

MATERIAL AND METHODS

Group I consisted of 10 patients with TBE virus infection presenting as meningitis; group II included 11 patients with TBE presenting as encephalomeningitis or myeloencephalomeningitis. The control group consisted of 8 patients, in whom neuroinfection and infection with TBE virus was excluded. The concentration of CCL5 was measured by ELISA in CSF and serum samples taken within 24 hours after hospitalization (examination 1) and in the convalescence period, on average after 16 days (examination 2).

RESULTS

Mean CCL5 concentration in serum did not differ between the groups, while in CSF it was significantly increased in group I (64.3+/-75.5 pg/ml in examination 1 and 44.4+/-39.5 pg/ml in examination 2) and in group II (38.4+/-17.0 pg/ml in examination 1 and 48.8+/-24.7 pg/ml in examination 2) in comparison with controls (3.7+/-5.3 pg/ml). There was no significant difference regarding CCL5 concentration between groups I and II and between the examination 1 and 2. There was no correlation between the concentration of CCL5 and CSF parameters.

CONCLUSIONS

The concentration of CCL5 is increased in CSF, but not in serum of patients with TBE. This increase does not depend on the clinical form of the disease and is sustained after the disappearance of the symptoms of acute infection. Further studies are necessary to determine the source of CCL5, and its role in the pathogenesis of TBE and its sequelae.

[Western-blot with VLSE protein and "in vivo" antigens in Lyme borreliosis diagnosis]

The aim of the study was the evaluation of the efficiency of Western blot (EcoLine) test detecting simoultanous presence of IgM and IgG antibodies against B. burgdorferi in diagnosis of early and late stage of Lyme borreliosis. The comparison of results achieved by performing test Western-blot, ELISA (based on recombinant antigens of three genospecies of Borrelia) and EIA (based on antigens of one B. burgdorferi genospecies). The tests Western blot: EcoLine (Virotech) with antygens "in vivo", ELISA Borrelia IgM, IgG recombinant (Biomedica), EIA: B. b. ss. IgG, EIA B. garinii IgG, EIA B. afzelii IgG (TestLine) were used. Results showed efficacy of detecting IgM, IgG antibodies against VlsE simultanously and IgG antibodies against "in vivo" antigens in diagnosis of early stages of Lyme disease when atypical picture skin lessions arise diagnostic doubts and in discerning early and late stage of disease. The EIA tests based on one B. burgdoreferi genospecies seem less effective in comparison to ELISA tests based on 3 genospecies antigens.

[Concentrations of soluble factors participating in regulation of apoptosis of lymphocyte from patients with chronic lyme arthritis (preliminary report)]

Lyme borreliosis is a chronic infectious disease caused by Borrelia burgdorferi spirochete. The excess and inadequate inflammatory response and even autoimmunity is considered to participate in its pathogenesis. Apoptosis (programmed cell death) of activated lymphocytes contributes to regulation of immunological response and terminating the inflammation.

AIM OF THE STUDY

To evaluate concentrations of soluble factors participating in regulation of apoptosis in the supernatants of the peripheral blood mononuclear cells (PBMC) of patients with chronic Lyme borreliosis.

MATERIAL AND METHODS

The study group consisted of 10 patients with chronic Lyme arthritis and the control group of 5 persons in whom Lyme borreliosis was excluded. In the supernatant of PBMC culture incubated with Borrelia burgdorferi antigens concentrations of potentially anti-apoptotic factors: soluble receptor for tumor necrosis factor alpha (sTNF-RI), soluble Fas (sFas) and soluble Fas ligand (sFasL), as well as the concentration of transforming growth factor beta (TGF-beta), cytokine synthesized in the final stage of apoptosis, were measured by ELISA.

RESULTS

Concentrations of sTNF-RI, sFas and sFasL, but also TGF-beta tended to be increased in the study group in comparison with nonstimulated PBMC and the control group.

CONCLUSIONS

These data, although they should be considered preliminary because of the small size of the groups, suggest possible impairment of the apoptosis of lymphocytes in the chronic Lyme borreliosis.

[Intercellular adhesion molecules sICAM-1, sICAM-2, sICAM-3 and IFNgamma in neuroborreliosis and tick-borne encephalitis]

OBJECTIVE

The aim of this study was to evaluate the serum and CSF concentration of soluble intercellular adhesion molecules sICAM-1, sICAM-2, sICAM-3 and proinflammatory cytokine IFNgamma in patients with tick-borne encephalitis (TBE) and neuroborreliosis.

METHODS

The study group consisted of 40: 20 with TBE meningitis and 20 with Lyme meningitis. The serum and CSF levels of adhesion molecules and IFNgamma were determined by ELISA assay twice: before and after treatment.

RESULTS

Before treatment the concentrations of adhesion molecules and IFNgamma in serum as well as in CSF were significantly higher in both studied groups than in control group (with the exception of the serum level of sICAM-2 in TBE group). After the treatment, the serum parameters in TBE group decreased to the control level. CSF levels were also reduced, but still remained higher than in the control group. In patients with neuroborreliosis serum concentration of sICAM-1 and sICAM-2 did not change as compared with its level before treatment but other studied parameters in serum and CSF decreased significantly.

CONCLUSIONS

The results of our study confirm the participation of intercellular adhesion molecules in the pathogenesis of viral (TBE) and bacterial (neuroborreliosis) neuroinfections.

Elevated concentration of the chemokine CCL3 (MIP-1alpha) in cerebrospinal fluid and serum of patients with tick borne encephalitis

PURPOSE

Chemokines, including a chemoattractant for mononuclear cells CCL3 (MIP-1alpha), are responsible for attracting leukocytes into central nervous system (CNS) and cerebrospinal fluid (CSF) in meningitis and encephalomeningitis. We investigated the possibility of the involvement of CCL3 in tickborne encephalitis (TBE) pathogenesis.

MATERIAL AND METHODS

We studied 26 patients with TBE; 13 with meningitis (group I) and 13 with encephalomeningits (group II). Control group included 11 patients without infectious disease of the CNS. CCL3 concentration was measured by ELISA in serum and CSF on admission (examination 1) and after 2 weeks (examination 2) in TBE patients and once in controls.

RESULTS

In all control samples CCL3 concentration was below detection limit. In TBE, CCL3 serum concentration was: in group I--10.1 +/- 4.1 (mean +/- SD, ng/ml) in examination 1 and 12.4 +/- 4.8 in examination 2, and in group II--12.5 +/- 3.9 and 13.5 +/- 4.8, respectively. In CSF, CCL3 was detected: in group I in 5 patients in examination 1 (178 +/- 236 pg/ml) and 11 in examination 2 (457 +/- 215), in group II--in 8 (357 +/- 311) and 7 patients (326 +/- 330), respectively. There were no differences between group I and II. The comparison of CCL3 concentration gradient with albumin gradient between serum and CSF supported the possibility of intrathecal synthesis of CCL3.

CONCLUSIONS

1) Synthesis of CCL3, perhaps including intrathecal synthesis, is increased in TBE. 2) CCL3 concentration was much lower in CSF than in serum of the TBE patients, which argues against its significant role as chemoattractant in this condition.

[Ultrasonography in diagnosing Lyme arthritis of the knee joints in correlation with anti-CCP antibodies]

Lyme disease, a multi-system disorder may be associated with arthritis. Lyme arthritis most commonly affects the knee joints. Ultrasonography can show the inflammation changes of the knee joint and can be a usefull method in diagnosis of Lyme arthritis. The most freguent ultrasonographic finding was knee joint effusion. Because of Lyme arthritis similarities to rheumatoid arthritis, a serologic test antibodies against cyclic cytrulinated peptid (anty CCP) can be helpfull in distinguishing of these two diseases.

[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.

[Assessment of antioxidative defense parameters in serum and age of patients showing antibodies anti-Borrelia burgdorferi presence--non-symptomatic carriers]

To evaluate in serum antioxidative deffence parameters--SOD EC.1.15.1.1 (superoxide dismutase), GSH-Px EC.1.15.1.1 (glutathine peroxidase), -SH (sulphhydryl groups) among patients previously diagnosed with borreliosis presently showing antibodies against Borrelia burgdorferi presence. The antioxidative deffence parameters were evaluated in 117 sera of patients with previously diagnosed borreliosis aged x = 43,07. Control group consisted of 39 persons aged x = 40,97 with no detectable anti-Borrelia burgdorferi antibodies in serum. Serologic diagnosis was performed with use of ELISA kit--Borrelia rekombinat IgM, IgG (Biomedica, Austria). Serum activity of antioxidative deffence parameters-- SOD EC.1.15.1.1 (superoxide dismutase), GSH-Px EC.1.15.1.1 (glutathine peroxidase), -SH (sulphhydryl groups) were detected in all patients from both groups. Obtained results were statistically analysed. There was showed no significant difference in serum activity of SOD and GSH-Px in group of former borreliosis patients and control group. Also serum -SH concentration did not differ significantly between both examined groups of patients. No correlation between SOD and GSH-Px serum activity as well as -SH concentration was detected.

[Comparison of two types of diagnostic test detecting antibodies against Borrelia burgdorferi: EIA based on one genospecies antigens and ELISA based on recombinant antigens]

The aim of the study was to compare the results of ELISA diagnostic kit detecting antibodies against B. burgdorferi based on combination of three genospecies recombinant and EIA kits based on one of three genospecies. Sera of 351 forest workers were evaluated with ELISA kit (Recombinant antigen, IgG). Seropositive samples were tested with EIA kits based on B. burgdorferi s.s., B. garinii, B. afzelii antigens. Diagnostic kits based on combination of antigens of three genospecies more often detect antibodies against B. burgdorferi and are more usefull as screening tests, in comparison with those based on one genospecies. Among diagnostic kits based on one genospecies, the most sesnitive in detection of antibodies against B. burgdorferi are those based on B. afzelii.

[Complications of tick-borne encephalitis in 15-year long experience of the Department of Infectious Diseases and Neuroinfections]

The clinical features of tick-borne encephalitis (tbe) were analyzed in the group of 477 patients hospitalized in the Department of the Infectious Disease and Neuroinfections of the Medical Academy in Białystok. The group included 31.4% women and 68.6% men, aged from 15 to 76 years. Persistent neurological sequelae were noted in 10.9% of patients: paresis or plegia in 5.66%, spinal dysfunction with lower limbs paraparesis in 1.68%, significant paresis of upper extremities in 0.63%, brachial plexus paresis in 2.31%. Cranial nerves involvement was present in 2.93%, including uni- or bilateral facial nerve palsy in 2.73% and trigeminal nerve involvement in 0.21%. Cerebellar dysfunction was present in 2,09% of patients. No fatal cases of tbe occured.

[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.

[Interferon gamma concentration in the cerebrospinal fluid of patients with tick-borne encephalitis]

BACKGROUND AND PURPOSE

The purpose of this work was to evaluate interferon gamma (IFN-g) concentration in the cerebrospinal fluid of patients with diagnosed tick-borne encephalitis (TBE) early in the course of the disease and after the treatment.

MATERIAL AND METHODS

The cerebrospinal fluid of 40 patients with TBE was examined. Patients were divided into 4 groups: group 1 consisted of 13 patients with mild clinical course, group 2 included 12 patients with prolonged TBE showing the presence of inflammatory markers after the treatment, group 3 comprised 9 patients with severe TBE presenting with disorders of consciousness and group 4 consisted of 6 patients with a simultaneous B. burgdorferi infection. The cerebrospinal fluid was examined twice--during TBE diagnosing and after the treatment. IFN-g was detected by the ELISA method.

RESULTS

The concentration of IFN-g in the cerebrospinal fluid in the first examination was significantly higher in all four groups of patients in comparison with controls. After the treatment, concentration of IFN-g decreased significantly in all studied groups. The highest concentration of IFN-g at the first examination was found in group 3. The concentration of IFN-g at the second examination was similar among 4 groups of patients and in controls.

CONCLUSIONS

We found the correlation between IFN-g concentration in the cerebrospinal fluid of patients at the early stage of TBE and inflammation activity. We did not find any association between IFN-g concentration and a persistent increase of the cerebrospinal fluid parameters.

[Concentration of interleukin-18, interleukin-1beta, soluble receptor for interleukin-1 (sIL-1RII) and C-reactive protein in patients with neuroborreliosis]

BACKGROUND AND PURPOSE

The aim of the present study was to determine the role of interleukin-18 (IL-18), interleukin-1beta (IL-1beta) and its soluble receptor sIL-1RII in the pathogenesis of neuroborreliosis as well as the usefulness of C-reactive protein (CRP) determination in the diagnosis and monitoring of treatment of Lyme neuroborreliosis.

MATERIAL AND METHODS

The study group consisted of 20 patients with Lyme meningitis (age range 16-72 years, mean age 42.6 years). For measurements of IL-18, IL-1beta and sIL-1RII levels in serum and cerebrospinal fluid (CSF) the control group consisted of 10 healthy volunteers and 10 patients with infection of the central nervous system ruled out, respectively. Cytokines and sIL-1RII levels in serum and CSF were measured twice, before and after the 30-day treatment period. Serum and CSF levels of IL-18, IL-1beta and sIL-1RII were measured using ELISA, and CRP serum levels were measured using the immunoturbidimetric method.

RESULTS

Before the treatment the concentration of IL-18, IL-1beta and sIL-1RII in serum as well as in CSF was significantly higher as compared to the controls. After the treatment end the level of IL-18, IL-1beta and sIL-1RII was reduced but the serum level of sIL-1RII and CSF level of IL-18 and sIL-1RII remained significantly higher than in the control group. The serum level of CRP was increased only in 15% of patients and after the treatment CRP concentration returned to a basal level (except one patient in whom CRP was slightly higher than in the control group). No correlation between CRP and IL-18, IL-1beta and sIL-1RII was observed.

CONCLUSIONS

Our results confirm the involvement of IL-18, IL-1beta and sIL-1RII in the pathogenesis of neuroborreliosis and uselessness of CRP determination in the diagnosis of Lyme meningitis.

Concentration of interferon-inducible T cell chemoattractant and monocyte chemotactic protein-1 in serum and cerebrospinal fluid of patients with Lyme borreliosis

PURPOSE

Chronic inflammation in Lyme borreliosis may be sustained by aberrant inflammatory response, characterized by Th1 lymphocyte predominance, which in turn may be determined by chemokines synthesized in inflammatory focus. The aim of the study was to evaluate synthesis of chemokines: interferon-induced T cell chemoattractant (I-TAC--chemoattractant for Th1 lymphocytes), and monocyte chemotactic protein (MCP-1) in Lyme borreliosis.

MATERIAL AND METHODS

Study group consisted of 13 patients with erythema migrans, 10 with Lyme arthritis and 6 with neuroborreliosis. Serum, as well as cerebrospinal fluid (CSF) in neuroborreliosis, was obtained before (examination 1) and during (examination 2) antibiotic treatment. Control serum was obtained from 8 healthy volunteers and control csf from 8 patients in whom meningitis and neuroborreliosis was excluded after diagnostic lumbar puncture. The samples were assayed for MCP-1 and I-TAC by ELISA.

RESULTS

Serum mean I-TAC concentration in examination 1 was 73.0 pg/ml in erythema migrans, 78.9 pg/ml in Lyme arthritis and 87.3 pg/ml in neuroborreliosis (29.9 pg/ml in controls, difference significant for neuroborreliosis) and did not change significantly in examination 2. MCP-1 serum concentration was significantly increased to 497.5 pg/ml in neuroborreliosis in examination 2. I-TAC concentration in csf remained low, while MCP-1 concentration in examination 1 was increased to 589.1 pg/ml, significantly higher than simultaneously in serum.

CONCLUSIONS

I-TAC synthesis is increased in Lyme borreliosis and may be a factor favoring predominance of Th1 lymphocyte subset. MCP-1 creates chemotactic gradient towards central nervous system and may contribute to csf pleocytosis in neuroborreliosis.

Prevalence of DNA and antibodies to Borrelia burgdorferi sensu lato in dogs suspected of borreliosis

The aim of the paper was an attempt to correlate clinical signs with the presence of DNA of Borrelia burgdorferi (sensu lato) s.l. and the antibodies against B. burgdorferi s.l. in the blood of dogs. Among the animals studied there were 62 dogs delivered to the Veterinary Clinic in Szczecin and 30 from the Municipal Animal Shelter in Szczecin with varied clinical signs of borreliosis. In all cases the owners admitted frequent contacts of their dogs with ticks, both in the past, as well as shortly before the onset of sickness. We used two methods: PCR for detecting DNA of B. burgdorferi s.l. and ELISA test for detecting antibodies against the spirochete. Lameness, the principal symptom of canine borreliosis was the most frequent symptom of the group of 31 PCR-positive animals. The other most common symptoms in PCR-positive dogs were fever, swelling of joints and loss of body weight. DNA of B. burgdorferi s.l. was most frequently detected in the blood of dogs of the group 2-5 years old (13/54.1 %). ELISA tests specific for IgG antibodies were positive in 37 of 92 sera (40.2 %) taken from examined dogs. Lameness was observed in 15 of 37 IgG-seropositive dogs and in 25 of 55 seronegative animals. In 54 % of dogs with the antibodies, swelling of instep- and wrist joints was observed compared to only 24.4 % in seronegative dogs. An attempt to correlate the PCR results with the results of tests detecting antibodies against B. burgdorferi s.l. revealed that fewer than half (45.1 %) of the dogs with presence of DNA of the spirochete, developed an immune response. Therefore the transfer of B. burgdorferi s.l. form, the primary lesion to the target tissues, is possible in dogs which did not develop immune response or develop an insufficient response. Among 92 borreliosis-suspected dogs 54 (over 58 %) were diagnosed positively using laboratory methods. In most cases there was a correlation between clinical symptoms of borreliosis and presence of DNA B. burgdorferi, thus PCR may contribute to improving to a large extent diagnostic of canine Lyme disease.

[Vitamin A, E and C serum concentration in patients with Borrelia burgdorferi antibodies--non-symptomatic carriers]

To estimate vitamin A, E and C serum concentrations among forestry workers showing antibodies against Borrelia burgdorferi presence. Vitamins A, E and C concentrations were evaluated in 117 sera of forestry workers. 78 persons aged 18-63 (x=43.07) showed antibodies against Borrelia burgdorferi presence. In this group 13 persons showed presence of IgM, 42 persons with IgG and 23 with IgM and IgG. Control group consisted of 39 persons aged 18-56 years (x=40,97), with no detectable anti-Borrelia burgdorferi antibodies in serum. Serologic diagnosis was performed with use of ELISA kit - Borrelia recombinant IgM, IgG (Biomedica, Austria). Vitamins A and E serum concentrations were detected by RP-HPLC method with spectrophotometric detection (De Leenheet and co.). Vitamin C was detected by RP-HPLS method with spectrophotometric method (Ivanovic and co). Obtains results were statistically analysed. Significantly lower of vitamin A and E serum concentration of persons with anti-borrelia antibodies presence. The lowest concentration was observed in group showing presence of IgM and IgG. No significant difference in vitamin C serum concentration in examined groups was observed. These results may suggest that low serum concentrations of vitamin A and E may have influence on Borrelia burgdorferi infection development.

[The polymerase chain reaction evaluation of Borrelia burgdorferi DNA presence in peripheral blood of patients with Lyme disease]

The purpose of this work was to evaluate Borrelia burgdorferi presence in peripheral blood of patients with Lyme disease using PCR method. The study was conducted on 96 patients divided into 4 groups depending on clinical form of the disease.

MATERIAL AND METHODS

There were 9 patients with erythema migrans, 11 with neuroborreliosis, 36 with Lyme arthritis, 18 with disseminated form of borreliosis and 22 patients whose initial suspicion of Lyme disease was excluded. The diagnosis was based on clinical examination and results of serologic test performed using ELISA method showing serum presence of antibodies anti-borrelia IgM and IgG.

RESULTS

The results of PCR examination were analysed depending on clinical form of the disease and result of serologic test. The highest rate of positive results in PCR examination was stated in group of patients showing serum presence of IgM anti-borrelia antibodies (34.48%) and in patients with diagnosed Lyme arthritis (38.88%). The lowest rate of positive PCR results (16.66%) was stated in group of patients with negative serologic test.

CONCLUSIONS

The probability of Borrelia burgdorferi DNA blood presence was highest (76.0%) in patients with positive serologic test IgM anti-borrelia antibodies and diagnosed Lyme arthritis.

[Role of interleukin-18, interleukin-1beta and its soluble receptor (sIL-1RII) in early and late Lyme borreliosis]

Although borreliosis was first described as a separate entity more than 20 years ago its pathogenesis still remains unknown. In recent years the role of pro- and antiinflammatory cytokines in the pathogenesis of borreliosis has been discussed. The purpose of the present study was to evaluate the role of IL-1beta, IL-18 and sIL-1RII in the development of early and late stages of borreliosis. The study group consisted of 60 patients divided into 3 groups: patients with erythema migrans, Lyme arthritis and neuroborreliosis. In all groups serum levels of IL-1beta, IL-18 and sIL-1RII were determined and in the patients with neuroborreliosis additionally in cerebrospinal fluid (CSF). The levels of cytokines and sIL-1RII were measured before the start of treatment and after its termination. Before the treatment the levels of IL-1beta, IL-18 and sIL-1RII in serum and CSF were significantly higher in all studied groups compared with the control. After the treatment, despite the regression of the clinical symptoms and significant reduction of initially high levels of the cytokines and sIL-1RII, only the levels of IL-1beta in all patients and the serum level of IL-18 in the patients with neuroborreliosis were comparable with the values in the control group. It could suggest that the inflammatory process was not inhibited completely and confirms the role of IL-1beta, IL-18 and sIL-1RII in the pathogenesis of borreliosis.

[Evaluation of proinflammatory cytokine (TNF-alpha, IL-1beta, IL-6, IFN-gamma) concentrations in serum and cerebrospinal fluid of patients with neuroborreliosis]

BACKGROUND AND PURPOSE

Neuroborreliosis is a tick transmitted disease which becomes an increasingly frequent diagnostic and therapeutic problem in physician practice. The purpose of this work was to evaluate the concentration of proinflammatory cytokines: IL-1beta, IL-6, TNF-alpha, IFN-gamma in serum and cerebrospinal fluid of patients with neuroborreliosis.

MATERIAL AND METHODS

20 persons with diagnosed neuroborreliosis and 10 persons as a control group were examined in this study. The examination of serum and cerebrospinal fluid was performed twice, before and after 4-week therapy with antibiotics. The concentration of cytokines was measured by the ELISA method using kits of Bender Medical System and Quantikine RD Systems.

RESULTS

The concentration of measured cytokines IL-1beta, IL-6, TNF-alpha and IFN-gamma in serum and cerebrospinal fluid was significantly higher before therapy. After 4-week therapy with antibiotics the concentration of cytokines in cerebrospinal fluid decreased but was still higher than in the control group except for IL-1beta.

CONCLUSIONS

The detection of proinflammatory cytokine concentration in serum and cerebrospinal fluid might be helpful as another parameter monitoring the inflammation course and therapy efficacy.

[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.

[Tick-borne encephalitis (TBE) cases in Białostocki and Podlaski regions in years 1993-2002]

TBE virus remains one of major etiologic agents of encephalitis in Poland. In the beginning of 90-ties great increase of TBE cases was observed. In the years 1993-2002 there were TBE 1966 cases reported in Poland, while in białostockie/podlaskie voivodeship there were 871 cases. In years 1993 and 1996 111 TBE cases annually were reported in this region. The highest TBE incidence in this region was registered in years 1993 and 1996 - 15.9 and the lowest in 2001 - 3.4. In analyzed period of time mean TBE incidence in Poland varied from 0.69 to 0.26. TBE cases from białostockie voivodeship from years 1993-1998 stated 43% of all cases in Poland and from podlaskie voivodeship from years 1999-2002 states 46% of all.

[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.

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.

[Serum and cerebrospinal fluid concentration of inflammatory proteins MIP-1-alpha and MIP-1-beta and of interleukin 8 in the course of borreliosis]

Chemokines constitute a group of cytokines with a strong chemotactic action, playing an important role in the pathogenesis of inflammatory responses, including infectious meningitis. The results of in vitro experiments suggest synthesis of chemokines during Borrelia burgdorferi infection. The aim of this study was to investigate serum and cerebrospinal fluid (CSF) concentrations of the following chemokines: interleukin-8 (Il-8) and macrophage inflammatory protein 1 alpha and 1 beta (MIP-1 alpha and MIP-1 beta) in patients with neuroborreliosis. The study group consisted of 20 patients admitted to Neuroinfections and Infectious Diseases Department of the Medical University in Białystok. The control group consisted of 12 healthy persons from whom blood samples were obtained, and 10 patients without meningitis, from whom CSF samples were taken for diagnostic purposes. Chemokine concentrations were measured with ELISA kits before treatment (baseline) and after 2 weeks of antibiotic therapy (post-treatment). Mean serum concentrations of chemokine were elevated in neuroborreliosis patients at baseline (Il-8--mean +/- SD = 668.25 +/- 661.51 pg/ml, MIP-1 alpha--124.90 +/- 89.37 pg/ml, MIP-1 beta--233.40 +/- 298.40 pg/ml) as compared to these in the control group (Il-8-23.72 +/- 7.68 pg/ml, MIP-1 alpha--36.81 +/- 4.74 pg/ml, MIP-1 beta--70.41 +/- 16.41 pg/ml). Post-treatment mean concentrations of Il-8 (197.70 +/- 285.56 pg/ml) and MIP-1 beta (102.70 +/- 42.56 pg/ml) remained significantly elevated, while the mean concentration of MIP-1 alpha (53.65 +/- 38.50 pg/ml) was insignificantly higher than that in the control group. The Il-8 mean concentration was the most elevated comparing to the controls and has decreased most significantly during the treatment. CSF concentrations of chemokines were significantly elevated both at baseline (Il-8--754.95 +/- 535.83 pg/ml, MIP-1 alpha--24.35 +/- 4.88 pg/ml, MIP-1 beta--27.6 +/- 8.38 pg/ml) and post-treatment (Il-8--98.20 +/- 74.74 pg/ml, MIP-1 alpha--18.60 +/- 2.87 pg/ml, MIP-1 beta--16.90 +/- 4.38 pg/ml) in comparison with the controls (Il-8--10.43 +/- 2.70 pg/ml, MIP-1 alpha--8.17 +/- 1.54 pg/ml, MIP-1 beta--7.27 +/- 1.58 pg/ml). MIP-1 alpha and MIP-1 beta CSF concentrations were significantly lower than their concentrations in serum. The Il-8 CSF concentration did not differ significantly from its serum concentration. However, in some patients Il-8 CSF concentration was much higher than that in the serum, which suggests its significant synthesis within the cns and its role in the pathogenesis of B. burgdorferi meningitis. Chemokine CSF concentrations were not correlated with cytosis and CSF protein concentration. The results indicate the induction of Il-8, MIP-1 alpha and MIP-1 beta synthesis in the course of neuroborreliosis and a decrease of their concentrations during 2 weeks of treatment, however, without reaching the normal values.

[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.

[Ehrlichia chaffeensis antibodies prevalence among patients bitten by ticks]

Human ehrlichiosis is a tick-borne antropozoonosis which was described in 1987 but in Poland up to now has not been diagnosed. The purpose of our work was to present 11 cases where antibodies against Ehrlichia chaffeensis were detected in serum. In 2000 we examined 68 sera of patients who were referred to our department with suspected Borreliosis or Tick-Borne Encephalitis (TBE). The detection of antibodies against E. chaffeensis was performed by indirect immunofluorescence assay. Five (45.4%) patients of 11 were diagnosed as Lyme borreliosis confirmed by serum presence of antibodies against B. burgdorferi. Three patients (27.2%) showed serum presence of antibodies against TBE. In one case presence of antibodies against three tick-borne agents was stated. None of our patients presented leucopenia characteristic of ehrlichiosis. trombocytopenia or increased aminotransferase level.

[Concentration of macrophage inflammatory proteins MIP-1 alpha and MIP-1 beta and interleukin 8 in erythema migrants]

Chemokines constitute a group of proinflammatory cytokines with a strong chemotactic activity towards different populations of leukocytes. Their role in Lyme borreliosis has not been confirmed, although in vitro studies suggest possibility of chemokine synthesis during Borrelia burgdorferi infection. The aim of present study was to evaluate concentrations of chemokines: interleukin 8 (IL-8) and macrophage inflammatory protein 1 alpha and 1 beta (MIP-1 alpha and MIP-1 beta) in serum of patients with early clinical manifestation of Lyme borreliosis--erythema migrans (EM). Study group consisted of 20 patients with EM, control group of 12 healthy blood donors. Chemokine concentrations were measured with ELISA assays twice: before (examination 1) and after two weeks of antibiotic therapy (examination 2). Mean serum concentrations of IL-8, MIP-1 alpha and MIP-1 beta in examination 1 and of MIP-1 alpha and MIP-1 beta in examination 2 were significantly higher in comparison with control group. Chemokine concentrations were also significantly lower in examination 2 then in examination 1. These results show expression of IL-8, MIP-1 alpha and MIP-1 beta in the course of EM and suggest their role in the inflammatory response to Borrelia burgdorferi infection.

[The course of the tick-born encephalitis (TBE) in patients hospitalized at the Department of Infectious Diseases in Bialystok in the year 2001]

AIM

To characterize epidemiological and clinical features of TBE in the Northeastern Poland.

METHODS

Analysis of clinical and epidemiological data of patients hospitalized with the diagnosis of TBE in the Department of the Infectious Diseases and Neuroinfections of the Medical University in Białystok in 2001.

MAIN OBSERVATIONS

TBE was diagnosed in 48 patients. From that number 18 (37.5%) presented symptoms of meningitis, 24 (50.0%) meningoencephalitis, 5 (10.4%) meningoencephalomyelitis and 1 (2.1%) meningoencephaloradiculitis.

RESULTS

Headache (100%) and fever (87.5%) were the most common complaints. Signs of meningitis were observed in 35 patients (72.9%). Common neurological abnormalities were Oppenheim and Babinski signs (18 patients, 37.5%), pareses (8; 16.7%), ataxia (7; 14.58%) and impaired consciousness (6; 12.5%). Cytosis in cerebrospinal fluid (csf) was observed in all patients, frequently accompanied by high csf protein concentration, raised erythrocyte sedimentation rate (61.5%), leucocytosis (31.25%) and aminotrasferase activity (12.5%). There were no professional forest workers among the patients.

[Incidence of antibody detection against Toxocara canis and clinical symptoms in inhabitants of North-Eastern Poland]

The purpose of this work was to evaluate the the level of exposition of humans on Toxocara eggs in North Eastern Poland on a base of serological tests and epidemiological and clinical data. 1025 inhabitants of North Eastern region of Poland were examine to detect antibodies against Toxocara antigens. 214 (20.7%) showed presence of antibodies against Toxocara. They were mostly males (71%) and country inhabitants (58.9%). No abnormalities in laboratory tests were found among these people. Some of them had complaints like joint pains (19.6%), temporary skin rash 2.3%).

[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.

[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.

[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.