ABSTRACT
BACKGROUND: The broad variations in the clinical manifestation in Lyme borreliosis underline the importance of laboratory investigations in serum and cerebrospinal fluid. MATERIAL AND METHODS: We have studied patients with neurological signs compatible with Lyme neuroborreliosis, pleocytosis in cerebrospinal fluid and positive Borrelia serology in serum/cerebrospinal fluid analysed by ELISA. We have evaluated clinical characteristics, laboratory parameters, treatment effects, and incidence variations. RESULTS: We included 25 patients in the study. Isolated facial palsy was often seen, but clinical manifestations showed huge variation. Fourteen of 25 (56%) patients had positive Borrelia burgdorferi-IgM and IgG titres in cerebrospinal fluid despite negative tests in serum. The mean annual incidence rate in the county judged by notified cases to the Norwegian Surveillance System for Communicable Diseases (MSIS) was 4.4/100,000 in the period 1989-99 as compared to the national rate of 4.3/100,000 in the same period. In 1998, however, the annual incidence rate in the county was 8.8/100,000 as compared to the national rate of 4.1/100,000. INTERPRETATION: The diversity of symptoms and signs suggests a liberal attitude towards serological testing including CSF analyses. Møre and Romsdal is a high incidence region for Lyme borreliosis in Norway. The annual variation in incidence might reflect a changing prevalence of the tick vector along the Norwegian coastline.
Subject(s)
Lyme Disease/diagnosis , Adolescent , Adult , Aged , Antibodies, Bacterial/blood , Antibodies, Bacterial/cerebrospinal fluid , Borrelia burgdorferi/immunology , Child , Child, Preschool , Female , Humans , Immunoglobulin G/blood , Immunoglobulin G/cerebrospinal fluid , Immunoglobulin M/blood , Immunoglobulin M/cerebrospinal fluid , Incidence , Lyme Disease/epidemiology , Lyme Disease/immunology , Male , Middle Aged , Norway/epidemiology , Retrospective Studies , Seroepidemiologic StudiesABSTRACT
We describe the history of a 29 year-old heterosexual female who presented symptoms and signs similar to those indicating infectious mononucleosis and influenza. However, the diagnosis turned out to be a primary HIV infection. The patient is highly infective at this phase of the HIV disease, and this report emphasizes the importance for general practitioners to have this diagnosis in mind when treating patients with "sero-negative" mononucleosis or influenza-like symptoms. The HIV-infection was suspected earlier but not confirmed until five weeks after the first positive screening test was taken. This illustrates the importance of repeated HIV testing when primary HIV infection is suspected.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Pregnancy Complications, Infectious/diagnosis , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/transmission , Adult , Diagnosis, Differential , Female , Humans , Infectious Mononucleosis/diagnosis , Influenza, Human/diagnosis , Pregnancy , Pregnancy Complications, Infectious/immunologyABSTRACT
Two EIA-tests (Chlamydiazyme, Abbott and Ideia, Celltech) were compared with culture for diagnosis of chlamydial infection in 1,185 patients from four different regions in Norway. The EIA-tests showed only minor differences in prevalences between the different regions (Chlamydiazyme: 4.1% to 5.4%; Ideia: 5.1% to 5.7%), but the agreement between the EIA-results was not satisfactory. 4.6 per cent of the specimens from Trondheim were culture-positive, but only 2.0% of the specimens from the other regions were culture-positive. Compared with the results from cultures from Trondheim (n = 349), the sensitivity, specificity, positive and negative predictive values for the EIA-tests were: Chlamydiazyme: 81.3%, 98.2%, 68.4% and 99.1% (81.3%, 96.4%, 52.0% and 99.1% without blocking test); Ideia: 93.8%, 98.5%, 75.0% and 99.7%. Culture should not be used as a routine method for detection of chlamydia in specimens sent by post without cooling.
Subject(s)
Bacteriological Techniques , Chlamydia Infections/diagnosis , Chlamydia trachomatis/isolation & purification , Immunoenzyme Techniques , Chlamydia Infections/immunology , Chlamydia Infections/microbiology , Chlamydia trachomatis/enzymology , Chlamydia trachomatis/immunology , Enzyme-Linked Immunosorbent Assay , Female , Humans , MaleSubject(s)
Disease Outbreaks , Psittacosis/epidemiology , Adolescent , Adult , Aged , Animals , Birds , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Norway , Psittacosis/transmissionABSTRACT
Chlamydia trachomatis was isolated from the cervix of 30 of 218 (13.8%) women admitted for legal termination of pregnancy. During the first two weeks after the abortion seven of the 30 (23.3%) patients developed pelvic inflammatory disease. Four of these had serological evidence of recent active chlamydial infection. Thus, routine examination of patients for genital chlamydial infection before termination of pregnancy is recommended.
PIP: The study objective was to record the incidence of Chlamydia trachomatis infections among patients admitted for legal abortion in Ullevaal Hospital (Oslo, Norway) and to follow those women harboring chlamydia, particularly those in whom it caused postoperative infections. 218 women admitted consecutively for abortion in the 1st trimester in 1980 were included in the study. The abortion procedure used was dilatation and vacuum aspiration. The diagnosis of pelvic inflammatory disease (PID) was made on the clinical basis of pelvic pain, adnexal masses, increased erythrocyte sedimentation rate, and fever. Patients who developed acute salpingitis were treated with doxycycline. Patients who harbored C trachomatis were recalled for follow up about 3 months after the abortion. Of the 218 patients, C trachomatis was isolated from the cervix in 30 (13.8%), N gonorrheae in 2 (2.8%), and both C trachomatis and N gonorrheae in 2. 7 of the 30 (23.3%) patients harboring C trachomatis developed PID. All the infections occurred in the 1st 2 weeks after the abortion. None of the patients with cervical gonorrhea developed salpingitis. 21 of the chlamydia positive patients attended for follow up 3 months after the abortion. Of the 7 patients with pelvic infection, 6 attended. 4 of these women had an appreciable rise in chlamydial IgG antibody titre while 2 had raised but unchanged titres. Another 4 patients had a 4-fold or more rise in titre but no clinical evidence of infection. Study findings indicate that patients harboring C trachomatis in the cervix at abortion are at high risk of developing postoperative infections and that C trachomatis is a major etiological agent in salpingitis occurring after abortion.
Subject(s)
Abortion, Therapeutic , Chlamydia Infections/complications , Pelvic Inflammatory Disease/etiology , Adult , Cervix Uteri/microbiology , Chlamydia trachomatis/immunology , Chlamydia trachomatis/isolation & purification , Female , Humans , Immunoglobulin G/analysis , Neisseria gonorrhoeae/isolation & purification , Postoperative Complications , PregnancyABSTRACT
An enzyme-linked immunosorbent assay (ELISA) for the detection of serum IgG antibodies to Chlamydia trachomatis has been developed. The C. trachomatis subtype LGV-2 was used as antigen. The ELISA was reproducible and its sensitivity and specificity compared well with that of the single-antigen immunofluorescence test (r = 0.83). 29 (85%) of the 34 patients with acute salpingitis had chlamydial serum IgG antibodies measured by the ELISA technique. The detection level in single blood donor specimens was 30%. Among the 34 patients with acute salpingitis, 16 paired serum specimens showed a fourfold or greater rise/fall in antibody titres, and 12 of these belonged to the 19 who harboured C. trachomatis in the lower genital tract.
