Course Of Lyme Disease Research Articles

Damage to the nerve roots of the brachial plexus in the course of Lyme disease in a 15-year-old girl

Damage to the nerve roots of the brachial plexus in the course of Lyme disease in a 15-year-old girl

Clinical-epidemiologic and serologic characteristics of Lyme disease in the Zaporizhzhia region (a retrospective analysis for 2015–2019 according to the Municipal Institution “Regional Infectious Hospital” of Zaporizhzhia Regional Council)

The aim of the work is to clarify the clinical and laboratory features of Lyme disease in the Zaporizhzhia region on the basis of a retrospective clinical, epidemiological and serological analysis of this disease cases in the period from 2015 to 2019. Materials and methods. A retrospective analysis of 62 medical cards of stationary patients with Lyme disease for the period from 2015 to 2019 was carried out. The age of the patients ranged from 18 to 79 years. There were 38 men and 24 women. All the patients were given a traditional complex clinical-laboratory examination; ELISA was used to defined serum IgM and IgG to Borrelia burgdorferi. Results. According to the study results it was found that Lyme disease in the Zaporizhzhia region had a clear seasonal prevalence in summer (56.5 %) and spring (25.8 %). The vast majority of patients (80.6 %) clearly indicated the tick bite. The disease was mostly acute (90.3 %) with a predominance of erythema (94.6 %). In the acute course of the disease, patients were seropositive in 75.0 % of cases with simultaneous detection of both IgM and IgG to Borrelia burgdorferi, and positive IgM in the absence of IgG. Seronegative 25.0 % of patients required clear clinical and epidemiological data to confirm the diagnosis. Under prolonged and chronic conditions, patients had positive IgG to Borrelia burgdorferi (100 %) and IgM (50.0 %). Certain clinical and laboratory features at different course of Lyme disease were revealed. So, the acute course was characterized by the predominance of erythema (94.6 %), mild or no manifestations of general intoxication syndrome, lack of pathological changes in the hemogram in most patients (80.4 %). In the prolonged and chronic course, there was no history of erythema, clinical symptoms were polymorphic, half of the patients had increased erythrocyte sedimentation rate in the absence of changes in blood count, mild cytolytic syndrome and hyperbilirubinemia. Conclusions. As a result of the retrospective analysis of Lyme disease cases in the period from 2015 to 2019, certain patterns of epidemiological, clinical and serological changes in different courses of this infection in the Zaporizhzhia region were revealed, namely the clear seasonality of the disease, in the acute course – the predominance of erythema and different variants of serological profile in patients, and in prolonged and chronic course – polymorphism of all clinical symptoms and no history of erythema.

Management and clinical outcomes of Lyme disease in acute care facilities in 2 endemic regions of Quebec, Canada: a multicentre retrospective cohort study.

Background:Despite increases in cases of Lyme disease, little is known about the management and clinical course of the disease in Canada. We aimed to describe the management and clinical course of Lyme disease in patients treated in acute care facilities in Quebec and to assess adherence to the 2006 Infectious Diseases Society of America (IDSA) guideline.Methods:This retrospective multicentre cohort study included pediatric and adult patients with serologically confirmed Lyme disease treated in acute care facilities (12 community hospitals and 2 tertiary care centres) of 2 endemic regions of Quebec (Estrie and Montérégie), from 2004 to 2017. We considered drug choice, prescribed dose and treatment duration in assessing adherence of prescriptions to the 2006 IDSA guideline. The main outcome was complete resolution of symptoms at 3 months after the initiation of treatment.Results:We included 272 patients from 14 institutions (age range 3–87 yr). Early disseminated Lyme disease (140 patients [51%]) was predominant. Adherence to the IDSA guideline was observed in 235 (90%) of the 261 cases with complete information, and adherence was stable over time (2004–2013: 57/64 [89%]; 2014–2015: 64/71 [90%]; 2016–2017: 114/126 [90%]; p = 0.8). Non-adherence to the guideline (n = 26) was predominantly due to longer-than-recommended treatment duration (16/26 [62%]). Resolution of objective signs at 3 months after treatment initiation occurred in 265 (99%) of 267 patients, whereas post-treatment Lyme disease syndrome was observed in 27 patients (10%) with increasing incidence over time (2004–2013: 3/65 [5%]; 2014–2015: 4/73 [5%]; 2016–2017: 20/129 [16%]; p = 0.02).Interpretation:We observed clinical resolution of Lyme disease in 99% of the patients, and most treatments (90%) complied with the 2006 IDSA guideline. The incidence of post-treatment Lyme disease syndrome increased over the study period, warranting further prospective studies.

Multiple cardiac arrests due to Lyme carditis

The most common form of Lyme carditis (LC) are different types of conduction abnormalities, especially atrioventricular (A-V) blocks. In most cases the course of the disease is benign and when the patient is diagnosed and treated appropriately, even the most advanced forms of A-V block typically resolve within one week. Implantation of a permanent pacemaker is only exceptionally necessary. We present a case of a patient with multiple cardiac arrests due to advanced A-V block. Despite the proper diagnosis of LC and targeted antibiotic therapy, the patient was completely dependent on temporary endocavitary pacing for more than one week. Finally, implantation of a permanent pacemaker was decided, however, during the next three months, A-V conduction abnormalities gradually subsided. This made us doubt whether the decision about implantation wasn’t made prematurely. The solution came at a one-year follow-up visit when it turned out that ventricular stimulation reappeared. We believe, that if A-V conduction disturbances in the course of Lyme disease persist for more than a week despite targeted antibiotic therapy, it is most likely a sign of serious and irreversible damage to the structures of the A-V node.

PrzydatnoŚĆ Diagnostyczna Reakcji Pcr W Rozpoznawaniu Boreliozy

Abstract Lyme disease is a multisystem disease caused by bacteria belonging to the group Borrelia burgdorferi sensu lato. The vector that carries the infection is a tick of the genus Ixodes, that infects subsequent hosts of the spirochete during blood-meal. The varied course of Lyme disease makes it impossible to recognize it on the basis of clinical symptoms. Therefore, the diagnosis of Lyme disease is based mainly on laboratory methods, both direct (detection of the presence of DNA or infectious agent proteins in the biological material collected from the patient) and indirect (mainly serological tests). A commonly recommended approach is serodiagnosis, however, due to the time required for the body to produce specific antibodies, it is not useful in the earliest period of infection. Microbiological diagnostics also can not be used to diagnose Lyme disease in the first weeks of the disease due to its low sensitivity and long waiting time for the result. The solution seems to be molecular diagnostics based on the detection of the spirochete DNA using PCR reaction that is highly specific and sensitive. However, the effectiveness of this approach depends on many factors, therefore it is necessary to develop a standardized protocol ensuring reproducibility of results in all laboratories. 1. Introduction. 2. Genome of B. burgdorferi s.l. 3. Diagnosis of Lyme borreliosis. 4. Types of PCR reactions used in the diagnosis of Lyme disease. 5. Target genes used to DNA detection of B. burgdorferi s.l. 6. Identification of B. burgdorferi s.l. genotypes. 7. Clinical material. 8. The factors affecting the efficiency of PCR. 9. Recommendations for the use of PCR diagnostics. 10. Summary

Czy alergia może mieć wpływ na przebieg boreliozy? Opis przypadku

Czy alergia może mieć wpływ na przebieg boreliozy? Opis przypadku

A Very Rare Case of ‘Lyme-Induced Pancreatitis’

Introduction: Lyme disease is the most common vector borne infection in the united state, There have been multiple cases of borreliosis reported across the world especially in North America and Europe in which the course of disease was characterized by long standing high fever, enlargement of liver and spleen, pancreatitis, pneumonia and anemia. Many GI manifestation of borreliosis have been reported in literature but involvement of the pancreas has so far not been reported. We describe a case of pancreatitis in a patient with serology-proven lyme disease (Borreliosis). Case Description: This is the case of 20 year old Caucasian female presented to ED with complaint of abdominal pain and generalized body aches. In late June she went camping in upstate, New York. She stayed there for the entire month, she had a tick bite during camping and tick was removed immediately; no symptoms reported at that time. Week later, she developed abdominal pain, nausea, vomiting and fever and was admitted in the hospital New York and was found to have pancreatitis. Lipase was elevated at 1250. Discussion: History of tick bite, rash with central clearing with bull's eye appearance is Erythema Migrans, the characteristic rash of early course of lyme disease. Abdominal pain, nausea, vomiting, with elevated lipase is characteristic symptoms of pancreatitis. Diagnosis of acute pancreatitis is established on clinical symptoms and laboratory testing. According to American College of Gastroenterology guidelines, the presence of two of the following three characteristics is sufficient for the diagnosis acute pancreatitis: Abdominal pain, serum lipase higher than three times the upper limit, and radiographic evidence of acute pancreatitis. The patient had 2 of these three characteristics. There has been no case reported associated with Lyme pancreatitis till today, the reason of reporting this case is to highlight the difficulty in diagnosing borreliosis. As borreliosis is multisystem disease and there have been reported cases where diagnosis was difficult to reach we suggest exploring other manifestation of this disease.

Impact of Co-Infections in Lyme Disease

Lyme disease is one of the most frequent tick-borne diseases worldwide, it can be multi-systemic and insidious, in particular when it shows a chronic course.In recent years co-infections represent an emerging issue in Lyme disease spectrum because in addition toBorrelia burgdorferi slmany other potential pathogens may be transmitted by hard ticks Ixodes species. The main co-infections found in Lyme disease described in this review are represented byAnaplasma phagocytophilum, Babesia species, Bartonella species, Rickettsiae species and tick-borne encephalitis virus. For each single co-infecting micro-organism, clinical features, diagnostic issues and therapeutical approaches are discussed.Co-infections represent an emerging problem because they might exacerbate Lyme disease clinical features, they can also mimic Lyme borreliosis sharing common manifestations, and eventually they can change the course of the disease itself.The presence of one or more co-infecting agent during the course of Lyme disease may represent an issue especially in endemic areas for tick-borne diseases and in people occupationally exposed.The aim of this review is to summarize the more important co-infections in patients with Lyme disease and to discuss their importance in the disease process.

Epitope-Specific Evolution of Human B Cell Responses to Borrelia burgdorferi VlsE Protein from Early to Late Stages of Lyme Disease.

Most immunogenic proteins of Borrelia burgdorferi, the causative agent of Lyme disease, are known or expected to contain multiple B cell epitopes. However, the kinetics of the development of human B cell responses toward the various epitopes of individual proteins during the course of Lyme disease has not been examined. Using the highly immunogenic VlsE as a model Ag, we investigated the evolution of humoral immune responses toward its immunodominant sequences in 90 patients with a range of early to late manifestations of Lyme disease. The results demonstrate the existence of asynchronous, independently developing, Ab responses against the two major immunogenic regions of the VlsE molecule in the human host. Despite their strong immunogenicity, the target epitopes were inaccessible to Abs on intact spirochetes, suggesting a lack of direct immunoprotective effect. These observations document the association of immune reactivity toward specific VlsE sequences with different phases of Lyme disease, demonstrating the potential use of detailed epitope mapping of Ags for staging of the infection, and offer insights regarding the pathogen's possible immune evasion mechanisms.

TGF-β1 of no avail as prognostic marker in lyme disease.

Background. Within the present in vivo study using the wild type mouse strains C3H/HeN and FVB/N it was intended to (1) measure TGF-β1 expression in the course of lyme disease, (2) examine the potential correlation of TGF-β1 expression with the clinical outcome of a Borrelia infection (with a focus on lyme arthritis), (3) develop a diagnostic tool based on the endogenous factor TGF-β1 to predict the progressivity of lyme disease.Findings. In the course of lyme disease there was an increase in the serum content of active TGF-β1, which became significant 56 days post infection (p < 0.001). The serum concentration of total TGF-β1 in the course of infection initially decreased then rebounded and subsequently dropped again. Despite considerable individual variations in active TGF-β1 serum concentrations there were no identifiable dissimilarities in the clinical appearance of the mice. Likewise, no correlation could be seen between the serum content of active TGF-β1 and the severity of lyme arthritis of tibiotarsal joints of infected mice.Conclusions. The present study clearly shows that TGF-β1 is of no avail as prognostic marker in lyme disease. Hence, the search for an endogenous predictive factor, which can be determined in an easy and reliable manner, remains open.

Clinical and epidemiological characteristics of tick-borne borreliosis in the Krasnodar Krai

The purpose of the study the improvement of early diagnostics of Lyme disease on the based of clinical and epidemiological analysis of the main clinical forms of the acute course of the disease in new natural foci in the Krasnodar Krai. Patients and methods. There was analyzed the clinical course of disease and epidemiological data for 207 patients in the early period of acute course of Lyme disease within the period from 2004 to 2013. Results. In the territory of the Krasnodar Krai and the Republic of Adygea there has formed a set of foci of tick-borne borreliosis (TB), i.e. Lyme disease (LD). The infection of cases is observed not only in the natural foci of disease, but also within the city limits. The disease is registered mainly in the erythematous form (74% of patients), non-erythematous form accounts for 26%. The average age of patients was 41,1±1,83, years, males 38%, females 62%. In the non-erythematous form initial clinical symptoms are recorded in average in 11,6 ± 2,20 days after tick suction; in the erythematous form in 6,4 ± 0,70 days ( p

Lyme Carditis Presenting With Complete Heart Block in a Patient Who Received a Heart Transplant

In immunocompetent patients, Lyme carditis is a well-established complication of untreated primary Lyme disease. Whether the presentation and course of Lyme disease differs in immunosuppressed patients has not been well established. There are rare case reports of Lyme disease presenting after solid organ transplantation. We describe a case of Lyme carditis in a patient who received a heart transplant presenting as complete heart block progressing to symptomatic heart failure. The patient required permanent dual-chamber pacemaker placement for cardiac synchronization; however, after treatment with intravenous ceftriaxone, she regained an intrinsic sinus rhythm. Practitioners should maintain a high index of suspicion for Lyme disease when assessing immunosuppressed patients with new-onset heart block. The classic manifestations of primary Lyme disease may be absent as was the case in this patient.

Alpha fucosidase and beta galactosidase in serum of a Lyme disease patients as a possible marker of accelerated senescence — a preliminary study

Lyme disease (LD) is the most prevalent tick-borne disease in Europe. LD is caused by the spirochete Borrelia burgdorferi. LD is a chronic disease which can attack a number of organs: skin, heart, brain, joints. Chronic, low-grade inflammation involves general production of pro-inflammatory cytokines and inflammatory markers and is a typical feature of aging. So far, the best method of diagnosing LD is a time-consuming and expensive two-stage serological method. The aim of our study was to evaluate the activity of two lysosomal exoglycosidases: α-fucosidase (FUC) and β-galactosidase (GAL) in the serum of patients with Lyme disease, as potential markers of LD. Due to the increasing number of patients with Lyme disease and a number of false results, new ways to diagnose this disease are still being sought. As elevated level of β-galactosidase is a manifestation of residual lysosomal activity in senescent cells, the increase in its activity in serum during chronic Lyme disease might be a marker of a potentially accelerated senescence process. The study was performed on serum taken from cubital veins of 15 patients with Lyme disease and eight healthy subjects (control group). FUC and GAL activity was measured by the method of Chatterjee et al. as modified by Zwierz et al. In the serum of patients with Lyme disease, GAL activity significantly increased (p = 0.029), and the activity of FUC had a tendency to increase (p = 0.153), compared to the control group. A significant increase in GAL activity in the serum of patients with Lyme disease indicates an increased catabolism of glycoconjugates (glycoproteins, glycolipids, proteoglycans) and could be helpful in the diagnosis of Lyme disease, although this requires confirmation in a larger group of patients. As GAL is the most widely used assay for detection of senescent cells, an elevated level of β-galactosidase might be a manifestation of accelerated senescence process in the course of Lyme disease.

Maladie de Lyme avec hépatite et corticothérapie : à propos d’une observation

IntroductionAbnormalities of liver function tests have been occasionally described in large series of Lyme disease, but only one case of hepatitis directly related to infection have been described in literature. Case reportA 78-year-old-man, with a past medical history of polymyalgia rheumatica (PMR) who had discontinued corticosteroids two years before, presented a transient acute fever and liver cholestasis and cytolysis after an exposure to tick bites. A few days later, cervical pain occurred and corticosteroids were resumed as a PMR relapse was suspected. Hematogenous dissemination with acute meningoradiculitis and multiple erythema migrans led to conclude to a stage 2 Lyme disease. ConclusionAlthough hepatitis complicating the course of Lyme disease has been described in literature, the marked inflammation in our patient led us to investigate the possibility of a co-infection. Also, we discuss the responsibility of corticosteroids in clinical worsening of Lyme disease if they are prescribed without concomitant antibiotics.

Epitope mapping of antibodies to VlsE protein of Borrelia burgdorferi in post-Lyme disease syndrome

The VlsE lipoprotein of Borrelia burgdorferi elicits a strong immune response during the course of Lyme disease. The present study was aimed at characterization of the epitopes of VlsE targeted by the antibody response in patients with post-Lyme disease syndrome, a condition characterized by persisting symptoms of pain, fatigue, and/or neurocognitive impairment despite antibiotic treatment of B. burgdorferi infection. Epitope mapping was carried out using microarrays that contained synthesized overlapping peptides covering the full sequence of VlsE from B. burgdorferi B31. In addition to the previously characterized IR6 region in the variable domain, specific sequences in the N- and C-terminal invariable domains of VlsE were found to be major B cell epitopes in affected patients. The crystal structure of VlsE indicated that the newly described epitopes form a contiguous region in the surface-exposed membrane-proximal part of the monomeric form of the protein.

Paralysie du nerf récurrent au cours d’une maladie de Lyme : à propos de deux observations

Introduction Neuroborreliosis can be a difficult diagnosis which requires epidemiologic, clinical and biologic arguments. Case reports We report two patients who presented with a recurrent laryngeal nerve palsy with positive Lyme serology and favorable outcome after antibiotic therapy. In one case, a lymphocytic meningitis with intrathecal production of specific antibodies was evidenced. Conclusion Recurrent laryngeal nerve palsy is an uncommon manifestation of neuroborreliosis. Lyme serology is an important tool when neurologic disorder occurs because of an atypical course of Lyme disease.

TLR2 Expression in Relation to IL‐6 and IL‐1β and theirNatural Regulators Production by PMN and PBMC in Patients withLyme Disease

Recently, it has been reported that TLR2 on macrophages plays a unique role in the inflammatory response and host defense to infection with Borrelia burgdorferi (Bb) which is an etiologic agent of Lyme disease. Experimental studies show that PMNs also play an essential role in infection control by Bb. However, there is no available data about TLR2 expression on PMN in the course of Lyme disease. In the present study, TLR2 expression and production of IL-1β and IL-6 as well as their natural regulators (sIL-1RII, IL-1Ra and sIL-6Rα, sgp130, resp) by PMN of peripheral blood in patients with Lyme disease were examined. For the purpose of comparison, the same activity of autologous peripheral blood mononuclear cells (PBMCs) was estimated. An effect of rhIL-15 on TLR2 and cytokine secretion was also studied. Increased TLR2 expression in unstimulated neutrophils suggests an important role of these cells in mechanism recognition of B burgdorferi in patients with Lyme disease. The relationship between IL-1β and IL-6 as well as their regulators by unstimulated PMN and PBMC, observed in the present study, may lead to enhanced IL-6- and to inhibition of IL-1β-mediated reactions in this patient group. Changes in the TLR2 expression after rhIL-15 stimulation appear to have a favorable effect on mechanism recognition of Bb. The relations between IL-6 and its regulators (sIL-6Rα and sgp130) as well as between IL-1β and its regulators (IL-1Ra and sIL-1RII) after rhIL-15 stimulation may lead to enhanced IL-1β- and IL-6-mediated inflammatory reactions in the course of Lyme disease.

Lyme disease.

Lyme disease is the most common tick-borne disease in the United States, and the number of reported cases has increased steadily since 1992. Coinfection of ticks with Borrelia burgdorferi and Ehrlichia phagocytophila did not appear to affect the transmission of the other agent. Serologic evidence of exposure to Babesia microti did not significantly impact the clinical course of Lyme disease. Two clinical studies indicated that the long-term outcome of Lyme disease is good. Results are pending of chronic Lyme disease studies funded by the US National Institutes of Health. A better understanding of the pathogenesis of Lyme disease provided clues about possible mechanisms for persistent symptoms. Use of the current method of diagnosis by the two-step approach has proven to be reliable, but new methods are under investigation. Treatment guidelines were published recently. OspA vaccination of children aged 2 to 5 years was shown to be safe and immunogenic.

Role of serology in the diagnosis of Lyme disease.

Numerous concerns regarding the potential for misdiagnosis of Lyme disease using commercial assays have been voiced by the US Food and Drug Administration (FDA). We attempted to clarify the clinical value of serologic testing for Lyme disease using the results of commonly marketed assays for detecting antibody to Borrelia burgdorferi, the organism that causes Lyme disease. We reviewed published studies on B burgdorferi test performance published through 1998, package insert labeling from FDA-cleared test kits for B burgdorferi, and Lyme Disease Survey Set LY-A from the College of American Pathologists. We assessed the sensitivity and specificity of commercial serologic tests (enzyme-linked immunosorbent assay [ELISA], immunofluorescence antibody [IFA], and immunodot) for diagnosis of Lyme disease. To reduce this risk of misdiagnosis, it is important that clinicians understand the performance characteristics and limitations of these tests. These tests, in common use in clinical or commercial laboratories, should be used only to support a clinical diagnosis of Lyme disease, not as the primary basis for making diagnostic or treatment decisions. Serologic testing is not useful early in the course of Lyme disease because of the low sensitivity of tests in early disease. Serologic testing may be more useful in later disease, at which time sensitivity and specificity of the test are improved. Positive or equivocal results on an ELISA, IFA, or immunodot assay requires supplemental testing with a Western blot assay. A negative result on the Western blot or ELISA indicates that there is no serologic evidence of infection by B burgdorferi at the time the sample was drawn.

Lyme disease.

Lyme disease (LD) is the most common tick-borne disease in the United States. The overall trend has been an average annual increase in reported cases since surveillance was initiated by the Centers for Disease Control and Prevention in 1982. Ixodes ticks often carry more than one potential pathogen, and co-infection with Borrelia burgdorferi and other organisms has been reported. The impact of dual infection upon the clinical course of LD is not known. Further studies of erythema migrans-like rashes in the Southern United States have indicated that it is likely caused by a related spirochetal organism. Case reports of unusual presentations have broadened our understanding of the clinical spectrum of LD. Studies in patients with chronic Lyme arthritis have indicated that an autoimmune process may be responsible for such cases. Results of two large, placebo-controlled trials of a recombinant Lyme vaccine have been reported and results indicate that the vaccine is safe and effective in preventing LD in adults.