1/213. Unusual presentations of neuroborreliosis (lyme disease) in childhood.Two children with atypical neuroborreliosis (cranial polyneuritis and acute transverse myelitis) are presented. The diagnosis was confirmed by the determination of specific antibodies against borrelia burgdorferi in both serum and CSF. neuroimaging findings were nonspecific, indicating, however, that neuroborreliosis should be included in the differential diagnosis of cases with cranial polyneuritis and acute transverse myelitis in childhood.- - - - - - - - - - ranking = 1keywords = burgdorferi (Clic here for more details about this article) |
2/213. Serologically diagnosed lyme disease manifesting erythema migrans in korea.lyme disease is a vector-borne infection, primarily transmitted by ixodes ticks, and caused by borrelia burgdorferi. It has a wide distribution in the northern hemisphere. In korea, however, only one human case has been reported, although B. burgdorferi was isolated from the vector tick I. persulcatus in the region. A 60-year-old male and a 45-year-old female developed the clinical sign of erythema migrans. Each patients were bitten by a tick four weeks and five weeks, respectively, before entering the hospital. On serologic examination, significantly increased IgM and IgG antibody titers to B. burgdorferi were observed in consecutive tests performed at an interval of two weeks. They responded well to treatment with tetracycline.- - - - - - - - - - ranking = 3keywords = burgdorferi (Clic here for more details about this article) |
3/213. borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder.BACKGROUND: We report on a 42-year-old female patient who presented with a schizophreniform disorder and complete relief of symptoms after specific therapy. methods: cerebrospinal fluid and magnetic resonance imaging findings led to the diagnosis of lyme disease. RESULTS: To our knowledge this is the first reported case with an exclusive psychiatric manifestation of lyme disease. CONCLUSIONS: In case of first manifestation of psychotic disorder, although neurological symptoms are lacking, lyme disease should be considered and be excluded by cerebrospinal fluid analysis.- - - - - - - - - - ranking = 4keywords = burgdorferi (Clic here for more details about this article) |
4/213. Diaphragmatic paralysis due to lyme disease.lyme disease is a tick-borne spirochaete infection which, in a proportion of patients, can lead to neuropathy. This article describes a case of diaphragmatic paralysis due to lyme disease. A 39-yr-old male presented to the hospital because of an acute left facial palsy. Six weeks prior to admission he had developed a circular rash on his left flank during a camping holiday. He also complained of shortness of breath and arthralgia for 1 week. His chest radiograph demonstrated a raised right hemi-diaphragm. Diaphragmatic paralysis was confirmed by fluoroscopy (a positive sniff test). serology revealed evidence of recent infection by borrelia burgdorferi. On the basis of the patient's clinical presentation, a recent history of erythema migrans, and positive Lyme serology, a diagnosis of neuroborreliosis was made. He received oral doxycycline therapy (200 mg x day(-1)) for three weeks. Facial and diaphragmatic palsies resolved within eight weeks. On the basis of this case, a diagnosis of lyme disease should be considered in patients from endemic regions with otherwise unexplained phrenic nerve palsy.- - - - - - - - - - ranking = 1.0441212750074keywords = burgdorferi, spirochaete (Clic here for more details about this article) |
5/213. central nervous system infection caused by borrelia burgdorferi. Clinico-pathological correlation of three post-mortem cases.The spirochete borrelia burgdorferi (B. burgdorferi) may cause severe meningoencephalomyelitis as the sole manifestation of Lyme borreliosis. We would like to present three such cases, where definite neuroborreliosis was clinically diagnosed in two cases and possible neuroborreliosis was recognized in one case. Alive spirochetes were isolated and cultured from blood and cerebrospinal fluid (CSF) in both definite cases. B. burgdorferi as the causative agent of the infection was confirmed in CSF by polymerase chain reaction (PCR) in one definite case. In the possible case spirochetes were cultured from blood and CSF. Alive spirochetes were not isolated, however anti-B. burgdorferi antibody value in serum was significantly elevated. On necropsy gross examination brain edema without focal changes was detected in two cases. Cerebral atrophy was seen in Case 3. Microscopically, lymphocytic infiltrates, microglial diffuse and nodular activation, spongiform changes, diffuse demyelination of the cerebral and cerebellar white matter, and diffuse astrocytosis, were characteristic pathological features in all presented cases. Multifocal, perivascular degenerative changes in the cerebral and cerebellar white matter were observed in the first case. Inflammatory changes in the nuclei and roots of cranial nerves were present in the third case.- - - - - - - - - - ranking = 8.372934914473keywords = burgdorferi, lyme (Clic here for more details about this article) |
6/213. cutis laxa acquisita: is there any association with borrelia burgdorferi?We report the first case of an acquired form of generalized cutis laxa which has positive serology and a positive polymerase chain reaction (PCR) result for lyme borreliosis. A 44-year-old man complained of excessively loose skin for four years and had no family history of any skin disease. Dermatological examination showed lax and wrinkled skin all over the body (especially on the cheeks and the intertriginous areas). Positive serology for lyme borreliosis and the presence of borrelia burgdorferi dna which was demonstrated by nested PCR in this acquired form of cutis laxa is interesting since it has not been reported in literature previously.- - - - - - - - - - ranking = 6.118804743419keywords = burgdorferi, lyme (Clic here for more details about this article) |
7/213. Identification of candidate T-cell epitopes and molecular mimics in chronic Lyme disease.Elucidating the cellular immune response to infectious agents is a prerequisite for understanding disease pathogenesis and designing effective vaccines. In the identification of microbial T-cell epitopes, the availability of purified or recombinant bacterial proteins has been a chief limiting factor. In chronic infectious diseases such as lyme disease, immune-mediated damage may add to the effects of direct infection by means of molecular mimicry to tissue autoantigens. Here, we describe a new method to effectively identify both microbial epitopes and candidate autoantigens. The approach combines data acquisition by positional scanning peptide combinatorial libraries and biometric data analysis by generation of scoring matrices. In a patient with chronic neuroborreliosis, we show that this strategy leads to the identification of potentially relevant T-cell targets derived from both borrelia burgdorferi and the host. We also found that the antigen specificity of a single T-cell clone can be degenerate and yet the clone can preferentially recognize different peptides derived from the same organism, thus demonstrating that flexibility in T-cell recognition does not preclude specificity. This approach has potential applications in the identification of ligands in infectious diseases, tumors and autoimmune diseases.- - - - - - - - - - ranking = 1keywords = burgdorferi (Clic here for more details about this article) |
8/213. The outcome of Lyme borreliosis in children.austria is an endemic area for Lyme borreliosis. The IgG seroprevalence of healthy blood donors as investigated by a DAKO flagellum-ELISA in Graz/Styria is 13%. In order to determine whether this high seroprevalence is caused by infection in childhood, 36 children aged 3 to 18 years (mean, 10.1 years) were followed up over 2 to 20 months (mean, 11.1 months) and reinvestigated for clinical symptoms and antibodies against B. burgdorferi by a commercial flagellum ELISA and a commercial B. garinii Western blot (WB). Twenty-seven children had erythema migrans (EM), one of them with reinfection, 5 had borrelia lymphocytoma (BL), 2 EM and BL, 1 acrodermatitis chronica atrophicans and 1 ACA/circumscribed scleroderma. Before treatment with either phenoxymethylpenicillin, amoxicillin, or minocyclin for 3-4 weeks, 64% of the patients were IgM and 44%, IgG seropositive. Clinically, all but 5 patients with EM recovered from Lyme borreliosis. Among these 5 patients--one of them with reinfection of EM--3 had mild arthralgia, 1 recurrent headache and 1 concentration disturbance. Only 2 children with arthralgia were IgM positive by ELISA and WB. One of 5 BL patients had a persistent swelling of the ear lobe although with a negative serology before and after several antibiotic treatments and at follow up. In 16 children serological investigations were performed after more than 12 months (range, 13-20 months). Eighteen percent of them had IgM antibodies by ELISA, 25% by WB, and 6% IgG antibodies by ELISA and 6% by WB. Although there was a decline of antibody response from 64% to 18% for IgM and from 44% to 6% for IgG as measured by ELISA, children remain seropositive for more than 1 year with or without clinical symptoms. The relevance of the association with clinical symptoms can be raised by combining several diagnostic methods. It is assumed that recurrent, often silent, infections might increase antibody titres. It should be noted that antibody titres also generally increase with the age of individuals.- - - - - - - - - - ranking = 1.2526358061612keywords = burgdorferi, borrelia (Clic here for more details about this article) |
9/213. borrelia burgdorferi as a cause of Morgagni-adams-stokes syndrome. Long time follow-up study.According the literature atrio-ventricular blockade (AVB) is the most frequent and well-known symptom of Lyme carditis. Typical signs of complete AVB include fatigue, lethargy and syncope- Morgagni-adams-stokes syndrome (MAS). The authors present their results and experience with 5 patients selected from a long-term study (conducted between 1987 and 1998) comprising 58 patients who developed MAS. The authors tried to evaluate the changes especially in the cardiovascular system. They correlated the clinical state with ECG findings, as well as with the levels of the borrelia burgdorferi antibodies. The following results were obtained: 1) all patients had typical syncope, 2) the clinical course was not complicated (except one patient who developed ventricular fibrillation), 3) two patients had frequent symptomatic and asymptomatic arrhythmia including chest pain and episodic rest dyspnea, 4) subjective difficulties (usually palpitations) correlated with ECG findings (Lown 3a, 3b). The authors also looked for any relationship between clinical difficulties and levels of antibodies. The results obtained with an early permanent pacemaker were less favourable than those reported in the literature. Despite early treatment 2 patients had repeated palpitations and ECG correlates during the next years.- - - - - - - - - - ranking = 5keywords = burgdorferi (Clic here for more details about this article) |
10/213. Eradication of borrelia burgdorferi infection in primary marginal zone B-cell lymphoma of the skin.Primary cutaneous B-cell lymphomas have been associated with borrelia burgdorferi, the spirochete responsible for lyme disease. Recently, cutaneous marginal zone B-cell lymphoma has been proposed as a distinct clinical-pathological entity. We report a case of primary cutaneous marginal zone lymphoma, associated with B burgdorferi infection. polymerase chain reaction (PCR) amplification of the third complementarity determining region (CDR3) of the immunoglobulin heavy chain gene showed the presence of a monoclonal lymphoproliferation, therefore strengthening the histological diagnosis of a malignant process. B burgdorfer-specific hbb gene sequences were detected by PCR in the lymphoma tissue at diagnosis but not after antibiotic treatment. A nearly complete clinical and histological regression was observed after B burgdorferi eradication, with immunohistochemistry studies showing disappearance of plasma cell differentiation and a marked decline in the number of CD3 T cells and Ki-67 cells. Our case confirms the link between B burgdorferi and some cutaneous lymphomas. The disappearance of the microorganism accompanied by the unequivocal decrease of most indicators of active T- and B-cell immune response strongly supported a pathogenetic role for B burgdorferi in sustaining an antigen-driven development and growth of this cutaneous marginal zone lymphoma. Antibiotic therapy (analogous to helicobacter pylori infection in gastric MALT lymphoma) might be helpful with the aim of averting or at least deferring the indication for more aggressive treatment.- - - - - - - - - - ranking = 9.372934914473keywords = burgdorferi, lyme (Clic here for more details about this article) |
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