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1/12. Erythema migrans in pregnancy.

    From 1990 through to 1997, 105 pregnant women with typical EM were investigated at the Lyme Borreliosis outpatients' Clinic of the Department of Infectious Diseases at the University Medical Centre in Ljubljana, slovenia. Twenty-five (23.8%) patients acquired borrelial infection during the first trimester of pregnancy; eight (7.6%) of them had noticed the skin lesion before they became pregnant. In 43 (40.6%) patients the EM appeared in the second trimester, and in 37 (35%) patients in the third trimester of pregnancy. Two (1.9%) patients received phenoxymethyl penicillin (1 million IU t.i.d.), three (2.9%) benzyl penicillin (10 million IU b.i.d.), and 100 (95.2%) ceftriaxone (2 g daily). All patients were treated for 14 days except three (2.9%) in whom the treatment with ceftriaxone was discontinued because of mild side effects. The outcome of disease was good in all 105 patients. Ninety-three (88.6%) out of 105 patients had normal pregnancies; the infants were delivered at term, were clinically healthy, and subsequently had a normal psychomotor development. In the remaining 12 (11.4%) patients an adverse outcome was observed. Two (1.9%) pregnancies ended with an abortion (one missed abortion at 9 weeks, one spontaneous abortion at 10 weeks), and six (5.7%) with preterm birth. One of the preterm babies had cardiac abnormalities and two died shortly after birth. Four (3.8%) babies born at term were found to have congenital anomalies; one had syndactyly at birth and three had urologic abnormalities which were registered at the age of 5, 7, and 10 months, respectively. A causal association with borrelial infection was not proven in any infant. For at least some unfavourable outcomes a plausible explanation not associated with Lyme borreliosis was found.
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2/12. Erythema migrans and the differential diagnosis of annular erythema.

    The diagnosis of lyme disease (LD) or Lyme borreliosis is often based on the recognition of erythema migrans (EM) because its clinical appearance precedes systemic manifestations of the disease and the antibody response. The clinical basis and variable presentation of EM leave room for diagnostic error and, as a consequence, potential long-term repercussions such as rheumatic, cardiac, ophthalmic, or neurologic complications. Most cases are reported in the Northcentral and Northeastern states. In areas where LD is not endemic, the differential diagnosis of annular erythema may not list EM highly, although all the features of a lesion may fit the typical description of EM. Therefore, a complete understanding of LD and its clinical presentation are key in making a diagnosis, especially in areas with low incidence. We present a hypothetical case report of EM from oklahoma, a state with low incidence of LD, for the purposes of review of this entity and the differential diagnosis of annular erythema.
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keywords = borreliosis
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3/12. Nodular fasciitis, erythema migrans, and oligoarthritis: manifestations of Lyme borreliosis caused by Borrelia afzelii.

    We describe a 35-year old patient with nodular fasciitis, erythema migrans, and gonarthritis four months after a bite of a Borrelia afzelii infected tick. The Borrelia afzelii infection was identified by a polymerase chain reaction and direct sequencing of the amplification product. Borrelia-specific dna was also detectable in nodular fasciitis tissue. We therefore conclude that Borrelia afzelii can be a causative agent of nodular fasciitis and Lyme arthritis in a highly endemic region of Northern germany.
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ranking = 4.1714420777974
keywords = borreliosis, lyme
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4/12. Lyme borreliosis in portugal caused by Borrelia lusitaniae? Clinical report on the first patient with a positive skin isolate.

    BACKGROUND: Borrelia lusitaniae was isolated from an ixodes ricinus tick in portugal in 1993 for the first time. Further, this borrelia genospecies has been found in ixodid ticks collected around the coasts of southern portugal and North africa. Its reservoir has not been defined yet. B. lusitaniae was isolated once until now from a patient with a long standing and expanding skin disorder. PATIENT AND methods: A 46-year-old Portuguese woman presented with a skin lesion on the left thigh which had evolved slowly over ten years. The patient reported limb paraesthesias, cramps, chronic headaches, and cardiac rhythm disturbances. history of tick bites was negative nor had the patient ever noticed a skin lesion comparable with erythema chronicum migrans. skin biopsies were taken for histological evaluation, culture and dna detection. antibodies to borrelia were searched by indirect immunofluorescence assay and Western-blot. RESULTS: A bilateral carpal tunnel syndrome and local synovitis was diagnosed. Dermato-histology was normal, serology was negative. Spirochaetal organisms were cultured from a skin biopsy and identified as B. lusitaniae. The patient improved after a 2-week course of intravenous ceftriaxone; the skin lesions did not expand further. CONCLUSIONS: This culture confirmed skin infection by B. lusitaniae in a patient from portugal suggests an additional human pathogen out of the B. burgdorferi sensu lato complex in europe, particularly in portugal.
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keywords = borreliosis
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5/12. Persistent atrioventricular block in Lyme borreliosis.

    Cardiac manifestations are reported in 0.3%-4.0% of European patients with borrelia burgdorferi (B.b.) infection. Usually symptoms disappear within 6 weeks. We report a case with persistent impairment of atrioventricular (AV) conduction. diagnosis was confirmed by demonstration of IgM antibodies and increase of IgG antibody titers against B.b. in serum, by isolation of the spirochete from skin biopsy material and by the typical clinical combination of erythema migrans, Bannwarth syndrome (meningoradiculitis), and complete heart block. Despite immediate antibiotic therapy with ceftriaxone, first degree AV block and second degree block Wenckebach with atrial pacing at 100 beats/minute persisted for 2 years. We conclude, that Lyme carditis can cause long-standing or irreversible AV conduction defects despite adequate and early antimicrobial therapy.
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ranking = 4
keywords = borreliosis
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6/12. Lyme and/or Lyme-like disease in missouri.

    missouri patients who fulfill the strict CDC surveillance definition for lyme disease have been reported in significant numbers since 1987, although there are no viable missouri human cultures of borrelia burgdorferi. The missouri erythema migrans rashes are indistinguishable from those in other areas, and the clinical syndrome appears similar to lyme disease nationally. The authors suspect atypical B. burgdorferi, and/or other Borrelia spirochetes of causing this clinical borreliosis syndrome.
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7/12. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting borrelia burgdorferi infection.

    Erythema migrans recurred in a patient 6 months after a course of treatment with minocycline for lyme disease. polymerase chain reaction on heparinized peripheral blood at that time demonstrated the presence of borrelia burgdorferi-specific dna. The patient was seronegative by Lyme enzyme-linked immunosorbent assay but showed suspicious bands on Western blot. Findings of a Warthin-Starry stain of a skin biopsy specimen of the eruption revealed a Borrelia-compatible structure. Reinfection was not believed to have occurred. Further treatment with minocycline led to resolution of the erythema migrans.
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ranking = 0.17144207779739
keywords = lyme
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8/12. Neuroborreliosis in the etiology of vestibular neuronitis.

    Symptoms and incidence of neuroborreliosis (NB) were studied in ambulatory patients visiting the ENT clinic in Helsinki. Especially we tried to search for possible markers indicating the connection between vestibular neuronitis and NB. A total of 350 patients were screened with the enzyme-linked immunosorbent assay (ELISA) technique for possible antibodies against borrelia burgdorferi (BB). Twelve patients had positive serological reactions for BB with sera titer levels ranging from 640-14700 (normal < 500). In 2 additional cases, NB was clinically confirmed. In 7 cases a history of tick bite and in 4 cases erythema chronicum migrans was confirmed. In 9 cases, vertigo was the predominant symptom, and in 3 cases the symptoms were linked to facial nerve paresis. Six patients suffered from hearing loss. In 7 cases, the diagnosis was initially settled as vestibular neuronitis. NB seems to be present in about 4% of cases with apparent otologic diseases in finland. In the majority of the cases, the disease resembles vestibular neuronitis in the acute stage. Since NB is tractable, all patients visiting the ENT clinic, especially those with vertigo, should be screened.
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ranking = 5
keywords = borreliosis
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9/12. Persistence of borrelia burgdorferi sensu lato in resolved erythema migrans lesions.

    Erythema migrans skin lesions resulting from a tick bite and infection with borrelia burgdorferi sensu lato eventually resolve, even without antibiotic therapy. The aim of the present study was to gauge the frequency of persistence of B. burgdorferi sensu lato in such lesions. Thus, the site of a previous lesion was biopsied and cultured in 48 patients: 39 with systemic or localized symptoms/signs and nine with no symptoms. B. burgdorferi sensu lato was isolated from biopsied skin from three symptomatic patients. Cultures of other tissues and fluids were negative. By genospecies-specific polymerase chain reaction (PCR) and pulsed-field gel electrophoretic (PFGE) analysis, two isolates were classified as Borrelia afzelii. The remaining isolate was a member of an unusual group of strains that type as B. burgdorferi sensu stricto by genospecies PCR but possess an atypical PFGE profile. All three patients had a dramatic clinical response to antibiotic treatment. These findings demonstrate the capacity of viable B. burgdorferi sensu lato organisms to persist in clinically normal-appearing skin at the site of a resolved erythema migrans rash for periods ranging from 2 months to 3.5 years. This observation may provide new insight into the organisms' ability to evade the host's immune response.
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ranking = 0.17144207779739
keywords = lyme
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10/12. Rocky Mountain "spotless" fever with an erythema migrans-like skin lesion.

    We report a case of Rocky Mountain "spotless" fever with a localized rash at the site of the tick bite that resembled the erythema migrans rash of Lyme borreliosis. physicians who practice in geographic areas where rocky mountain spotted fever occurs should be aware of this unusual presentation.
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keywords = borreliosis
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