A Sample of Babesia and Lyme Abstracts

Complications of Confections with Babesia and Lyme Disease After Appendectomy

Ya'aqov Abrams, MD

The patient is a 58-year-old man who had a trauma-related splenectomy 25 years ago. In August 2002 he presented to the office with several days of fluctuating fevers of 102° F or higher, rash, malaise, chills, and sweats. He spent a week at Cape Cod before a trip abroad to Brazil, from which he had just returned. His symptoms developed after the first week in Rio de Janeiro, Brazil. He recalled having no mosquito or other insect bites while in Brazil or Cape Cod.

His temperature was 100.5° F and he had an eyrthema multiforme-like macular rash on his back and abdomen. An infectious disease specialist was consulted. Laboratory studies were notable for bandemia of 11%, mildly elevated liver injury tests, normal bilirubin, negative babesiosis, ehrlichia, Rocky Mountain Spotted Fever and typhus immunoglobulin IgG and IgM antibody titers, negative hepatitis A and hepatitis B titers, and a negative thick smear for intra-erythrocytic parasites.

He was prescribed doxycycline but did not improve. Twelve days after presentation he noted myalgias with associated difficulty walking and was seen in the emergency department. Intra-erythrocytic parasites were noted on a thick blood smear; malaria was diagnosed and the patient was prescribed oral chloroquine.

One day later the diagnosis was changed to babesiosis and treatment was changed to oral clindamycin and quinine. Several days later the patient was hospitalized with dark-colored urine and Babesia parasitemia of 4%.

He initially received intravenous quinine and clindamycin, but he did not respond and treatment was changed to atovaquone, azithromycin, and a 2-week course of doxycycline.

He developed adult respiratory distress syndrome, presumably from a Babesia parasitemia now up to 16%; this necessitated an exchange transfusion. The myalgias and weakness worsened and primary demyelinating polyneuropathy was diagnosed on electromyography.

A magnetic resonance image of the brain was normal but serum I’m and Western Blotting were positive for Lyme disease. Despite a 1-month course of ceftriaxone, neuropathic symptoms did not improve until he received a 5-day course of intravenous immune globulin (IVIG).

Five years later, the patient still has mild residual lower extremity sensory neuropathy but is otherwise well. He did not recall previously receiving vaccinations for encapsulated bacteria and was given meningitis, Haemophilus, and pneumococcal vaccines.

Babesiosis is a malaria-like parasitic disease caused by Babesia, a genus of protozoal piroplasms.[1] After trypanosomes, Babesia are thought to be the second most common blood parasites of mammals and they can have a major impact on health of domestic animals in areas without severe winters. Human babesiosis is uncommon, but reported cases have risen recently because of expanded medical awareness.[2]

The disease is named for the genus of the causative organism,[3] which was in turn named after the bacteriologist Victor Babeş.[4] Equine babesiosis is also known as piroplasmosis.

Epidemiology

Asbestosis is a vector-borne illness usually transmitted by Iodide ticks. Babesia microti uses the same tick vector, Ixodes scapularis, as Lyme disease and ehrlichiosis, and may occur in conjunction with these other diseases. In endemic areas, the organism can also be transmitted by blood transfusion.

In North America, the disease is prominently found in eastern Long-Island, its barrier island, Fire Island, and islands of Nantucket and Martha's Vineyard off of the coast of Massachusetts. More generally it can be found the northern midwestern and New England states.[5][6][7][8] It is sometimes called "The Malaria of The Northeast." Cases of babesiosis have been reported in a wide range of European countries. Disease in Europe is usually due to infection with Babesia divergens, while in the United States Babesia microti and Babesia duncani are the species most commonly associated with human disease. Babesiosis has also been observed in Korea.[9]

Most cases of babesia infection are asymptomatic or include mild fevers and anemia and go unnoticed. In more severe cases, there are symptoms similar to malaria, with fevers up to 105°F / 40°C, shaking chills, and severe anemia (hemolytic anemia). Organ failure may follow including adult respiratory distress syndrome. Severe cases occur mostly in people who have had their spleen removed surgically. Severe cases are also more likely to occur in the very young, very old, and persons with immunodeficiency, such as HIV/AIDS patients. Some people with babesiosis have additional tick-borne illnesses, such as Lyme disease.[2].

A reported increase in babesiosis diagnoses in the 2000s is thought to be caused by more widespread testing and higher numbers of people with immunodeficiencies coming in contact with ticks, the disease vector.[2] Little is known about the occurrence of Babesia species in malaria-endemic areas, where Babesia can easily be misdiagnosed as Plasmodium.

1. Minerva Med. 2010 Feb;101(1):1-7.

Safety of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.

Stricker RB, Green CL, Savely VR, Chamallas SN, Johnson L.

Union Square Medical Associates, San Francisco, CA, USA - rstricker@usmamed.com.

AIM: Although intravenous antibiotic therapy is recommended for neurologic Lyme disease, safety concerns have been raised about treatment beyond 30 days in patients with persistent neurologic symptoms. The goal of our study was to evaluate the safety of extended intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease. METHODS: We enrolled 200 consecutive patients with significant neurologic symptoms and positive testing for Borrelia burgdorferi. Patients were treated with intravenous antibiotics using various intravascular devices (IVDs). Standard IVD care was administered to all patients, and monitoring for medication reactions and IVD complications was performed on a weekly basis. RESULTS: The mean length of intravenous antibiotic treatment was 118 days (range, 7-750 days) representing 23,654 IVD-days. Seven patients (3.5%) experienced allergic reactions to the antibiotic medication, and two patients (1.0%) had gallbladder toxicity. IVD complications occurred in 15 patients (7.5%) representing an incidence of 0.63 per 1,000 IVD-days. The IVD problems occurred an average of 81 days after initiation of treatment (range, 7-240 days). There were six suspected line infections for an incidence of 0.25 per 1,000 IVD-days. Only one of the IVD infections was confirmed, and no resistant organisms were cultured from any patient. None of the IVD complications were fatal. CONCLUSION: Prolonged intravenous antibiotic therapy is associated with low morbidity and no IVD-related mortality in patients referred for treatment of neurologic Lyme disease. With proper IVD care, the risk of extended antibiotic therapy in these patients appears to be low.

PMID: 20228716 [PubMed - in process]

2. Brain Behav Immun. 2010 Mar 18. [Epub ahead of print]

Anti-neural antibody reactivity in patients with a history of Lyme borreliosis and persistent symptoms.

Chandra A, Wormser GP, Klempner MS, Trevino RP, Crow MK, Latov N, Alaedini A.

Department of Neurology and Neuroscience, Cornell University, New York, NY, USA.

Some Lyme disease patients report debilitating chronic symptoms of pain, fatigue, and cognitive deficits despite recommended courses of antibiotic treatment. The mechanisms responsible for these symptoms, collectively referred to as post-Lyme disease syndrome (PLS) or chronic Lyme disease, remain unclear. We investigated the presence of immune system abnormalities in PLS by assessing the levels of antibodies to neural proteins in patients and controls. Serum samples from PLS patients, post-Lyme disease healthy individuals, patients with systemic lupus erythematosus, and normal healthy individuals were analyzed for anti-neural antibodies by immunoblotting and immunohistochemistry. Anti-neural antibody reactivity was found to be significantly higher in the PLS group than in the post-Lyme healthy (p<0.01) and normal healthy (p<0.01) groups. The observed heightened antibody reactivity in PLS patients could not be attributed solely to the presence of cross-reactive anti-borrelia antibodies, as the borrelial seronegative patients also exhibited elevated anti-neural antibody levels. Immunohistochemical analysis of PLS serum antibody activity demonstrated binding to cells in the central and peripheral nervous systems. The results provide evidence for the existence of a differential immune system response in PLS, offering new clues about the etiopathogenesis of the disease that may prove useful in devising more effective treatment strategies. Copyright © 2010 Elsevier Inc. All rights reserved.

PMID: 20227484 [PubMed - as supplied by publisher]

3. BMC Infect Dis. 2010 Feb 5;10:20.

Mapping of hormones and cortisol responses in patients after Lyme neuroborreliosis.

Tjernberg I, Carlsson M, Ernerudh J, Eliasson I, Forsberg P.

Department of Clinical Chemistry, Kalmar County Hospital, SE-391 85 Kalmar, Sweden. ivart@ltkalmar.se

BACKGROUND: Persistent symptoms after treatment for neuroborreliosis are common for reasons mainly unknown. These symptoms are often unspecific and could be caused by dysfunctions in endocrine systems, an issue that has not been previously addressed systematically. We therefore mapped hormone levels in patients with previous confirmed Lyme neuroborreliosis of different outcomes and compared them with a healthy control group. METHODS: Twenty patients of a retrospective cohort of patients treated for definite Lyme neuroborreliosis were recruited 2.3 to 3.7 years (median 2.7) after diagnosis, together with 23 healthy controls. Lyme neuroborreliosis patients were stratified into two groups according to a symptom/sign score. All participants underwent anthropometric and physiological investigation as well as an extensive biochemical endocrine investigation including a short high-dose adrenocorticotropic hormone stimulation (Synacthen) test. In addition to hormonal status, we also examined electrolytes, 25-hydroxy-vitamin D and interleukin-6. RESULTS: Eight patients (40%) had pronounced symptoms 2-3 years after treatment. This group had a higher cortisol response to synacthen as compared with both controls and the Lyme neuroborreliosis patients without remaining symptoms (p < 0.001 for both comparisons). No other significant differences in the various baseline biochemical parameters, anthropometric or physiological data could be detected across groups. CONCLUSIONS: Apart from a positive association between the occurrence of long-lasting complaints after Lyme neuroborreliosis and cortisol response to synacthen, no corticotropic insufficiency or other serious hormonal dysfunction was found to be associated with remaining symptoms after treatment for Lyme neuroborreliosis.

PMCID: PMC2827415

PMID: 20137075 [PubMed - indexed for MEDLINE]

4. Arthritis Res Ther. 2009;11(6):258. Epub 2009 Dec 17.

Treatment of Lyme borreliosis.

Girschick HJ, Morbach H, Tappe D.

Paediatric Rheumatology, Immunology, Osteology and Infectious Diseases, Children's Hospital, University of Wuerzburg, Josef-Schneider-Str, 2, 97080 Wuerzburg, Germany. Hermann.Girschick@mail.uni-wuerzburg.de

ABSTRACT : Borrelia burgdorferi sensu lato is the causative agent of Lyme borreliosis in humans. This inflammatory disease can affect the skin, the peripheral and central nervous system, the musculoskeletal and cardiovascular system and rarely the eyes. Early stages are directly associated with viable bacteria at the site of inflammation. The pathogen-host interaction is complex and has been elucidated only in part. B. burgdorferi is highly susceptible to antibiotic treatment and the majority of patients profit from this treatment. Some patients develop chronic persistent disease despite repeated antibiotics. Whether this is a sequel of pathogen persistence or a status of chronic auto-inflammation, auto-immunity or a form of fibromyalgia is highly debated. Since vaccination is not available, prevention of a tick bite or chemoprophylaxis is important. If the infection is manifest, then treatment strategies should target not only the pathogen by using antibiotics but also the chronic inflammation by using anti-inflammatory drugs.

PMID: 20067594 [PubMed - in process]

5. Antimicrob Agents Chemother. 2010 Feb;54(2):643-51. Epub 2009 Dec 7.

Ineffectiveness of tigecycline against persistent Borrelia burgdorferi.

Barthold SW, Hodzic E, Imai DM, Feng S, Yang X, Luft BJ.

Center for Comparative Medicine, School of Medicine, University of California at Davis, One Shields Avenue, Davis, CA 95616, USA. swbarthold@ucdavis.edu

The effectiveness of a new first-in-class antibiotic, tigecycline (glycylcycline), was evaluated during the early dissemination (1 week), early immune (3 weeks), or late persistent (4 months) phases of Borrelia burgdorferi infection in C3H mice. Mice were treated with high or low doses of tigecycline, saline (negative-effect controls), or a previously published regimen of ceftriaxone (positive-effect controls). Infection status was assessed at 3 months after treatment by culture, quantitative ospA real-time PCR, and subcutaneous transplantation of joint and heart tissue into SCID mice. Tissues from all saline-treated mice were culture and ospA PCR positive, tissues from all antibiotic-treated mice were culture negative, and some of the tissues from most of the mice treated with antibiotics were ospA PCR positive, although the DNA marker load was markedly decreased compared to that in saline-treated mice. Antibiotic treatment during the early stage of infection appeared to be more effective than treatment that began during later stages of infection. The viability of noncultivable spirochetes in antibiotic-treated mice (demonstrable by PCR) was confirmed by transplantation of tissue allografts from treated mice into SCID mice, with dissemination of spirochetal DNA to multiple recipient tissues, and by xenodiagnosis, including acquisition by ticks, transmission by ticks to SCID mice, and survival through molting into nymphs and then into adults. Furthermore, PCR-positive heart base tissue from antibiotic-treated mice revealed RNA transcription of several B. burgdorferi genes. These results extended previous studies with ceftriaxone, indicating that antibiotic treatment is unable to clear persisting spirochetes, which remain viable and infectious, but are nondividing or slowly dividing.

PMCID: PMC2812145 [Available on 2010/8/1]

PMID: 19995919 [PubMed - indexed for MEDLINE]

6. Neurobiol Dis. 2010 Mar;37(3):534-41. Epub 2009 Nov 26.

Inflammation and central nervous system Lyme disease.

Fallon BA, Levin ES, Schweitzer PJ, Hardesty D.

Department of Psychiatry, Columbia University, New York, NY 10032, USA. PUB Lyme disease, caused by the bacterium Borrelia burgdorferi, can cause multi-systemic signs and symptoms, including peripheral and central nervous system disease. This review examines the evidence for and mechanisms of inflammation in neurologic Lyme disease, with a specific focus on the central nervous system, drawing upon human studies and controlled research with experimentally infected rhesus monkeys. Directions for future human research are suggested that may help to clarify the role of inflammation as a mediator of the chronic persistent symptoms experienced by some patients despite antibiotic treatment for neurologic Lyme disease. 2009 Elsevier Inc. All rights reserved.

PMID: 19944760 [PubMed - in process]

7. Duodecim. 2009;125(12):1269-76.

[Chronic Lyme borreliosis--fact or fiction?]

[Article in Finnish]

Wahlberg P, Nyman D.

Persistent infection after proper antibiotic treatment in Lyme borreliosis is rare. Symptoms may sometimes continue, especially from the nervous and the articular systems. There are many possible mechanisms for persistence of inflammation even after successful treatment of the infection. The lack of indicators of active infection impedes diagnostics. Early diagnosis and treatment are the most important means for preventing prolonged symptoms and signs. The differential diagnostics are crucial. Repeated treatment with antibiotics is seldom needed, and overlong treatments should be avoided. Lyme borreliosis may sometimes cause permanent tissue damage for which there is no cure.

PMID: 19711595 [PubMed - indexed for MEDLINE]

8. Am J Med. 2009 Sep;122(9):843-50.

Psychiatric comorbidity and other psychological factors in patients with "chronic Lyme disease".

Hassett AL, Radvanski DC, Buyske S, Savage SV, Sigal LH.

Division of Rheumatology and Connective Tissue Research, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA. a.hassett@umdnj.edu

BACKGROUND: There is no evidence of current or previous Borrelia burgdorferi infection in most patients evaluated at university-based Lyme disease referral centers. Instead, psychological factors likely exacerbate the persistent diffuse symptoms or "Chronic Multisymptom Illness" (CMI) incorrectly ascribed to an ongoing chronic infection with B. burgdorferi. The objective of this study was to assess the medical and psychiatric status of such patients and compare these findings to those from patients without CMI. METHODS: There were 240 consecutive patients who underwent medical evaluation and were screened for clinical disorders (eg, depression and anxiety) with diagnoses confirmed by structured clinical interviews at an academic Lyme disease referral center in New Jersey. Personality disorders, catastrophizing, and negative and positive affect also were evaluated, and all factors were compared between groups and with functional outcomes. RESULTS: Of our sample, 60.4% had symptoms that could not be explained by current Lyme disease or another medical condition other than CMI. After adjusting for age and sex, clinical disorders were more common in CMI than in the comparison group (P <.001, odds ratio 3.54, 95% confidence interval, 1.97-6.55), but personality disorders were not significantly more common. CMI patients had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P <.001) than did the comparison group. Except for personality disorders, all psychological factors were related to worse functioning. Our explanatory model based on these factors was confirmed. CONCLUSIONS: Psychiatric comorbidity and other psychological factors are prominent in the presentation and outcome of some patients who inaccurately ascribe longstanding symptoms to "chronic Lyme disease."

PMCID: PMC2751626 [Available on 2010/9/1]

PMID: 19699380 [PubMed - indexed for MEDLINE]

9. Nervenarzt. 2009 Oct;80(10):1239-51.

[Neuroborreliosis]

[Article in German]

Kaiser R, Fingerle V.

Neurologische Klinik, Klinikum Pforzheim, Kanzlerstrasse 2-6, 75175, Pforzheim, Deutschland. rkaiser@klinikum-pforzheim.de

Neuroborreliosis is easily diagnosed by means of clinical symptoms and laboratory findings. Guiding symptoms are radicular pain and pareses of the extremities and the facial nerve. There is a great number of further less frequently occurring neurological symptoms, which can be attributed to a borrelial infection only by appropriate investigations of the CSF. Radiculitis is cured adequately by oral doxycycline while symptoms of the central nervous system are probably better treated intravenously by ceftriaxone, cefotaxime or penicillin G. Post-Lyme syndrome is a diffuse description of non-specific complaints, which are not the explicit result of a former infection with B. burgdorferi. As further antibiotics do not help and the CSF is unremarkable in most patients, a persistent infection with B. burgdorferi s.l. in all probability can be excluded.

PMID: 19536517 [PubMed - indexed for MEDLINE]

10. Arch Gen Psychiatry. 2009 May;66(5):554-63.

Regional cerebral blood flow and metabolic rate in persistent Lyme encephalopathy.

Fallon BA, Lipkin RB, Corbera KM, Yu S, Nobler MS, Keilp JG, Petkova E, Lisanby SH, Moeller JR, Slavov I, Van Heertum R, Mensh BD, Sackeim HA.

Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA. baf1@columbia.edu

CONTEXT: There is controversy regarding whether objective neurobiological abnormalities exist after intensive antibiotic treatment for Lyme disease. OBJECTIVES: To determine whether patients with a history of well-characterized Lyme disease and persistent cognitive deficit show abnormalities in global or topographic distributions of regional cerebral blood flow (rCBF) or cerebral metabolic rate (rCMR). DESIGN: Case-controlled study. SETTING: A university medical center. PARTICIPANTS: A total of 35 patients and 17 healthy volunteers (controls). Patients had well-documented prior Lyme disease, a currently reactive IgG Western blot, prior treatment with at least 3 weeks of intravenous cephalosporin, and objective memory impairment. MAIN OUTCOME MEASURES: Patients with persistent Lyme encephalopathy were compared with age-, sex-, and education-matched controls. Fully quantified assessments of rCBF and rCMR for glucose were obtained while subjects were medication-free using positron emission tomography. The CBF was assessed in 2 resting room air conditions (without snorkel and with snorkel) and 1 challenge condition (room air enhanced with carbon dioxide, ie, hypercapnia). RESULTS: Statistical parametric mapping analyses revealed regional abnormalities in all rCBF and rCMR measurements that were consistent in location across imaging methods and primarily reflected hypoactivity. Deficits were noted in bilateral gray and white matter regions, primarily in the temporal, parietal, and limbic areas. Although diminished global hypercapnic CBF reactivity (P < .02) was suggestive of a component of vascular compromise, the close coupling between CBF and CMR suggests that the regional abnormalities are primarily metabolically driven. Patients did not differ from controls on global resting CBF and CMR measurements. CONCLUSIONS: Patients with persistent Lyme encephalopathy have objectively quantifiable topographic abnormalities in functional brain activity. These CBF and CMR reductions were observed in all measurement conditions. Future research should address whether this pattern is also seen in acute neurologic Lyme disease.

PMID: 19414715 [PubMed - indexed for MEDLINE]

11. Minerva Med. 2009 Apr;100(2):171-2.

Analysis of a flawed double-blind, placebo-controlled, clinical trial of patients claimed to have persistent Lyme disease following treatment.

Wormser GP, Shapiro ED, Halperin JJ, Porwancher RB, O'Connell S, Nadelman RB, Strle F, Radolf JD, Hovius JW, Baker PJ, Fingerle V, Dattwyler R.

Comment in: Minerva Med. 2009 Oct;100(5):435-6.

Comment on: Minerva Med. 2008 Oct;99(5):489-96.

PMID: 19390504 [PubMed - indexed for MEDLINE]

12. Curr Probl Dermatol. 2009;37:191-9. Epub 2009 Apr 8.

What should be done in case of persistent symptoms after adequate antibiotic treatment for Lyme disease?

Puéchal X, Sibilia J.

Service de Rhumatologie, Centre Hospitalier du Mans, Le Mans, France. xpuechal@ch-lemans.fr

The most common cause of treatment failure is incorrect diagnosis. Most patients cured of Lyme disease remain seropositive for long periods, and no laboratory test allows one to differentiate between cured and active infection. The first step is to check that the patient fulfils the diagnostic criteria for Lyme disease and that the antibiotic regimen has been administered according to the current recommendations. In the case of persistent arthritis after a first course of antibiotics, it is generally recommended to give a second course of treatment with a different drug. Ceftriaxone should be administered intravenously for arthritis that did not respond to previous oral therapy with doxycycline or amoxicillin. Despite resolution of the objective manifestations of Lyme disease after antibiotic treatment, a small proportion of patients still complain of subjective musculoskeletal pain, fatigue, difficulties with concentration or short-term memory, or all these symptoms. Given the risk of serious adverse events and the lack of efficacy, a consensus has emerged that repeated courses of antibiotic therapy are not indicated for persistent subjective symptoms following Lyme disease. The patient should be thoroughly examined for medical conditions that could explain the symptoms. If a diagnosis is made for which no specific treatment can be proposed, emotional support and management of pain, fatigue and other symptoms is required. Copyright 2009 S. Karger AG, Basel.

PMID: 19367104 [PubMed - indexed for MEDLINE]

13. Curr Probl Dermatol. 2009;37:178-82. Epub 2009 Apr 8.

Is serological follow-up useful for patients with cutaneous Lyme borreliosis?

Department of Dermatology, State Hospital Wiener Neustadt, Wiener Neustadt, Austria. robert.muellegger@wienerneustadt.lknoe.at

Serologic follow-up examinations are frequently performed in patients with erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans (the 3 dermatoborrelioses) to evaluate treatment efficacy. There is, however, substantial proof in the literature that antibody titer development after therapy is unpredictable and variable, and moreover it is largely uncorrelated with the clinical course and mode of antibiotic treatment. For example, persistent positive IgG and/ or IgM antibody titers do not indicate treatment failure. Thus, repeated serologic testing is of very limited value for assessing therapy efficacy, and therefore not recommended in the follow-up of dermatoborrelioses patients. Since cultivation of the etiologic agent, Borrelia burgdorferi sensu lato, and polymerase chain reaction are also inadequate for this purpose, the assessment of patients with cutaneous manifestations of Lyme borreliosis in the follow-up rests primarily on the clinical picture. Copyright 2009 S. Karger AG, Basel.

PMID: 19367102 [PubMed - indexed for MEDLINE]

14. Parasitology. 2009 Oct;136(12):1403-13. Epub 2009 Apr 14.

Tick-borne disease systems emerge from the shadows: the beauty lies in molecular detail, the message in epidemiology.

Randolph SE.

Department of Zoology, University of Oxford, South Parks Road, Oxford, UK. sarah.randolph@zoo.ox.ac.uk

This review focuses on some of the more ground-shifting advances of recent decades, particularly those at the molecular and cellular level that illuminate mechanisms underpinning the natural ecology of tick-host-pathogen interactions and the consequent epidemiology of zoonotic infections in humans. Knowledge of components of tick saliva, now recognized as the central pillar in the tick's ability to complete its blood meal and the pathogen's differential ability to use particular hosts for transmission, has burgeoned with new molecular techniques. Functional studies have linked a few of them to saliva-assisted transmission of non-systemic infections between co-feeding ticks, the quantitative key to persistent cycles of the most significant tick-borne pathogen in Europe. Human activities, however, may be equally important in determining dynamic patterns of infection incidence in humans.

PMID: 19366480 [PubMed - indexed for MEDLINE]

15. Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun;112(2):496-501.

[Results of etiologic diagnosis in clinical syndrome consistent with acute and chronic borreliosis]

[Article in Romanian]

Persecă T, Feder A, Molnar GB.

Institutul de Sănătate Publică, Prof. Dr. Iuliu Moldovan" Cluj Napoca.

Borreliosis is a multisystem infection, which in the absence of adequate diagnosis and clinical management, may develop towards various clinical forms of chronic pathology. Due to the heterogeneity of clinical manifestations it is known under more names: erythema migrans, Lyme disease, neuroborreliosis etc. MATERIAL AND METHOD: Taking into account the present interest and the weight in pathology of syndromes consistent with the suspicion of a Borrelia spp. infection, since 2002 we applied in current practice the investigation of this etiology. There have been investigated 481 subjects, clinically suspected of Borrelia spp. infection that had historical risk of tick bite and cases of serous meningitis, after exclusion of usual etiology. Tests were performed on ELISA kits with standardised immunoreagents and recently, for result validation, on Western immunoblot kits (WB). RESULTS: Our results revealed the Borrelia etiology in 32% of cases (27.96-36.29% CI = 95%) at the screening, value expressed by the persistent positivity of the specific immunoglobulins (Ig) IgM (80.5%) and IgM+IgG (19.5%). Historic infection, represented exclusively by IgG positivity, was present in 8.6% (5.87-11.98% CI = 95%) from the cases that were negative for IgM (68%, 63.71-72.04%, CI = 95%). This weight is superposable with the results obtained in investigating a comparable sample of healthy individuals (193 subjects with 6.74% historical IgG, 3.79-10.96%, CI = 95%). Based on these results, it can be considered that ELISA procedure is useful and of reliable prognosis value for screening the Borrelia spp. etiology, the next step, taking into account the higher sensitivity of WB, being WB procedure which is useful for confirmation of ELISA positive cases and for treatment efficiency surveillance. The results prove that Borrelia spp. infections are a public health issue, which due to the diversity of clinical manifestations and diagnosis difficulties need repeated and complex laboratory investigations.

PMID: 19295026 [PubMed - indexed for MEDLINE]