All Posts Tagged With: "Erythema migrans"

Linda’s Comment:   Bell’s palsy and Lyme neuroborreliosis are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Borrelia burgdorferi.\

Excerpt:

CONCLUSIONS: We found that the time of the year, associated neurological
symptoms and mononuclear pleocytosis were strong predictive factors for
Lyme neuroborreliosis as a cause of peripheral facial palsy in an area
endemic for Borrelia.

Linda’s comment…Evidence is emerging for differential pathogenicity among Borrelia burgdorferi genotypes in the United States. By using two linked genotyping systems, ribosomal RNA intergenic spacer type (RST) and outer surface protein C (OspC), we studied the inflammatory potential of B. burgdorferi genotypes in cells and patients with erythema migrans or Lyme arthritis.

Link: http://www.ncbi.nlm.nih.gov/pubmed/21641395

Excerpt:

Differences among genotypes were not as great in patients
with Lyme arthritis, but those infected with RST1 strains more often had
antibiotic-refractory arthritis. Thus, the B. burgdorferi RST1 (OspC type A)
genotype, followed by the RST3 (OspC type I) genotype, causes greater
inflammation and more severe disease, establishing a link between spirochetal
virulence and host inflammation

Linda’s comment:  Clinical, diagnostic and immunological characteristics of patients with possible neuroborreliosis without intrathecal Ig-synthesis against Borrelia antigen in the cerebrospinal fluid.

PCR did not reveal any Borrelia antigen in CSF. The diagnosis
and treatment of possible but not confirmed neuroborreliosis is a
clinical challenge. The clinical response to treatment may be the best
option in these cases.

Linda’s comment: The first Swiss patient with meningovasculitis due to neuroborreliosis, with recurrent multiple ischemic strokes in multiple vascular territories is evident in clinical manifestation of borreliosis. Strokes have also been found with patients with Bartonella.

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20434741&retmode=ref&cmd=prlinks

Excerpt:

The
treatment with ceftriaxone stopped the progression, but the
patient is still suffering from severe invalidating cognitive
disorders. We also comment on the pathophysiology and review the
literature of other clinical cases. Copyright (c) 2010 Elsevier
Masson SAS. All rights reserved.

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=21117376&retmode=ref&cmd=prlinks

Excerpt:

Lyme disease is rare in the U.K. but there is evidence of an increase in
both prevalence of, and patient concern about, the infection. There are no
published data characterising Lyme disease as it is seen in the U.K. The
clinical and laboratory features of 65 patients diagnosed with the disease
between 2002 and
2007 were recorded and their clinical presentation and response to treatment
documented. In total, 34% of patients acquired the infection in the UK, 20%
in North America and 46% in Europe. Exposure to ticks was reported by 58% of
patients. Erythema migrans was seen in 91%, systemic upset in 62%, headaches
in 31%, arthralgia or arthritis in 28%, radiculitis in 11% and cranial nerve
palsies in 4.6%. Screening enzyme immunoassay tests were negative in 39% and
reference laboratory immunoblots were negative in 31% of patients,
principally those with early infection. The majority of patients were cured
with one course of antibiotic treatment, three patients had evidence of
persistent infection after treatment and two required intravenous therapy.
No cases of chronic Lyme disease were seen.

Link: http://www.biomedcentral.com/content/pdf/1471-2334-10-352.pdf

Excerpt:

Background

Skin erythemas of unknown origin are a frequent reason for consulting the general practitioner or dermatologist.

Case presentation

Here we report a case of an erythema resembling the erythema migrans manifestation of Lyme disease, but with atypical symptoms like persistent pruritus. The patient had no history of a recent tick-bite but displayed a positive serology for an advanced stage of Lyme borreliosis, which stood in contrast to the clinical manifestation of erythema migrans as a symptom of early Lyme disease. Three skin swabs and soil samples, collected in the area where the patient possibly acquired the infection, were examined by bacterial and fungal culture methods. Microorganisms were identified by using 16S rRNA gene sequencing and bioinformatics. The patient and soil isolates were compared by employing RAPD analysis. The serum samples of the patient were examined by immunoblotting. Arthrobacter mysorens, a soil bacterium, was isolated from the collected skin and soil samples. The identity of both isolates was determined by molecular fingerprinting methods. A.mysorens was proven to be causative for the erythema by direct isolation from the affected skin and a positive serology, thus explaining the atypical appearance of the erythema compared to erythema migrans caused by Borrelia infection.

Conclusions

Infections with A.mysorens might be underreported and microbiological diagnostic techniques should be applied in cases of patients with unclear erythemas, resembling erythema migrans, without a history of tick bites.

Link: http://www.liebertonline.com/doi/abs/10.1089/vbz.2010.0018

Excerpt:

Purpose: Limited data exist on differences of erythema migrans patients with either positive or negative Borrelia burgdorferi sensu lato skin culture.

Methods: We analyzed 252 adult patients with erythema migrans in whom skin biopsy specimen was cultured for the presence of B. burgdorferi sensu lato. Evaluations of epidemiological, clinical, and microbiological findings were conducted at baseline, 14 days, 2, 6, and 12 months after treatment with either doxycycline or cefuroxime axetil.

Results: One hundred fifty-one (59.9%) patients had positive skin culture (86.9% B. afzelii, 8.0% B. garinii, 5.1% B. burgdorferi sensu stricto) and 101 (40.1%) had negative skin culture. Patients in the culture-positive and culture-negative groups were comparable for the basic demographic, epidemiological, clinical, and laboratory characteristics at presentation. Statistically significantly worse selected treatment outcome parameters in the culture-positive group compared with the culture-negative group were established during follow-up. Treatment failure was documented in two patients who were culture positive and in none in the culture-negative group.

Conclusions: Although findings for the pretreatment characteristics were comparable between the erythema migrans skin culture-positive and culture-negative patients, some parameters indicate that borrelia skin culture positivity may predict a less-favorable treatment outcome.

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=21173795&retmode=ref&cmd=prlinks

Excerpt:

Background A 71-year-old woman presented to a rheumatologist with what she
believed to be a 2-year history of Lyme disease, progressing from erythema
migrans to Lyme arthritis.Investigations History, physical examination and
serologic testing confirmed the diagnosis of Lyme disease.Diagnosis Lyme
disease.Management The patient refused antibiotic therapy during the first 2
years of her illness. During the next 2 years, she consulted a
rheumatologist, but declined antibiotic therapy. She continued to have
recurrent episodes of arthritis, following which she was successfully
treated with doxycycline, given initially for 2 weeks, with a second, 4-week
cycle administered 2 months later.
This case illustrates the natural history of untreated Lyme disease, which
is rarely observed in most patients since diagnosis almost always leads to
successful antibiotic treatment. Furthermore, this case also demonstrates
that infection with Borrelia burgdorferi can persist for years in untreated
patients; however, antibiotic therapy is still likely to be effective,
despite long-term infection.

Excerpt:

Background Lyme borreliosis (LB) is the most common tickborne infection in Sweden and the seroprevalence of Borrelia immunoglobulin G (IgG) antibodies varies between 2% and 26%. The seroprevalence in young Swedish children is unknown and the relation to clinical data has not been previously studied. Objective To determine the seroprevalence of Borrelia IgG antibodies in serum of young Swedish children and to relate it to gender, geographical location, reported tick bites, symptoms and previous treatment for LB. Methods 2000 healthy 5-year-old children (n=2000) were randomly selected from among participants of a larger prospective population-based study, the ABIS (All Babies in Southeast Sweden) study. Serum samples were collected and a Borrelia specific ELISA test (Dako) were performed for IgG antibody detection. Clinical data were collected from questionnaires completed by the parents. Results The seroprevalence of Borrelia IgG antibodies was 3.2% (64/2000). Previous tick bite had been noted in 66% of these seropositive children but the majority (94%) had not previously been treated for LB. In addition, another 55 children reported a history of LB but were negative to Borrelia IgG antibodies in serum. Many of these seronegative children had received treatment for erythema migrans (n=24), which is a clinical diagnosis. Whether children were correctly treated or overtreated for LB is however unknown. No differences in gender, geographical location or reported tick bites were found when comparing Borrelia-seropositive children (n=64) and seronegative children with previous LB (n=55). Conclusion This population-based study demonstrates a Borrelia IgG antibody seroprevalence of 3.2% in young Swedish children. Very few of these seropositive children report previous symptoms or treatment for LB. Thus the findings suggest that exposure to the Borrelia spirochaete (with subsequent antibody response in serum) does occur in young children, mostly without giving rise to clinical LB. Future studies on cell-mediated immune responses are needed to investigate explanatory immunological mechanisms.

Full article: http://www.smh.com.au/nsw/court-grants-lyme-disease-autopsy-20100719-10hyx.html

Excerpt:

A SYDNEY woman has been awarded a Supreme Court injunction to have her dead husband tested for a disease the Health Department says does not exist in Australia.

Mualla Akinci’s husband, Karl McManus, died last Wednesday – three years after he was bitten by a tick she says carried Lyme disease, a bacterial infection which, if left untreated, can cause profound neurological damage.

Mr McManus, 43, from Turramurra, was bitten on the left side of his chest during filming for the television show Home and Away in bushland in Waratah Park, northern Sydney. Within six weeks he lost mobility in one of the fingers on his left hand. That quickly spread to paralysis in his left arm and across to his right arm.

Mr McManus was diagnosed with multifocal neuropathy after testing negative for Lyme disease, but Ms Akinci, a pharmacist, insisted he be tested again at clinics in the US and Germany. Both tests returned positive for Lyme disease.

She argues that Australian tests are inadequate because pathologists looks for antibodies in the blood, rather than for proteins in specific bacteria within tissue.

”Lyme doesn’t usually live in the blood. It lives in tissues unless someone’s system is flushed with it so it stands to reason that every test will come back negative,” Ms Akinci said.

The Health Department maintains that no case has been transmitted in Australia and the organisms that cause it – three species of the genus borrelia – are not carried here by wildlife, livestock or their parasites.

The NSW Health Minister, Carmel Tebbutt, said in May there was not enough evidence to support the existence of ticks carrying the borrelia organism.

”Until there is solid evidence to indicate that locally acquired Lyme disease is a significant public health matter in Australia, specific measures to educate the general public or clinicians are difficult to justify,” she said.