TITLE:
Epidemiologic, ecologic and clinical characteristics of Lyme borrelliosis in northwest Croatia.
AUTHORS:
Golubic D; Rijpkema S; Tkalec-Makovec N; Ruzic E
AUTHOR AFFILIATION:
Department of Infectious Diseases, County Hospital, Cakovec, Croatia. dragutin.golubic@public.srce.hr
LANGUAGES:
Eng
ABSTRACT:
Investigated were the epidemiologic, ecologic and clinical characteristics of Lyme borreliosis in northwest Croatia. In a seroepidemiologic study, human sera were analyzed by indirect immunofluorescent assay (IFA), and ten out of 134 serum samples were positive for B. burgdorferi antibodies. In a seroepizootiologic study, wildlife and domestic animals were tested by inhibition ELISA. Antibodies to B. burgdorferi were found in nine out of 42 roe deer sera, and in three out of nine hare sera. Sera of wild boars (n = 10), cattle (n = 103), and dogs (n = 13) were negative for antibodies to B. burgdorferi. The presence of Borrelia burgdorferi sensu lato was assessed in ixodes ricinus ticks in the Lyme borreliosis endemic region of northwest Croatia. Ticks (n = 123) were collected at five-different locations and analyzed by polymerase chain reaction (PCR). Borrelia burgdorferi sensu lato DNA was detected in 56 out of 124 ticks (45%). Four genomic groups were identified by genotyping: B. afzelii (n = 26), B. garinii (n = 5), VS116 group (n = 5), and Borrelia burgdorferi sensu stricto (n = 1). Mixed infections of B. afzelii with VS116 group (n = 10), and B. afzelii with Borrelia burgdorferi sensu stricto (n = 1) were also detected. Eight ticks contained B. burgdorferi sensu lato that could not be typed, indicating the possible existence of a specific genomic group of B. burgdorferi sensu lato in northwest Croatia. Sex distribution of Lyme borreliosis patients in northwest Croatia showed a slight preponderance of the female gender and prevalence of the working active age range of 20 to 50 years. The persons who periodically visit the landscape, are most commonly affected, whereas those with an increased risk of tick bites are considerably less frequently involved. The most frequent clinical manifestation of Lyme borreliosis in northwest Croatia is erythema migrans with 46%, followed by neurologic manifestations, particularly peripheral neuritis, with 32%. The rest of clinical manifestations in stage II and III of Lyme borreliosis are very rarely recorded. The presence of B. afzelii and B. garinii in the highest percentage is in agreement with the local occurrence of cutaneous and neurologic manifestations of Lyme borreliosis. The presence of VS116 group in ticks from northwest Croatia in this and other studies in some European countries may indicate that VS116 group is well established in the European ixodes ricinus ticks. The role of the VS116 group in the etiology of Lyme borreliosis remains to be clarified.
NLM PUBMED CIT. ID: 9599811 NLM CIT. ID: 98262545
SOURCE: Acta Med Croatica 1998;52(1):7-13

TITLE:
[The clinico-epidemiological and laboratory characteristics of the early period of Lyme borreliosis in Kirov Province]
VERNACULAR TITLE:
Kliniko-epidemiologicheskie i laboratornye osobennosti rannego perioda laim-borrelioza v Kirovskoi oblasti.
AUTHORS:
Bondarenko AL; Abbasova SV; Tikhomolova EG; Tikhomolova EP; Savinykh MV; Komarova LB
LANGUAGES:
Rus
ABSTRACT:
Tick borreliosis is widespread in the Kirov Province of Russia due to its specific climatic and geographical conditions. Early tick borreliosis was studied in 191 patients in the city of Kirov in 1995-1996. The diagnosis was verified by the epidemiological history, clinical symptoms (chronic erythema migrans), and/or positive serological assays. Tick erythema migrans was detected in 165 (86%) patients. Specific antibodies to Borrelia afcelii antigen were revealed in 128 (67%) patients. The serological tests were false-negative in early infection or just after initiation of treatment. Only 84 (44%) patients with borrelial erythema migrans had specific antibodies to B. afcelii antigen. Mixed tick infection was detected in 6 (3%) patients who showed antibodies to B. afcelii antigen and to tick encephalitis virus. All the patients benefited from wide spectrum antibiotics just within the first days of the disease.
NLM PUBMED CIT. ID: 9445988 NLM CIT. ID: 98071764
SOURCE: Med Parazitol (Mosk) 1997 Oct-Dec;(4):18-21

TITLE:
Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group [see comments]
AUTHORS:
Gerber MA; Shapiro ED; Burke GS; Parcells VJ; Bell GL
AUTHOR AFFILIATION:
Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
COMMENTS:
Comment in: N Engl J Med 1997 Apr 10;336(15):1107; discusssion 1107-8
LANGUAGES:
Eng
ABSTRACT:
BACKGROUND: Although the incidence of Lyme disease is highest in children, there are few prospective data on the clinical manifestations and outcomes in children. METHODS: We conducted a prospective, longitudinal, community-based cohort study of children with newly diagnosed Lyme disease in an area of Connecticut in which the disease is highly endemic. We obtained clinical and demographic information and performed serial antibody tests and follow-up evaluations. RESULTS: Over a period of 20 months, 201 consecutive patients were enrolled; their median age was 7 years (range, 1 to 21). The initial clinical manifestations of Lyme disease were a single erythema migrans lesion in 66 percent, multiple erythema migrans lesions in 23 percent, arthritis in 6 percent, facial-nerve palsy in 3 percent, aseptic meningitis in 2 percent, and carditis in 0.5 percent. At presentation, 37 percent of the patients with a single erythema migrans lesion and 89 percent of those with multiple erythema migrans lesions had antibodies against Borrelia burgdorferi. All but 3 of the 201 patients were treated for two to four weeks with conventional antimicrobial therapy, which was administered orally in 96 percent. All had prompt clinical responses. After four weeks, 94 percent were completely asymptomatic (including the two patients whose parents had refused to allow antimicrobial treatment). At follow-up a mean of 25.4 months later, none of the patients had evidence of either chronic or recurrent Lyme disease. Six patients subsequently had a new episode of erythema migrans. CONCLUSIONS: About 90 percent of children with Lyme disease present with erythema migrans, which is an early stage of the disease. The prognosis is excellent for those with early Lyme disease who are treated promptly with conventional courses of antimicrobial agents.
NLM PUBMED CIT. ID: 8857006 NLM CIT. ID: 96427293
SOURCE: N Engl J Med 1996 Oct 24;335(17):1270-4

TITLE:
[Nervous system lesions in patients with ixodid tick-borne borreliosis]
VERNACULAR TITLE:
Porazheniia nervnoi sistemy u bol'nykh iksodovym kleshchevym borreliozom.
AUTHORS:
Vorob'eva NN; Burylov AIa; Volegova GM
LANGUAGES:
Rus
ABSTRACT:
Previous studies indicated that in the Perm Region there are two pathogen species: B. garinii and B. afzelii which cause the disease mainly with neurological and dermatological manifestations. In 1990-1994, in the Perm Region 646 patients with Ixodes tick-borne borreliosis (ITBB), including 535 with erythema migrans, 54 without it, and 57 with late chronic disease were studied. Damages to the central and peripheral nervous systems were detected at all stages of an infectious process. The prevalent clinical manifestations are encephalitis, encephalomyeloradiculoneuropathies, mono- and polyneuropathies. These abnormalities are more frequently formed in patients with its erythema-free type both in the acute period of the disease and in the late period of infection. A varying spectrum of neurological syndromes and their significant incidence determine the resemblance of ITBB in Russia and West Europe. The clinical findings are in good agreement with the results of etiological structural studies of ITBB in the region.
NLM PUBMED CIT. ID: 9036275 NLM CIT. ID: 97085145
SOURCE: Med Parazitol (Mosk) 1996 Jul-Sep;(3):19-22

TITLE:
[Frequency of the clinical manifestations of Lyme borreliosis in Spain]
VERNACULAR TITLE:
Frecuencia de las manifestaciones clinicas de la borreliosis de Lyme en Espana.
AUTHORS:
Guerrero A; Escudero R; Marti-Belda P; Quereda C
AUTHOR AFFILIATION:
Unidad de Enfermedades Infecciosas, Universidad de Alcala de Henares, Madrid.
LANGUAGES:
Spa
ABSTRACT:
INTRODUCTION: There are differences in the clinical manifestations of Lyme borreliosis (LB) in different parts of the world. The aim of this work was to analyze its clinical manifestations in Spain. METHODS: We evaluated by ELISA and IFI the sera of 1,500 patients with clinical suspicion of LB between January 1987 to February 1993. Spanish criteria of LB (amplified CDC criteria of LB for epidemiological purpuse) were used. Clinical and serological data were evaluated with the patients' physicians and other etiologies were reasonably excluded in accepted cases of LB. RESULTS: Sixty-four patients of 138 with a positive serology (46%) met the LB criteria. Neurological manifestations were presented by 40 patients (62.5%) (in control group 23%, p less than 0.05) cutaneous lesions by 20 patients (31%), articular manifestations by 18 patients (28%) (in control groups 56%; p less than 0.05) and cardiac manifestations in two. Cutaneous manifestations included 17 erythema migrans, 2 acrodermatitis chronica atrophicans and 1 lymphocytoma). Artritis was present in 18 cases. Neurological manifestations included 16 cases of meningitis (2 with encephalitis), 11 of craneal neuropathy and 25 of peripheral neuropathy (13 of polyneuropathy). Cardiac manifestations acepted was 2 atrioventricular blockade. We detected 21% of false positive serology and in 33% of the positive cases, the LB criteria was not met. CONCLUSIONS: The low percentage of cutaneous manifestations is probably due to the fact that this series consist predominantly of hospital patients. In Spain, as in the rest Europe the predominant manifestations are neurological, however artritis are not infrequent manifestations.
NLM PUBMED CIT. ID: 8714152 NLM CIT. ID: 96307899
SOURCE: Enferm Infecc Microbiol Clin 1996 Feb;14(2):72-9

TITLE:
Lyme disease surveillance in Maryland, 1992.
AUTHORS:
Steinberg SH; Strickland GT; Pena C; Israel E
AUTHOR AFFILIATION:
Department of Epidemiology and Preventive Medicine, University of Maryland at Baltimore 21201, USA.
LANGUAGES:
Eng
GRANT/CONTRACT ID:
5 R01 HSO7813
ABSTRACT:
The incidence of Lyme disease (LD) reported to the Maryland Department of Health and Mental Hygiene during 1992 was 6.5/100,000 population, ranging from 29.3 cases/100,000 on the Eastern Shore (74.4% of all cases) to no cases in the mountains of western Maryland. Among the 317 reported patients, 44.4% gave a history of tick exposure and 78.9% had positive serologic test results. For the 187 (59.0%) patients meeting the Centers for Disease Control and Prevention (CDC) surveillance case definition, erythema migrans (EM) occurred in 69.5%, with arthritic (26.7%), neurologic (13.4%), and cardiac (2.1%) manifestations being less frequent. Patients not meeting the surveillance case definition were significantly more likely to have influenza-like symptoms, a smaller rash, and arthralgia. Patients meeting the CDC criteria were more likely to have an onset during the major transmission season in the summer (odds ratio (OR): 2.1; confidence interval (CI): 1.2 to 3.6) since this was the time when most (115/130) patients with EM were detected. Positive serologic results were more likely (OR: 2.2; CI: 1.2 to 4.2) in those not meeting the case definition. The treatment given to patients thought to have LD was almost always that recommended in the literature and there was no difference between treatment prescribed for patients meeting and those not meeting the case definition. These data show that physicians in Maryland are treating many patients for LD who are clinically diagnosed as having LD (e.g., febrile patients with flulike symptoms, patients with arthralgias or erythematous rashes less than 5 cm in size) and who have positive serologic test results but who do not meet the CDC surveillance case definition. These patients and the large number of unreported patients being seen and treated for LD or tick bites must be added to the overall burden of LD in the state.
NLM PUBMED CIT. ID: 8680620 NLM CIT. ID: 96284008
SOURCE: Ann Epidemiol 1996 Jan;6(1):24-9

TITLE:
Neurologic manifestations in children with Lyme disease.
AUTHORS:
Bingham PM; Galetta SL; Athreya B; Sladky J
AUTHOR AFFILIATION:
Division of Neurology, Children's Hospital of Philadelphia, PA 19104, USA.
LANGUAGES:
Eng
ABSTRACT:
OBJECTIVE. Lyme disease (LD) is a tick-borne spirochetal infection with a wide range of neurologic and non-neurologic manifestations. The clinical diversity of LD and limitations in serologic diagnosis often make it difficult to document the diagnosis of neuroborreliosis with certainty. METHODS. We reviewed clinical manifestations in 97 seropositive children with particular attention to neurologic manifestations. Diagnostic criteria used in other case surveys were applied to determine how often a definitive diagnosis of neuroborreliosis could be made in children. RESULTS. Of 69 children who met criteria for LD, 32% (22) had new neurologic signs, 73% (16) of which were accounted for by facial palsy and aseptic meningitis. Five of those with neurologic findings also had erythema migrans (EM), and one had both EM and arthritis. Among those with neurologic involvement, boys outnumbered girls two to one. Neurologic abnormalities resolved spontaneously in five children before their serologic results were known. CONCLUSION. In our series, only 27% of children with neurologic abnormalities due to LD had a history of EM or arthritis. Seropositivity commonly constituted the primary basis for diagnosis of LD. Despite its nonspecificity, seropositivity for LD in children with neurologic symptoms usually signifies active neuroborreliosis.
NLM PUBMED CIT. ID: 7491220 NLM CIT. ID: 96095153
SOURCE: Pediatrics 1995 Dec;96(6):1053-6

TITLE:
An epidemiologic study of Lyme disease in southern Sweden [see comments]
AUTHORS:
Berglund J; Eitrem R; Ornstein K; Lindberg A; Ringer A; Elmrud H; Carlsson M; Runehagen A; Svanborg C; Norrby R
AUTHOR AFFILIATION:
Department of Community Health Sciences, University of Lund, Sweden.
COMMENTS:
Comment in: N Engl J Med 1996 Mar 21;334(12):803
LANGUAGES:
Eng
ABSTRACT:
BACKGROUND. Lyme disease is the most common vector-borne infection in some temperate regions of the Northern Hemisphere. However, for most areas of endemic disease reliable epidemiologic data are sparse. METHODS. Over a one-year period, we conducted a prospective, population-based survey of cases of Lyme disease in southern Sweden. The diagnosis was made on the basis of the presence of erythema migrans at least 5 cm in diameter or characteristic clinical manifestations such as arthritis, neuroborreliosis, and carditis. RESULTS. We identified 1471 patients with Lyme disease, for an overall annual incidence of 69 cases per 100,000 inhabitants. The incidence varied markedly according to geographic region, and there were several areas where disease was widely prevalent. The incidence varied according to age, with the highest rates among people 5 to 9 and 60 to 74 years of age, but not according to sex. The most frequent clinical manifestation was erythema migrans (seen in 77 percent of all cases), followed by neuroborreliosis (16 percent) and arthritis (7 percent). Carditis was rare. A preceding tick bite was reported by 79 percent of the patients. Bites in the head and neck region were more common among children than among adults and were associated with an increased risk of neuroborreliosis. CONCLUSIONS. Lyme disease is very common in southern Sweden, with a relatively high frequency of neurologic complications and arthritis. With the exception of the low incidence of carditis, the pattern of disease we found in Sweden was similar to that reported in the United States.
NLM PUBMED CIT. ID: 7566023 NLM CIT. ID: 96036649
SOURCE: N Engl J Med 1995 Nov 16;333(20):1319-27

TITLE:
Lyme disease in children.
AUTHORS:
Shapiro ED
AUTHOR AFFILIATION:
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
LANGUAGES:
Eng
ABSTRACT:
Lyme disease is the most common vector-borne disease among children in the United States; the incidence of Lyme disease is higher among children than among adults. Extensive publicity in the lay press about the effects of Lyme disease has led to widespread anxiety about this illness that is out of proportion to the actual frequency of severe consequences, especially among children. The problem is exacerbated by the difficulty of documenting the diagnosis (or more often of ruling out the diagnosis in children with vague symptoms), especially when the diagnosis depends on serologic tests that are often inaccurate. This caveat applies particularly to commercial laboratories using prepackaged kits, which often give inaccurate results that should not be relied on by themselves to make a diagnosis. Careful prospective studies have found that nearly 90% of children with Lyme disease have erythema migrans. Although there has been great concern about congenital Lyme disease, no data suggest that it is a significant problem, nor has transmission of Lyme disease through breast milk been documented. Virtually all children will respond well to treatment for any stage of Lyme disease. Misdiagnosis is the most common reason for treatment failure. Long-term follow-up studies indicate that the prognosis for children with Lyme disease is excellent.
NLM PUBMED CIT. ID: 7726195 NLM CIT. ID: 95243257
SOURCE: Am J Med 1995 Apr 24;98(4A):69S-73S

TITLE:
Lyme arthritis in European children and adolescents. The Pediatric Rheumatology Collaborative Group.
AUTHORS:
Huppertz HI; Karch H; Suschke HJ; Doring E; Ganser G; Thon A; Bentas W
AUTHOR AFFILIATION:
Children's Hospital, University of Wurzburg, Germany.
LANGUAGES:
Eng
ABSTRACT:
OBJECTIVE. To evaluate and describe Lyme arthritis in European children and adolescents. METHODS. This was a prospective multicenter study. The diagnosis of Lyme arthritis required the exclusion of other diseases and positive findings on serology for IgG antibodies to Borrelia burgdorferi. Enzyme-linked immunosorbent assay, immunoblotting, and polymerase chain reaction techniques to identify infection by B burgdorferi were used. RESULTS. Among 62 children and adolescents with Lyme arthritis, only 1 had a preceding erythema migrans. Arthritis was episodic in 62% and was chronic at onset in 18%. The most common manifestation was monarthritis of the knee. Joint involvement in patients with oligoarthritis was predominantly unilateral or symmetric. Arthralgia was very rare. Treatment with 1 or 2 courses of different antibiotics resulted in disappearance of the arthritis in 77% of the patients. CONCLUSION. The clinical presentation of Lyme arthritis in children is different from that in adults. The calculated incidence of Lyme arthritis in persons under the age of 17 years (4/100,000) exceeds previous estimations.
NLM PUBMED CIT. ID: 7880190 NLM CIT. ID: 95185915
SOURCE: Arthritis Rheum 1995 Mar;38(3):361-8

TITLE:
[Neurologic manifestations of Lyme disease. Apropos of 25 cases]
VERNACULAR TITLE:
Manifestations neurologiques de la maladie de Lyme. A propos de 25 cas.
AUTHORS:
Ragnaud JM; Morlat P; Buisson M; Ferrer X; Orgogozo JM; Julien J; Beylot J; Aubertin J
AUTHOR AFFILIATION:
Clinique medicale et des maladies infectieuses, hopital Pellegrin, Bordeaux, France.
LANGUAGES:
Fre
ABSTRACT:
We studied retrospectively the cases of neurological forms of Lyme disease observed in two internal and two neurological departments from 1986 till 1993. Twenty five cases have been collected among 15 men and ten women whose mean age was 61 years. Tick bites were previously noticed in 11 cases. Erythema chronicum migrans (ECM) was mentioned in 16 cases mostly on lower limbs. The mean time between ECM and the onset of neurological symptoms was less than 1 month in 11 cases, 2 months in three cases, and 6 months in two cases. Neurological abnormalities were often associated in the same patient. Hyperalgic radiculitis (n = 16), mainly noticed in the ECM territory (n = 10) was only sensitive in six cases and associated with motor deficit in ten. Atypical polyradiculoneuritis was achieved in six cases. Clinical (n = 5) or biological (n = 22) meningitis could occur: CSF was clear with pleiocytosis (132 per mm3), mainly lymphocytic, and hyperproteinorachia (1.2 g/l) with normoglycorachia. An increase of the CSF immunoglobulins G with oligoclonal fragmentation was noticed in 11 cases. Cranial neuropathy was frequent: VII (n = 8), VI (n = 2), III, IV, VIII (n = 1). Encephalitis (with white matter demyelination) resolved partially in two cases. Diagnosis was always confirmed by Borrelia burgdorferi serology (indirect immunofluorescence) with a significant increase of the antibodies titer (n = 17) or a CSF titer greater than 1/4 (n = 11). Syphilitic serology was always negative. All patients were treated with parenteral beta lactamins and four with corticosteroids. Outcome was favorable in 20 patients with incomplete resolution of neurological symptoms in two patients.
NLM PUBMED CIT. ID: 7569417 NLM CIT. ID: 96008886
SOURCE: Rev Med Interne 1995;16(7):487-94

TITLE:
Antibiotic therapy for Lyme disease in Maryland.
AUTHORS:
Strickland GT; Caisley I; Woubeshet M; Israel E
AUTHOR AFFILIATION:
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201.
LANGUAGES:
Eng
GRANT/CONTRACT ID:
5 RO1 HS07813/HS/AHCPR
ABSTRACT:
The recommended treatment of Lyme disease is evolving and important questions remain unanswered, such as (a) Are inexpensive oral regimens effective in curing acute illness and preventing arthritic, neurologic, and cardiac manifestations or are much more costly, and potentially toxic, intravenous antibiotics required? (b) Are relatively short 2- to 3-week courses of antibiotics sufficient or are prolonged regimens of a month, or more, better? This study reviews antibiotic therapy prescribed by Maryland physicians for the 283 cases reported in 1991 that meet the Centers for Disease Control and Prevention's case definition for Lyme disease. The purpose of the review was to obtain baseline information on the antibiotics being used by physicians in practice to treat patients that they believe have Lyme disease. The most frequently prescribed antibiotics for either the 60 percent of patients presenting with erythema migrans or the 40 percent with arthritic, neurologic, or cardiac manifestations were oral doxycycline (47 percent), tetracycline (11 percent), and amoxicillin (13 percent). Seventy-one percent of therapeutic courses were for 2 to 3 weeks. Amoxicillin was used in two-thirds of children younger than 8 years. Sixty (21 percent) received intravenous therapy, of which ceftriaxone, with or without other antibiotics, was almost always (95 percent) used. Intravenous therapy was more frequently given to those with arthritic, neurologic, and cardiac manifestations than to those with erythema migrans (odds ratio = 3.7) and to those with these systemic symptoms along with erythema migrans than to those with erythema migrans alone (odds ratio = 3.8).(ABSTRACT TRUNCATED AT 250 WORDS)
NLM PUBMED CIT. ID: 7800782 NLM CIT. ID: 95098967
SOURCE: Public Health Rep 1994 Nov-Dec;109(6):745-9

TITLE:
Early and specific antibody response to OspA in Lyme Disease.
AUTHORS:
Schutzer SE; Coyle PK; Dunn JJ; Luft BJ; Brunner M
AUTHOR AFFILIATION:
Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103.
LANGUAGES:
Eng
GRANT/CONTRACT ID:
AR-41518/AR/NIAMS
AI-324501/AI/NIAID
AR-40470/AR/NIAMS
ABSTRACT:
Borrelia burgdorferi (Bb), the cause of Lyme disease, has appeared not to evoke a detectable specific antibody response in humans until long after infection. This delayed response has been a biologic puzzle and has hampered early diagnosis. Antibody to the abundant organism-specific outer surface proteins, such as the 31-kD OspA, has rarely been detected less than 6 mo after infection. Antibody to a less organism-specific 41-kD flagellin protein, sharing common determinants with other bacteria and thus limiting its diagnostic potential, may appear after 4 to 6 wks. To investigate our hypothesis that specific antibody to OspA may actually be formed early but remain at low levels or bound in immune complexes, we analyzed serum samples from patients with concurrent erythema migrans (EM). This is the earliest sign of Lyme disease and occurs in 60-70% of patients, generally 4-14 d after infection. We used less conventional but more sensitive methods: biotin-avidin Western blots and immune complex dissociation techniques. Antibody specificity was confirmed with recombinant OspA. Specific complexed antibody to whole Bb and recombinant OspA was detected in 10 of 11 of the EM patients compared to 0 of 20 endemic area controls. IgM was the predominant isotype to OspA in these EM patients. Free IgM to OspA was found in half the EM cases. IgM to OspA was also detected in 10 of 10 European patients with EM who also had reactive T cells to recombinant OspA. In conclusion a specific antibody response to OspA occurs early in Lyme disease. This is likely to have diagnostic implications.
NLM PUBMED CIT. ID: 8040289 NLM CIT. ID: 94314934
SOURCE: J Clin Invest 1994 Jul;94(1):454-7

TITLE:
Maryland physicians' survey on Lyme disease.
AUTHORS:
Jung PI; Nahas JN; Strickland GT; McCarter R; Israel E
AUTHOR AFFILIATION:
University of Maryland School of Medicine, Baltimore 21201.
LANGUAGES:
Eng
GRANT/CONTRACT ID:
HL07612-07/HL/NHLBI
5 R01 HS07813/HS/AHCPR
ABSTRACT:
In a survey of 252 physicians practicing in Maryland, 170 responders diagnosed 142 cases of Lyme disease (LB) during 1990 and 1991. About 80% of the cases were diagnosed by primary care physicians. The most common clinical finding, erythema migrans (EM), was reported in half the cases and arthritis was reported in a quarter. Only 22.2% had a history of a tick bite; serological tests were ordered in a third of the cases. EM was treated with oral antibiotics for 10-21 days. Most physicians treated Lyme arthritis with the same therapy, although some used intravenous ceftriaxone. The most commonly used treatment for neurologic or cardiac complications was intravenous ceftriaxone. These preliminary data suggest that LB may be diagnosed by Maryland physicians more frequently than syphilis and tuberculosis. The data also indicate LB is a much larger problem in Maryland than suggested by official reports to the Centers for Disease Control. The clinical characteristics of the illness and the antibiotics prescribed for it in Maryland are similar to those reported in northeastern states.
NLM PUBMED CIT. ID: 8052097 NLM CIT. ID: 94328894
SOURCE: Md Med J 1994 May;43(5):447-50

TITLE:
Lyme disease: an infectious and postinfectious syndrome.
AUTHORS:
Asch ES; Bujak DI; Weiss M; Peterson MG; Weinstein A
AUTHOR AFFILIATION:
Department of Medicine, New York Medical College, Valhalla 10595.
LANGUAGES:
Eng
ABSTRACT:
OBJECTIVE. To determine chronic morbidity and the variables that influence recovery in patients who had been treated for Lyme disease. METHODS. Retrospective evaluation of 215 patients from Westchester County, NY, who fulfilled Centers for Disease Control case definition for Lyme disease, were anti-Borrelia antibody positive and were diagnosed and treated at least one year before our examination. RESULTS. Erythema migrans had occurred in 70% of patients, neurological involvement in 29%, objective cardiac problems in 6%, arthralgia in 78% and arthritis in 41%. Patients were seen at a mean of 3.2 years after initial treatment. A history of relapse with major organ involvement had occurred in 28% and a history of reinfection in 18%. Anti-Borrelia antibodies, initially present in all patients, were still positive in 32%. At followup, 82 (38%) patients were asymptomatic and clinically active Lyme disease was found in 19 (9%). Persistent symptoms of arthralgia, arthritis, cardiac or neurologic involvement with or without fatigue were present in 114 (53%) patients. Persistent symptoms correlated with a history of major organ involvement or relapse but not the continued presence of anti-Borrelial antibodies. Thirty-five of the 114 (31%) patients with persistent symptoms had predominantly arthralgia and fatigue. Antibiotic treatment within 4 weeks of disease onset was more likely to result in complete recovery. Children did not significantly differ from adults in disease manifestations or in the frequency of relapse, reinfection or complete recovery. CONCLUSION. Despite recognition and treatment, Lyme disease is associated with significant infectious and postinfectious sequelae.
NLM PUBMED CIT. ID: 8006888 NLM CIT. ID: 94275745
SOURCE: J Rheumatol 1994 Mar;21(3):454-61

TITLE:
[Clinical characteristics of Lyme disease]
VERNACULAR TITLE:
Klinicke karakteristike lajmske bolesti.
AUTHORS:
Bojic I; Mijuskovic P; Dokic M; Nozic D; Lako B; Kapulica I; Marinkovic V; Miletic J
AUTHOR AFFILIATION:
Vojnomedicinska akademija, Klinika za infektivne i tropske bolesti, Institut za mikrobiologiju.
LANGUAGES:
Scr
ABSTRACT:
Clinical characteristics of Lyme disease were analysed in 22 patients. Erythema migrans was found in 20 (91%), arthralgia in 18 (81%), neuralgia in 8 (36%), encephalitis in 3 (13%), carditis in 2 (9%) and arthritis in 2 (9%) patients. The positive antibody titer was found in 14 (63%) patients. Favourable effects of antibiotic therapy was achieved in all patients. Erythema migrans has been manifested up to 12 days after tick sting and arthralgia, arthritis, neuralgia, hepatitis and chronic dermatitis within a year. Carditis and encephalitis have been developing from a month to ten years after tick sting. Lyme borreliosis is commonly manifested as a systemic disease. Together with the skin, most commonly have been involved ankle joints, heart and nervous system. The time from tick sting to the onset of first signs of the diseases varies by the involved organs.
NLM PUBMED CIT. ID: 8273306 NLM CIT. ID: 94098813
SOURCE: Vojnosanit Pregl 1993 Jul-Aug;50(4):359-64

TITLE:
[Lyme borreliosis: how is it manifested in Spain?]
VERNACULAR TITLE:
Borreliosis de Lyme: como se manifiesta en Espana?
AUTHORS:
Guerrero A; Quereda C; Marti-Belda P; Escudero R
AUTHOR AFFILIATION:
Seccion de Enfermedades Infecciosas, Hospital Ramon y Cajal, Universidad de Alcala de Henares, Madrid.
LANGUAGES:
Spa
ABSTRACT:
BACKGROUND: Lyme borreliosis is not usually diagnosed in Spanish patients since before 1987. The aim of this study was to know the clinical spectrum of infection by Borrelia burgdorferi in Spain by a prospective epidemiologic study. METHODS: The period of collection of cases was from 1987 to 1989 and the follow-up period was of 2 years following diagnosis. Detection of serum antibodies was performed by indirect immunofluorescence and ELISA to patients with clinical suspicion of Lyme borreliosis established in 17 Spanish hospitals. The clinical and serologic data and the possibility of other disease which could justify the symptoms were evaluated with the doctor responsible for the patient. RESULTS: Fifty-four patients with clinical manifestations and serologic data indicative of the disease and in whom other diagnosis were excluded were detected. Other diseases which could be the cause of the symptomatology were diagnosed in 26 patients with positive serology. Sixty-three percent of the patients had neurologic symptoms, 46% articular symptoms, 44% cutaneous symptoms and 9% cardiac symptoms. CONCLUSIONS: Lyme borreliosis is not exceptional in Spain. Its clinical spectrum may be situated half way between American and European epidemiologic descriptions. Serology must be interpreted by the clinical manifestations.
NLM PUBMED CIT. ID: 8315978 NLM CIT. ID: 93302310
SOURCE: Med Clin (Barc) 1993 May 29;101(1):5-7

TITLE:
[Epidemiologic characteristics of Lyme borreliosis in Vojvodina]
VERNACULAR TITLE:
Epidemiloske karakteristike Lyme borreliosis u Vojvodini.
AUTHORS:
Stefanovic S; Vukovic B; Seguljev Z; Nikolic V; Cik-Nadj V
LANGUAGES:
Scc
ABSTRACT:
In the period 1988-1992 in the region of Vojvodina diseases caused by Borrelia burgdorferi were investigated for the first time. This investigation encompassed 398 persons with tick bites. There were 340 clinically healthy and 58 affected by Lyme borreliosis. Lyme borreliosis was registered in all age groups. The youngest patient was 5 and the oldest 75. Erythema migrans, clinical disease marker, was found in 94.8% of affected persons. Rheumatic disorders--arthralgiae were found in 3.5% and Sclerodermia circumscripta in 1.7%. Antibodies to Borrelia burgdorferi antigen were found in 46.9% of 32 patients tested by IFA test. In 55 (94.8%) patients the infestion took place in region of Vojvodina.
NLM PUBMED CIT. ID: 8262427 NLM CIT. ID: 94085834
SOURCE: Glas Srp Akad Nauka [Med] 1993;(43):67-75

TITLE:
[Lyme borreliosis in Belgrade]
VERNACULAR TITLE:
Lyme borreliosis u Beogradu.
AUTHORS:
Djerkovic V; Dmitrovic R; Djordjevic D; Drndarevic D; Lako B; Obradkovic M; Stajkovic N; Kovacevic M
LANGUAGES:
Scc
ABSTRACT:
In the period 1990-1992 in Belgrade area a diagnosis of Lyme disease was registered in 487 patients. There were 195 men and 292 women. The disease was registered in all ages groups, median age 38 y. The tick bite has been confirmed in 379 (77.8%) patients. Erythema migrans was the first sign of illness in 387 (84.6%) patients. The disease resoted in neurologic symptoms in 1.8%, joint manifestation in 4.8% and cardiac involvement in 0.9%. Antibodies to Borrelia burgdorferi have been detected by indirect immunofluorescence microscopy in 23.4%. Lyme disease has been registered in all districts of Belgrade. Acarological investigations have detected an infection by Borrelia burgdorferi in 29.0% of investigated ticks.
NLM PUBMED CIT. ID: 8262413 NLM CIT. ID: 94085820
SOURCE: Glas Srp Akad Nauka [Med] 1993;(43):23-31

TITLE:
[Lyme disease in children and adolescents]
VERNACULAR TITLE:
Lajmska bolesti u dece i adolescenata.
AUTHORS:
Grubisic S; Lazovic M
LANGUAGES:
Scc
ABSTRACT:
148 children and adolescents with Lyme borreliosis and tick bite or suspection on tick bite were examined. The examined patients were aged from 14 months to 24 years and divided into four age groups. Skin lesions were discovered in 25 percent of patients with tick bite. Erythema migrans occurred in 91 percent, Lymphocytoma in 3 percent and sclerodermatous lesions (Lichen sclerosus et atrophicus and Morphea) in 6 percent of patients with Lyme disease. Serologic tests on the presence of antibodies to Borreliae burgdorferi were performed in 96 percent of cases with tick bite. Antibody titer 1:80 or higher in 8 percent of patients with tick bite, was discovered. We found positive serologic test results in 5 (29 percent) of 29 persons with Erythema migrans, in 4 (4 percent) of 110 patients with tick bite (without skin lesions), as well as, in 1 patient with Lymphocytoma. Antibiotic therapy was applied in all cases with Erythema migrans, in person with Lymphocytoma, as well as, in patients with asymptomatic infections (patients without skin lesion recalling a tick bite and with antibodies against Borrelia burgdorferi). A general sensitivity, to infection with Borrelia burgdorferi, is stressed, a fact based on appearance by Lyme borreliosis in all age groups even in the newborn children.
NLM PUBMED CIT. ID: 8262401 NLM CIT. ID: 94085808
SOURCE: Glas Srp Akad Nauka [Med] 1993;(43):161-7

TITLE:
[Skin changes in patients with Lyme borreliosis]
VERNACULAR TITLE:
Kozne promene u obolelih od Lyme borreliosis.
AUTHORS:
Karadaglic Dj; Veljkovic M; Lazovic M; Jankovic B; Grubisic S; Jurisic D; Zecevic R; Krstic A
LANGUAGES:
Scc
ABSTRACT:
In introduction some clinical characteristics of Erythema migrans, Borrelia lymphocytoma and acrodermatitis chronica atrophica has been described. The importance of atypical forms of Erythema migrans and the difficulties in differential diagnosis of cutaneous manifestation has been stressed. In a prospective, and partly retrospective investigation of 1292 persons with tick bites, signs of Lyme borreliosis have been found in 18.96%. Number of such persons seen in dermatology wards is rising, and 18.2% of these are children less than 15 years of age. Patients seen in dermatology are mostly women (56.5%:43.5%). Nearly half of the patients with Erythema migrans did not known that they had a tick bite (42.5%). Lyme borreliosis was manifested mainly as Erythema migrans, 89% of patients. Borrelia lymphocytoma was encountered in 2%, and Acrodermatitis chronica atrophicans in 0.4% of patients, significantly less than in other reports. Sclerotic skin lesions were found in 4.1% of patients, and some macular and urticarial lesions were recorded. An incubation period generally less than three weeks preceded to skin manifestations, but in some patients this period could not be recorded. Skin lesions were located on lower extremities in 50.4% of patients, trunk in 25.5%, and upper extremities in 10.5% of patients. In 87% of patients skin lesions lasted less than three weeks. Symptoms were present in 62% of patients. Seropositivity to Borrelia burgdorferi has been found in 10.2% of patients, mostly three weeks after the tick bite.
NLM PUBMED CIT. ID: 8262399 NLM CIT. ID: 94085806
SOURCE: Glas Srp Akad Nauka [Med] 1993;(43):141-53

TITLE:
[Neurologic manifestations in Lyme disease. Apropos of 22 cases]
VERNACULAR TITLE:
Manifestations neurologiques de la maladie de Lyme. A propos de 22 cas.
AUTHORS:
Ragnaud JM; Morlat P; Ferrer X; Orgogozo JM; Julien J; Beylot J; Aubertin J
AUTHOR AFFILIATION:
Clinique medicale et des maladies infectieuses, hopital Pellegrin, Bordeaux.
LANGUAGES:
Fre
ABSTRACT:
The main clinical and biological features of 22 cases of neurological forms of Lyme disease are reviewed. Radiculitis (n = 15), cranial nevritis (n = 7), meningitis (n = 5) and encephalitis (n = 4) are often associated. Tick bites were previously noticed in only 40% of cases; erythema chronicum migrans in 73%, "one to six months before the onset of neurological symptoms". Titers of Borrelia Burgdorferi antibodies were always above 1/256. Among 18 patients, DR W2 HLA haplotype was present in 15.
NLM PUBMED CIT. ID: 8009078 NLM CIT. ID: 94278335
SOURCE: Rev Med Interne 1993;14(10):985

TITLE:
Current recommendations for the treatment of Lyme disease.
AUTHORS:
Sigal LH
AUTHOR AFFILIATION:
Lyme Disease Center, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick.
LANGUAGES:
Eng
ABSTRACT:
Lyme disease is a multisystem inflammatory disease caused by infection with Borrelia burgdorferi. Soon after the tick bite which transmits the infection, the pathognomonic skin rash erythema chronicum migrans occurs in 50 to 70% of patients, often with associated symptoms resembling a 'summer cold' or viral infection. Therapy for this stage of disease consists of 3 to 4 weeks of oral therapy. The agents currently used are: amoxicillin (500 mg 3 or 4 times daily) with or without probenecid 500 mg 3 times daily, doxycycline (100 mg twice daily), or tetracycline (500 mg 4 times daily). Longer duration therapy has never been evaluated and therefore is not currently indicated. Even patients with severe early manifestations of Lyme disease should be treated orally. Later features of Lyme disease include carditis and neurological disease, which can occur days to approximately 9 months after the onset of illness, and arthritis and neurological disease which can occur weeks to years after the onset of the illness. Treatment at this stage is with 2 to 3 weeks of intravenous antibiotics, currently cefotaxime (3 g every 12 hours), ceftriaxone (1 g every 12 hours or 2 g every day) and benzylpenicillin (14 g in divided doses). There is no evidence that longer duration therapy is indicated or more efficacious. The exception to this suggestion is the patient with isolated facial seventh cranial nerve palsy; if such a patient has no other signs or symptoms to suggest Lyme disease and has normal spinal fluid, oral therapy is usually sufficient, although some physicians will give concomitant corticosteroids to hasten the resolution of the palsy. Of major consequence to the practitioner and patient is the possibility that persistent symptoms (e.g. fibromyalgia) may be caused by a process which is no longer antibiotic-sensitive. Special care in the management of so-called 'chronic Lyme disease' is crucial lest the clinician prescribes prolonged or unending courses of antibiotics for such noninfectious problems.
NLM PUBMED CIT. ID: 1379147 NLM CIT. ID: 92347202
SOURCE: Drugs 1992 May;43(5):683-99

TITLE:
[Positive anti-Borrelia antibodies in patients with clinical manifestations compatible with neuroborreliosis]
VERNACULAR TITLE:
Anticuerpos anti-Borrelia positivos en pacientes con manifestaciones clinicas compatibles con neuroborreliosis.
AUTHORS:
Izquierdo G; Aguilar J; Barranquero A; Navarro G; Borobio MV; Angulo S; Dominguez I; Quesada MA
AUTHOR AFFILIATION:
Servicio de Neurologia, Hospital Universitario Virgen de la Macarena, Sevilla.
LANGUAGES:
Spa
ABSTRACT:
The clinical features of 19 patients with neurological manifestations unexplained by another disease and positive serology for Borrelia burgdorferi were studied. ECM was present in only 11% of the cases and 32% referred tick bite. The characteristic features for suspicion of NB according to our series was the presence of polyneuritis in 84% of the cases specially in the form of multiple mononeuritis and involvement of the facial nerve (79%) leading to even greater suspicion with the association of V pair involvement. Seizures, sleep disorders, and higher mental dysfunction may be found in association with other more characteristic neurological features. The typical triad of NB (aseptic meningitis, facial paralysis and polyradiculoneuritis) was found in 21% of the patients and in the absence of another disease to justify the same neuroborreliosis (NB) seemed evident. In all the cases components of this triad were found. Headache, arthralgia, fever and, less frequently, arthritis are other symptoms often past with the presence of anti-BB antibodies. Patients with the shortest evolution most frequently presented antecedents of facial paralysis, sensory alterations and Romberg's sign than patients of longer evolution. CSF demonstrated the presence of pleocytosis in 24% of the cases and in only one patient a slight increase in the intrathecal activity of IgG was observed which may be of use in differential diagnosis with MS. MR showed alterations in 61% of the patients and, while not specific, the lesions present subcortical predominance.
NLM PUBMED CIT. ID: 1610600 NLM CIT. ID: 92304621
SOURCE: Neurologia 1992 Feb;7(2):50-4

TITLE:
Lyme arthritis in The Netherlands: a nationwide survey among rheumatologists.
AUTHORS:
Blaauw I; Nohlmans L; van den Berg-Loonen E; Rasker J; van der Linden S
AUTHOR AFFILIATION:
Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
LANGUAGES:
Eng
ABSTRACT:
A nationwide survey among all 118 Dutch rheumatologists (response rate 85%) yielded 42 patients with Lyme arthritis. The arthritis was nonpersistent in all these patients. A tick bite was reported by 23 of these 42 patients (55%). Erythema migrans was recalled by 19 patients (45%). Cardiac manifestations occurred in 4 patients (9%) and neurologic symptoms in 14 patients (33%). By immunoabsorbent assay or immunofluorescence technique 37 patients (88%) had positive IgG antibodies to Borrelia burgdorferi. The distribution of HLA-DR alleles of 28 of these patients was not different from the healthy population. The response to antibiotic treatment was considered good in 34 patients (81%). The clinical features of the Dutch patients with Lyme arthritis closely resemble the description of the disease reported from the United States.
NLM PUBMED CIT. ID: 1795318 NLM CIT. ID: 92177289
SOURCE: J Rheumatol 1991 Dec;18(12):1819-22

TITLE:
Lyme borreliosis in Dutch forestry workers.
AUTHORS:
Kuiper H; de Jongh BM; Nauta AP; Houweling H; Wiessing LG; van Charante AW; Spanjaard L
AUTHOR AFFILIATION:
Department of Medical Microbiology, University of Amsterdam, The Netherlands.
LANGUAGES:
Eng
ABSTRACT:
Serum samples from 127 Dutch forestry workers and 127 matched controls were tested for antibodies against Borrelia burgdorferi in an indirect immunofluorescence assay (IFA). Those of the forestry workers were also tested by Western blotting. The forestry workers were examined clinically for evidence of Lyme borreliosis without the examiner or the workers knowing the results of the laboratory tests. Seroprevalence of B. burgdorferi antibodies among forestry workers (25/127) was significantly higher than among controls matched for age and place of residence (8/127), odds ratio 3.7 (95% CI 1.5-9.7). Of the 25 sera of forestry workers positive in the IFA, 23 reacted with at least five bacterial polypeptides in the Western blot test. According to adapted CDC criteria, seven forestry workers (6%) were classified as being a case of Lyme borreliosis. In only one of them had the diagnosis been made before this investigation. Five persons had a history of erythema migrans, one of arthritis, and one of persistent infection. We conclude that Lyme borreliosis is an occupational disease among forestry workers in the Netherlands, with a three-fold higher seroprevalence than among matched controls. The disease, often not diagnosed among this high-risk group, warrants more attention to achieve early recognition and to prevent late complications.
NLM PUBMED CIT. ID: 1753136 NLM CIT. ID: 92091833
SOURCE: J Infect 1991 Nov;23(3):279-86

TITLE:
The descriptive epidemiology of Lyme disease in Oklahoma.
AUTHORS:
Reiner KL; Huycke MM; McNabb SJ
AUTHOR AFFILIATION:
General Communicable Diseases Division, Oklahoma State Department of Health (OSDH), Oklahoma City.
LANGUAGES:
Eng
ABSTRACT:
Lyme disease is a tick-borne illness that primarily occurs in the United States in three endemic areas: the northeast, upper midwest, and pacific coastal regions. Although Oklahoma is considered a non-endemic area of Lyme disease, other tick-borne infections such as Rocky Mountain spotted fever, ehrlichiosis, and tularemia occur at endemic levels. In order to determine the extent of Lyme disease in Oklahoma, the Oklahoma State Department of Health collected information on all possible cases of Lyme disease. The first reported Oklahoma case occurred in 1985. In 1988, and 1989, 8 and 25 cases, respectively, of Lyme disease were reported in Oklahoma residents who acquired their infection indigenously. The mean age of case-patients was 38 years. Twenty-eight of 33 (85%) case-patients were white, and 4 of 33 (12%) were American Indian (race was unknown for 1 case-patient). The female/male ratio was 2.3. Most case-patients had onset of illness between May and September. Twenty-two counties reported cases, with Oklahoma County accounting for 4 of 33 (12%). Only 21 of 33 (64%) recalled a tick bite, and only 19 of 33 (58%) had erythema migrans. Continued active case-finding and passive reporting (as now mandated by state law) will further increase our knowledge of the epidemiology, ecology, and prevention of Lyme disease in Oklahoma.
NLM PUBMED CIT. ID: 1744781 NLM CIT. ID: 92079140
SOURCE: J Okla State Med Assoc 1991 Oct;84(10):503-9

TITLE:
The long-term course of Lyme arthritis in children [see comments]
AUTHORS:
Szer IS; Taylor E; Steere AC
AUTHOR AFFILIATION:
Department of Pediatrics, Floating Hospital for Infants and Children, New England Medical Center, Tufts University School of Medicine, Boston.
COMMENTS:
Comment in: N Engl J Med 1991 Dec 26;325(26):1886
LANGUAGES:
Eng
GRANT/CONTRACT ID:
AR-20358/AR/NIAMS
ABSTRACT:
BACKGROUND AND METHODS. The natural history of Lyme disease is not completely known. We studied the long-term course of Lyme arthritis in 46 children in whom the onset of the disease occurred between 1976 and 1979 and who received no antibiotic therapy for at least the first four years of the illness. RESULTS. Of the 46 children (age range, 2 to 15 years), 33 (72 percent) initially had erythema migrans, 7 (15 percent) had influenza-like symptoms, and 6 (13 percent) had migratory joint pain. These manifestations were followed by brief attacks of arthritis, particularly affecting the knee. The percentage of children with recurrent episodes of arthritis declined each year. By year 4, only 10 children still had a mean of two episodes of arthritis per year; the duration of arthritis was generally longer in older children (P less than 0.05). During the sixth year of illness, two children (4 percent) had keratitis, and more than 10 years after the onset of disease, a subtle encephalopathy developed in two other children. Of the 39 children whom we were able to contact in 1988-1989, 12 (31 percent) still had occasional brief episodes of joint pain and 1 (3 percent) had marked fatigue. All 46 children had positive IgG antibody responses to Borrelia burgdorferi throughout the illness and on long-term follow-up. As compared with those who became asymptomatic, the children with recurrent symptoms more often had IgM responses to the spirochete and had significantly higher IgG titers (P less than 0.05). CONCLUSIONS. The course of initially untreated Lyme disease in children may include acute infection followed by attacks of arthritis and then by keratitis, subtle joint pain, or chronic encephalopathy.
NLM PUBMED CIT. ID: 2052061 NLM CIT. ID: 91270328
SOURCE: N Engl J Med 1991 Jul 18;325(3):159-63

TITLE:
[Borrelia infections from a dermatological viewpoint]
VERNACULAR TITLE:
Borrelieninfektion aus dermatologischer Sicht.
AUTHORS:
Vocks E; Engst R; Borelli S
AUTHOR AFFILIATION:
Dermatologische Klinik und Poliklinik Technischen Universitat Munchen.
LANGUAGES:
Ger
ABSTRACT:
Erythema migrans (EM), Borrelia lymphocytoma (BL) and acrodermatitis chronica atrophicans (ACA) are the established dermatological manifestations of borrelia infection, a complex multiorganic disease. Analogous to syphilis Borrelia infection can be classified by three stages, at which stage I (localized infection) and II (disseminated infection) are manifestations of early infection and stage III (persistent infection) a symptom of late infection. At all stages skin manifestations can be present, the above mentioned as stage-marker as well as other non-specific polymorphous skin lesions which sometimes appear at stage II. Because of its frequent (60-80%) occurrence in all borrelia infections EM has a pathognomonic importance for borrelia infection. In diagnosis serology is currently the only practical laboratory aid. False negative and false positive results must be considered. Treatment of choice is ceftriaxone, penicillin G (or amoxycillin) or tetracycline. Prophylactic antibiotic therapy for tick bites is not recommended. Congenital borrelia infections seem to be unusual, but it is likely that they can occur and cause different adverse fetal outcome or abortion.
NLM PUBMED CIT. ID: 1922122 NLM CIT. ID: 92017931
SOURCE: Monatsschr Kinderheilkd 1991 Jul;139(7):425-8

TITLE:
[Geographic distribution of Lyme disease in Mudanjiang]
AUTHORS:
Zhang Z
AUTHOR AFFILIATION:
Institute of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine.
LANGUAGES:
Chi
ABSTRACT:
Four forestry plant in Mudanjiang with different geographic characteristics were investigated in 1989. 2178 people were inquired and examined. 74 cases including 54 of ECM, 12 of nervous system disorder and 8 of arthritis were confirmed as Lyme disease. There were some patients at other places of forest areas of Mudanjiang. The prevalence rate of Lyme disease ranged from 1% to 4.5% at four plants with higher rate in mountainous area than in hilly land. It is first report that one strain of Lyme disease spirochetes was isolated from a patient with psychiatric derangement. It proved that Ixodes persulcatus play the leading role in transmission of Lyme disease spirochetes, as the growth curve of Ixodes persul catus is coincident with that of the patient with ECM.
NLM PUBMED CIT. ID: 1863948 NLM CIT. ID: 91322805
SOURCE: Chung Hua Liu Hsing Ping Hsueh Tsa Chih 1991 Jun;12(3):154-7

TITLE:
Lyme disease during pregnancy.
AUTHORS:
Schutzer SE; Janniger CK; Schwartz RA
AUTHOR AFFILIATION:
Department of Allergy and Immunology, New Jersey Medical School, Newark 07103-2714.
LANGUAGES:
Eng
ABSTRACT:
Lyme disease, caused by infection with Borrelia burgdorferi, can affect those exposed to a vector tick. Pregnant women are no exception, and such infection places the fetus at risk. It is particularly important to recognize the disease early so that effective therapy may be instituted. Although the present patient had a favorable outcome, not all do. Clinical diagnosis is especially important since conventional laboratory tests may be inadequate or require lengthy periods of time before a positive result occurs. The dermatologic sign of Lyme disease, erythema migrans, although occurring in only 50 percent of cases, is likely to be the most important diagnostic sign.
NLM PUBMED CIT. ID: 2070648 NLM CIT. ID: 91300895
SOURCE: Cutis 1991 Apr;47(4):267-8

TITLE:
Diagnosing Lyme disease: often simple, often difficult.
AUTHORS:
Schutzer SE; Schwartz RA
AUTHOR AFFILIATION:
Department of Medicine, UMDNJ-New Jersey Medical School, Newark 07103.
LANGUAGES:
Eng
ABSTRACT:
Lyme disease has as its hallmark erythema migrans. However, it is only present in about one half of the patients who contract this disease. In its absence, the diagnosis of Lyme disease may be difficult. It depends upon a compatible history of exposure and clinical signs and symptoms together with positive results of serologic testing. Unfortunately, seronegativity for antibody to the pathogen may occur both during the first six weeks of infection and be chronic due to the reactive antibody being bound in immune complexes. The selective use of new diagnostic tests may be required to confirm the diagnosis. These tests include assays for antibody or antigen analysis of immune complex components, as well as polymerase chain reactions.
NLM PUBMED CIT. ID: 2070642 NLM CIT. ID: 91300888
SOURCE: Cutis 1991 Apr;47(4):229-30, 232

TITLE:
Diagnosis of Lyme disease based on dermatologic manifestations.
AUTHORS:
Malane MS; Grant-Kels JM; Feder HM Jr; Luger SW
AUTHOR AFFILIATION:
University of Connecticut, Farmington.
LANGUAGES:
Eng
ABSTRACT:
Lyme disease, or Lyme borreliosis, is an infection caused by the spirochete Borrelia burgdorferi, which is most commonly transmitted to humans by a tick bite. Characterized by early and late phases, Lyme disease is a multisystem illness involving the skin, heart, joints, and nervous system. Diagnosis is based predominantly on clinical manifestations, the most specific being dermatologic. Thus, recognizing the dermatologic manifestations of Lyme disease is important for diagnosis and institution of appropriate, effective therapy. Approximately 75% of patients with Lyme disease present with the pathognomonic skin lesion erythema migrans, an expanding erythematous lesion. During early infection, secondary erythema migrans lesions or Borrelia lymphocytoma may occur. Borrelia lymphocytoma commonly presents as an erythematous nodule on the ear lobe or nipple. During late infection, acrodermatitis chronica atrophicans, an erythematous, atrophic plaque unique to Lyme disease may appear; it has been described in about 10% of patients with Lyme disease in Europe. Fibrotic nodules associated with acrodermatitis chronica atrophicans as well as other sclerotic and atrophic lesions, such as morphea, lichen sclerosus et atrophicus, anetoderma, and atrophoderma of Pasini and Pierini, have been seen late in the course of Lyme disease. In a few cases, other sclerodermatous lesions, such as eosinophilic fasciitis and progressive facial hemiatrophy, have been linked to B. burgdorferi infection. We review the cutaneous lesions associated with Lyme disease.
NLM PUBMED CIT. ID: 1994797 NLM CIT. ID: 91136056
SOURCE: Ann Intern Med 1991 Mar 15;114(6):490-8

TITLE:
Indigenous cases of Lyme disease diagnosed in North Carolina.
AUTHORS:
Levine JF; Apperson CS; Spiegel RA; Nicholson WL; Staes CJ
AUTHOR AFFILIATION:
Department of Microbiology, Pathology, and Parasitology, College of Veterinary Medicine, North Carolina State University, Raleigh 27606.
LANGUAGES:
Eng
ABSTRACT:
Between January 1984 and December 1989, 102 indigenous cases of Lyme disease were reported in North Carolina. Lyme disease was reported in each of the three major geographic regions of the state: mountain, piedmont, and coastal plain. One or more diagnoses were made in 42 of 100 counties. Patients ranged in age from 5 months to 78 years (median, 27 years); 58 patients (57%) reported a history of tick exposure within 1 month of the onset of symptoms. Erythema migrans was reported by 93 patients (91%). Arthritis (30%), neurologic symptoms (10%), and cardiac abnormalities (7%) were observed. Thirty of the 102 cases were confirmed serologically by indirect fluorescence microscopy or enzyme-linked immunosorbent assay.
NLM PUBMED CIT. ID: 1986423 NLM CIT. ID: 91095998
SOURCE: South Med J 1991 Jan;84(1):27-31

TITLE:
Joint manifestations of Lyme borreliosis in Czechoslovakian patients.
AUTHORS:
Valesova M; Trnavsky K
AUTHOR AFFILIATION:
Research Institute of Rheumatic Diseases, Prague.
LANGUAGES:
Eng
ABSTRACT:
Involvement of the musculoskeletal system in 50 Lyme borreliosis patients seen in Czechoslovakia is described. Thirty-three patients reported tick bites or that they had removed a tick, four patients had been bitten by some other insect. Skin reaction following tick bite were found in 29 patients. Neurologic involvements have been described in 40 subjects. In one patient complete heart block developed after ECM, so that a permanent pacemaker was necessary for two weeks. Mainly three types of involvement of the musculoskeletal system were observed, mostly as intermittent episodes of arthralgia or migratory musculoskeletal pain. In 37 patients brief attacks of monoarthritis or asymmetrical oligoarthritis were seen, chiefly of intermittent subacute course. Chronic arthritis was diagnosed in seven cases, sacroiliitis in four patients. The authors discuss differential diagnosis, especially in patients with chronic joint involvement.
NLM PUBMED CIT. ID: 2238860 NLM CIT. ID: 91049939
SOURCE: Z Rheumatol 1990 Jul-Aug;49(4):192-6

TITLE:
[Data on the epidemiology of Lyme disease in Bulgaria]
VERNACULAR TITLE:
Materialy po epidemiologii bolezni Laima v Bolgarii.
AUTHORS:
Angelov L; Aeshliman A; Korenberg E; Gern L; Shereva Kh; Marinova R; Kalinin M
LANGUAGES:
Rus
ABSTRACT:
134 patients with clinically, epidemiologically and serologically confirmed Lyme's disease have been examined. 89.5% of them had erythema chronicum migrans, 112 patients (83.6%) were known to have had tick bites. The majority of patients were white-collar workers and townspeople. Hungry ticks collected from plants were shown to contain B. burgdorferi. 497 foresters and animal farmers have been serologically examined, using an indirect immunofluorescence test. Antibodies to B. burgdorferi in diagnostic titres have been revealed in 15.3% of foresters and 17.8% of animal farmers.
NLM PUBMED CIT. ID: 2233527 NLM CIT. ID: 91042129
SOURCE: Med Parazitol (Mosk) 1990 Jul-Aug;(4):13-4

TITLE:
Lyme disease in childhood: clinical and epidemiologic features of ninety cases.
AUTHORS:
Williams CL; Strobino B; Lee A; Curran AS; Benach JL; Inamdar S; Cristofaro R
AUTHOR AFFILIATION:
Department of Pediatrics, New York Medical College, Valhalla 10595.
LANGUAGES:
Eng
ABSTRACT:
In 1982 and 1983 practicing pediatricians in a Lyme disease-endemic county, reported 90 cases of Lyme disease among children 19 years of age and younger (median age, 9 years). Three-fourths of the children had initial symptom onset in the summer months, with peak incidence in July. Infection occurred twice as often in boys than in girls, and tick bites were recalled by less than half (49%) of the children or parents. Erythema chronicum migrans was present in two-thirds (67%) of the cases with median onset 7 days after a definite tick bite. Arthritis or arthralgia occurred in 59% and neurologic symptoms, especially seventh nerve palsy, occurred in 14%. Asymmetric involvement of a few large joints, especially the knee, was most commonly reported for those with joint involvement. antibiotics were prescribed for 79% of the children, three-fourths of whom were treated with oral penicillin. Initial diagnosis of Lyme disease is usually made on clinical grounds alone because serologic tests are often negative. Serologic tests for antibody to Borrelia burgdorferi were more often positive in cases with neurological or joint involvement, in addition to erythema chronicums migrans (80%), than in cases presenting with erythema chronicums migrans only.
NLM PUBMED CIT. ID: 2300409 NLM CIT. ID: 90138041
SOURCE: Pediatr Infect Dis J 1990 Jan;9(1):10-4

TITLE:
Isolation of Borrelia burgdorferi from the blood of seven patients with Lyme disease.
AUTHORS:
Nadelman RB; Pavia CS; Magnarelli LA; Wormser GP
AUTHOR AFFILIATION:
Department of Medicine, New York Medical College, Valhalia.
LANGUAGES:
Eng
GRANT/CONTRACT ID:
AI-19824/AI/NIAID
ABSTRACT:
PURPOSE: Borrelia burgdorferi, the etiologic agent of Lyme disease, has rarely been successfully cultured from blood. We report on seven patients from Westchester County, New York, with B. burgdorferi bacteremia diagnosed between April 1987 and August 1987. PATIENTS AND METHODS: One hundred thirty-two attempts to isolate spirochetes were made on blood specimens obtained from 104 patients. Twenty-two of these specimens were obtained from nine patients who had recently been bitten by Ixodes ticks but who were asymptomatic. Heparinized blood or serum specimens (0.2 to 0.4 mL) were inoculated onto 6 mL of modified Barbour-Stoenner-Kelly medium. Lyme serology was performed by enzyme-linked immunosorbent polyvalent, IgM, and IgG assays, fluorescent immunoassay, and microhemagglutination. RESULTS: Four of the seven patients had erythema migrans, two had facial nerve palsy, and one had a flu-like syndrome without rash. These patients represented 21% (four of 19) of all patients with the characteristic skin lesion who had blood cultures for B. burgdorferi, and 40% (two of five) of all those with facial nerve palsy. Serologic testing was frequently nonreactive; two patients had no detectable antibody on multiple sera by five different assays. All patients improved with antibiotic treatment, and had negative subsequent blood cultures, but five of seven had persistent complaints after completion of therapy. CONCLUSION: Culturing blood for B. burgdorferi may be useful in confirming the diagnosis of Lyme disease in selected patients. Use of spirochete blood cultures may facilitate a better understanding of the pathogenesis and natural history of Lyme disease.
NLM PUBMED CIT. ID: 2294761 NLM CIT. ID: 90102528
SOURCE: Am J Med 1990 Jan;88(1):21-6

TITLE:
[Investigation of Lyme disease in northeast of China]
AUTHORS:
Zhang ZF
LANGUAGES:
Chi
ABSTRACT:
In 1987-1988, we conducted investigation of Lyme disease in Northeast of China. The disease was widespread in the forest areas of Heilonjiang and Jilin provinces where Ixodes persulcatus population thrives. The disease occurred at Daqing tree farm where 628 people were inquired and examined among them, 37 cases including 23 cases of ECM, 6 cases of neurological abnormalities, 7 cases of arthritis and 1 case of acrodermatitis chronica atrophicans were confirmed being Lyme disease. The sera of patients suspected with the disease and that of the residents at Xiaobai tree farm were tested for antibodies against Borrelia burgdorferi (B31) by ELISA. Seventeen out of 22 patients were positive and 54 out of 240 residents had significant IgG titers. Samples of tick midgut were inoculated into BSK medium and cultivated. Three isolates of spirochetes were cultivated from Ixodes persulcatus. One of them (M7) was confirmed being Borrelia burgdorferi. Recently another isolate was cultivated from a patient with ECM.
NLM PUBMED CIT. ID: 2611866 NLM CIT. ID: 90124589
SOURCE: Chung Hua Liu Hsing Ping Hsueh Tsa Chih 1989 Oct;10(5):261-4

TITLE:
Lyme disease surveillance in the United States, 1983-1986.
AUTHORS:
Ciesielski CA; Markowitz LE; Horsley R; Hightower AW; Russell H; Broome CV
AUTHOR AFFILIATION:
Epidemiology Section, Centers for Disease Control, Atlanta, Georgia 30333.
LANGUAGES:
Eng
ABSTRACT:
During 1983-1986, 5,016 cases of Lyme disease were reported to the Centers for Disease Control. Cases were acquired in 31 states; however, 86% of the cases were acquired in seven states: Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Wisconsin, and Minnesota. For 63% of patients the disease began in summer; 52% recalled a tick bite. Erythema chronicum migrans (ECM) occurred in 91% of the patients; arthritis, in 57%; neurologic complications, in 18%; and cardiac manifestations, in 10%. When serum samples were obtained greater than or equal to 21 days after onset of symptoms, 14% (6 of 42) with ECM alone and 19% (17 of 89) with complicated Lyme disease (ECM plus organ-system involvement) had positive serologic tests. Antimicrobial therapy did not appear to affect serologic response. Lyme disease is now the most commonly reported tick-borne illness in the United States and has been reported from 32 states since 1980. Physicians nationwide need to be familiar with the protean signs and symptoms associated with Lyme disease and with the limitations of current serologic techniques in diagnosing early illness.
NLM PUBMED CIT. ID: 2682955 NLM CIT. ID: 90048515
SOURCE: Rev Infect Dis 1989 Sep-Oct;11 Suppl 6:S1435-41

TITLE:
[Articular involvement in Swiss patients with a Borrelia burgdorferi infection--report of 8 cases]
VERNACULAR TITLE:
Atteintes articulaires chez des patients suisses avec une infection a Borrelia burgdorferi--rapport de huit cas.
AUTHORS:
Gerster JC
LANGUAGES:
Fre
ABSTRACT:
Eight cases of Lyme's arthritis are reported. In four of them, they are related to an erythema chronicum migrans, in two to an acrodermatitis atrophicans. In two cases, there was no cutaneous manifestation, but the serology was strongly positive for Borrelia burgdorferi, and there was rapid relief of the pain with antibiotic therapy. It is suggested that Lyme's arthritis is not rare in Switzerland and that it must be searched for in every case of arthritis of unknown etiology, especially when there is a history of cutaneous involvement. The arthritis is cured by antibiotics.
NLM PUBMED CIT. ID: 2740677 NLM CIT. ID: 89297941
SOURCE: Schweiz Rundsch Med Prax 1989 May 23;78(21):614-6

TITLE:
Epidemiological and clinical features of 1,149 persons with Lyme disease identified by laboratory-based surveillance in Connecticut.
AUTHORS:
Petersen LR; Sweeney AH; Checko PJ; Magnarelli LA; Mshar PA; Gunn RA; Hadler JL
AUTHOR AFFILIATION:
Division of Field Services, Centers for Disease Control, Atlanta, Georgia 30333.
LANGUAGES:
Eng
ABSTRACT:
Laboratory-based surveillance of Lyme disease in Connecticut during 1984 and 1985 identified 3,098 persons with suspected Lyme disease; 1,149 were defined as cases. Lyme disease incidence in Connecticut towns ranged from none to 1,407 cases per 100,000 population in 1985. A comparison of 1985 data with data from 1977 epidemiologic studies indicated that incidence increased by 129 percent to 453 percent in towns previously known to be endemic for Lyme disease and that Lyme disease had spread northward into towns thought to be free of Lyme disease in 1977. Children aged five to 14 years had the highest incidence. Of persons with Lyme disease, 83 percent had erythema migrans, 24 percent had arthritis, 8 percent had neurologic sequelae, and 2 percent had cardiac sequelae. The distribution of symptoms was age-dependent: case-persons less than 20 years old were almost twice as likely to have arthritis than older case-persons (35 percent versus 18 percent). Of persons with arthritis, 92 percent of those less than 20 years of age, compared to 68 percent of older persons, did not have antecedent erythema migrans. We conclude that Lyme disease is increasing in incidence and geographic distribution in Connecticut. Of those with Lyme disease, children may be more likely than adults to develop arthritis and have it as their first major disease manifestation.
NLM PUBMED CIT. ID: 2683415 NLM CIT. ID: 90051459
SOURCE: Yale J Biol Med 1989 May-Jun;62(3):253-62

TITLE:
Lyme borreliosis in Finland in 1986-1988.
AUTHORS:
Schauman K; Kovanen J; Seppala I
AUTHOR AFFILIATION:
Department of Bacteriology, University of Helsinki, Finland.
LANGUAGES:
Eng
ABSTRACT:
In 1986-1988 there were 123 patients with positive serology for Lyme borreliosis out of 4000 sera referred to the Department of Bacteriology and Immunology, University of Helsinki. Of the 63 patients with positive serology in 1986-1987 20 showed a predominant involvement of the nervous system, 18 complained of joint symptoms and 11 patients merely showed a skin involvement including 8 patients with erythema chronicum migrans (ECM) and 3 patients with acrodermatitis chronica atrophicans (ACA). Two of the patients had unspecific general symptoms and in 5 patients the type of involvement remained unknown. The serology was considered to be falsely positive in 2 patients with tuberculous meningitis, in one with syphilis and in another with recurrent fever.
NLM PUBMED CIT. ID: 2686770 NLM CIT. ID: 90074697
SOURCE: Biomed Pharmacother 1989;43(6):427-30

TITLE:
Orthopaedic complications of Lyme disease in children.
AUTHORS:
Davidson RS
AUTHOR AFFILIATION:
Department of Orthoapedic Surgery, Childrens' Hospital Philadelphia, PA 19104.
LANGUAGES:
Eng
ABSTRACT:
Lyme disease is transmitted by the tick Ixodes dammini ("deer tick") or a related ixodid tick. Early diagnosis of children with Lyme disease is difficult because the bite of the ixodid tick often goes unnoticed. Furthermore, erythema chronicum migrans, the characteristic rash of the disease, occurs in less than 50% of cases. However, an awareness of orthopaedic complications of Lyme disease may facilitate an early diagnosis of this disease. Orthopaedic complications of Lyme disease include those which are oligoarticular in nature. Brief intermittent attacks of swelling and pain in one or more joints--primarily large ones--is the pattern of disease most frequently presented. The knee is the joint most commonly affected. In most cases, pain is not severe enough to debilitate the patient or prevent weight-bearing activity. An elevated sedimentation rate is the only consistently abnormal routine laboratory finding in Lyme disease. The only radiographic abnormalities noted in children are effusion and osteopenia. However, the radiograph of a patient known to have Lyme disease may not show any abnormalities at all. Lyme disease shares symptoms in common with septic arthritis and juvenile rheumatoid arthritis. Whenever a distinction between Lyme arthritis and septic arthritis is difficult to make, treatment should be directed at septic arthritis while serological tests for Lyme disease are pending. The physician should consider Lyme disease to be a possible diagnosis of any patient with arthritis and a history of rash or fever, idiopathic neurological disease, or a cardiac conduction defect--especially if there is a history of possible exposure to the carrier tick.(ABSTRACT TRUNCATED AT 250 WORDS)
NLM PUBMED CIT. ID: 2686766 NLM CIT. ID: 90074693
SOURCE: Biomed Pharmacother 1989;43(6):405-8

TITLE:
A clinical and sero-epidemiological study of 190 Belgian patients suffering from Lyme borreliosis.
AUTHORS:
Bigaignon G; Tomasi JP; Goubau P; Martin P; Pierard D; Sindic CJ; Dupuis M; Marcelis L; Degreef H; Willocx D; et al.
LANGUAGES:
Eng
ABSTRACT:
We present a sero-epidemiological study of 190 Belgian cases of Lyme borreliosis, a multisystemic disease caused by the spirochaete Borrelia burgdorferi and transmitted by a tick bite. The whole spectrum of clinical pictures was observed in these patients, including "erythema chronicum migrans" (63%), neurological involvement (47%) and arthritis (22%), frequently in combination. Our results are compared to findings in other countries. Among the 437 Ixodes ricinus ticks collected in the Sambre and Meuse valleys around Namur, we discovered 43 ticks (9.8%) with spirochaetes in the midgut. The ecology of these arthropods explains why this infection is more prevalent in the spring and the summer. Perhaps for the same reason, the incidence ranges from low near the coast to medium in the central part and high in the wooded south-eastern part of Belgium. The main conclusions are that Lyme borreliosis is endemic in Belgium, that all the clinical pictures can be observed ant that a clear epidemiological case-definition is needed, combining clinical signs and serological results.
NLM PUBMED CIT. ID: 2683538 NLM CIT. ID: 90052157
SOURCE: Acta Clin Belg 1989;44(3):174-81

TITLE:
Lyme borreliosis in California. Acarological, clinical, and epidemiological studies.
AUTHORS:
Lane RS; Lavoie PE
AUTHOR AFFILIATION:
Department of Entomological Sciences, University of California, Berkeley 94720.
LANGUAGES:
Eng
GRANT/CONTRACT ID:
RR07006/RR/NCRR
AI22501/AI/NIAID
ABSTRACT:
The relative abundance of, and spirochetal-infection rates in, adult ixodid ticks from eight Lyme borreliosis clinical-case areas and two comparison areas were investigated in northern California from late fall to early spring, 1984-87. The western black-legged tick (Ixodes pacificus) was the most abundant species at seven of nine sites yielding specimens as determined with a tick drag method. The Pacific Coast tick (Dermacentor occidentalis) was the most abundant species at two sites, and lesser numbers of this tick and the American dog tick (D. variabilis) were obtained from seven and two sites, respectively. Abundance of I. pacificus adults varied in clinical-case areas as well as in the comparison areas, and was not correlated significantly with spirochetal infection rates in this tick. Overall, spirochetes were detected in 1.4 and 1.0% of the adult I. pacificus collected from clinical case (n = 857) and comparison sites (n = 383), respectively, and in 0.8% of adult D. occidentalis (n = 253) from one comparison area. An additional 244 D. occidentalis adults from all other sites were tested with negative results. Five spirochetal isolates recovered from I. pacificus adults were identified as Borrelia burgdorferi with specific monoclonal antibodies. Seven of 10 patients interviewed reportedly contracted their infections in summer, and six presented with a history of tick bite. Nine patients owned or occasionally harbored one or more dogs, and at least one of the dogs contracted Lyme borreliosis at the same site as its owner. Clinical manifestations of the disease in human patients included erythema migrans (100%), arthritis/arthralgia (60%), neurologic abnormalities (60%), and cardiac involvement (20%). Four of nine patients whose sera were assayed by indirect immunofluorescence contained significant antibody titers to B. burgdorferi.
NLM PUBMED CIT. ID: 3263826 NLM CIT. ID: 89048792
SOURCE: Ann N Y Acad Sci 1988;539:192-203

TITLE:
[Lyme borreliosis in South Germany. Epidemiologic data on the incidence of cases and on the epidemiology of ticks (Ixodes ricinus) carrying Borrelia burgdorferi]
VERNACULAR TITLE:
Lyme-Borreliose in Suddeutschland. Epidemiologische Daten zum Auftreten von Erkrankungsfallen sowie zur Durchseuchung von Zecken (Ixodes ricinus) mit Borrelia burgdorferi.
AUTHORS:
Wilske B; Steinhuber R; Bergmeister H; Fingerle V; Schierz G; Preac-Mursic V; Vanek E; Lorbeer B
AUTHOR AFFILIATION:
Max-von-Pettenkofer-Institut fur Medizinische Mikrobiologie und Hygiene der Universitat Munchen.
LANGUAGES:
Ger
ABSTRACT:
Among 2403 ticks (Ixodes ricinus) tested in 1985 for Borrelia 328 (13.6%) were carriers (adults about 20%, nymphs about 10%, larvae about 1%). The highest prevalence of infected ticks was among adult ticks in the Isar region north of Munich (33.8%). Among 9383 persons whose serum had been examined by fluorescence serology in 1985 and 1986, 1035 (11%) had raised Borrelia-specific IgG and/or IgM antibodies greater than or equal to 1:64. In 18.7% only IgM antibodies were demonstrated. Among 375 proven cases there were 78 with erythema migrans, 211 with neurological signs, 48 with Lyme arthritis and 36 with acrodermatitis. Seasonal incidence peaks were in June-August for erythema migrans, July-September for neurological signs, with no clear-cut seasonal peaks with Lyme arthritis and acrodermatitis. The incubation time for 80% of cases of each abnormality was 5-29 days for erythema migrans, 20-59 for neurological signs and 2-8 months for Lyme arthritis. Erythema migrans was most frequent among those aged 30-60 years, neurological signs among children and juveniles up to 20 years and those aged 40 to 70 years, Lyme arthritis among those aged 30-60 years, and acrodermatitis among those aged 40-80 years. Significantly more women than men developed acrodermatitis.
NLM PUBMED CIT. ID: 3678074 NLM CIT. ID: 88054604
SOURCE: Dtsch Med Wochenschr 1987 Nov 6;112(45):1730-6

TITLE:
Clinical and geographic characteristics of Lyme disease in New York.
AUTHORS:
Benach JL; Coleman JL
LANGUAGES:
Eng
ABSTRACT:
The clinical and geographic characteristics of 679 patients who met the clinical definition of Lyme disease and who had antibody titers of greater than or equal to 1: 128 to Borrelia burgdorferi for a two year period, 1983-1984, are described. Males outnumbered females 60% to 40% for the two year period and nearly half of all cases were children and young adults nineteen years old or younger. Forty percent of the patients reported single or multiple tick bites prior to the onset of illness and tick bites were clustered in the summer months. Skin lesions (ECM) were reported in 63% of all the patients. Joint involvement as the only manifestation of Lyme disease was reported in 21% and 22% of all the patients in 1983 and 1984 respectively. A 2: 1 ratio of males to females was noted on this subgroup and 63% of these were 19 years old or less. Onset of joint manifestations were most frequent in the last three months of the year. Neurological manifestations were noted in 20% of the patients with facial palsy being the most frequent. Twenty nine patients had neurological disorders as the only manifestation of Lyme disease. Cardiovascular symptoms were reported in 26 patients (4%). The secondary manifestations of Lyme disease were of summer and early fall onset. Lyme disease in New York is restricted to suburbs north of New York City in Westchester County, and in suburbs to the east of New York City in Suffolk County, Long Island. Incidence for the two year period can range from 0.01 cases per 1000 in some communities to 28 cases per 1000 in highly endemic areas.
NLM PUBMED CIT. ID: 3591104 NLM CIT. ID: 87237063
SOURCE: Zentralbl Bakteriol Mikrobiol Hyg [A] 1987 Feb;263(3):477-82

TITLE:
Epidemiology of borrelia infections in Austria.
AUTHORS:
Stanek G; Flamm H; Groh V; Hirschl A; Kristoferitsch W; Neumann R; Schmutzhard E; Wewalka G
LANGUAGES:
Eng
ABSTRACT:
From April 1984 to July 1985 873 cases of Borrelia infections were registered at the Hygiene Institute of the University of Vienna. 2609 serum samples of these patients were investigated for antibodies against B. burgdorferi by means of IFA- and ELISA-tests. Erythema chronicum migrans (ECM) was recognized in 60.9% of patients, neurological abnormalities were recorded in 23.4% of which the majority manifested themselves as polyradiculitis and meningopolyneuritis (MPN). Acrodermatitis chronica atrophicans (ACA) was recognized in 11.5%. A small number of patients suffered from Lymphadenosis cutis benigna (LCB), arthritis and cardiac abnormalities. Sixty percent of patients were females and 40% males. Infections were found in all age groups ranging from 2-83 years in females and 1-85 years in males. Tick- or insect-bites prior to the onset of illness were reported by 47.2% and 15.6% of patients, respectively. The main vector is the hard tick Ixodes ricinus. Flying insects from the family tabanidae, i.e. Chrysops caecutiens and Haematopota species, must also be considered as transmitters. Antibodies to B. burgdorferi were found in 22.3%, 93.6% and 100% of sera from patients with ECM, MPN and ACA, respectively. Six of 11 patients with LCB and all with arthritis and cardiac abnormalities showed serologic reactivity. Geographically, Borrelia infections are distributed in all states of Austria. The seasonal distribution of cases show a peak in July and August, but the onset of clinical manifestation could be observed throughout the year. These results present Austria as an area where tick- or insect-borne Borrelia infections are very frequent and endemic in all Austrian states.
NLM PUBMED CIT. ID: 3591096 NLM CIT. ID: 87237055
SOURCE: Zentralbl Bakteriol Mikrobiol Hyg [A] 1987 Feb;263(3):442-9

TITLE:
Erythema chronicum migrans disease in the Federal Republic of Germany.
AUTHORS:
Schmidt R; Kabatzki J; Hartung S; Ackermann R
LANGUAGES:
Eng
ABSTRACT:
Epidemiology and clinical presentation of Erythema chronicum migrans disease are not well known yet. During a period of only 19 months, serological and clinical investigation of 2955 patients rendered 1106 cases of infection whose widespread incidence was remarkable: of the 328 administration districts of the FRG, 205 were affected. Accordingly, positive antibodies against Borrelia burgdorferi could be demonstrated in an average of 15.7% of the investigated rural population (2830 persons). Typical clinical signs were encountered in 817 of 1106 infected persons. Erythema (458 cases) and meningopolyneuritis (404 cases) were especially prominent. In comparison to Lyme disease the occurrence of arthritis (63 cases), carditis (13 cases) multiple erythema, recurrence, and central nervous symptoms in meningopolyneuritis (10%) were rare. On the other hand, progressive borrelia encephalomyelitis (45 cases) was surprisingly common. Acrodermatitis chronica atrophicans occurred in 72 cases; lymphadenosis benigna cutis in 5 patients. The variability of this disease is demonstrated by the combined syndromes occurring in only 27% of the cases.
NLM PUBMED CIT. ID: 3591095 NLM CIT. ID: 87237054
SOURCE: Zentralbl Bakteriol Mikrobiol Hyg [A] 1987 Feb;263(3):435-41

TITLE:
Emerging pattern of Lyme disease in the United Kingdom and Irish Republic.
AUTHORS:
Muhlemann MF; Wright DJ
LANGUAGES:
Eng
ABSTRACT:
In the past year there have been 68 cases of Lyme disease in the United Kingdom and Republic of Ireland. 41 patients had erythema chronicum migrans, and 8 of them had associated neurological disease. 13 further patients presented with neurological disease without a preceding skin lesion. Myocarditis was present in 1 patient. Ixodes ricinus was confirmed as the vector for Lyme disease. In two areas deer were found to be infected by Borrelia burgdorferi, the causative organism of Lyme disease. 86% of 45 deer sera tested had significant antibody titres against B burgdorferi.
NLM PUBMED CIT. ID: 2880076 NLM CIT. ID: 87114424
SOURCE: Lancet 1987 Jan 31;1(8527):260-2

TITLE:
Lyme arthritis in children. An orthopaedic perspective.
AUTHORS:
Culp RW; Eichenfield AH; Davidson RS; Drummond DS; Christofersen MR; Goldsmith DP
LANGUAGES:
Eng
ABSTRACT:
The cases of forty-three children with clinical and serological evidence of Lyme arthritis that was diagnosed between August 1983 and July 1985 were evaluated. The mean length of follow-up was twenty months, with a range of five to thirty months. All of the children lived in or had visited an area where the disease was known to be endemic. Arthritis was the presenting feature in more than half of the children, and half of the children had initially consulted an orthopaedic surgeon, none of whom made the correct diagnosis. Only twenty patients had a history of erythema chronicum migrans, the characteristic rash that precedes the arthritis, and for only nineteen children was there any recollection of having been bitten by a tick. Three patients had Bell palsy and one had a popliteal cyst in conjunction with the arthritis. All of the patients had oligoarticular involvement. The knee was involved in all but two patients. Recurrent attacks of synovitis were common. Effusion was the only radiographic abnormality that was observed, and it was found in thirty-two patients. The sedimentation rate was elevated in thirty of thirty-six patients. Immunofluorescent serology for Lyme disease, which is sensitive and specific, was uniformly positive. Of thirty-three patients who were treated with oral administration of penicillin or tetracycline alone, thirty-one responded, while two patients who had recurrent attacks of the disease responded to parenteral administration of antibiotics. The remaining ten patients responded to combinations of orally and parenterally administered antibiotics. Longer follow-up is needed to further document the apparently low rate of relapse after antibiotic therapy in this young population.
NLM PUBMED CIT. ID: 3805076 NLM CIT. ID: 87109380
SOURCE: J Bone Joint Surg [Am] 1987 Jan;69(1):96-9

TITLE:
[Disease (Lyme disease) in pediatric patients in Switzerland caused by spirochetes (Borrelia burgdorferi) of Ixodes ricinus]
VERNACULAR TITLE:
Durch Ixodes-ricinus-Spirochaten (Borrelia burgdorferi) verursachte Krankheitsbilder (Lyme-Krankheit) bei padiatrischen Patienten in der Schweiz.
AUTHORS:
Schaad UB; Flueler U; Schaub H; Suter H; Vischer D; Caflisch U; Tschumi A; Wick H; Vest M; Durrer D
LANGUAGES:
Ger
ABSTRACT:
Lyme disease in children is studied in the light of questionnaires sent out twice to departments and divisions of pediatrics in Switzerland. Thirty-six serologically proven cases were collected. The 48 clinical signs attributed to Lyme disease involved the skin in 40%, the nervous system in 40%, and the joints in 20%. They were erythema chronicum migrans (13), lymphocytoma (4), acrodermatitis chronica atrophicans (2), peripheral facial palsy (14), sensomotor radiculoneuritis (2), meningoencephalitis (3) and arthritis (10, 7 of which were monoarthritic). Only half the patients had a history of tick-bite. Antibiotic therapy, usually with penicillin, reduced both the duration of symptoms and frequency of secondary disease. Cardiac involvement and chronic stages with residua were not observed in this series.
NLM PUBMED CIT. ID: 3787225 NLM CIT. ID: 87069803
SOURCE: Schweiz Med Wochenschr 1986 Oct 18;116(42):1426-30

TITLE:
Neurologic abnormalities in Lyme disease without erythema chronicum migrans.
AUTHORS:
Reik L Jr; Burgdorfer W; Donaldson JO
LANGUAGES:
Eng
ABSTRACT:
The clinical features in eight patients with neurologic abnormalities typical of Lyme disease and elevated titers of antibody to the spirochete, Borrelia burgdorferi, its causative agent, are described. None of the patients had the diagnostic skin lesion, erythema chronicum migrans. Lyme arthritis, the other clinical marker for the disease, developed subsequently in only three. The neurologic abnormalities included aseptic meningitis, encephalitis, cranial neuritis, motor and sensory radiculitis, and myelitis in various combinations. The occurrence of severe encephalitis resulting in dementia in two of these patients and irreversible myelopathy in one enlarges the known spectrum of neurologic abnormalities due to infection with B. burgdorferi. Lyme disease can present with neurologic abnormalities without diagnostic extraneural features, can be suspected on clinical and epidemiologic grounds, and can be diagnosed serologically.
NLM PUBMED CIT. ID: 3728556 NLM CIT. ID: 86265764
SOURCE: Am J Med 1986 Jul;81(1):73-8

TITLE:
Lyme disease: epidemiologic characteristics of an outbreak in Westchester County, NY.
AUTHORS:
Williams CL; Curran AS; Lee AC; Sousa VO
LANGUAGES:
Eng
ABSTRACT:
Epidemiological and clinical characteristics of 210 cases of Lyme disease in Westchester County, New York, reported during 1982 and 1983 are described. Most cases occurred during summer months in individuals under age 40 (male: female ratio 1:2 to 1). Symptoms included skin rash (75 per cent), joint pain or swelling (50 per cent), Bell's palsy (11 per cent), and aseptic meningitis (3 per cent). With greater public and medical awareness of this tick-borne disease, Lyme disease is being recognized with increasing frequency characteristic of an emerging epidemic in Westchester County.
NLM PUBMED CIT. ID: 3940454 NLM CIT. ID: 86074659
SOURCE: Am J Public Health 1986 Jan;76(1):62-5

TITLE:
[Erythema migrans borreliosis in the Federal Republic of Germany. Epidemiology and clinical aspects]
VERNACULAR TITLE:
Erythema-migrans-Borreliose in der Bundesrepublik Deutschland.
Epidemiologie und klinisches Bild.
AUTHORS:
Schmidt R; Kabatzki J; Hartung S; Ackermann R
LANGUAGES:
Ger
ABSTRACT:
A positive antibody titre against Ixodes-ricinus-Borrelia (burgdorferi), using indirect immunofluorescence or ELISA, could be detected in serum and (or) liquor of 935 (32%) out of a total of 2955 patients between January 1984 and July 1985. In 289 of these cases the typical clinical manifestations were lacking whereas a characteristic disease picture enabled a diagnosis to be made in 171 patients with negative or borderline antibody titres. The 1106 cases of infection observed covered all regions of the country. A typical clinical syndrome was seen in 817 (74%) of these. Most common were erythema chronicum migrans (n = 458) and meningopolyneuritis Garin-Bujadoux-Bannwarth (n = 404); in 42% of the cases meningopolyneuritis was preceded by an erythema. Arthritis (n = 63), acrodermatitis chronica atrophicans (n = 72), carditis (n = 13) and lymphadenosis benigna cutis (n = 5) were much less common. Chronic Borrelian encephalomyelitis (n = 45) appeared surprisingly often (n = 45). The fact that in 73% of cases the various syndromes appeared alone, were double in 24% and combined only in 3%, illustrates the polymorphic nature of this disease.
NLM PUBMED CIT. ID: 3905325 NLM CIT. ID: 86055347
SOURCE: Dtsch Med Wochenschr 1985 Nov 22;110(47):1803-7

TITLE:
Epidemiologic features of Lyme disease in New York.
AUTHORS:
Hanrahan JP; Benach JL; Coleman JL; Bosler EM; Grabau JC; Morse DL
LANGUAGES:
Eng
ABSTRACT:
During 1982, surveillance identified 207 cases of Lyme disease in New York State. Cases were clustered in two geographic areas, eastern Long Island and northern Westchester counties. Symptoms and signs of Lyme disease in cases were consistent with previous reports, with erythema chronicum migrans (ECM) being the most frequently (77 percent) reported sign of disease. Facial palsy was reported in a surprisingly high 18 percent of cases. Of 160 cases whose sera were submitted for Lyme spirochete specific IgG antibody testing, 112 (70 percent) had titers greater than or equal to 64, while 88 (55 percent) had titers greater than or equal to 128. Positive titers were not associated with any single sign or symptom of disease, but were significantly associated with symptom onset or tick bite occurring during the three-month period of June, July, and August. We conclude that the incidence of Lyme disease in New York is much higher than previously recognized. In addition, our data suggest that a serologic test for Lyme-spirochete IgG antibody lacks sensitivity, but can be useful in confirming the diagnosis of Lyme disease when antibody titers are high.
NLM PUBMED CIT. ID: 6334940 NLM CIT. ID: 85092799
SOURCE: Yale J Biol Med 1984 Jul-Aug;57(4):643-50

TITLE:
Clinical manifestations and descriptive epidemiology of Lyme disease in New Jersey, 1978 to 1982.
AUTHORS:
Bowen GS; Griffin M; Hayne C; Slade J; Schulze TL; Parkin W
LANGUAGES:
Eng
ABSTRACT:
Clinical manifestations and epidemiologic characteristics of 117 cases (31 children and 86 adults) of Lyme disease in New Jersey from 1978 to 1982 are summarized. The male-female sex ratio was 1.9:1. An endemic focus in Monmouth County has been recognized. Erythema chronicum migrans was present in 93% of cases and was the only clinical manifestation in 25% of patients. Nonspecific febrile syndrome, in addition to erythema chronicum migrans, was present in 45% of cases; 26% had arthritis. The proportion of cases with arthritis in 1982 (7/56) was less than for 1978 to 1981 (24/61) probably because of better recognition of milder cases by physicians and earlier antibiotic treatment, which may have reduced late complications. Meningitis (10%) and cranial nerve palsies (8%) were the most frequent neurological manifestations. As medical personnel and the public become more aware of the disease, Lyme disease is being recognized with increased frequency in central and southern New Jersey.
NLM PUBMED CIT. ID: 6708273 NLM CIT. ID: 84165252
SOURCE: JAMA 1984 May 4;251(17):2236-40

TITLE:
Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum.
AUTHORS:
Steere AC; Malawista SE; Hardin JA; Ruddy S; Askenase W; Andiman WA
LANGUAGES:
Eng
ABSTRACT:
Thirty-two patients with the onset of erythema chronicum migrans, Lyme arthritis, or both in mid-1976 were studied prospectively. The skin lesion (24 patients) typically lasted about 3 weeks, beginning as a red macule or papule that expanded to form a large ring with central clearing. Associated symptoms ranged from none to malaise, fatigue, chills and fever, headache, stiff neck, backache, myalgias, nausea, vomiting, and sore throat. Three patients had been bitten by ticks at the site of the initial lesion 4 to 20 days before its onset. Nineteen patients suddenly developed a monoarticular or oligoarticular arthritis 4 days to 22 weeks (median, 4 weeks) after onset of the skin lesion; eight developed arthritis without a preceding skin lesion. Seven of these 27 experienced migratory joint pains. Arthritis attacks, most commonly in the knee, were typically short (median, 8 days) but sometimes persisted for months. Other manifestations included neurologic abnormalties, myocardial conduction abnormalities, serum cryoprecipitates, elevated serum IgM levels, and elevated erythrocyte sedimentation rates. The diagnostic marker is the skin lesion; without it, geographic clustering is the most important clue.
NLM PUBMED CIT. ID: 869348 NLM CIT. ID: 77200064
SOURCE: Ann Intern Med 1977 Jun;86(6):685-98

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Links to federal and state agencies on prevalence of Lyme disease rash in Lyme disease patients

NIH: Tick-Borne Diseases: An Overview for Physicians, NIAID Fact Sheet, more than 50%
NIH NIAMS: RFP for Diagnosis and Treatment of Lyme Disease, 1991, 60%
CDC NASD: Protect Yourself from Ticks and Lyme Disease, 70%
CDC Division of Vector-Borne Infectious Diseases: Lyme Disease: Questions and Answers, 80%
FDA: Getting Lyme Disease to Take a Hike (June 1994), 80%
GSA: Lyme Disease, The Facts, The Challenge, 75%

California DPR: Information about Ticks at Henry W. Coe State Park, CA, 60%
Tick & Lyme disease, Contra Costa, CA, Mosquito and Vector Control District, 60-80%
California, San Mateo County: Lyme Disease, 60-80%
CA: State Health Director Reminds Californians of Lyme Disease Threat, May 2000, 90%
Connecticut Agricultural Experiment Station: Tick Associated Diseases, 60-80%
Illinois Department of Public Health, Lyme Disease, 60%
Indiana DOH: Tick-borne Disease of Indiana, April 2000, 60-80%
Massachusetts: DPH: Lyme Disease in MA: An Update for Health Care Providers, Feb 2000, 85%
Michigan DNR: Michigan Wildlife Diseases Manual: Lyme Disease, 70%
New York: Dutchess County: Lyme Disease, about 50%
North Dakota Department of Health, Caution Urged During Tick Season, 1998, 60%
Pennsylvania DOH: Lyme Disease Fact Sheet, 60%
Rhode Island DOH: Lyme Disease, 85%
Texas: Lyme Disease (Lyme Borreliosis), Zoonosis Control Division, 35%
Virginia DOH: Preventing Tick-borne Diseases in Virgina, 60%
Wyoming DOH: Lyme Disease, 60%-80%

Lyme disease, Texas A&M, less than 60%
Symptoms of Lyme disease, Brown University, 60%
Lyme Disease- A Monograph and Guide for Washington Physicians, 60-80%
Lyme Disease, University of Wisconsin-Madison, 60-80%
Spirochetal Infection and Disease I and II, UCLA, 60 to 80%
Ticks, Clemson Extension Service, 70% to 90%
Lyme Disease, University of Chicago Primary Care Group, up to 85%

Lyme Disease FAQ, Lloyd E. Miller, DVM, Troy, New York, 50%
Why are Ticks and Tick Borne Infections Increasing? - Magnarelli, 1997, 70%

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For more information about Lyme disease, see:

Lots Of Links On Lyme Disease
http://www.geocities.com/HotSprings/Oasis/6455/lyme-links.html

This document can be found at:

The Lyme Disease Rash -
How often does it occur in Lyme disease patients? - An Annotated Bibliography
http://www.geocities.com/HotSprings/Oasis/6455/ecm-abstracts.html

Comments or questions concerning this page should be directed to Art Doherty.

Last updated on 7 December 2000 by
Art Doherty
Lompoc, California
doherty@utech.net

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