Lyme borreliosis infection as a cause of dilated cardiomyopathy.

The relatively low percent of patients affected with the cardiac form of Lyme borreliosis is difficult to diagnose, especially if the disease manifests itself in ways other than atrio-ventricular blockade. The advanced stage of Lyme carditis manifesting as dilated cardiomyopathy is a special case of this affliction. The authors of this report present clinical experience with an attempt to support the working hypothesis about involvement of Lyme borreliosis infection in the development of dilated cardiomyopathy. The patients were clinically examined thoroughly with special attention to the cardiovascular system. In addition to the basic clinical methods, the following procedures have been employed: dynamic Holter's electrocardiography, exercise ECG test, coronarography, and myocardial biopsy. From laboratory methods pertaining to the detection of Borrelia, ELISA method, Western blot, PCR, electron microscopy and histopathological analysis were used. In all three cases, clinical and laboratory findings provided the evidence of the borreliosis infection involvement in the development of dilated cardiomyopathy.

Clinical and demographic characteristics of psychiatric patients seropositive for Borrelia burgdorferi.

PURPOSE: Borrelia burgdorferi (Bb) infection can affect the central nervous system and possibly lead to psychiatric disorders. We compared clinical and demographic variables in Bb seropositive and seronegative psychiatric patients and healthy controls. METHOD: Nine hundred and twenty-six consecutive psychiatric patients were screened for antibodies to Bb and compared with 884 simultaneously recruited healthy subjects. RESULTS: Contrary to healthy controls, seropositive psychiatric patients were significantly younger than seronegative ones. None of the studied psychiatric diagnostic categories exhibited stronger association with seropositivity. There were no differences between seropositive and seronegative psychiatric patients in hospitalization length, proportion of previously hospitalized patients and proportion of subjects with family history of psychiatric disorders. CONCLUSION: These findings elaborate on potential association between Bb infection and psychiatric morbidity, but fail to identify any specific clinical 'signature' of Bb infection.

Lyme borreliosis--waiting for Lyme carditis? A long-term prospective study.

A long-term prospective study of patients with confirmed non-cardiac form of Lyme disease (n=221) over a mean follow-up period of 40.6 months is reported. The study revealed no case of Borrelia-related cardiac involvement developed after several years in patients who had received antibiotic therapy in the early period. Therefore, these patients do not need follow-up by a cardiologist.

Study of awareness of tick-borne diseases among children and young people in the Czech Republic.

In the 2000 and 2001 years, there was performed a study which has given some insight on the knowledge of youths about ticks and tick-borne diseases. Two thousand seven hundred and sixty-three respondents from 6 to 26 years of age took part in this investigation. More than 98% of respondents knew about the existence of ticks. Almost 93% of children and 97% of adolescents reported that ticks feed on blood. Although the majority of respondents aged 10 to 26 years is convinced that ticks live on vegetation, 23% of them supposed that ticks jump on humans from trees. As many as 93.5% of youths knew that Lyme disease is transmitted by ticks. The main sources of information about Lyme disease for students and pupils older than 10 years of age are television and radio (40.9%) and the press (37.5%). The frequency of contact of young people with ticks is high--90.4% of children younger than 12 years, and 93.7% of youths from 10 to 26 years of age had at least once an attached tick. 56.1% of youths older than 10 years use oil to remove an attached tick. Almost 23.7% remove ticks with bare hands. People used those methods of tick removal although even children younger than 12 years of age knew that it was an incorrect habit. After removing, a tick is most frequently burned.

[Prevalence of antiborrelia antibodies in two populations: various interpretations of the same data]. / Prevalence antiborreliových protilátek u dvou populací: ruzná interpretace stejných dat.

OBJECTIVE: The objective of the work was to test whether differently formulated hypotheses, when using correct statistical methods, and the same data lead to the same results. The work pertains to the interpretation of the prevalence of antiborrelia antibody levels in more or less high risk populations. GROUP: A group of 200 blood donors from Prague (100 men, mean age 33.5 years and 100 women mean age 24.4 years) and 71 subjects with a higher risk of contact with ticks infected with Borrelia burgdorferi--forestry workers from the Sumava mountains (39 men, mean age 40.6 years and 32 women, mean age 44.5 years). METHOD: In all participants antiborrelia antibodies class IgM and IgG were assessed and using the Western blot method the presence of specific antigens was examined. The blood samples of all probands were analyzed in the national reference laboratory for Lyme borreliosis CEM in the National Institute of Public Health in Prague. To test the hypothesis on the difference of groups as regards the frequency of positive antibody levels the chi square test was used. For testing the hypothesis on the difference of the groups as regards antibodies irrespective of normal laboratory values the non-parametric method--the Mann-Whitney test was used. RESULTS: The group of Prague blood donors and forestry workers from the Sumava mountains do not differ as to the individual frequency of positive antibody values assessed by the ELISA method in class IgM and IgG but they differ in class IgM assessed by the Western blot method. Both groups differ moreover markedly in the general distribution of antibodies unrelated to normal laboratory values assessed by the ELISA method in class IgM, in class IgG the distribution does not differ. CONCLUSION: We provided evidence that when using a different formulation of the hypothesis while using correct statistical methods identical data can be differently interpreted. Thus in the interpretation of the prevalence of antiborrelia antibody levels in healthy populations with a different risk--even if the two groups do not differs as to the frequency of positive findings, there is a significant statistical difference in their distribution.

[Culture of Borrelia burgdorferi sensu lato from patients in the Czech Republic]. / Kultivace Borrelia burgdorferi sensu lato z pacientu v Ceské republice.

Spirochete of Borrelia burgdorferi sensu lato were isolated in a modified BSK medium from 26 patients of 275 investigated suffering from early and late borreliosis. The isolates were specified by phenotype and genotype analysis using monoclonal antibodies, by immunochemical methods and by including species specific 16S rRNA, OspA and OspC primers and probes in a polymerase chain reaction with hybridization. Borrelia afzelii was found in 9 patients, Borrelia garinii in 16 and B. burgdorferi sensu stricto in one instance. B. afzelii was isolated from 5 biopsies with erythema migrans. 2 with acrodermatitis chronica atrophicans and from blood of 2 patients with arthritis. B. garinii cultures were prepared from 6 cerebrospinal fluids, 3 blood samples, 1 placenta, 1 liver biopsy and 5 skin samples. Unique was B. burgdorferi detected in a bioptic sample of the heart muscle which was positive on immunohistochemical examination. Monoclonal antibodies against OspA and genotype analysis provided evidence that Borrelia garinii isolates from cerebrospinal fluid are close to serotype IV. One CSF isolate was resistant to antibiotics; the tropism of B. garinii to nervous tissue is contemplated.

Sensitivity of Borrelia burgdorferi strains isolated in the Czech Republic.

We tested in vitro susceptibility of 5 strains of Borrelia burgdorferi sensu lato, isolated from patients in the Czech Republic, to penicillin G, ceftriaxone, cefotaxime, doxycycline and amoxycillin combined with clavulanic acid by broth macrodilution method on BSK medium. Results confirmed high efficacy of the tested drugs, particularly on B. afzelii and B. burgdorferi sensu stricto. A strain of B. garinii, isolated from cerebrospinal fluid, required a longer period of antibiotic activity before inhibitory effects were achieved. Penicillin G was effective only in higher concentrations, attainable by i. v. application. Ceftriaxone had the strongest borreliacidal activity.

[Informational value of the prevalence of antiborrelia antibodies in a healthy and at risk population]. / Výpovední hodnota prevalence antiboreliových protilátek u zdravé a rizikové populace.

The authors tried to confirm data on the prevalence of antiborrelia antibodies class IgM and IgG in the local healthy population (200 blood donors) and in subjects with an increased risk of infection (forestry labourers, forestry workers and huntsmen). All blood samples were analyzed in the National Reference Laboratory for Lyme borreliosis CEM (LB) in the National Institute of Public Health in Prague by the ELISA NRLB KC 90 method and in case of a positive result they were confirmed by the Western blot Lyme method. All patients completed a special questionnaire used as a standard procedure in the consultation centre for LB. In the group of blood donors 100 men were examined, mean age 33.5 years and 100 women, mean age 24.4 years. In 26 positive antibodies against Borrelia burgdorferi (Bb) were confirmed, but on invitation to medical examination only 22 attended, 11 men and 11 women (10.1%). Examination of antiborrelia antibodies by the ELISA method proved positivity of class IgM 7 times and of class IgG 9 times. By the Western blot method (WB) class IgG was confirmed three times. In the risk group 39 men were examined, mean age 40.6 years and 32 women. In 12 of them (17.9%) positivity of antiborrelia antibodies against Borrelia burgdorferi (Bb) was proved by the ELISA method as well as the WB method. If the percentage confidence interval of the control group is taken as a basis for comparison, then the value of the risk group is within this interval at a significance value of alpha = 0.01. In the conclusion the authors discuss the problem of interpretation of positive serological results and the pitfalls of their evaluation not only from the aspect of validity of laboratory findings, due to the absence of standardization of methods, but also with regards to obscure aspects of the persistence of IgM antibodies after years of lege artis antibiotic treatment.

[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.

[IgG antibodies to Borrelia in dogs in the area of Kosice]. / Antiboreliové protilátky IgG u psov z regiónu Kosíc.

An ELISA investigation showed that 26.9% of dogs in Kosice region were positive for anti-borrelia IgG antibodies. A significantly higher seroprevalence was detected only in hunting dogs (40.0%) compared with service dogs (11.8%; p < 0.05). An analysis of seroprevalence by age showed a significant difference only between dogs in the categories 1-3 years (37.8%) and under 1 year of age (8.3%; p < 0.05). In other age groups no significant differences in seroprevalence were observed. No significant difference in seroprevalence was detected between sex either. A high correlation was determined to exist between the seroprevalence and the number of engorged ticks (R = 0.8) and the frequency of the exposure of dogs to the tick-infested wooded areas with the focal occurrence of boreliae (R = 1). The analysis of results suggests that seroprevalence of Lyme borreliosis in dogs of the Kosice region is not negligible. The breed, age and sex do not influence the seroprevalence of the disease. The decisive role is, however, played by the time of the exposure of dogs to the environment infested by Borrelia-contaminated ticks.

Electron microscopy and the polymerase chain reaction of spirochetes from the blood of patients with Lyme disease.

Results of studies using direct antigen detection suggest that seronegative Lyme borreliosis is not rare and support the hypothesis that Borrelia antigens can persist in humans. We report three successful cultures from blood out of 30 attempts from 96 Lyme disease patients. The proof of borreliaemia in early or late phases of Lyme disease by immuno-capture electron microscopy has practical importance for subsequent cultivation. The polymerase chain reaction with oligonucleotide sequences directed against 16S rRNA identified two of our blood isolates as Borrelia burgdorferi genospecies III., VS 461 group, and one as Borrelia garinii sp. nov. All of the three isolates were reactive with monoclonal antibody H9724 against flagellin and with antibody against main extracellular protein at 83 kDa. Borrelia garinii had a single predominant protein OspA at 33.5 kDa and reacted with monoclonal antibody H5332 in contrast to two isolates of the VS 461 group with two major proteins OspA and OspB at 32.5 and 35 kDa. We conclude that isolation of spirochetes from the blood might prove successful in clinically selected cases of Lyme borreliosis. Immuno-capture electron microscopy has proved to be a sensitive assay for monitoring and studying Lyme borreliosis.

[Early-stage lyme borreliosis during pregnancy: treatment in 15 women with erythema migrans]. / Casné stadium lymeské borreliózy v prubehu tehotenství: lécba 15 zen s erythema migrans.

The authors treated and followed-up since July 1987 9 women with non-complicated erythema migrans and 4 women with erythema migrans associated with general signs and symptoms during pregnancy; two patients were treated only after delivery. For treatment antibiotics of the penicillin series were used. The course of gestation in 14 patients was without complications, one patient was followed-up on account of oedema of the lower extremities. The infants of 14 women were born in term, one infant was born during the 37th week of gestation. All infants were eutrophic. Umbilical blood for serological examination was collected from 8 infants, elevated IgG antibody levels against Borrelia burgdorferi were detected in one. The post-partum development of all infants was normal. During the subsequent follow-up for 6-26 months elevated antibodies against Borrelia burgdorferi were not found in any of the 4 infants subjected to serological examination. One child was operated at the age of one year on account of a patent ductus arteriosus, another child was treated at the age of two years on account of cryptorchism, two children were treated on account of hypoplastic enamel, in one infant at the age of 10 months the psychomotor development was retarded by two months. Transplacental transmission of Borrelia burgdorferi was not proved. With regard to the variety of the observed deviations and the small number of data the problem of a possible teratogenic action of this spirochete remains open.

Prevention and treatment of nosocomial infections, with special reference to antibiotic policy.

Hospital infections are of a major and growing health concern worldwide. They are the cause of appreciable economic loss, but what raises the particular alarm, both ethically and as a public health problem, is their continuous trend towards increasing lethality. The incidence of nosocomial infections can be prevented by creating a system of barriers that would interrupt their spread and transmission. Apart from strict adherence to general hygiene rules and the rational employment of examination methods it is essential in this respect that a prime attention is paid to the sensible use of antimicrobials, i.e. the persuance of a sound antibiotic policy. Its integral components are the systematic laboratory control, continuous epidemiological surveillance of bacterial drug resistance patterns, study of variations in the biological properties of multiple resistant bacterial strains, and the development of, and adherence to, effective and indicated treatment schedules. The particular problems related to bacterial enzyme activities and the genetic information (plasmids) coding for resistance to antimicrobials, as well as the virulence and pathogenicity of agents responsible for the onset of hospital infection are also discussed in this context. It is pointed out that for an effective hospital infection control it is essential to avoid the onesided pressure of badly applied antibiotic therapy.

Haemophilus influenzae: the current status of its in vitro susceptibility to antimicrobials.

Continuous surveillance of the antimicrobial susceptibility patterns of strains of Haemophilus influenzae (H. i.) is part of a routine surveillance of bacterial sensitivity to antibiotics. In this study a major attention was given to the clinically important antimicrobials used in the treatments of H. i. infections, namely ampicillin, chloramphenicol and some cephalosporin preparations. Antimicrobial susceptibility determinations carried out in 1983 and before on H.i. strains isolated in different Czech regions show a clear-cut tendency towards the higher incidence of strains resistant to ampicillin and its derivative amoxycillin. The rise in resistance to erythromycin was also observed. Susceptibility to chloramphenicol continues to remain unchanged. Of the cephalosporin antimicrobials tested (cephalothin, ceftriaxone, cefaperazone, cefsulodine and cefadroxil) the most active were ceftriaxone and cefaperazone. The need of a further continuation of surveillance of H.i. drug susceptibility patterns is strongly emphasized; to ensure effective treatment results antibiograms should be done in each case of H.i. infection.

Administration of antibiotics in combination. The antibacterial activity of blood serum and urine after a simultaneous administration of aminoglycosides and ampicillin.

Blood serum and urine samples collected from a group of volunteers treated with single doses of ampicillin and aminoglycoside preparations given separately or in combination were tested for their antimicrobial activity against the reference strains Staphylococcus aureus SZK 76/69 and ATCC 6538, Pseudomonas aeruginosa SZK 444 and SZK 385, and Escherichia coli SZK 326/71. Out of all antimicrobials and their combinations tested the most powerful was the combination of netilmicin with ampicillin. Of the therapeutic combinations used nowadays in clinical practice the combined use of gentamicin and ampicillin proved also effective. These antibiotic combinations appear thus to be best suited for the treatment of mixed Pseudomonas aeruginosa and Staphylococcus aureus infections and of urinary tract infections caused by bacterial strains exhibiting in the in vitro susceptibility assays a reduced sensitivity to some of the antibiotic preparations used.

Effect of antibiotics on the formation of specific antibodies.

Immune response to staphylococcal haemolysin and Haemophilus influenzae capsular antigen administered simultaneously with antibiotics was studied in rabbits. In addition to specific humoral antibodies, the quantitative values of IgG, IgA, IgM and C'3 complement were determined. Statistically significant deficiency of immune response was observed in all cases in animals which were given the antigen with the antibiotic in comparison with the controls which were immunized by the antigen alone. Statistically significant differences were also observed in the levels of immunoglobulins (mainly IgG and IgM) in animals which were given antigens simultaneously with antibiotics in comparison with animals which were given antibiotics alone.