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M F Finkel

Publications and source records attributed to M F Finkel.

15 recordsLinked to original sources
PubMed2001

Population-based incidence of human granulocytic ehrlichiosis in northwestern Wisconsin, 1997-1999.

The incidence of human granulocytic ehrlichiosis (HGE) in the upper Midwest is uncertain. Active surveillance for suspected HGE was conducted from 1997 through 1999 in a 13-county region of northwestern Wisconsin. Suspected HGE cases were classified, according to the national case definition, as confirmed, probable, or not HGE. In total, 112 confirmed cases and 30 probable cases of HGE were identified. The median age of the 142 case patients was 56 years, and 92 (65%) were male; 111 (78%) were residents of the surveillance region. The mean annual incidence of confirmed and probable HGE was 9.3 cases per 100,000 residents; there was no increase from 1997 to 1999. The incidence was highest among persons > or =50 years old and residents of Washburn County. The incidence of HGE in this region exceeded prior estimates, but it was lower than the reported incidence in areas of endemicity in Connecticut.

Adolescent↗
PubMed2001

Tickborne infections as a cause of nonspecific febrile illness in Wisconsin.

Lyme disease, human granulocytic ehrlichiosis (HGE), and babesiosis are tickborne infections that are indigenous to Wisconsin. To assess their importance as a cause of nonspecific fever, we recruited patients with febrile illness at 10 clinics in northwestern Wisconsin from May through August of both 1997 and 1998. Eligible patients had a temperature >38.0 degrees C but no rash or other localizing source. Acute and convalescent serological tests were performed for Borrelia burgdorferi, Babesia microti, and Ehrlichia equi; polymerase chain reaction was performed to detect granulocytic Ehrlichia rDNA. Seventeen (27%) of 62 eligible patients had laboratory evidence of tickborne infection, including 7 (11%) with probable Lyme disease only, 8 (13%) with HGE only, and 2 (3%) with apparent coinfection. No patients with Babesia infection were identified. Patients with and without tickborne infection were similar with regard to age, sex, symptoms, history of tick bite, and outdoor exposure. The results suggest that tickborne infections are an important cause of nonspecific febrile illness during the tick season in northwestern Wisconsin.

Adolescent↗
PubMed2000

Pramipexole is a possible effective treatment for primary orthostatic tremor (shaky leg syndrome).

OBJECTIVE: To report the successful treatment of primary orthostatic tremor in a 76-year-old man. BACKGROUND: Primary orthostatic tremor is a rare condition, with few reports describing therapies. Established therapies had previously failed in our patient. METHODS: Using an evidence-based evaluation of treatments via MEDLINE's GRATEFUL MED search engine, a therapeutic option was determined during the first consultation with the patient, and pramipexole therapy was initiated. RESULTS: The therapy proved effective, and the patient had relief from his symptoms for the first time in 6 years. CONCLUSION: Pramipexole is a potential therapy for primary orthostatic tremor. Arch Neurol. 2000;57:1519-1520

Aged↗
PubMed1999

Clinical and epidemiological features of early Lyme disease and human granulocytic ehrlichiosis in Wisconsin.

To compare clinical features and assess risk factors for human granulocytic ehrlichiosis (HGE) and early Lyme disease, we enrolled patients in a case-control study during the 1996 and 1997 tick seasons. Clinical and demographic characteristics were assessed for patients with laboratory-confirmed cases of HGE or Lyme disease, and risk factors were compared with those of matched control subjects. We identified 83 persons with Lyme disease, 27 with HGE, and 11 with apparent coinfection. Unsuspected Ehrlichia infection was identified in 8 (13%) of 60 patients with Lyme disease. Patients with HGE were older and more likely to have fever, chills, or dyspnea than were those with Lyme disease only. Most patients with apparent coinfection did not have hematologic abnormalities. In the risk factor analysis, tickborne illness was independently associated with rural residence and camping. The clinical spectrum of HGE overlaps that of Lyme disease, and physicians in areas of endemicity should consider both diseases in treating patients with a compatible rash or febrile illness.

Adult↗
PubMed1997

Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease.

BACKGROUND: Localized Lyme disease, manifested by erythema migrans, is usually treated with oral doxycycline or amoxicillin. Whether acute disseminated Borrelia burgdorferi infection should be treated differently from localized infection is unknown. METHODS: We conducted a prospective, open-label, randomized, multicenter study comparing parenteral ceftriaxone (2 g once daily for 14 days) with oral doxycycline (100 mg twice daily for 21 days) in patients with acute disseminated B. burgdorferi infection but without meningitis. The erythema migrans skin lesion was required for study entry, and disseminated disease had to be indicated by either multiple erythema migrans lesions or objective evidence of organ involvement. RESULTS: Of 140 patients enrolled, 133 had multiple erythema migrans lesions. Both treatments were highly effective. Rates of clinical cure at the last evaluation were similar among the patients treated with ceftriaxone (85 percent) and those treated with doxycycline (88 percent); treatment was considered to have failed in only one patient in each group. Among patients whose infections were cured, 18 of 67 patients in the ceftriaxone group (27 percent) reported one or more residual symptoms at the last follow-up visit, as did 10 of 71 patients in the doxycycline group (14 percent, P > or = 0.05). Mild arthralgia was the most common persistent symptom. Both regimens were well tolerated; only four patients (6 percent) in each group withdrew because of adverse events. CONCLUSIONS: In patients with acute disseminated Lyme disease but without meningitis, oral doxycycline and parenterally administered ceftriaxone were equally effective in preventing the late manifestations of disease.

Acute Disease↗
PubMed1993

The progressive paralytic disorders associated with Lyme disease.

The clinical disorders of B. burgdorferi infection continue to be elucidated. The neurologic disorders, especially those that produce progressive paralytic syndromes, have been reasonably well described. They frequently occur in conjunction with syndromes affecting other body systems. The appropriate use of antibiotics is usually effective in eradicating the infection. However, some individuals may have residual deficits as a result of the infectious process, even after the bacterial infection is eradicated. These are treated by appropriate supportive and symptomatic therapies, not by endless, useless courses of antibiotics. Finally, although early discussions of the pathophysiology and the clinical syndromes associated with B. burgdorferi infection compared the neurologic syndromes of with those of T. pallidum, raising the specter of another Great Imitator, this frame of reference has lost its usefulness. Modern laboratory techniques have allowed much better definition of the syndromes associated with this disorder. Whereas I once subscribed to the slogan, "Remember the Great Imitator," I now recommend that neurologists "Imitate Great Thinkers and Forget the Great Imitator."

Humans↗
PubMed1992

Invasion of the central nervous system by Borrelia burgdorferi in acute disseminated infection.

OBJECTIVE: To determine central nervous system (CNS) involvement in acutely disseminated Borrelia burgdorferi infection by measurement of borrelia-specific DNA using the polymerase chain-reaction (PCR) assay and to compare the results of this with standard serological tests. DESIGN: Prospective study with laboratory investigators blinded to clinical data. SETTING: Multicenter office practice with a central reference laboratory. PATIENTS: Cerebrospinal fluid (CSF) was collected from 12 patients with acute disseminated Lyme borreliosis with less than 2 weeks of active disease. The normal control specimens came from 16 patients whose CSF samples had been sent to the clinical laboratory for tests unrelated to the present study. MAIN OUTCOME MEASURES: Clinical evidence of disease and laboratory abnormalities. RESULTS: Eight of the 12 patients (four of six with multiple areas of erythema migrans and four of six with cranial neuritis without erythema migrans) had B burgdorferi-specific DNA in their CSF. Among the 12 patients studied, nine had acute cranial neuritis and six had multiple erythema migrans lesions. Just four of the eight who were found to have spirochetal DNA in their CSF had complaints suggestive of CNS infection. In three of the PCR-positive CSF samples, no other abnormalities were noted. None of 16 samples from controls were positive in the PCR assay. CONCLUSION: B burgdorferi can invade the CNS early in the course of infection. Careful consideration should be given to choosing antibiotics that achieve adequate CSF levels in patients with disseminated infection.

Antibodies, Bacterial↗
PubMed1992

Nervous system Lyme borreliosis--revisited [corrected; erratum to be published].

A great deal of confusion surrounds the diagnosis, clinical phenomenology, and treatment of Lyme borreliosis. Most diagnostic methods currently in use are indirect and do not differentiate between prior exposure and current infection. A critical review of the literature permits the characterization of a distinct set of neurologic disorders that are almost certainly caused by this infection and their differentiation from the plethora of syndromes that have been anecdotally linked to infection, but in which causality has never been established. This article describes the range of clinical disorders associated with Lyme borreliosis, provides an overview of current approaches to diagnosis, and reviews current treatment protocols.

Anti-Bacterial Agents↗
PubMed1990

Borrelia lymphocytoma: a possible North American case.

Borrelia lymphocytoma is a rare dermatologic manifestation of Lyme disease, thus far reported only in European patients. A possible North American case is presented and the significance of the first North American case is discussed.

Acute Disease↗
PubMed1988

Lyme disease and its neurologic complications.

Lyme disease is recognized as a cause of illness involving multiple organ systems. The transmission of the Borrelia burgdorferi spirochete depends on a complicated vector life cycle, involving multiple mammalian and avian hosts. Although the illness is reported worldwide, variable clinical presentations on different continents raise questions about disease mechanisms. Multiple neurologic syndromes can occur alone or in combination, producing peripheral neuropathies, radiculopathies, myelopathies, encephalitides, meningitides, and pain syndromes. These may be noted with dermatological, rheumatological, and cardiological syndromes. Several pathophysiologic mechanisms are reviewed. Antibiotic therapy for different clinical presentations is discussed.

Central Nervous System Diseases↗