All Posts Tagged With: "rheumatology"

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

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:

To report on the differential diagnosis of lyme arthritis and synovial hemangioma due to similar clinical and radiological signs and symptoms. A 15-year-old boy presented at the age of 9 with recurrent rather painless swelling of the right knee. Altogether four episodes lasting for 1-2 weeks each occurred over a period of 18 months before medical advice was sought. Physical examination revealed only a slightly limited range of motion. Living in an endemic area of borreliosis, he reported a tick bite 6 months prior to onset of his symptoms with erythema migrans and was treated for 10 days with amoxicillin. Serology revealed two positive unspecific bands in IgG immunoblot (p41 and 66) with slight positivity for ELISA. Ultrasound revealed synovial thickening and increased fluid. Despite the weak positive serology a diagnosis of lyme arthritis could not be excluded and intravenous antibiotic treatment with ceftriaxone was started. After two further relapses antiinflammatory therapy including intraarticular steroids were introduced with no long lasting effect. A chronical disease developed with alternate periods of swelling and almost complete remission. Ultrasound as well as MRI demonstrated ongoing signs of synovitis, therefore after further progression, a diagnostic arthroscopy was performed showing an inconspicuous knee joint. A second MRI showed focal suprapatellar enhancement and was followed by open arthrotomy revealing a histopathological proven synovial cavernous juxtaarticular hemangioma. To our knowledge, the differential diagnosis of lyme arthritis and synovial hemangioma has not yet been reported despite obvious clinical similarities. In conclusion, in children and adolescents synovial hemangioma has to be considered in differential diagnosis of recurrent knee swelling. Early diagnosis is important to prevent prolonged suffering from chronic joint swelling with probable joint damages, unnecessary treatment procedures and as well school and sports absenteeism.

Excerpt:

We describe a 37-year-old woman who presented with bilateral pleural effusion combined with intermittent low grade fever. Lyme disease was confirmed by seroreactivities against Borrelia burgdorferi spirochetes. The unique clinical findings reveal a rare manifestation with a possible association between B. burgdorferi infection and pleural effusion.

Infectious agents have been implicated in the etiopathogenesis of various
vasculitides via numerous and overlapping mechanisms including direct microbial
invasion of endothelial cells, immune complex mediated vessel wall damage and
stimulation of autoreactive B and/or T cells through molecular mimicry and
superantigens. While the causative role of hepatitis B virus in polyarteritis
nodosa and hepatitis C virus in mixed cryoglobulinemia is clearly established,
evidence for the association of other infectious agents with vasculitis,
including human immunodeficiency virus, parvovirus B19, cytomegalovirus,
varicella zoster virus, Staphylococcus aureus, rickettsiaceae, Treponema
pallidum and Borrelia burgdorferi, among numerous others, is accumulating. The
spectrum of association of infectious agents; bacteria, viruses and parasites,
with systemic vasculitides, will be reviewed herewith. Continued

We report the case of a 62-yr-old man who presented with Lyme pericarditis leading to cardiac tamponade shortly followed by an arthritis. IgM and IgG antibodies to Borrelia burgdorferi were demonstrated in serum by indirect immunofluorescence. Borrelia burgdorferi was demonstrated and identified in pericardial fluid by indirect immunofluorescence using serum from a patient with proven Lyme disease and by a monoclonal antibody immuno-gold silver stain. Spirochetes were also found in synovial biopsies using a silver stain. The tamponade was treated with pericardiocentesis; the arthritis was treated with intravenous ceftriaxone (2 g once daily) for 14 days. The patient recovered completely within days of commencing treatment. This case report demonstrates that borrelial infection may lead to pericarditis and cardiac tamponade. Continued

To delineate the inflammatory potential of the 3 pathogenic species of Borrelia burgdorferi sensu lato, we stimulated monocyte-derived macrophages from healthy human donors with 10 isolates each of B. burgdorferi, Borrelia afzelii, or Borrelia garinii recovered from erythema migrans skin lesions of patients with Lyme borreliosis from the United States or Slovenia. B. burgdorferi isolates from the United States induced macrophages to secrete significantly higher levels of interleukin (IL)-8, CCL3, CCL4, IL-6, IL-10, and tumor necrosis factor than B. garinii or B. afzelii isolates. Consistent with this response in cultured macrophages, chemokine and cytokine levels in serum samples of patients from whom the isolates were obtained were significantly greater in B. burgdorferi-infected patients than in B. afzelii- or B. garinii-infected patients. These results demonstrate in vitro and in vivo that B. burgdorferi has greater inflammatory potential than B. afzelii and B. garinii, which may account in part for variations in the clinical manifestations of Lyme borreliosis. Continued