Incidence of Borrelia garinii and Borrelia afzelii in Ixodes ricinus ticks in an urban environment, Prague, Czech Republic, between 1995 and 1998.

The presence of Borrelia burgdorferi sensu lato and its individual genospecies was determined using a single-step polymerase chain reaction in a total of 779 Ixodes ricinus ticks collected from an urban park in Prague, Czech Republic. The incidence of Borrelia burgdorferi sensu lato was 9.2% in 1995, 3.4% in 1996, 4.5% in 1997 and 2.8% in 1998. The Borrelia garinii to Borrelia afzelii ratio was 1.4:1 and it did not differ significantly throughout the study period. Borrelia burgdorferi sensu stricto was not detected. Borrelia garinii/Borrelia afzelii coinfection was found in 5.7% of positive ticks. The results indicate it is possible for the urban population to come in contact with the causative agent of Lyme disease in an urban park.

Incidence of spirochetes (Borrelia sp.) in the tick Ixodes ricinus in the urban environment (capital of Prague) between 1994-1997.

A total of 12287 ticks were collected from 10 localities of the capital of Prague between 1994 and 1997 (2978 ticks in 1994, 5612 ticks in 1995-1996, 3686 ticks in 1997). The presence of Borrelia was investigated by the indirect immunofluorescence assay using hyperimmune rabbit sera. The tick infestation ranged between 3.8% and 9.7% (1994), 7.9% and 11.3% (1995), 3.6% and 6.2% (1996) and 4.8% and 9.2% (1997). The results obtained are indicative of a relatively high opportunity for exposure to the causative agent in Prague--the dynamics of the spirochete positivity rates in ticks in different years corresponds with the dynamics recorded in the incidence of Lyme borreliosis in the same region.

[Single-step polymerase chain reaction in the detection of Borrelia burgdorferi and the genome species in the Ixodes ricinus tick]. / Pouzití jednokrokové polymerázové retezové reakce k detekci Borrelia burgdorferi sensu lato a jejich genomospecies u klíst'at Ixodes ricinus.

The objective of the work to introduce screening PCR into the diagnosis of Borrelia burgdorferi sensu lato in the vector selection of the most suitable primer, derived from chromosomal DNA and detection of different genome species. The sensitivity of primers, described in the literature (LD, 16S, Wk, 5S-23S) was tested by different amounts of DNA strains of borrelias. The most sensitive primer--LD was used for detection of borrelias in the vector. Ticks were collected in municipal parks from 1995-1997. A total of 635 ticks were examined. The positivity of the group differs in individual years: 9.2% in 1995, 3.4% in 1996, and 4.5% in 1997. Adult ticks were markedly more infected than nymphs. Borrelia garinii prevails at the site, Borrelia burgdorferi sensu stricto was not detected so far. Mixed infection with Borrelia garinii/Borrelia afzelii was found in 1997 in one sample (female ticks). PCR is a sensitive and specific method suitable for assessment of the herd immunity of ticks with borrelias. It makes it possible to differentiate with a relatively high sensitivity individual genome species of Borrelia burgdorferi in the vector. Before its use the sensitivity of the reaction must be tested in the presence of tick DNA.

[Educational status of the Czech population about Lyme borreliosis and experience with tick bites--pilot study]. / Príspevek k informovanosti obyvatelstva o lymeské borelióze a zkusenosti s napadením klíst'aty--pilotní studie.

The incidence of Lyme borreliosis (LB) has a rising trend since 1995. In 1995 6,302 cases were reported, in 1996 4,192 (EPIDAT, SZU). The objective of the present work was to assess in a selected population sample knowledge of ticks and their relationship to Lyme borreliosis. The investigation was based on a survey using questionnaires. 110 respondents were selected according to the following pattern: 19 secondary school students, 32 blood donors, 44 visitors of parks, 15 countryside people. 99.1% of the subjects knew about the existence of ticks in the Czech Republic, 10.9% of the respondents do not know about Lyme borreliosis. More than 80% of the people are in the countryside at least once a week. 87% of the people report they had a tick, 75% removed a tick from another person. Only 6.7% of the respondents never had any contact with ticks. When removing ticks 17% of the subjects use disinfection, 67% use oil. Almost 30% of the respondents remove ticks with bare hands and more than 14% destroy them by squashing them between their fingers. 41% are not aware of the risk of transmission of tick-borne encephalitis. From the investigation a frequent contact of the population with ticks is apparent. Theoretical knowledge of the problem is extensive, practical experience is different. Unfortunately unsuitable habits in removal of ticks persist and this increases the risk of transmission of Lyme borreliosis.

Contact with ticks and awareness of tick-borne diseases among the Czech population--a pilot study.

In the Czech Republic, the incidence of Lyme borreliosis (LB) has shown a rising trend since 1988. The goal of this study has been to find out to what extent a selected part of population is aware of ticks and of the relationship between ticks and LB. The study was based on a questionnaire survey. A total of 110 respondents were selected, including 19 secondary school students, 32 blood donors, 44 park-goers, 15 countryside people. As many as 99% of the respondents were aware of the presence of ticks, 91% knew that ticks are sucking blood of humans and animals, 1.8% thought they eat leaves. 74.5% of the respondents expect ticks to reach them from the vegetation while 22% believe that ticks fall from the trees. Furthermore, 87% and 75% of the respondents indicated to have had ticks attached to the skin or to have removed a tick from other persons' skin, respectively. Only 6.7% of them had never come into contact with ticks. 17% of the respondents use disinfectant when removing a tick, while 67% use oil for tick removal. Almost 30% remove ticks with naked hands. Over 14% destroy the ticks by squashing them with naked fingers. Finally, about 11% of the population studied had never heard about LB and 41% were not aware of the risk of tick-borne encephalitis.

Localization of Borrelia burgdorferi in murine Lyme borreliosis by electron microscopy.

Lyme borreliosis is a newly recognized systemic infection with protean clinical manifestations. Because the localization of the causative spirochete (Borrelia burgdorferi) in infected tissues is unknown, we used electron microscopy to find spirochetes in the hearts of chronically infected mice. There were three predominant locations for the spirochete in the hearts. In mice infected for one month or less, the spirochetes were mostly in or around blood vessels. They were either in the lumen or in the perivascular space. Mice infected for more than one month had B. burgdorferi in cardiac myocytes as well, often with clear spaces around them. The third area in which spirochetes were common was collagen fibers; the borreliae were wrapped around fibers with their long axis parallel to the fibers. The number of spirochetes was relatively low, but there was no appreciable decrease in numbers of spirochetes with increasing time postinfection. Inflammatory infiltrates were primarily in the endocardium and pericardium, but spirochetes were generally not in or near areas of inflammation. These data are consistent with previously published information that have identified the heart as a site of chronic infection and inflammation in the mouse. The studies extend our understanding of the behavior of the spirochete in vivo by identifying common locations of B. burgdorferi and by noting the disparity between infection and inflammation.

Electron microscopy of Langerhans cells and Borrelia burgdorferi in Lyme disease patients.

To investigate dermal and epidermal involvement in the presence of Borrelia burgdorferi and to analyze the role of Langerhans cells and keratinocytes, 14 cases of erythema chronicum migrans and two controls were studied by means of electron microscopy, using negative staining and sectioning techniques. Using immunoelectron microscopy and histochemistry, positive results for B. burgdorferi were disclosed in 5 cases of erythema chronicum migrans and 3 cases of neuroborreliosis which were confirmed by cultivation. We cultured 4 stains of B. burgdorferi from the skin, 1 from blood and 2 from cerebrospinal fluid in BSK medium. Near to the centre of erythema chronicum migrans with focal necrosis were both a dissolved basal membrane and keratinocyte desmosomes surrounding damaged B. burgdorferi cells in the epidermis. Markedly oedematous keratinocytes and Langerhans cells with B. burgdorferi were released into lymphocyte infiltrates. At the periphery of all erythema chronicum migrans lesions, keratinocytes were well preserved while all dendritic cells seemed to be vacuolated. Above foci of B. burgdorferi located perivascular or among collagen fibers, Langerhans cells were frequent and more granulated. The possible role of Langerhans cells in the identification and elimination of B. burgdorferi is discussed.

An advocacy intervention program for women with abusive partners: initial evaluation.

Experimentally tested the hypotheses that (1) battered women are in need of numerous community resources upon exit from a domestic violence shelter, (2) working with advocates increases women's effectiveness in obtaining needed resources and social support, and (3) success in obtaining resources and social support increases women's levels of life satisfaction and decreases their risk of further abuse. The initial findings of a short-term intervention project designed to provide postshelter advocacy services to women with abusive partners are presented. One-hundred forty-one battered women were interviewed immediately upon their exit from a domestic violence shelter as well as 10 weeks thereafter. Half the sample was randomly assigned to receive the services of trained advocates who assisted them in accessing needed community resources. Women who worked with advocates reported being more effective in accessing resources and had higher levels of social support and overall quality of life postintervention. Although all women reported some decrease in postshelter abuse, there were no differences between those with and those without advocates, and abuse continued to be a problem for many women.

After the crisis: a needs assessment of women leaving a domestic violence shelter.

The current study presents the results of a needs assessment of 141 women exiting an emergency shelter for women with abusive partners. Extensive in-person interviews were conducted. Results indicate that battered women need numerous community resources upon their shelter exit, including legal assistance, employment, and housing. Race, age, and whether a woman was returning to her assailant influenced which resources she reported needing at shelter exit. Most of the women had experienced severe abuse and injuries, and required physical protection. Implications of these findings as they relate to program development and integration of social services are discussed.

An ecological approach to tracking battered women over time.

The current study examined the difficulties inherent in using an experimental, longitudinal design to determine the effects of an advocacy program designed to increase battered women's access to community resources. The current research employed a multitude of techniques to follow battered women over the first year following their stay at a shelter for women with abusive partners. The tracking rate was very successful; 96% were found and interviewed at the 10-week project termination point, 96% at the 6-month follow-up, and 94% at the 12-month followup. The intricate system of procedures used for successfully tracking this mobile population over time are presented as an effective methodology for doing necessary longitudinal research with battered women as well as other transient, or "difficult to follow" populations.

Autonomic hyperreflexia: intraoperative control with pentolinium tartrate.

Autonomic hyperreflexia (AH) is a clinical syndrome associated with the development of severe hypertension. It usually occurs in patients with high-level chronic spinal cord injury, and in response to stimuli associated with the distension of a hollow viscus. Protection against AH by the prophylactic use of pentolinium tartrate (Ansolysen) in doses of 10-15 mg was evaluated in a controlled study of unanaesthetized patients who were either quadriplegic or paraplegic and who were undergoing rectal and bladder surgical procedures. When compared with the control group, the systolic and diastolic arterial pressures during operation were significantly less (P less than 0.05) and remained near normal in the pretreated patients. The use of pentolinium to prevent or control AH during surgical procedures in patients with chronic spinal cord damage is a simple alternative to spinal or general anaesthesia.