All Posts Tagged With: "arthralgia"

Excerpt:

A 71-year-old man was referred to our outpatient clinic because of arthralgia and swelling of his right hand. He also showed a subcutaneous nodule on his left knee. A second patient, a 57-year-old woman, was referred because of painful skin of her legs. Dermatologic examination revealed erythemateous livid discoloration on both feet and legs. There were reticular varices, corona flebectatia paraplantaris medialis and minimal pitting oedema. Serology tested positive in both patients for Borrelia and they both recalled tick bites. A third patient, a 73-year-old woman, was referred because of erythema and maculae located at her lower legs and positive Borrelia serology. Pathologic examination was typical for acrodermatitis chronica atrophicans, a late skin manifestation of Lyme borreliosis. In all patients, symptoms improved after treatment with doxycycline for four weeks. A lack of familiarity with this skin condition may lead to unnecessary vascular investigations and considerable delay in adequate treatment.

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20977545&retmode=ref&cmd=prlinks

Excerpt:

In this study, we enrolled within 1 year 122 patients with
suspected chronic LNB. One hundred and fourteen patients had
previously tested positive for BB.
All patients had previously received antibiotic treatment. Each
patient received a clinical examination and measurement of
BB-specific antibodies. The diagnosis of neuroborreliosis was
made according to the national guidelines of the German Society
of Neurology. Nine patients had acute borreliosis. One of the
nine met the criteria of acute LNB. Of the remaining 113
patients, 85 patients underwent a lumbar puncture. Ten
seronegative subjects without lumbar puncture were also
considered. In 61.8% of these 95 patients the quality of life, of
sleep, mood, and anxiety were assessed. 
Results:  Of 95 patients, 25.3% had symptoms without a somatic
cause or evidence of borreliosis, 38.9% had a well-defined
illness unrelated to BB infection, and 29.5% suffered from
symptoms without a detectable somatic cause, displaying
antibodies against BB. Six patients were grouped as post-LNB
syndrome. Most common symptoms in all categories were arthralgia,
myalgia, dysaesthesia, depressive mood and chronic fatigue. 
Conclusion: 
Patients with persistent symptoms with elevated serum antibodies
against BB but without signs of cerebrospinal fluid inflammation
require further diagnostic examinations to exclude ongoing
infection and to avoid co-infections and other treatable
conditions (e.g. autoimmune diseases). One patient with acute
LNB, who was treated with ceftriaxone for 3 weeks suffered from
LNB with new headaches and persistent symptoms 6 months later.
These data should encourage further studies with new experimental
parameters. (c) 2010 The Author(s) European Journal of Neurology
(c) 2010 EFNS.

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20699042&retmode=ref&cmd=prlinks

Excerpt:

A 71-year-old man was referred to our outpatient clinic because
of arthralgia and swelling of his right hand. He also showed a
subcutaneous nodule on his left knee. A second patient, a
57-year-old woman, was referred because of painful skin of her
legs. Dermatologic examination revealed erythemateous livid
discoloration on both feet and legs. There were reticular
varices, corona flebectatia paraplantaris medialis and minimal
pitting oedema. Serology tested positive in both patients for
Borrelia and they both recalled tick bites. A third patient, a
73-year-old woman, was referred because of erythema and maculae
located at her lower legs and positive Borrelia serology.
Pathologic examination was typical for acrodermatitis chronica
atrophicans, a late skin manifestation of Lyme borreliosis. In
all patients, symptoms improved after treatment with doxycycline
for four weeks. A lack of familiarity with this skin condition
may lead to unnecessary vascular investigations and considerable
delay in adequate treatment.

Full article: https://www.thieme-connect.com/ejournals/abstract/neuropediatrics/doi/10.1055/s-2006-974121

Excerpt:

Neuroborreliosis often presents with cranial nerve palsy, aseptic meningitis or meningoencephalitis. Cerebral arteriopathy has rarely been reported as single cases. Here we present a retrospective analysis from 1997 to 2005 in the Berlin area. In this period neuroborreliosis was confirmed in 47 children through the finding of specific antibodies against Borrelia burgdorferi in CSF.

22 (47%) suffered from facial palsy as a presenting symptome, in one of them the palsy was bilateral. Four children (9%) had palsies of other cranial nerves, and four patients (9%) presented with paresis of an arm, hemiparesis, or spastic paraparesis. 16 children (34%) reported headache on admission, 15 (32%) presented with myalgia and/or arthralgia. Two patients (4%) had paraesthesia, another two (4%) were atactic. Ten (21%) had unspecific symptoms such as fever, fatigue, loss of appetite, or nausea. Other symptoms included general slowdown, sensoric or motoric aphasia, agitation, confusion, incomplete Horner’s syndrome, and mucosa haemorrhage, each in one patient.

In 19 patients (40%) cerebral imaging was performed. 13 (68%) were found to be normal, or rather revealed typical lesions in a patient with an underlying neurofribromatosis type 1. In one child with hemiparesis, and in one with multiple cranial nerve palsies, arterial subtraction angiography (DAS) confirmed multifocal vasculitis and dissection of the left Aa. vertebralis and basilaris, respectively. In one girl with hemiplegia, MRI revealed an infarction of the according internal capsule. Although angiography was not done this finding is suspicious of focal arteriopathy. The girl also had a homozygous mutation of factor V Leiden.

Full article: http://adv.medicaljournals.se/article/pdf/10.2340/00015555-0756

Excerpt:

An 11-year-old boy presented in February 2008 with a facial
erythematosus was repeatedly suspected and the boy was
referred for further examinations. A detailed medical history
did not reveal any arthralgia, fever, malaise, exanthema,
intense exposure to ultraviolet (UV) light in the period one
to three weeks before onset of the rash.

Excerpt:

A 56-year-old woman was referred to our department for an
eruption on the front side of the left thigh present for 6 months,
accompanied more recently by arthralgia and localized subjective
neurological symptoms.
The eruption started a few days after an insect bite by a red papule which secondarily enlarged.
The erythema was of variable intensity. Clinical examination revealed
peripilar red papules of the thigh from the groin to the knee( fig. 1 ).
The patient had no remarkable contralateral keratosis pilaris.

Full article: http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=000209229

Full article: http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=000209229

Excerpt:

Lyme serology was positive for both IgG and IgM (ELISA, Enzygnost
Borreliosis , Siemens, Dade Behring, Germany, and blot,
Euroline WB , Euroimmun, Germany). A punch biopsy of a papule showed a dermal perifollicular ( fig. 2 ) – and occasionnally perineural – infiltrate of lymphocytes and plasma cells, consistent with a borrelial infection. Borrelia burgdorferi DNA was amplified from fresh tissue obtained from a skin biopsy performed on a peripilar papule, using a specific real-time PCR according to Mäkinen et al. [1] (culture not performed). The erythema resolved after a 3-week doxycycline treatment whereas arthralgia and dysesthesia persisted.

Linda’s comments:  Lyme Carditis in children is not getting the attention it should be getting.  Makes me wonder how many of the athletes who drop dead in their sport isn’t suffering from Lyme Carditis and have been grossly mis-diagnosed??

NEW YORK (Reuters Health) May 01 – Manifestations of Lyme carditis in children can range from asymptomatic first-degree heart block to fulminant myocarditis, physicians at Harvard Medical School report in the May issue of Pediatrics. Data from their case series indicate that older age, arthralgia, and cardiopulmonary symptoms were independent predictors of carditis in pediatric patients with early disseminated Lyme disease. Continued

Full article: http://www.lymeneteurope.org/forum/viewtopic.php?f=7&t=1336#p9502

Excerpt:

Abstract
Using PCR in conjunction with pre-enrichment culture, we detected Bartonella henselae and B. vinsonii subspecies berkhoffii in the blood of 14 immunocompetent persons who had frequent animal contact and arthropod exposure.

Attempts to isolate Bartonella sp. from immunocompetent persons with serologic, pathologic, or molecular evidence of infection are often unsuccessful; several investigators have indicated that Bartonella isolation methods need to be improved (1–4). By combining PCR and pre-enrichment culture, we detected B. henselae and B. vinsonii subspecies berkhoffii infection in the blood of immunocompetent persons who had arthropod and occupational animal exposure

The Study

From November 2004 through June 2005, blood and serum samples from 42 persons were tested, and 14 completed a questionnaire, approved by the North Carolina State University Institutional Review Board. Age, sex, animal contact, history of bites, environment, outdoor activity, arthropod contact, travel, and medical history were surveyed. Bacterial isolation, PCR amplification, and cloning were performed by using previously described methods (5–7). Each blood sample was tested by PCR after direct DNA extraction, pre-enrichment culture for at least 7 days, and subculture onto a blood agar plate (Figure). An uninoculated, pre-enrichment culture was processed simultaneously as a control. Methods used for DNA extraction and conventional and real-time PCR targeting of the Bartonella 16S-23S intergenic spacer (ITS) region and heme-binding protein (Pap31) gene have been described (7,8). Conventional PCR amplicons were cloned with the pGEM-T Easy Vector System (Promega, Madison, WI, USA); sequencing was performed by Davis Sequencing, Inc. (Davis, CA, USA). Sequences were aligned and compared with GenBank sequences with AlignX software (Vector NTI Suite 6.0 (InforMax, Inc., Bethesda, MD, USA) (7,8). B. vinsonii subsp. berkhoffii, B. henselae, and B. quintana antibodies were determined by using a modification of a previously described immunofluorescence antibody assay (IFA) procedure (9

Study participants included 12 women and 2 men, ranging in age from 30 to 53 years; all of them reported occupational animal contact for >10 years (Table). Most had daily contact with cats (13 persons) and dogs (12 persons). All participants reported animal bites or scratches (primarily from cats) and arthropod exposure, including fleas, ticks, biting flies, mosquitoes, lice, mites, or chiggers. All participants reported intermittent or chronic clinical symptoms, including fatigue, arthralgia, myalgia, headache, memory loss, ataxia, and paresthesia (Table). Illness was most frequently mild to moderate in severity, with a waxing and waning course, and all but 2 persons could perform occupational activities. Of the 14 participants, 9 had been evaluated by a cardiologist, 8 each by an infectious disease physician or a neurologist, and 5 each by an internist or a rheumatologist. Eleven participants had received antimicrobial drugs.