Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies (II). Biological diagnosis, treatment, persistent symptoms after documented or suspected Lyme borreliosis.

The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30-40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both>90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.

Aqueous humor contamination during phacoemulsification in a university teaching hospital.

PURPOSE: To evaluate the intraoperative contamination of the anterior chamber in eyes undergoing phacoemulsification in a university teaching hospital. DESIGN: Prospective, non-randomized clinical trial. METHODS: This study included 113 eyes of 113 consecutive patients undergoing cataract surgery performed by experienced surgeons and residents. Phacoemulsification was conducted through a scleral tunnel incision or through a corneal incision. The intraocular lens was implanted with an injector. Aqueous fluid was obtained at the end of surgery before viscoelastic removal, with a cannula through the corneal paracentesis. Povidone-iodine 10% solution was used to prepare the eyebrow and eyelids and povidone-iodine 5% to disinfect the ocular surface. All patients were given a single oral dose of 400mg ofloxacin 2h before surgery. No preoperative antibiotics were administered locally. RESULTS: Anterior chamber fluid aspirates were positive for bacteria in two eyes (1.8%). No eye developed endophthalmitis during the follow-up period. DISCUSSION AND CONCLUSION: Low anterior chamber bacterial contamination rates may be achieved under routine phacoemulsification in a teaching hospital practicing careful antisepsis measures.

[Septicaemia with Capnocytophaga sputigena in a newborn child]. / Sepsis à Capnocytophaga sputigena chez un nouveau-né

We describe in this article a case of septicaemia with Capnocytophaga suptigena in a premature newborn child. The newborn child exhibited fever at birth, a light inflammatory syndrome and a respiratory failure. The germ was initially identified in the blood-culture of the newborn child by conventional techniques, and then confirmed by sequencing of the ARN 16S. After investigation, it was also found in the mother's vaginal sample. Capnocytophaga sputigena carried by the mother is certainly responsible for infection of the newborn child by ascending way. After antibiotherapy, both mother and child did not present aftereffects. This is the 16th case described in the literature; Capnocytophaga sputigena carried in vaginal area is responsible for preterm labor and for septicaemia associated to respiratory failure of the newborn child. It is thus important not to neglect this germ and to estimate its sensibility to antibiotics.

[Acute hemiparesis revealing a neuroborreliosis in a child]. / Hémiparésie aiguë révélatrice d'une neuroborréliose chronique chez un enfant.

We report on a 11-year-old boy who had 2 acute hemiparesis episodes over a period of 1 month. He suffered from headache and fatigue since 1 year. He could not remember neither a tick bite nor a local erythematous skin lesion. The diagnosis of neuroborreliosis was based on intrathecal production of specifics antibodies. Furthermore, the CSF/blood glucose ratio was decreased (0.14), which was rarely described. Cranial MRI showed left capsulothalamic inflammation and a vasculitis. The patient was successfully treated by ceftriaxone. Neuroborreliosis should be considered in all children with stroke-like episode, even in the absence of a history of a tick bite.