asymptomatic – F.I.G.H.T for your health!

Follicular Borreliosis: An Atypical Presentation of Erythema Chronicum Migrans

Linda — Sat, 13 Mar 2010 19:18:30 +0000

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.

Severe ehrlichia infection in pediatric oncology

Linda — Wed, 24 Feb 2010 05:46:55 +0000

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20052776&retmode=ref&cmd=prlinks
PMID: 20052776

Excerpt:

Ehrlichiosis, a tickborne illness transmitted by tick vectors Amblyomma
americanum and Ixodes scapularis, can be acquired in endemic areas. Clinical
manifestations range from asymptomatic to fulminant in nature. We report three
cases of ehrlichiosis in pediatric oncology patients, one of whom was a stem
cell transplant recipient. Early symptoms included fever, malaise, and vague
gastrointestinal symptoms. Laboratory abnormalities were initially attributed to
chemotherapy toxicity. Illness was severe in all three patients and one patient
died even after initiation of doxycycline.

Lyme Carditis in Children Usually Transient but Can Be Life Threatening

Linda — Sun, 06 Dec 2009 04:34:34 +0000

Lyme Carditis in Children Usually Transient but Can Be Life Threatening

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.

In untreated Lyme disease, signs and symptoms of early dissemination may manifest within weeks to months of a tick bite, Dr. John M. Costello and co-investigators note. To characterize the clinical course of Lyme carditis in children, they reviewed cases of 207 children treated between 1994 and 2008 for early disseminated Lyme disease.

Records showed that 33 (16%) had carditis, along with a wide range of systemic involvement. According to the Boston-based research team, only one patient presented with isolated carditis and no erythema migrans or noncardiac systemic manifestations. Duration of hospitalization ranged from 1 to 13 days, and there were no deaths.

Fourteen patients had advanced heart block, including 9 with complete block, but recovery of sinus rhythm took no more than 7 days.

In addition, among the 33 patients with carditis, 4 had depressed ventricular systolic function and 3 of them required mechanical ventilation, temporary pacing, and inotropic support.

Analysis showed that significant independent predictors of Lyme carditis were age over 10 years (adjusted odds ratio 8.3), arthralgias (OR 5.8), and cardiopulmonary symptoms (OR 76.8). Sensitivity and specificity of cardiopulmonary symptoms for Lyme carditis were 42% and 99%, respectively.

Of 27 patients for whom follow-up data were available, complete recovery occurred in 24. One patient had ongoing second-degree atriventricular block at 2.7 years. The other 2 patients had improved but still had mildly prolonged PR intervals at short-term follow-up.

Thus, Dr. Costello’s group states, “A full recovery should be expected with supportive care and antibiotic therapy.” However, they point out that 6 patients had prolonged corrected QT intervals and advise physicians “to avoid drugs that prolong the QT interval in these patients until the electrocardiogram has normalized.”

Pediatrics 2009;123:e835-e841.

Chlamydia May Play Role In a Type of Arthritis

Linda — Mon, 23 Nov 2009 05:18:38 +0000

Spondylarthritis (SpA) represents a group of arthritidies that share clinical features such as inflammatory back pain and inflammation at sites where tendons attach to bone. It includes ankylosing spondylitis (AS), psoriatic arthritis, inflammatory bowel-disease-related arthritis, reactive arthritis (ReA) and undifferentiated spondylarthritides (uSpA). Since Chlamydia trachomatis or Chlamydia pneumoniae (which are often asymptomatic) frequently cause ReA, a new study examined whether there was a connection between these two infections and uSpA.

The study was published in the May issue of Arthritis & Rheumatism (http://www3.interscience.wiley.com/journal/76509746/home).

Led by John D. Carter of theUniversity of South Florida, the study involved blood and synovial tissue analysis from 26 patients who had chronic uSpA or Chlamydia-induced ReA. Synovial tissue samples from 167 osteoarthritis patients were used as controls. Samples were analyzed to assess chlamydial DNA and the 26 subjects were asked if they had any known exposure to Chlamydia trachomatis or Chlamydia pneumoniae and if so, the infection was documented in relation to the onset of their uSpA. They also underwent a physical exam that included evaluation of swollen and tender joints and other symptoms of SpA. The results showed that the rate of Chlamydiainfection was 62 percent in uSpA patients, significantly higher than the 12 percent seen in control subjects.

It is believed that as many as 150,000 cases of Chlamydia trachomatis-induced ReA may appear in the U.S. each year compared to about 125,000 new cases of rheumatoid arthritis. This is a low estimate since it does not include cases resulting from Chlamydia pneumoniae. “Thus, Chlamydia-induced ReA represents a considerable burden on the health care systems of the U.S. and other nations, and its impact on those systems may well be significantly under recognized,” the authors state.

Most women with genital Chlamydia trachomatis infection have no symptoms at the time of the initial infection; this was also true of the patients in the study who had DNA evidence of Chlamydia. For Chlamydia pneumoniae, as many as 70 percent of acute infections are asymptomatic and, even when there are symptoms, definitive identification of the organism is rare. The authors point out that relying on identification of a symptomatic infection may therefore result in routine underdiagnosis or misdiagnosis of Chlamydia-induced ReA.

They add that because ReA is a type of SpA and patients with ReA do not present with the classic combination of symptoms of arthritis, conjunctivitis/iritis and urethritis, it is reasonable to believe that Chlamydia trachomatis plays a role in causing uSpA, which may in fact be ReA. They conclude that although there is no diagnostic test for Chlamydia-induced ReA, testing for chlamydial DNA in the synovial tissue of patients thought to have ReA may be the most accurate way of diagnosing the condition.

Article: “Chlamydiae as Etiologic Agents in Chronic Undifferentiated Spondylarthritis,” John D. Carter, Hervé C. Gérard, Luis R. Espinoza, Louis R. Ricca, Joanne Valeriano, Jessica Snelgrove, Cynthia Oszust, Frank B. Vasey, Alan P. Hudson,Arthritis & Rheumatism, May 2009.