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PubMed1988

[Immunochemical analysis of the immune response in late manifestations of Lyme borreliosis].

Compared to American strains, European Borrelia burgdorferi strains revealed considerable heterogeneity of major proteins. Four strains isolated from ticks, human skin and human CSF were selected from our 23 Borrelia burgdorferi isolates. These strains and the American type strain B31 were characterized by SDS-PAGE (Coomassie Blue staining) and Western blots (using rabbit immune sera against two of the strains and two monoclonal antibodies (H5323 and H3TS) against a major outer surface protein (OspA]. The strains showed considerable differences in SDS-PAGE pattern. Corroborating the results of a previous study, we could demonstrate that the OspA (31/32K) can change from a minor to a major protein and in reverse the pC (21/22K) from a major to a minor protein during subculturing. Moreover, European strains can antigenically differ in OspA, pC and also in a further low molecular weight protein of 17/18K. To examine whether the antigenic heterogeneity of European isolates is reflected in the immune response of European patients we examined sera from patients with late manifestations of Lyme Borreliosis by Western blot using the five strains as antigens. Sera from seven patients with acrodermatitis chronica atrophicans (ACA) showed a surprisingly strong reactivity with the skin isolate. All sera had antibodies against the 17/18K protein of the skin isolate, but none was reactive with the analogous 17/18K of the other strains. On the other hand a comparable predominance of one strain was not found testing sera from patients with Lyme arthritis. One patient even had antibodies against OspA and OspB proteins of strain B31. Contrary to findings in American Lyme Disease antibodies against the OspA were rarely observed in the sera of our patients (only one patient had such antibodies) although we tested the patients sera with five different strains. Only two patients had stronger reactions with the skin isolate. These findings suggest that ACA is caused by antigenically closely related Borreliae. This could explain the finding that ACA is rarely observed in the US (US strains are antigenically closely related to strain B31). Our findings in patients with Lyme Arthritis--on the other hand--suggest that "different serotypes" can cause Lyme Arthritis. This does not exclude the possibility that Borrelia proteins are an important factor in the pathogenesis of Lyme arthritis. Finally the differences in reactivity of sera with different strains in the Western blot led us to examine whether such differences are also found in serodiagnostic tests using different strains as antigens.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1986

[Lyme borreliosis].

Lyme borreliosis has in common features with another spirochetosis, syphilis, e.g. the development in three stages and the occurrence of reinfection and congenital infection. The European variant (erythema migrans disease in the broader sense) initially more often seems to have a mild course than in the United States, but lymphocytoma, Bannwarth syndrome and acrodermatitis chronica atrophicans seem to be more common in Europe. Administration of tetracycline for stage 1 and of parenteral penicillin G in high doses for stages 2 and 3 and during pregnancy is recommended.

Anti-Bacterial Agents↗

PubMed1986

[Disease (Lyme disease) in pediatric patients in Switzerland caused by spirochetes (Borrelia burgdorferi) of Ixodes ricinus].

Lyme disease in children is studied in the light of questionnaires sent out twice to departments and divisions of pediatrics in Switzerland. Thirty-six serologically proven cases were collected. The 48 clinical signs attributed to Lyme disease involved the skin in 40%, the nervous system in 40%, and the joints in 20%. They were erythema chronicum migrans (13), lymphocytoma (4), acrodermatitis chronica atrophicans (2), peripheral facial palsy (14), sensomotor radiculoneuritis (2), meningoencephalitis (3) and arthritis (10, 7 of which were monoarthritic). Only half the patients had a history of tick-bite. Antibiotic therapy, usually with penicillin, reduced both the duration of symptoms and frequency of secondary disease. Cardiac involvement and chronic stages with residua were not observed in this series.

Adolescent↗

PubMedDate not supplied

Ixodes ricinus spirochete and European erythema chronicum migrans disease.

From three endemic locations of erythema chronicum migrans disease in North Rhine-Westphalia, Germany, we recovered 19 isolates of a spirochete from Ixodes ricinus ticks. The infection rate in adult ticks was 16 percent. The isolated spirochete is immunologically related to the Ixodes dammini spirochete, Borrelia duttoni, and Treponema pallidum. Using indirect immunofluorescence, the sera of 90 patients with erythema chronicum migrans disease showed antibody titers against the isolated spirochete, which correlated with the clinical course. Similarly, antibodies were demonstrated in the sera of 21 patients with acrodermatitis chronica atrophicans. These results suggest an etiologic role for the Ixodes ricinus spriochete in European erythema chronicum migrans disease.

Antibodies, Bacterial↗

PubMed1995

[Diagnosis of Lyme borreliosis].

Lyme borreliosis is an infectious disease, caused by the spirochaete Borrelia burgdorferi and transmitted by ticks, in our regions by the tick Ixodes ricinus. The disease mainly affects skin, nervous system, joints and heart. Lyme borreliosis develops in three stages, and the various clinical manifestations may assigned to the respective stages. As far as skin is concerned, in stage I typically appears erythema chronicum migrans, very often accompanied by flu-like symptoms; in stage III, months to years after the manifestations of the early phase, acrodermatitis chronica atrophicans, may be encountered. Among the neurological manifestations, in stage II, meningoradiculoneuritis (Bannwarth's syndrome) develops as the most frequent disease, characterized by pheripheral paresis at the lower extremities and bilateral facial nerve palsy. Lyme arthritis mainly affects the knee. To assure the diagnosis of Lyme borreliosis, a number of serological tests is performed as the direct detection of the causative agent is rather difficult and time consuming. Possibly, the use of the polymerase chain reaction to detect B. burgdorferi DNA may improve the diagnostic tools.

Animals↗

PubMed1994

[Lyme disease].

Lyme disease is an infectious disease due to Borrelia burgdorferi, which is transmitted by a tick bite. Bearing ticks belong to the "Ixodes" type. Germ reservoirs include rodents, birds, deers... The disease onset usually takes place in summer or in autumn. Its early stage is characterized by erythema chronicum migrans. The secondary stage, initiated by a virus-like syndrome indicating the hematogenous and lymphatic dissemination may include neurologic symptoms and signs--the most frequent ones in France and Europe (meningoradiculitis, meningitis, palsy of one or several cranial nerves), cardiac symptoms (conduction dysfunction), a relapsing oligoarthritis, and sometimes ocular signs. In some cases, joint and/or nervous system symptoms may become chronic: it's the tertiary (late) stage, which may include, too, acrodermatitis chronica atrophicans. Any of these symptoms may initiate the disease or be its only manifestation. When erythema chronicum migrans is missing, diagnosis lays upon serology which may turn positive only lately, or remain negative; the possibility of false positivity must also be noticed. Antibiotherapy must be initiated as soon as possible; even when started lately, it may prove beneficial. It consists essentially of beta lactamins or doxycyclin. Studies are progressing in view of the elaboration of a vaccine.

Anti-Bacterial Agents↗

PubMed1993

[Skin changes in patients with Lyme borreliosis].

In introduction some clinical characteristics of Erythema migrans, Borrelia lymphocytoma and acrodermatitis chronica atrophica has been described. The importance of atypical forms of Erythema migrans and the difficulties in differential diagnosis of cutaneous manifestation has been stressed. In a prospective, and partly retrospective investigation of 1292 persons with tick bites, signs of Lyme borreliosis have been found in 18.96%. Number of such persons seen in dermatology wards is rising, and 18.2% of these are children less than 15 years of age. Patients seen in dermatology are mostly women (56.5%:43.5%). Nearly half of the patients with Erythema migrans did not known that they had a tick bite (42.5%). Lyme borreliosis was manifested mainly as Erythema migrans, 89% of patients. Borrelia lymphocytoma was encountered in 2%, and Acrodermatitis chronica atrophicans in 0.4% of patients, significantly less than in other reports. Sclerotic skin lesions were found in 4.1% of patients, and some macular and urticarial lesions were recorded. An incubation period generally less than three weeks preceded to skin manifestations, but in some patients this period could not be recorded. Skin lesions were located on lower extremities in 50.4% of patients, trunk in 25.5%, and upper extremities in 10.5% of patients. In 87% of patients skin lesions lasted less than three weeks. Symptoms were present in 62% of patients. Seropositivity to Borrelia burgdorferi has been found in 10.2% of patients, mostly three weeks after the tick bite.

Adolescent↗

PubMed1993

[Lyme borreliosis: review of present knowledge].

The author reviews hitherto assembled knowledge on a bacterial disease, Lyme borreliosis transmitted by ticks. Initial information on Lyme borreliosis appeared at the beginning of the 20th century. In Czechoslovakia attention to the disease was paid since cca 1960. The infection occurs as a rule in the summer months during the period when ticks are parasitic and at that time the causal agent of the disease is transmitted to hosts. Information on the prevalence and incidence of Lyme borreliosis in Europe is not complete and so far we do not possess a standardized diagnostic method for assessment of circulating antibodies in the patients' serum and cerebrospinal fluid. The infectious disease is caused by the gram-negative spirochete Borrelia burgdorferi. The Borrelia cell has a similar morphological structure as cells of other gram-negative bacteria. Chemical analysis of the external membrane of B. burgdorferi revealed the presence of 46% proteins, 51% lipids and 3% carbohydrates. The typical shape of borrelias indicates marked ondulation of 8-14 periplasmatic flagellae along the cell body. Borrelias can be cultivated in vitro in modified Barbour-Stoenner-Kelly medium at an optimal temperature of 30-37 degrees C. The change of morphology during cultivation is typical for B. burgdorferi. Clinically Lyme borreliosis is manifested in two stages. A typical manifestation of the early stage is a skin lesion--erythema migrans. The later stage is characterized above all by relapsing arthritis, CNS infection and chronic acrodermatitis chronica atrophicans. The disease is treated by administration of a number of antibiotics either by the oral route or by injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1993

[Diagnosis and therapy of Lyme arthritis].

Several distinct patterns of rheumatic manifestations can be seen throughout the course of Lyme borreliosis: intermittent and migratory musculoskeletal pain without objective findings, intermittent arthritis, chronic erosive arthritis, and joint deformities under affected skin in acrodermatitis chronica atrophicans. Commonly, Lyme arthritis is a late disease manifestation. A clinical history of extra-articular disease manifestations is the most reliable key to Lyme arthritis. However, arthritis often occurs without antecedent early-disease manifestations. The diagnostic significance of serological findings suggesting Lyme arthritis must be considered carefully with regard to the typical clinical features of Lyme arthritis and its potential differential diagnoses. Otherwise, Lyme arthritis will be frequently over-diagnosed. Lyme arthritis can be cured with antibiotics. However, treatment failures occur with any of the hitherto recommended regimens.

Anti-Bacterial Agents↗

PubMed1996

[Frequency of the clinical manifestations of Lyme borreliosis in Spain].

INTRODUCTION: There are differences in the clinical manifestations of Lyme borreliosis (LB) in different parts of the world. The aim of this work was to analyze its clinical manifestations in Spain. METHODS: We evaluated by ELISA and IFI the sera of 1,500 patients with clinical suspicion of LB between January 1987 to February 1993. Spanish criteria of LB (amplified CDC criteria of LB for epidemiological purpuse) were used. Clinical and serological data were evaluated with the patients' physicians and other etiologies were reasonably excluded in accepted cases of LB. RESULTS: Sixty-four patients of 138 with a positive serology (46%) met the LB criteria. Neurological manifestations were presented by 40 patients (62.5%) (in control group 23%, p < 0.05) cutaneous lesions by 20 patients (31%), articular manifestations by 18 patients (28%) (in control groups 56%; p < 0.05) and cardiac manifestations in two. Cutaneous manifestations included 17 erythema migrans, 2 acrodermatitis chronica atrophicans and 1 lymphocytoma). Artritis was present in 18 cases. Neurological manifestations included 16 cases of meningitis (2 with encephalitis), 11 of craneal neuropathy and 25 of peripheral neuropathy (13 of polyneuropathy). Cardiac manifestations acepted was 2 atrioventricular blockade. We detected 21% of false positive serology and in 33% of the positive cases, the LB criteria was not met. CONCLUSIONS: The low percentage of cutaneous manifestations is probably due to the fact that this series consist predominantly of hospital patients. In Spain, as in the rest Europe the predominant manifestations are neurological, however artritis are not infrequent manifestations.

Adolescent↗

PubMed1997

[Musculoskeletal symptoms often incorrectly attributed to Lyme disease].

OBJECTIVE: To establish, in patients referred with persisting noninflammatory musculoskeletal complaints. diagnosed elsewhere with Lyme disease, whether Lyme disease was present. SETTING: Outpatient Clinic for Rheumatology. Eemland Hospital Amersfoort and University Hospital Utrecht, the Netherlands. DESIGN: Descriptive, prospective. METHOD: Patients were classified as having had Lyme disease in the past, having ongoing Lyme disease of no Lyme disease at all, on the basis of clinical history, physical examination, and classification criteria for Lyme disease. RESULTS: In a two-year period 37 consecutive patients (mean age 50 years) were examined, 20 (54%) of whom had (a history of) Lyme disease. Of these 20, two suffered from erythema migrans, one of synovitis of the knee, and one of acrodermatitis chronica atrophicans (these four had not been treated). while one had persistent chronic oligoarthritis. Seventeen patients did not have Lyme disease, but were suffering from aspecific, noninflammatory musculoskeletal problems. CONCLUSION: In this patient group with persisting musculo-skeletal complaints, 'Lyme disease' had been diagnosed correctly as often as incorrectly.

Adolescent↗

PubMedDate not supplied

Neurological manifestations of Lyme borreliosis.

After the isolation of Borrelia burgdorferi, the previously unknown causative agent of Lyme disease, two neurological disorders, Bannwarth's syndrome and acrodermatitis chronica atrophicans-associated neuropathy, which have been known in Europe for decades, gained new interest. With the availability of serodiagnostic tests, a chronic debilitating disorder--progressive borrelia encephalomyelitis--was found to be caused by chronic infection with B. burgdorferi. Beside these typical manifestations, a growing number of publications about various neurological phenomena appeared, which were thought to be caused by B. burgdorferi. This assumption was based in many cases on the results of serodiagnostic tests only. Considerations for causal connections were frequently lacking. While prior to the availability of serodiagnostic tests neurological manifestations of Lyme borreliosis frequently remained undiagnosed, we now face a tendency for overdiagnosis. The great variety of neurological manifestations in Lyme borreliosis--most of them can also be attributed to other conditions--and the high rate of seropositivity for B. burgdorferi amongst the population living in endemic areas require strict criteria for the correct diagnosis of new and typical neurological manifestations.

Clinical Protocols↗

PubMed1953