PubMed Health⌕ Search

Biomedical subjects

D H Rees

Publications and source records attributed to D H Rees.

10 recordsLinked to original sources
PubMed1999

Increased IgA rheumatoid factor and V(H)1 associated cross reactive idiotype expression in patients with Lyme arthritis and neuroborreliosis.

OBJECTIVE: To investigate whether autoreactive mechanisms occur in Lyme disease (LD) by determining IgA, IgG and IgM rheumatoid factor (RF) concentrations and RF associated cross reactive idiotype (CRI) expression in the serum of LD patients, with comparison to patients with rheumatoid arthritis (RA). METHODS: The RF isotype profiles were determined in 59 patients with LD; erythema migrans (EM) (n=19), neuroborreliosis (NB) (n=20) and Lyme arthritis (LA) (n=20). Mouse monoclonal antibodies (mAbs) G6 and G8 (V(H)1 gene associated), D12 (V(H)3 gene associated) and C7 (V(kappa)III gene associated) were then used to determine the RF associated CRI expression on IgM antibodies in 16 of these LD patients (eight seropositive for RF); (EM (n=3), NB (n=6), LA (n=7)). RESULTS: Seven (18%) patients with either NB or LA had increased concentrations of IgA RF compared with none with EM. Significant differences in the number of patients with raised concentrations of IgG RF or IgM RF were not found between the LD patient groups. Five (3NB, 1LA and 1 EM) (31%) and three (2NB and 1LA) (19%) of LD patients had raised concentrations of the CRIs recognised by mAbs G6 and G8, respectively. These CRIs were detected in LD sera both with and without raised concentrations of RF and were not demonstrated on anti-Borrelia burgdorferi antibodies using ELISA. No LD sera tested had raised concentrations of the determinants recognised by mAbs C7 or D12. CONCLUSION: Significantly raised concentrations of IgA RF and increased use of V(H)1 germline gene associated CRIs are found on IgM antibodies in the serum of LD patients. These data indicate the recruitment of autoreactive B lymphocytes in some patients with the later stages of LD.

Adolescent↗
PubMed1995

The value of serological testing for Lyme disease in the UK.

Although the prevalence of Lyme disease (LD) in the UK is low, patients with clinical presentations compatible with the condition are common. Arthritis often complicates LD in North America, however it is a very rare complication of the condition in the UK. Many patients seen at St George's Hospital, London have visited endemic areas for LD within the UK, Europe and North America. To determine the value of serological testing for LD in the UK, we prospectively studied 120 patients seen at this hospital with clinical manifestations suggestive of LD (12 of whom were recruited to the LD clinic from outside the hospital catchment area), regardless of whether an alternative diagnosis seemed likely. A history of tick bite was obtained and serum antibodies to Borrelia burgdorferi detected initially by enzyme-linked immunosorbent assay (ELISA) and reactive samples immunoblotted to further assess antibody specificity. Tick bites were reported by 22 patients, 16 of whom were bitten in endemic areas for LD. A further 11 patients had exposure to tick habitats in endemic areas, but were unaware of a tick bite. Raised antibody levels were detected by ELISA in 14 individuals (seven of whom had a history of tick bite or tick exposure in an endemic area); however, only four of these had specific antibodies to B. burgdorferi confirmed on immunoblot. All of these four had a history of tick bite in an endemic area, all had arthritis and in three of the four, this was the only manifestation of the condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Evidence for Lyme disease in urban park workers: a potential new health hazard for city inhabitants.

In the UK, cases of Lyme disease have only been reported from rural areas. Recently, however, Ixodes ticks infected with Borrelia burgdorferi have been found in London parks. To determine whether this constituted a health hazard, we questioned 44 workers from Richmond and Bushey parks to assess their exposure to tick bites and whether they had a clinical history of Lyme disease. Their serum was subsequently investigated for antibodies to two different preparations of Borrelia burgdorferi (whole cell sonicate and flagellin) and the specificity of these antibodies determined by immunoblotting. Comparison was made to zoo keepers (n = 27) from a wildlife park outside London. Tick bites were reported in 23% of park workers and of these, three described symptoms compatible with Lyme disease. Raised antibody levels were found in 10 (24%) of the park workers compared with one (4%) of the zoo keepers using ELISA with whole cell sonicate as antigen (P = 0.02) and 6 (14%) of park workers and none of the zoo keepers using purified flagellin as antigen (P < 0.05). Analysis of the immunoblots revealed more bands were detected in park workers (mean 1.8, range 0-6) than in the zoo keeper controls (mean 0.8, range 0-4); P < 0.001 and 14 (32%) of the park workers had reactivity with three or more protein bands, whilst only one of the zoo keepers showed this level of antigen binding (P < 0.005). These data suggest previous infection with B. burgdorferi in London park workers which has important health implications for these individuals, other park workers and possibly park visitors.

Adolescent↗
PubMed1994

Lyme arthritis.

Explore the source record for details and available documents.

Arthritis, Infectious↗
PubMed1994

No evidence to implicate Borrelia burgdorferi in the pathogenesis of dilated cardiomyopathy in the United Kingdom.

OBJECTIVE: To determine whether Borrelia burgdorferi is implicated in the pathogenesis of dilated cardiomyopathy in the United Kingdom. DESIGN: A controlled prospective study. Patients' notes were reviewed for evidence of Lyme disease and serum samples were tested by enzyme linked immunoadsorbent assay (ELISA) for antibodies to B burgdorferi. Samples with raised antibody concentrations were subsequently analysed by immunoblotting to determine their antibody binding specificity. SETTING: Tertiary referral centre. PATIENTS: 97 consecutive patients with dilated cardiomyopathy diagnosed according to World Health Organisation criteria were studied. Serum samples were taken from two matched control groups. The first group (n = 38) was age, sex, and geographically matched. The second control group (n = 39) was environmentally matched and consisted of members of the patients' own households. MAIN OUTCOME MEASURES: Clinical evidence of Lyme disease. Presence of raised antibody concentrations to B burgdorferi. RESULTS: No patients had a previous illness compatible with Lyme disease. Analysis of the ELISA data showed eight of 97 patients with dilated cardiomyopathy (8.2%) and two of 77 controls (3.9%) had raised antibody concentrations. Immunoblot analysis, however, did not show binding patterns consistent with the presence of IgG specific for B burgdorferi in any of these samples. CONCLUSIONS: There was no clinical or serological evidence to implicate B burgdorferi in the pathogenesis of idiopathic dilated cardiomyopathy in the United Kingdom. In the absence of specific symptoms or likely exposure to B burgdorferi routine serological testing for Lyme disease in this group of patients is not recommended. Furthermore, raised antibodies to B burgdorferi are not diagnostic of active infection and ELISA results should be interpreted with caution unless specific B burgdorferi antibody bands have been found by immunoblot analysis.

Adolescent↗