1/7. Isolation of Borrelia afzelii from circumscribed scleroderma.A 45-year-old man presented with circumscribed scleroderma (CS) on the extremities. histology of lesional skin showed the typical manifestations of scleroderma including a perivascular and interstitial infiltrate of lymphocytes and plasma cells; in one of the biopsies spirochaetes could be detected. Despite treatment with penicillin, progression of CS was observed and spirochaetes were isolated from skin cultures obtained from active scleroderma lesions. These spirochaetes were identified as Borrelia afzelii by sodium dodecyl sulphate-polyacrylamide gel electrophoresis of outer surface proteins and polymerase chain reaction (PCR) analysis of their chromosome. After two courses with ceftriaxone the lesions stopped expanding and sclerosis of the skin was diminished. At this time cultures for spirochaetes and PCR of lesional skin for Borrelia afzelii dna remained negative. The pathogenetic role of Borrelia afzelii in the development of CS is discussed.- - - - - - - - - - ranking = 1keywords = spirochaete, lyme (Clic here for more details about this article) |
2/7. borrelia burgdorferi-associated lymphocytoma cutis simulating a primary cutaneous large B-cell lymphoma.The distinction between primary cutaneous B-cell lymphoma and B-cell pseudolymphoma on a histologic basis may be difficult, particularly in some cases of borrelia burgdorferi-associated lymphoid proliferations. We report two cases of B. burgdorferi-associated pseudolymphoma that showed a dense infiltrate with a predominance of large atypical B cells. Because of this misleading histologic feature, a diagnosis of primary cutaneous large B-cell lymphoma was first suspected in both cases. In one case, successive recurrences led to aggressive therapies before the B. burgdorferi infection was recognized. However, a detailed review of histologic and immunohistochemical features was finally suggestive of a B. burgdorferi-associated pseudolymphoma in both cases. The etiologic role of B. burgdorferi was confirmed by serology, polymerase chain reaction analysis of B. burgdorferi dna within the lesional skin, and response to antibiotic therapy. Because the distinction between B. burgdorferi-associated pseudolymphoma and primary cutaneous B-cell lymphomas may be difficult and true B. burgdorferi-associated B-cell lymphomas have been described, we suggest that antibiotic therapy should be considered as a first-line treatment in suspected or confirmed cases of primary cutaneous B-cell lymphoma in regions with endemic B. burgdorferi infection.- - - - - - - - - - ranking = 0.00099522698504288keywords = lyme (Clic here for more details about this article) |
3/7. Molecular diagnosis of borrelia burgdorferi infection (lyme disease).In spite of significant advances in immunologically based testing, accurate diagnosis of Lyme borreliosis remains problematic. To address this issue, a dna amplification-based diagnostic test was developed utilizing the polymerase chain reaction (PCR) and oligonucleotide primers specific for the OspA and OspB genes of borrelia burgdorferi. In this approach, a relatively large dna fragment is amplified with an outer set of primers, and a "nested" internal sequence of the PCR product subsequently reamplified with an inner set of primers. This nested approach coupled with simple differential centrifugation allowed specific detection of as few as four B. burgdorferi organisms mixed in 2 ml of blood. This methodology was utilized on patients' samples, and it allowed detection of B. burgdorferi in the peripheral blood and urine of several individuals with clinical evidence of Lyme borreliosis. PCR became negative and symptoms improved following antibiotic therapy of treated individuals. These studies suggest that direct detection of Borrelia in infected individuals can aid in diagnosis and evaluation of therapy for Lyme borreliosis.- - - - - - - - - - ranking = 0.00099522698504288keywords = lyme (Clic here for more details about this article) |
4/7. Neuroborreliosis simulating a progressive stroke.A 55-year-old man with an onset and course of neurological symptoms of a progressive stroke was found to have a CNS infection caused by the borrelia spirochete. Almost complete recovery was seen after intravenous infusion of bencylpenicillin. Elevated borrelia IgG antibody titers could be seen for long time after recovery. The possibility of an infection due to neuroborreliosis must be considered. If CT scan doesn't show any focal ischemic or hemorrhagic area further investigation with lumbar puncture is necessary in stroke patients.- - - - - - - - - - ranking = 25.106106928928keywords = borrelia (Clic here for more details about this article) |
5/7. Destructive chronic borrelia meningoencephalitis in a child untreated for 15 years.A case of borrelia spirochetosis with recurring episodes of progressively destructive chronic meningoencephalitis, untreated for 15 years, is presented. The patient, now 23 years old, represents an example of the natural course of the disease and may serve as a reminder of the diagnosis in retrospective cases as well as prospectively for acute and chronic states of serous meningitis/meningoencephalitis both in children and adults.- - - - - - - - - - ranking = 62.76526732232keywords = borrelia (Clic here for more details about this article) |
6/7. Borrelia meningoradiculitis with severe pains.A 54-year-old woman with severe pains in the region of the right arcus costalis is presented. This case was a great therapeutic and diagnostic problem during 4 weeks. A borrelia meningoradiculitis was finally diagnosed by detection of specific antibodies in the cerebrospinal fluid. Intravenous benzylpenicillin in combination with epidural morphine hydrochloride resulted in a dramatic relief of the severe pains.- - - - - - - - - - ranking = 12.553053464464keywords = borrelia (Clic here for more details about this article) |
7/7. Borrelial fasciitis: diffuse fasciitis and peripheral eosinophilia associated with Borrelia infection.We present four cases of diffuse fasciitis (DF) associated with peripheral eosinophilia in which spirochetal organisms were identified. Two patients had borderline positive results on serologic evaluation for borrelia burgdorferi. Deep biopsy showed dermal sclerosis associated with variable degrees of perivascular mononuclear inflammation. Diffuse fasciitis, septal panniculitis, and myositis with mononuclear cell infiltrates and varying numbers of eosinophils were observed. All cases showed a striking lymphocytic vasculopathy associated with atypical reactive endothelial cells. Using modified Dieterle and Steiner silver stains, multiple organisms were seen in one specimen, a single unequivocal organism detected in two specimens. In one case, no organisms were detected on silver stain; however, organisms were demonstrated using rabbit polyclonal antibodies against B. burgdorferi. B. burgdorferi-specific dna was identified in one patient by the polymerase chain reaction. These results indicate that some cases of eosinophilic fasciitis are an expression of lyme disease. We have previously proposed the more specific term "borrelial fasciitis" to describe such lesions.- - - - - - - - - - ranking = 12.554048691449keywords = borrelia, lyme (Clic here for more details about this article) |