RESUMEN
Forty-seven patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA) and with objective neurological and/or neurophysiological findings were followed up after antibiotic treatment with dermatological, serological, neurological and neurophysiological controls. Despite a good therapeutic effect on ACA lesions, specific antibody values and symptoms of irritative nerve lesions, the objective neurological and neurophysiological findings of nerve deficit remained unchanged. There was no progress of neuropathy findings during the follow-up time. Our interpretation of the results is that the remaining neuropathy signs after treatment of ACA are neurological sequelae and not manifestations of persisting Borrelia infection.
Asunto(s)
Acrodermatitis/complicaciones , Acrodermatitis/tratamiento farmacológico , Antibacterianos/uso terapéutico , Borrelia burgdorferi/patogenicidad , Cefuroxima/uso terapéutico , Doxiciclina/uso terapéutico , Enfermedad de Lyme/complicaciones , Enfermedad de Lyme/tratamiento farmacológico , Penicilinas/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/etiología , Acrodermatitis/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Borrelia burgdorferi/efectos de los fármacos , Femenino , Estudios de Seguimiento , Humanos , Enfermedad de Lyme/fisiopatología , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Estudios Prospectivos , Factores de TiempoRESUMEN
In a prospective study, detailed clinical and neurophysiological examinations were performed in 17 patients with polyneuropathy associated with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA). Similar clinical and neurophysiological signs were found in most of the patients. The findings were those of a sensory polyneuropathy, mainly affecting large nerve fibres. Marked abnormality of vibration threshold was a common finding and in 4 patients this raised a suspicion of spinal cord engagement, in addition to a polyneuropathy. Sural nerve biopsy, performed in 3 of the patients, showed a mainly axonal neuropathy. Biopsy findings did not confirm earlier reports of vasculitis of epineural vessels in ACA-associated polyneuropathy.
Asunto(s)
Enfermedad de Lyme/diagnóstico , Polineuropatías/diagnóstico , Acrodermatitis/diagnóstico , Acrodermatitis/patología , Acrodermatitis/fisiopatología , Anciano , Anciano de 80 o más Años , Axones/patología , Axones/fisiología , Biopsia , Femenino , Humanos , Enfermedad de Lyme/patología , Enfermedad de Lyme/fisiopatología , Masculino , Fibras Nerviosas/patología , Fibras Nerviosas/fisiología , Examen Neurológico , Polineuropatías/patología , Polineuropatías/fisiopatología , Nervio Sural/patología , Nervio Sural/fisiopatología , Vasa Nervorum/patología , Vasa Nervorum/fisiopatología , Vasculitis/diagnóstico , Vasculitis/patología , Vasculitis/fisiopatologíaRESUMEN
Sera from 210 patients with Lyme borreliosis (LB) were studied by an enzyme-linked immunosorbent assay (ELISA) based on a synthetic peptide (pepC10) comprising the C-terminal 10-amino-acid residues of OspC of Borrelia burgdorferi. We found that 36.3 and 45.0% of the serum samples from patients with erythema migrans (EM) and neuroborreliosis (NB), respectively, displayed immunoglobulin M (IgM) anti-pepC10 reactivities, while these samples rarely (=8%) displayed IgG antibody reactivities. Sera from patients with acrodermatitis chronica atrophicans did not contain anti-pepC10 antibodies. The diagnostic performance of this newly developed peptide ELISA was compared with those of an ELISA based on the full-length recombinant OspC protein (rOspC) and a commercially available ELISA based on the B. burgdorferi flagellum (Fla). The sensitivity of the IgM pepC10 ELISA was slightly lower (P < 0.04) than that of the rOspC ELISA for EM patients (36.3 versus 43.8%), while there was no difference for NB patients (45.0 versus 48.0%). However, the optical density values obtained by the pepC10 ELISA were generally higher than those obtained by the rOspC ELISA, leading to a significantly better quantitative discrimination between seropositive patients with NB and controls (P < 0.008). The specificity of the pepC10 ELISA was similar to those of the rOspC ELISA and the Fla ELISA for relevant controls including patients with syphilis and mononucleosis. Although the overall diagnostic sensitivity of the Fla ELISA was superior, 8.8 and 12.0% of the EM and NB patients, respectively, were antibody positive only by the pepC10 ELISA. Thus, use of a diagnostic test for LB based on the detection of IgM antibodies to pepC10 and Fla has increased sensitivity for the diagnosis of early LB.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Grupo Borrelia Burgdorferi/inmunología , Enfermedad de Lyme/diagnóstico , Fosfatidilcolinas/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/inmunología , Pruebas SerológicasRESUMEN
We studied 111 consecutive, untreated and serologically confirmed patients with acrodermatitis chronica atrophicans. Emphasis was on the histopathologic patterns of erythematous and fibrous lesions, and on an assay used to correlate histopathologic findings with such clinical features as fibrous nodules, ulnar bands and the pain reaction allodynia. There was a significant correlation between allodynia and signs of marked inflammation, but not between allodynia and neural and perineural cell infiltrates or fibrosis. Moreover, there was no significant correlation between serum IgG titers to Borrelia and the density of inflammatory cell infiltrates or the proportion of plasma cells in tissue. Histopathologic examination did not reveal any important differences between fibrous nodules, ulnar bands and sclerodermatous lesions. The histopathologic pattern is not diagnostic per se, but characteristic enough to alert the experienced pathologist.
Asunto(s)
Acrodermatitis , Acrodermatitis/microbiología , Acrodermatitis/patología , Acrodermatitis/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Vasos Sanguíneos/patología , Vasos Sanguíneos/fisiopatología , Infecciones por Borrelia , Edema/patología , Edema/fisiopatología , Células Epidérmicas , Epidermis/patología , Femenino , Fibrosis/patología , Histocitoquímica , Humanos , Sistema Linfático/patología , Sistema Linfático/fisiopatología , Linfocitos/patología , Masculino , Persona de Mediana Edad , Fibras Nerviosas/patología , Células Plasmáticas/patología , Esclerosis/patología , Piel/patología , Piel/fisiopatologíaRESUMEN
Clinical and/or neurophysiological signs of peripheral neuropathy were found in 64% of 63 consecutive untreated patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA). The neuropathy frequency was significantly higher in the patients than in 30 age- and sex-matched control persons of whom 27% had neuropathy findings. The most common neuropathy in ACA was a symmetric distal sensory polyneuropathy. In a subgroup of patients with localized or asymmetric neuropathy, the changes were found more often in extremities with than without visible ACA lesions. Neuropathy symptoms, most often pain and/or paresthesia, were present in 64% of the patients, compared to in 13% of the control persons. Thus, both symptoms and signs of neuropathy were significantly more frequent in patients with untreated ACA than in control subjects.
Asunto(s)
Acrodermatitis/epidemiología , Enfermedad de Lyme/complicaciones , Enfermedades del Sistema Nervioso Periférico/epidemiología , Acrodermatitis/microbiología , Acrodermatitis/patología , Adulto , Factores de Edad , Anciano , Grupo Borrelia Burgdorferi/aislamiento & purificación , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Comorbilidad , Extremidades/patología , Extremidades/fisiopatología , Femenino , Humanos , Hiperalgesia/patología , Hiperalgesia/fisiopatología , Hipoestesia/patología , Hipoestesia/fisiopatología , Masculino , Persona de Mediana Edad , Dolor/clasificación , Dolor/patología , Dolor/fisiopatología , Parestesia/patología , Parestesia/fisiopatología , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/patología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Suecia/epidemiologíaAsunto(s)
Control de Ácaros y Garrapatas , Enfermedades por Picaduras de Garrapatas , Garrapatas , Animales , Vectores Arácnidos , Europa (Continente)/epidemiología , Humanos , Investigación , Enfermedades por Picaduras de Garrapatas/diagnóstico , Enfermedades por Picaduras de Garrapatas/epidemiología , Enfermedades por Picaduras de Garrapatas/terapia , Garrapatas/ultraestructuraRESUMEN
The aim of this study was to evaluate the polymerase chain reaction (PCR) as a diagnostic tool for Lyme borreliosis on large numbers of samples from clinically well-defined cases of early and late cutaneous borreliosis. Skin biopsy specimens from patients with erythema migrans and acrodermatitis chronica atrophicans were analysed blindly together with an equal number of control biopsies. Using two different dilutions of each DNA specimen increased the number of total positives detected. All of the 76 control biopsies were PCR negative. Biopsy specimens from 18 of 26 (69%) erythema migrans lesions and from 22 of 36 (61%) acrodermatitis chronica atrophicans lesions were PCR positive. Fourteen post-therapy biopsies from patients with acrodermatitis chronica atrophicans were all negative, supporting the opinion that antibiotic therapy is successful in this chronic manifestation of Lyme borreliosis.
Asunto(s)
Grupo Borrelia Burgdorferi/aislamiento & purificación , ADN Bacteriano/análisis , Enfermedad de Lyme/diagnóstico , Acrodermatitis/diagnóstico , Acrodermatitis/tratamiento farmacológico , Secuencia de Bases , Biopsia , Grupo Borrelia Burgdorferi/genética , Eritema Crónico Migrans/diagnóstico , Humanos , Enfermedad de Lyme/patología , Enfermedad de Lyme/fisiopatología , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , Sensibilidad y Especificidad , Piel/microbiología , Piel/patologíaRESUMEN
The kinetics of Borrelia burgdorferi-specific serum IgG antibody values in 74 patients treated for acrodermatitis chronica atrophicans was analysed by means of enzyme-linked immunosorbent assay. At the last clinical control, there had been no clinical signs of active infection. The serological follow-up time ranged from 12 months to 5 1/2 years (median 2 years and 1 month). In 68 (92%) of the 74 patients, a significant decrease of the specific antibody values was found within 3 years after the initiation of therapy. In 53 (72%) of the patients, this decrease was found within 15 months. Most of the patients remained seropositive during the follow-up period. The results show that a significant decline of the levels of serum IgG antibodies to Borrelia burgdorferi can be expected in the majority of patients who do not exhibit clinical evidence of persistent infection after antibiotic treatment of acrodermatitis chronica atrophicans.
Asunto(s)
Acrodermatitis/inmunología , Acrodermatitis/microbiología , Anticuerpos Antibacterianos/sangre , Grupo Borrelia Burgdorferi/inmunología , Eritema Crónico Migrans/inmunología , Inmunoglobulina G/sangre , Acrodermatitis/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Ensayo de Inmunoadsorción Enzimática , Eritema Crónico Migrans/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The possibility of an association between manifestations of Lyme borreliosis and HLA class II alleles has been investigated with varying results. In the present study, we used genomic typing techniques to determine the DR, DQ and DP allele frequencies in 29 patients with erythema migrans and 36 patients with acrodermatitis chronica atrophicans. We did not find a significant deviation from controls in the distribution of the HLA class II alleles in any of these disease manifestations, nor in the subgroup of 8 patients with acrodermatitis chronica atrophicans and long-standing arthritis. With the additional information obtained by the typing techniques used, our results are thus in accord with those studies where no association between the development of the late disease manifestation acrodermatitis chronica atrophicans and HLA class II alleles has been found.
Asunto(s)
Acrodermatitis/inmunología , Alelos , Eritema Crónico Migrans/inmunología , Antígenos de Histocompatibilidad Clase II/genética , Enfermedad de Lyme/inmunología , Acrodermatitis/complicaciones , Acrodermatitis/genética , Atrofia , Southern Blotting , Eritema Crónico Migrans/genética , Antígenos HLA-D/genética , Haplotipos , Humanos , Enfermedad de Lyme/complicaciones , Enfermedad de Lyme/genética , Polimorfismo de Longitud del Fragmento de Restricción , SueciaAsunto(s)
Enfermedad de Lyme , África/epidemiología , Américas/epidemiología , Animales , Asia/epidemiología , Australia/epidemiología , Europa (Continente)/epidemiología , Humanos , Incidencia , Enfermedad de Lyme/clasificación , Enfermedad de Lyme/complicaciones , Enfermedad de Lyme/epidemiología , Enfermedad de Lyme/microbiología , Terminología como AsuntoAsunto(s)
Enfermedad de Lyme , Animales , Antibacterianos/uso terapéutico , ADN Bacteriano/genética , Humanos , Enfermedad de Lyme/complicaciones , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/tratamiento farmacológico , Enfermedad de Lyme/genética , Enfermedad de Lyme/microbiología , Enfermedades del Sistema Nervioso/etiología , Reacción en Cadena de la Polimerasa , Enfermedades de la Piel/etiologíaAsunto(s)
Acrodermatitis/diagnóstico , Grupo Borrelia Burgdorferi , Acrodermatitis/sangre , Acrodermatitis/tratamiento farmacológico , Acrodermatitis/microbiología , Anciano , Antibacterianos/uso terapéutico , Atrofia , Grupo Borrelia Burgdorferi/aislamiento & purificación , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Linfáticas/sangre , Enfermedades Linfáticas/microbiología , Persona de Mediana Edad , Piel/patologíaRESUMEN
A new semisynthetic macrolide roxithromycin was evaluated for its potential use in the treatment of Lyme borreliosis. Using a macro-dilution broth technique, Borrelia burgdorferi was shown to be susceptible to roxithromycin with a minimal bactericidal concentration (MBC) of 0.06-0.25 microgram/ml. A systemic B. burgdorferi infection was established in gerbils; a dosage of greater than or equal to 25 mg/kg/day roxithromycin for 10 days eliminated the infection. A single blind, randomized multicenter study was performed to evaluate the efficacy of roxithromycin 150 mg b.i.d. versus phenoxymethyl-penicillin 1 g b.i.d. for 10 days in patients with uncomplicated erythema migrans. The study was interrupted when 19 patients had enrolled because of five treatment failures. All 5 patients had received roxithromycin; three patients had persisting or recurrent erythema migrans, one developed a secondary erythema migrans-like lesion and severe arthralgia and one developed neuroborreliosis. B. burgdorferi was isolated from skin biopsies after roxithromycin therapy from two patients with persistent erythema migrans and both isolates were still highly susceptible to roxithromycin (MBC = 0.03 microgram/ml). No treatment failures were seen in 10 patients treated with phenoxymethyl-penicillin. Roxithromycin is thus not recommended for treatment of Lyme borreliosis.
Asunto(s)
Eritema Crónico Migrans/tratamiento farmacológico , Enfermedad de Lyme/tratamiento farmacológico , Roxitromicina/uso terapéutico , Adulto , Anciano , Animales , Modelos Animales de Enfermedad , Susceptibilidad a Enfermedades , Femenino , Gerbillinae , Humanos , Masculino , Persona de Mediana Edad , Penicilina V/uso terapéutico , Recurrencia , Método Simple Ciego , SueciaRESUMEN
In order to assess patients' preferences for different inhalation devices a questionnaire has been developed. The questionnaire consisted of items covering various aspects considered important for patients who regularly use inhalation devices. The questions were designed to be of a general character so any inhalation device could be evaluated. We evaluated the questionnaire in a multicenter, open crossover study comparing patients' opinions of MDI with and without spacer and of a dry powder inhaler, Turbuhaler. One hundred twenty-three patients with stable asthma confirmed by daily peak expiratory flow rate (PEF) measurements used for 2 weeks MDI only and MDI with spacer and for 2 weeks Turbuhaler. The order was randomized. The drugs were terbutaline inhaled via MDI and Turbuhaler and budesonide inhaled via MDI with spacer and turbuhaler. At the end of each evaluation period the patients answered a number of questions about their opinion by marking on a visual analogue scale. A factor analysis revealed that the different questions represent a few common factors important for evaluating opinion about inhalation devices. These factors are handling of the device, use, time to learn how to use the device properly, how confident the patients feel about the use of it, and taste/irritation. A standardized questionnaire of reduced size seems to be a suitable method for evaluating patient preference for different inhalation devices.
Asunto(s)
Nebulizadores y Vaporizadores/normas , Satisfacción del Paciente , Administración por Inhalación , Adulto , Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Budesonida , Humanos , Persona de Mediana Edad , Pregnenodionas/administración & dosificación , Pregnenodionas/uso terapéutico , Encuestas y Cuestionarios , Terbutalina/administración & dosificación , Terbutalina/uso terapéuticoRESUMEN
Three different enzyme-linked immunosorbent assays (ELISA) and Western blot were compared in regard to the detection of antibodies to Borrelia burgdorferi in sera from 100 patients with erythema migrans and from 100 controls. For IgG detection, a commercial indirect ELISA kit with flagellum antigen (flagellum ELISA) was significantly more sensitive than the routinely-used indirect ELISA with sonicated whole-cell antigen (sonicate ELISA) (p = 0.008). The difference in positivity in the IgM test was of borderline significance (p = 0.058). An IgM antibody-capture ELISA with sonicated whole-cell antigen (capture ELISA) was significantly more sensitive than either the IgM sonicate ELISA (p less than 0.001) or IgM flagellum ELISA (p less than 0.001). With the Western blot pattern chosen as the criterion for positivity, IgM Western blot was at least equal to IgM capture ELISA in terms of the number of positive erythema migrans sera, but a frequent discrepancy between these two tests was noted as to positivity in individual sera. IgG Western blot was considered to be of less value for the diagnosis of current disease due to a high occurrence of positivity among controls.
Asunto(s)
Anticuerpos Antibacterianos/análisis , Grupo Borrelia Burgdorferi/inmunología , Eritema Crónico Migrans/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Western Blotting , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Lactante , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
On the basis of answers by clinicians to a questionnaire concerning the classification and staging of Lyme borreliosis, the following classification is proposed: EARLY LYME BORRELIOSIS Localized infection: Erythema migrans and borrelial lymphocytoma without signs or symptoms of disseminated infection. (Regional lymphadenopathy and/or minor constitutional symptoms may be present). Early disseminated infection: Multiple erythema migrans-like skin lesions. Early manifestations of neuroborreliosis, arthritis, carditis or other organ involvement. LATE LYME BORRELIOSIS Chronic infection: Acrodermatitis chronica atrophicans. Neurologic, rheumatic or other organ manifestations--persistent or remitting for at least 12 (or 6) months.
Asunto(s)
Eritema Crónico Migrans/etiología , Enfermedad de Lyme/etiología , HumanosRESUMEN
At the IVth international Conference on Lyme borreliosis the cutaneous manifestations and differential diagnoses were reviewed. Erythema migrans (EM) is a spontaneously healing erythematous lesion occuring at the site of borrelial inoculation. Typically it is homogeneous or is annular with centrifugal spreading. Atypical variants may also occur. Borrelial lymphocytoma (BL) generally presents as a bluish-red nodule. Histologically there is a dense polyclonal lymphocytic infiltrate. Predilection sites are the ear and the breast. It may appear secondarily to EM or be the first manifestation of Lyme borreliosis. EM and BL are early, localized cutaneous manifestations, but sometimes extracutaneous signs or symptoms of disseminated disease may appear simultaneously with either of these lesions. Multiple EM-like lesions, occurring as a result of hematogenous spread, are the cutaneous markers of disseminated disease. Acrodermatitis chronica atrophicans is a chronic skin lesion which is generally seen on the extremities. It starts with an inflammatory phase with bluish-red discoloration, which years to decades later may be followed by an atrophic phase. Sclerotic skin lesions may also develop. Important differential diagnoses are granuloma annulare, malignant lymphoma, benign lymphoreticular infiltrations and sclerotic lesions of non-borrelial origin, collagenoses and circulatory insufficiency.
Asunto(s)
Eritema Crónico Migrans/complicaciones , Enfermedad de Lyme/complicaciones , Enfermedades Cutáneas Infecciosas/complicaciones , Diagnóstico Diferencial , Eritema Crónico Migrans/diagnóstico , Eritema Crónico Migrans/patología , Europa (Continente) , Humanos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/patología , América del Norte , Esclerosis , Enfermedades Cutáneas Infecciosas/diagnóstico , Enfermedades Cutáneas Infecciosas/patologíaRESUMEN
During this decade, Lyme borreliosis has emerged as an important health problem, especially in Europe and in the United States, and there has been an explosive growth of knowledge about this condition. The true incidence of lxodes-borne borrelial infection is probably increasing, at least in parts of the world, but the reported increase is also partly attributable to a greater recognition and awareness of this infection. This paper reviews the basic knowledge about Borrelia burgdorferi, its vectors, and its reservoirs. The tendency for Lyme borreliosis to mimic other diseases and the similarities to syphilis are described. The nomenclature of the dermatologic manifestations and the staging of the disease as a localized, disseminated, and chronic infection are summarized. The clinical manifestations, from the dermatologist's point of view, and the sometimes difficult task of diagnosis both at the clinical and laboratory level are reviewed. The dermatologic manifestations erythema migrans, secondary, multiple erythema migranslike skin lesions, borrelial lymphocytoma, and acrodermatitis chronica atrophicans may serve as helpful landmarks in the identification of Lyme borreliosis.