MEDLINE Abstracts: Lyme Disease
MEDLINE Abstracts: Lyme Disease
What's new concerning Lyme disease? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Rheumatology.
Seltzer EG, Gerber MA, Cartter ML, Freudigman K, Shapiro ED
JAMA. February 2, 2000;283(5):609-616
Context: Few data exist about the long-term outcomes of patients with Lyme disease.
Objective: To assess the long-term outcomes of patients with Lyme disease.
Design: Two-part project including a community-based longitudinal cohort study and a matched cohort study.
Setting and Participants: Six hundred seventy-eight patients identified from a random sample of all reports of Connecticut residents with suspected Lyme disease submitted to the Connecticut Department of Public Health from 1984-1991 were evaluated in the longitudinal study; for a random subsample of 212 patients from the larger study, 212 age-matched controls without Lyme disease also were enrolled.
Main Outcome Measures: Self-reports or parents' reports of symptoms and ability to perform certain daily activities since diagnosis of Lyme disease; scores on the 36-Item Short-Form Health Survey and the Center for Epidemiologic Studies-Depression scale, for adults, by case-definition status and between patients and controls.
Results: Of the 678 patients, 51.6% were female, 34.4% were children, and 64.3% met the national surveillance case definition for Lyme disease. Most patients (85.6%) were treated with antimicrobial agents. Interviews were conducted a median of 51 months after diagnosis (range, 15-135 months). An increased frequency of symptoms (eg, pain, fatigue) or of difficulty with daily activities (eg, performing housework, exercising) was reported by 69% of the patients, although few (19%) of these problems were attributed to Lyme disease. Whenever there was a statistically significant difference in the frequencies of either increased symptoms or increased difficulties with typical activities between those who did or did not meet the surveillance case definition, in all instances the greater frequency of problems was in the group that did not meet the case definition. The frequencies of reports of both increased symptoms and increased difficulties with typical activities among patients who had been diagnosed as having Lyme disease were similar to those among age-matched controls without Lyme disease.
Conclusions: In this cohort, although many patients reported increases in symptoms and/or increased difficulties with typical daily activities between 1 and 11 years after diagnosis of Lyme disease, the frequencies of these reports were similar to the frequencies of such reports among age-matched controls without Lyme disease.
Full text:http://jama.ama-assn.org/issues/v283n5/full/joc90967.html
Simon MM, Bauer Y, Zhong W, Hofmann H, Wallich R
Int J Med Microbiol Virol Parasitol Infect Dis. December 1999;289(5-7):690-695
Research of recent years on Lyme disease has greatly increased our understanding on antigenic structures and genotypic variability of the aetiological agent, Borrelia (B.) burgdorferi sensu lato, as well as on mechanisms underlying host-parasite interactions and induction/mode of action of protective immune responses. A vaccine formula on the basis of the outer surface lipoprotein A (OspA), previously developed in our laboratory, has successfully been tested in a clinical trial involving nearly 10,000 subjects in the USA. The OspA vaccine is unique in that it protects the mammalian host from infection by eliminating spirochaetes from the vector, but does not cure an established disease. This is because spirochaetes express OspA exclusively in the tick, but not when transmitted into the vertebrate host. For Europe, a more complex vaccine formula is required in order to achieve full protection. This is due to the higher degree of heterogeneity of OspA molecules among isolates of B. burgdorferi in Europe and the inability of the monovalent vaccine to convey complete cross-protection.
Croke CL, Munson EL, Lovrich SD, et al.
Infect Immun. February 2000;68(2):658-663
Arthritis is a frequent and major complication of infection with Borrelia burgdorferi sensu stricto. The antigens responsible for the induction of arthritis are unknown. Here we provide direct evidence that a major surface protein, outer surface protein A (OspA), can induce arthritis. Hamsters were vaccinated with 30, 60, or 120 g of recombinant OspA (rOspA) in aluminum hydroxide and challenged with B. burgdorferi sensu stricto isolate 297 or C-1-11. Swelling of the hind paws was detected in 100, 100, and 50% of hamsters vaccinated with 30, 60, or 120 g of rOspA, respectively. In addition, arthritis developed in 57% of hamsters vaccinated with a canine rOspA vaccine after infection with B. burgdorferi sensu stricto. When the canine rOspA vaccine was combined with aluminum hydroxide, all vaccinated hamsters developed arthritis after challenge with B. burgdorferi sensu stricto. Histopathologic examination confirmed the development of severe destructive arthritis in rOspA-vaccinated hamsters challenged with B. burgdorferi sensu stricto. These findings suggest that rOspA vaccines should be modified to eliminate epitopes of OspA responsible for the induction of arthritis. Our results are important because an rOspA vaccine in aluminum hydroxide was approved by the Food and Drug Administration for use in humans.
Belman AL
Semin Pediatr Neurol. December 1999;6(4):249-266
Tick-transmitted infectious agents have assumed increased importance as causes of human disease in the United States. During the past two decades, Lyme borreliosis, ehrlichiosis, and babesiosis have emerged as newly described tick-borne infectious diseases of significance for pediatricians and pediatric neurologists. In fact, the highest rates of infection for Lyme disease and Rocky Mountain spotted fever (RMSF), by decade of age, are in childhood. As such, tick-borne infectious disease are of considerable public health concern, particularly for children residing in endemic regions. RMSF and human ehrlichioses can be life-threatening but are also eminently treatable when recognized early. Delays in diagnosis and treatment can lead to adverse outcomes. This article reviews the clinical and epidemiological features of Lyme borreliosis, RMSF, and ehrlichiosis, important causes of neurological illness among children, and summarizes current therapeutic and preventive strategies.
Weissman K, Jagminas L, Shapiro MJ
Eur J Emerg Med. December 1999;6(4):397-401
We present a case of a 20-year-old woman who presented with a febrile illness, frightening dreams and repeated short episodes of apparent seizure activity. Third degree heart block and ventricular asystole were noted on the monitor when the patient experienced a spell during conscious sedation for a lumbar puncture. The combination of heart block and a predominantly lymphocytic cerebrospinal fluid led to the diagnosis of Lyme disease. Lyme titres were strongly positive and subsequently confirmed by Western Blot analysis. Cardiac aetiologies and specifically heart block associated with Lyme disease should be considered in patients from endemic areas presenting with fever and unexplained spells or seizure-like activity.
Harjacek M, Diaz-Cano S, Alman BA, et al.
J Rheumatol. January 2000;27:497-503
Objective: To examine the cytokine profiles in synovium of patients with juvenile rheumatoid arthritis (JRA) or Lyme arthritis, 2 chronic inflammatory arthritides that affect children.
Methods: We used in situ hybridization with specific riboprobes to determine the expression of mRNA for proinflammatory or antiinflammatory cytokines in synovial samples from 5 patients with early, untreated JRA, 15 patients with late, treated JRA, and 9 patients with chronic Lyme arthritis. For comparison, synovia were examined from 6 patients with rheumatoid or psoriatic arthritis, and from 9 patients with various orthopedic conditions.
Results: Among the children with early, untreated JRA, a median of 3 to 8% of inflammatory cells in synovial samples expressed mRNA for the proinflammatory cytokines interleukin 1ß (IL-1ß), tumor necrosis factor-a (TNF-a), or interferon-g (IFN-g). Although a median of 3.9% of the cells expressed mRNA for the antiinflammatory cytokine IL-10, none had IL-4 mRNA. Most of the patients with late, treated JRA, chronic Lyme arthritis, rheumatoid, or psoriatic arthritis had mRNA for each of these proinflammatory cytokines in about 1% of the cells, whereas mRNA for the antiinflammatory cytokines was less frequent. The inflammatory cell density was much less in the synovium of patients with various orthopedic conditions, but about 1% of the infiltrating cells expressed mRNA for at least one of the proinflammatory cytokines.
Conclusion: Patients with early or late JRA or chronic Lyme arthritis have expression of mRNA in synovial tissue primarily for proinflammatory cytokines, with less expression of antiinflammatory cytokines.
MEDLINE Abstracts: Lyme Disease
What's new concerning Lyme disease? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Rheumatology.
Long-term Outcomes of Persons With Lyme Disease
Seltzer EG, Gerber MA, Cartter ML, Freudigman K, Shapiro ED
JAMA. February 2, 2000;283(5):609-616
Context: Few data exist about the long-term outcomes of patients with Lyme disease.
Objective: To assess the long-term outcomes of patients with Lyme disease.
Design: Two-part project including a community-based longitudinal cohort study and a matched cohort study.
Setting and Participants: Six hundred seventy-eight patients identified from a random sample of all reports of Connecticut residents with suspected Lyme disease submitted to the Connecticut Department of Public Health from 1984-1991 were evaluated in the longitudinal study; for a random subsample of 212 patients from the larger study, 212 age-matched controls without Lyme disease also were enrolled.
Main Outcome Measures: Self-reports or parents' reports of symptoms and ability to perform certain daily activities since diagnosis of Lyme disease; scores on the 36-Item Short-Form Health Survey and the Center for Epidemiologic Studies-Depression scale, for adults, by case-definition status and between patients and controls.
Results: Of the 678 patients, 51.6% were female, 34.4% were children, and 64.3% met the national surveillance case definition for Lyme disease. Most patients (85.6%) were treated with antimicrobial agents. Interviews were conducted a median of 51 months after diagnosis (range, 15-135 months). An increased frequency of symptoms (eg, pain, fatigue) or of difficulty with daily activities (eg, performing housework, exercising) was reported by 69% of the patients, although few (19%) of these problems were attributed to Lyme disease. Whenever there was a statistically significant difference in the frequencies of either increased symptoms or increased difficulties with typical activities between those who did or did not meet the surveillance case definition, in all instances the greater frequency of problems was in the group that did not meet the case definition. The frequencies of reports of both increased symptoms and increased difficulties with typical activities among patients who had been diagnosed as having Lyme disease were similar to those among age-matched controls without Lyme disease.
Conclusions: In this cohort, although many patients reported increases in symptoms and/or increased difficulties with typical daily activities between 1 and 11 years after diagnosis of Lyme disease, the frequencies of these reports were similar to the frequencies of such reports among age-matched controls without Lyme disease.
Full text:http://jama.ama-assn.org/issues/v283n5/full/joc90967.html
Lyme Disease: Pathogenesis and Vaccine Development
Simon MM, Bauer Y, Zhong W, Hofmann H, Wallich R
Int J Med Microbiol Virol Parasitol Infect Dis. December 1999;289(5-7):690-695
Research of recent years on Lyme disease has greatly increased our understanding on antigenic structures and genotypic variability of the aetiological agent, Borrelia (B.) burgdorferi sensu lato, as well as on mechanisms underlying host-parasite interactions and induction/mode of action of protective immune responses. A vaccine formula on the basis of the outer surface lipoprotein A (OspA), previously developed in our laboratory, has successfully been tested in a clinical trial involving nearly 10,000 subjects in the USA. The OspA vaccine is unique in that it protects the mammalian host from infection by eliminating spirochaetes from the vector, but does not cure an established disease. This is because spirochaetes express OspA exclusively in the tick, but not when transmitted into the vertebrate host. For Europe, a more complex vaccine formula is required in order to achieve full protection. This is due to the higher degree of heterogeneity of OspA molecules among isolates of B. burgdorferi in Europe and the inability of the monovalent vaccine to convey complete cross-protection.
Occurrence of Severe Destructive Lyme Arthritis in Hamsters Vaccinated With Outer Surface Protein A and Challenged With Borrelia Burgdorferi
Croke CL, Munson EL, Lovrich SD, et al.
Infect Immun. February 2000;68(2):658-663
Arthritis is a frequent and major complication of infection with Borrelia burgdorferi sensu stricto. The antigens responsible for the induction of arthritis are unknown. Here we provide direct evidence that a major surface protein, outer surface protein A (OspA), can induce arthritis. Hamsters were vaccinated with 30, 60, or 120 g of recombinant OspA (rOspA) in aluminum hydroxide and challenged with B. burgdorferi sensu stricto isolate 297 or C-1-11. Swelling of the hind paws was detected in 100, 100, and 50% of hamsters vaccinated with 30, 60, or 120 g of rOspA, respectively. In addition, arthritis developed in 57% of hamsters vaccinated with a canine rOspA vaccine after infection with B. burgdorferi sensu stricto. When the canine rOspA vaccine was combined with aluminum hydroxide, all vaccinated hamsters developed arthritis after challenge with B. burgdorferi sensu stricto. Histopathologic examination confirmed the development of severe destructive arthritis in rOspA-vaccinated hamsters challenged with B. burgdorferi sensu stricto. These findings suggest that rOspA vaccines should be modified to eliminate epitopes of OspA responsible for the induction of arthritis. Our results are important because an rOspA vaccine in aluminum hydroxide was approved by the Food and Drug Administration for use in humans.
Tick-Borne Diseases
Belman AL
Semin Pediatr Neurol. December 1999;6(4):249-266
Tick-transmitted infectious agents have assumed increased importance as causes of human disease in the United States. During the past two decades, Lyme borreliosis, ehrlichiosis, and babesiosis have emerged as newly described tick-borne infectious diseases of significance for pediatricians and pediatric neurologists. In fact, the highest rates of infection for Lyme disease and Rocky Mountain spotted fever (RMSF), by decade of age, are in childhood. As such, tick-borne infectious disease are of considerable public health concern, particularly for children residing in endemic regions. RMSF and human ehrlichioses can be life-threatening but are also eminently treatable when recognized early. Delays in diagnosis and treatment can lead to adverse outcomes. This article reviews the clinical and epidemiological features of Lyme borreliosis, RMSF, and ehrlichiosis, important causes of neurological illness among children, and summarizes current therapeutic and preventive strategies.
Frightening Dreams and Spells: A Case of Ventricular Asystole From Lyme Disease
Weissman K, Jagminas L, Shapiro MJ
Eur J Emerg Med. December 1999;6(4):397-401
We present a case of a 20-year-old woman who presented with a febrile illness, frightening dreams and repeated short episodes of apparent seizure activity. Third degree heart block and ventricular asystole were noted on the monitor when the patient experienced a spell during conscious sedation for a lumbar puncture. The combination of heart block and a predominantly lymphocytic cerebrospinal fluid led to the diagnosis of Lyme disease. Lyme titres were strongly positive and subsequently confirmed by Western Blot analysis. Cardiac aetiologies and specifically heart block associated with Lyme disease should be considered in patients from endemic areas presenting with fever and unexplained spells or seizure-like activity.
Prominent Expression of mRNA for Proinflammatory Cytokines in Synovium in Patients With Juvenile Rheumatoid Arthritis or Chronic Lyme Arthritis
Harjacek M, Diaz-Cano S, Alman BA, et al.
J Rheumatol. January 2000;27:497-503
Objective: To examine the cytokine profiles in synovium of patients with juvenile rheumatoid arthritis (JRA) or Lyme arthritis, 2 chronic inflammatory arthritides that affect children.
Methods: We used in situ hybridization with specific riboprobes to determine the expression of mRNA for proinflammatory or antiinflammatory cytokines in synovial samples from 5 patients with early, untreated JRA, 15 patients with late, treated JRA, and 9 patients with chronic Lyme arthritis. For comparison, synovia were examined from 6 patients with rheumatoid or psoriatic arthritis, and from 9 patients with various orthopedic conditions.
Results: Among the children with early, untreated JRA, a median of 3 to 8% of inflammatory cells in synovial samples expressed mRNA for the proinflammatory cytokines interleukin 1ß (IL-1ß), tumor necrosis factor-a (TNF-a), or interferon-g (IFN-g). Although a median of 3.9% of the cells expressed mRNA for the antiinflammatory cytokine IL-10, none had IL-4 mRNA. Most of the patients with late, treated JRA, chronic Lyme arthritis, rheumatoid, or psoriatic arthritis had mRNA for each of these proinflammatory cytokines in about 1% of the cells, whereas mRNA for the antiinflammatory cytokines was less frequent. The inflammatory cell density was much less in the synovium of patients with various orthopedic conditions, but about 1% of the infiltrating cells expressed mRNA for at least one of the proinflammatory cytokines.
Conclusion: Patients with early or late JRA or chronic Lyme arthritis have expression of mRNA in synovial tissue primarily for proinflammatory cytokines, with less expression of antiinflammatory cytokines.