ro13-9904 and Erythema-Chronicum-Migrans

A 69-year-old man presented with multiple livid maculae and infiltrated urticarial plaques, as well as elevated liver enzymes. Based on typical clinical picture, histopathology and positive PCR from a skin biopsy, we diagnosed an early disseminated infection with Borrelia afzelii presenting with multiple erythema migrans (erythemata migrantia) and a subclinical hepatitis. During antibiotic treatment with intravenous ceftriaxone, the maculae and plaques vanished almost completely and the liver enzymes decreased within 14 days. Dermatologists should keep in mind that early disseminated borreliosis can present with multiple erythema migrans and hepatitis.

Topics: Aged; Alanine Transaminase; Anti-Bacterial Agents; Biopsy; Borrelia burgdorferi Group; C-Reactive Protein; Ceftriaxone; Doxycycline; Erythema Chronicum Migrans; gamma-Glutamyltransferase; Hepatitis A; Hepatomegaly; Humans; L-Lactate Dehydrogenase; Lyme Disease; Male; Skin

Human Lyme borreliosis is a multisystem disorder that can progress in stages and is transmitted by ticks of the Ixodes ricinus complex infected with the spirochete Borrelia burgdorferi sensu lato. Today, Lyme borreliosis is regarded as the most important human tickborne illness in the northern hemisphere. Soon after the causative agent was correctly identified and successfully isolated in 1982, antibiotic treatment was shown to be effective and since then a variety of in vitro and in vivo studies have been performed to further characterize the activity of antimicrobial agents against B. burgdorferi s.l. Although many antimicrobial agents have been tested for their in vitro activity against borreliae, the full spectrum of antibiotic susceptibility in B. burgdorferi s.l. has not been defined for many compounds. Moreover, our current understanding of possible antimicrobial resistance mechanisms in B. burgdorferi s.l. is limited and is largely founded on in vitro experiments on relatively few borrelial isolates. This review will summarize what is and what is not known about antimicrobial resistance in B. burgdorferi s.l. and will discuss open questions that continue to fuel the current debate on treatment-resistant Lyme borreliosis.

Topics: Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Azithromycin; Borrelia burgdorferi Group; Calorimetry; Ceftriaxone; Cefuroxime; Drug Resistance, Bacterial; Erythema Chronicum Migrans; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Species Specificity; Time Factors

There are still no definite patterns for antibiotic therapy of Lyme borreliosis. Recent studies have shown that ceftriaxone or tetracyclines are superior to the conventional penicillin. Against erythema chronica migrans (stage I) oral therapy, preferably with tetracycline, is sufficient. In cases with stage II symptoms, such as arthritis or neurological affections, high dose parenteral treatment, preferably with ceftriaxone, is recommended, although its effect on the neurologic symptoms is not yet proven. Carditis also calls for high dose parenteral administration of antibiotics, even though there are no published studies on this treatment as yet. Opinion is divided on the cutaneous symptoms such as acrodermatitis chronica atrophicans, morphea, lichen sclerosus et atrophicus (acute inflammatory stage) and lymphadenitis cutis benigna. Even if oral penicillin or tetracycline can cure existing symptoms, in the absence of longterm observations, it remains an open question whether oral treatment can prevent further complications or evolution to chronicity (stage III). For these clinical pictures there is also a tendency to give high dose parenteral antibiotics, and ceftriaxone is likely to win favour. In stage II Lyme borreliosis, autoimmune processes occur which scarcely respond to antibiotics any longer. Nevertheless, parenteral administration of high dose antibiotics remains sensible as a means of eradicating pathogens from the tissues, CSF or synovial fluids, and to avoid further complications. Evaluation of the therapeutic effects of corticosteroids or other immunosuppressive agents would require prospective studies.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Erythema Chronicum Migrans; Humans; Lyme Disease; Nervous System Diseases; Skin Diseases; Tetracyclines

Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB.. Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi-specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months.. Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was -3.9 in the doxycycline group and -3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, -.59 to .92], which is within the prespecified equivalence margins of -1 to 1 units). Participants in both groups improved equally.. Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB.. NCT01635530 and EudraCT 2012-000313-37.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Erythema Chronicum Migrans; Humans; Lyme Neuroborreliosis

Despite rather strict recommendations for antibiotic treatment of disseminated Lyme borreliosis (LB), evidence-based studies on the duration of antibiotic treatment are scarce. The aim of this multicenter study was to determine whether initial treatment with intravenous ceftriaxone (CRO) for 3 weeks should be extended with a period of adjunct oral antibiotic therapy. A total of 152 consecutive patients with LB were randomized in a double-blind fashion to receive either amoxicillin (AMOX) 1 g or placebo (PBO) twice daily for 100 days. Both groups received an initial treatment of intravenous CRO 2 g daily for 3 weeks, followed by the randomized drug or PBO. The outcome was evaluated using the visual analogue scale at the follow-up visits. The final analysis included 145 patients, of whom 73 received AMOX and 72 PBO. Diagnoses of LB were categorized as either definite or possible, on the basis of symptoms, signs, and laboratory results. The diagnosis was definite in 52 of the 73 (71.2%) AMOX-treated patients and in 54 of the 72 (75%) PBO patients. Of the patients with definite diagnoses, 62 had neuroborreliosis, 45 arthritis or other musculoskeletal manifestations, and 4 other manifestations of LB. As judged by the visual analogue scale and patient records, the outcome after a 1-year follow-up period was excellent or good in 114 (78.6%) patients, controversial in 14 (9.7%) patients, and poor in 17 (11.7%) patients. In patients with definite LB, the outcome was excellent or good in 49 (92.5%) AMOX-treated patients and 47 (87.0%) PBO patients and poor in 3 (5.7%) AMOX-treated patients and 6 (11.1%) PBO patients (difference nonsignificant, p = 0.49). Twelve months after the end of intravenous antibiotic therapy, the levels of antibodies against Borrelia burgdorferi were markedly decreased in 50% of the patients with definite LB in both groups. The results indicate that oral adjunct antibiotics are not justified in the treatment of patients with disseminated LB who initially receive intravenous CRO for 3 weeks. The clinical outcome cannot be evaluated at the completion of intravenous antibiotic treatment but rather 6-12 months afterwards. In patients with chronic post-treatment symptoms, persistent positive levels of antibodies do not seem to provide any useful information for further care of the patient.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Borrelia burgdorferi; Ceftriaxone; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Erythema Chronicum Migrans; Female; Humans; Lyme Neuroborreliosis; Male; Middle Aged; Placebos; Treatment Outcome

Treatment of patients with early Lyme disease has trended toward longer duration despite the absence of supporting clinical trials.. To evaluate different durations of oral doxycycline treatment and the combination of oral doxycycline and a single intravenous dose of ceftriaxone for treatment of patients with early Lyme disease.. Randomized, double-blind, placebo-controlled trial.. Single-center university hospital.. 180 patients with erythema migrans.. Ten days of oral doxycycline, with or without a single intravenous dose of ceftriaxone, or 20 days of oral doxycycline.. Outcome was based on clinical observations and neurocognitive testing. Efficacy was assessed at 20 days, 3 months, 12 months, and 30 months.. At all time points, the complete response rate was similar for the three treatment groups in both on-study and intention-to-treat analyses. In the on-study analysis, the complete response rate at 30 months was 83.9% in the 20-day doxycycline group, 90.3% in the 10-day doxycycline group, and 86.5% in the doxycycline-ceftriaxone group (P > 0.2). The only patient with treatment failure (10-day doxycycline group) developed meningitis on day 18. There were no significant differences in the results of neurocognitive testing among the three treatment groups and a separate control group without Lyme disease. Diarrhea occurred significantly more often in the doxycycline-ceftriaxone group (35%) than in either of the other two groups (P < 0.001).. Extending treatment with doxycycline from 10 to 20 days or adding one dose of ceftriaxone to the beginning of a 10-day course of doxycycline did not enhance therapeutic efficacy in patients with erythema migrans. Regardless of regimen, objective evidence of treatment failure was extremely rare.

Topics: Administration, Oral; Anti-Bacterial Agents; Ceftriaxone; Cognition; Double-Blind Method; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Erythema Chronicum Migrans; Female; Humans; Injections, Intravenous; Lyme Disease; Male; Middle Aged; Placebos; Treatment Outcome

CME: Neuroborreliosis

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Erythema Chronicum Migrans; Humans; Lyme Disease; Ticks

Topics: Abducens Nerve Diseases; Aged; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Erythema Chronicum Migrans; Humans; Lyme Disease; Male; Optic Neuritis

Neonatal tick bites place infants at risk for acquiring infections that have rarely or never been documented in this age group. We describe 2 rare cases of tickborne infection in neonates. The first patient presented with multiple erythema migrans and fever, leading to a diagnosis of early disseminated Lyme disease. The second patient presented with irritability, fever, and worsening anemia due to babesiosis. Both infants had been bitten by arthropods fitting the description of ticks before the onset of symptoms. Our cases demonstrate the clinical course of 2 common tickborne infections occurring at an atypical age, opening the door to new, complex questions for which little guiding data exists. As tickborne infections become more prevalent, we expect other clinicians will be faced with similarly challenging neonatal cases. Providers must use past experience and a keen eye to identify neonates with tickborne infections and sort through their optimal diagnosis and management. In this article, we raise some of the questions we faced and discuss our conclusions.

Topics: Animals; Anti-Bacterial Agents; Antiprotozoal Agents; Atovaquone; Azithromycin; Babesiosis; Ceftriaxone; Erythema Chronicum Migrans; Exanthema; Female; Humans; Infant, Newborn; Parasitemia; Tick Bites

Lyme disease is an emerging problem in Poland. Analysis has been undertaken of the medical documentation of 86 patients hospitalized in the Infectious Diseases Department, University Hospital in Cracow in 2013-2016, suspected of Lyme arthritis. It has especially considered medical history including potential exposure to the infection, detailed characteristics of the symptoms, diagnostic challenges and results of the treatment. Only some patients had a history of erythema migrans and not all of them recalled tick-bite. The majority of the patients had affected large joints, especially knee joints, and polyarthritis was rarely observed. Symptoms were resolved completely or partially after antibiotic treatment in most patients. The diagnosis of Lyme arthritis in areas endemic for Lyme disease is still a diagnostic challenge in patients with other rheumatic diseases, including osteoarthritis.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Diagnosis, Differential; Doxycycline; Erythema Chronicum Migrans; Female; Foot Joints; Hand Joints; Hip Joint; Hospitalization; Hospitals, University; Humans; Knee Joint; Lyme Disease; Male; Middle Aged; Osteoarthritis; Poland; Shoulder Joint; Tick Bites; Treatment Outcome

A 56-year-old man was sustained ticks at the left axilla and flank. He did not have a rash. About 3 months after the tick bites, he developed back pain, right leg weakness, right abducens nerve palsy, and left facial palsy. Western blot analysis for serum IgM and IgG antibodies against Borrelia were positive. We diagnosed Lyme borreliosis. The patient was treated with antibiotics and steroids, and the symptoms improved. Our findings demonstrate that, even if erythema migrans is not obvious, neuroborreliosis should be considered when neurological signs, such as multiple cranial nerve palsies, are present.

Topics: Administration, Oral; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Biomarkers; Borrelia; Ceftriaxone; Erythema Chronicum Migrans; Humans; Immunoglobulin G; Immunoglobulin M; Infusions, Intravenous; Lyme Neuroborreliosis; Male; Methylprednisolone; Middle Aged; Prednisolone; Pulse Therapy, Drug; Tick Bites; Treatment Outcome

Canada has seen a sixfold increase in Lyme disease since being nationally notifiable in 2009. This is the first Canadian series on Lyme carditis manifested as high-degree atrioventricular block. We report 5 recent cases presented over a 2-year period. The variation of nonspecific presentations requires a high index of suspicion for prompt diagnosis and correct management. Recognizing this early would curtail the progression of conduction disorders and potentially avoid permanent pacemaker implantation.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Atrioventricular Block; Canada; Ceftriaxone; Doxycycline; Echocardiography; Electrocardiography; Erythema Chronicum Migrans; Exercise Test; Humans; Lyme Disease; Male; Myocarditis; Severity of Illness Index; Tick Bites; Young Adult

Erythema migrans (EM) is the most common manifestation of Lyme borreliosis (LB), caused by the spirochete Borrelia burgdorferi sensu lato. The infection can disseminate into the nervous system and cause Lyme neuroborreliosis (LNB), the second most frequent LB manifestation in children. The aim of this prospective cohort study is to describe the occurrence of EM among children with LNB and to evaluate possible differences in clinical characteristics or outcome between LNB patients with and without EM.. Children being evaluated for LNB in southeast Sweden during the period 2010-2014 underwent a clinical examination, laboratory testing and filled out a questionnaire regarding duration and nature of symptoms, EM and the child's health. Children were classified according to European guidelines for LNB. Clinical recovery was evaluated at a 2-month follow-up.. The occurrence of EM among children with LNB was 37 out of 103 (36%). Gender, age, observed tick bite, clinical features, duration of neurological symptoms or clinical outcome did not differ significantly between LNB patients with or without EM. However, facial nerve palsy was significantly more common among children with EM in the head and neck area.. EM occurred in 36% of children with LNB and the location on the head and neck was more common among children with facial nerve palsy. EM was not associated with other specific clinical characteristics or outcome. Thus, the occurrence of EM in children with LNB cannot be useful as a prognostic factor for clinical outcome. This aspect has not previously been highlighted but seems to be relevant for the paediatrician in a clinical setting.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Doxycycline; Erythema Chronicum Migrans; Facial Paralysis; Female; Head; Humans; Infant; Lyme Neuroborreliosis; Male; Neck; Prospective Studies; Sweden

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Brain Neoplasms; Ceftriaxone; Child; Diagnosis, Differential; Diplopia; Erythema Chronicum Migrans; France; Humans; Intracranial Hypertension; Lyme Neuroborreliosis; Male; Scotland; Travel

A 20-year-old Caucasian male patient presented after a single episode of syncope. His heart rate was 40 beats per minute. ECG showed new onset complete heart block. A temporary pacer was placed. He had a macular rash on the body from past 2 weeks and was diagnosed with contact dermatitis. Erythema migrans was considered as differential for rash. Lyme titre was ordered and found to be positive. After antibiotic therapy and observation on telemetry, his heart block resolved. He was subsequently discharged and a follow-up ECG revealed persistent normal sinus rhythm.

Topics: Anti-Bacterial Agents; Bradycardia; Ceftriaxone; Electrocardiography; Erythema Chronicum Migrans; Heart Block; Humans; Lyme Disease; Male; Myocarditis; Pacemaker, Artificial; Syncope; Treatment Outcome; Young Adult

Erythema of the ear lobe in the context of Lyme disease is caused by either borrelial lymphocytoma or localized erythema migrans. Here we present a case of chondritis limited to the ear cartilage caused by Lyme disease. The patient was treated with ceftriaxone with complete resolution of symptoms.

Topics: Anti-Bacterial Agents; Borrelia; Cartilage Diseases; Ceftriaxone; Child; Diagnosis, Differential; Ear Cartilage; Erythema Chronicum Migrans; Female; Humans

Topics: Anti-Bacterial Agents; Ceftriaxone; Chemokine CXCL13; Chronic Disease; Erythema Chronicum Migrans; Humans; Lyme Neuroborreliosis; Lymphocyte Activation; Neurologic Examination

Topics: Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Ceftriaxone; Cognition Disorders; Confusion; Diagnosis, Differential; Disease Progression; Erythema Chronicum Migrans; Humans; Inappropriate ADH Syndrome; Lyme Neuroborreliosis; Male; Neurologic Examination; Serologic Tests; Treatment Outcome; Tremor

Lyme borreliosis is a MULTISYSTEM: tick-borne infection caused by the spirochete Borrelia burgdorferi. We present a survey of clinical stages, diagnosis, treatment and prognosis of Lyme borreliosis in adults.. The article is based on literature retrieved through database searches and own experience.. In Norway, Lyme borreliosis is most prevalent in coastal areas from the south and up to Trøndelag. Lyme disease can be classified into three stages; localised stage, and early and late disseminated stages. A laboratory gold standard does not exist, so the diagnosis is based on a combination of clinical manifestations and indirect detection of the bacteria, most often specific antibodies. Antibody results must be interpreted with caution. No medication is needed after a tick bite, but all manifestations of Lyme borreliosis should be treated with antibiotics according to guidelines. The prognosis is generally good. Post Lyme disease with persistent symptoms after borreliosis is a controversial condition. No studies have demonstrated persistent infection with borrelia bacteria in patients with chronic complaints after adequate antibiotic treatment, and additional antibiotic treatment does not improve quality of life in these patients.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Borrelia burgdorferi; Ceftriaxone; Doxycycline; Erythema Chronicum Migrans; Humans; Lyme Disease; Lyme Neuroborreliosis; Norway; Practice Guidelines as Topic; Prognosis

To investigate the kinetics of anti-Borrelia burgdorferi antibodies for a minimum of 1 year after antibiotic therapy in patients with erythema migrans (EM) and to correlate antibody titer kinetics with clinical variables.. Retrospective study of serial anti-B burgdorferi antibodies in correlation to clinical variables.. University-based hospital.. One hundred thirteen patients with EM.. Pretreatment and a median of 4 consecutive posttreatment serum samples from median follow-up of more than 400 days were simultaneously investigated for anti-B burgdorferi IgG and IgM antibodies. Semiquantitative titers were plotted to identify different groups of antibody kinetics. Individual patients were then stratified to those groups according to their antibody development. A statistical comparison of clinical and therapy-related characteristics among the serologic groups was performed.. Anti-B burgdorferi IgG and IgM antibody titers developed in 3 distinct courses: persistent positivity across follow-up (IgG: 12 patients, 11%; IgM: 14, 12%), persistent negativity (IgG: 63, 56%; IgM: 47, 42%), and decrease of a positive pretreatment titer to a negative titer approximately 5 months after therapy (IgG: 34, 30%; IgM: 49, 43%). Statistics revealed significant correlations only between persistent positive IgG titers and long disease duration or large EM lesions before therapy.. Long duration or large size of EM before therapy correlates with persistence of a positive anti- B burgdorferi IgG antibody titer after therapy. Serologic profiles do not depend on the type or duration of therapy or the clinical course thereafter. Thus, antibody testing in the follow-up of patients with EM is inappropriate for the assessment of therapeutic response.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Antibodies, Bacterial; Antibody Formation; Borrelia burgdorferi; Ceftriaxone; Child; Doxycycline; Enzyme-Linked Immunosorbent Assay; Erythema Chronicum Migrans; Female; Humans; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Minocycline; Penicillin V; Predictive Value of Tests; Retrospective Studies

Borrelia lusitaniae was isolated from an Ixodes ricinus tick in Portugal in 1993 for the first time. Further, this borrelia genospecies has been found in ixodid ticks collected around the coasts of southern Portugal and North Africa. Its reservoir has not been defined yet. B. lusitaniae was isolated once until now from a patient with a long standing and expanding skin disorder.. A 46-year-old Portuguese woman presented with a skin lesion on the left thigh which had evolved slowly over ten years. The patient reported limb paraesthesias, cramps, chronic headaches, and cardiac rhythm disturbances. History of tick bites was negative nor had the patient ever noticed a skin lesion comparable with erythema chronicum migrans. Skin biopsies were taken for histological evaluation, culture and DNA detection. Antibodies to borrelia were searched by indirect immunofluorescence assay and Western-blot.. A bilateral carpal tunnel syndrome and local synovitis was diagnosed. Dermato-histology was normal, serology was negative. Spirochaetal organisms were cultured from a skin biopsy and identified as B. lusitaniae. The patient improved after a 2-week course of intravenous ceftriaxone; the skin lesions did not expand further.. This culture confirmed skin infection by B. lusitaniae in a patient from Portugal suggests an additional human pathogen out of the B. burgdorferi sensu lato complex in Europe, particularly in Portugal.

Topics: Animals; Anti-Bacterial Agents; Biopsy; Borrelia; Carpal Tunnel Syndrome; Ceftriaxone; Diagnosis, Differential; Erythema Chronicum Migrans; Female; Humans; Ixodes; Lyme Disease; Lyme Neuroborreliosis; Middle Aged; Portugal; Skin; Synovitis

Topics: Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Erythema Chronicum Migrans; Humans; Male; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic; Time Factors

Topics: Administration, Oral; Anti-Bacterial Agents; Ceftriaxone; Double-Blind Method; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Erythema Chronicum Migrans; Female; Humans; Injections, Intravenous; Lyme Disease; Male; Middle Aged; Placebos; Treatment Outcome

Topics: Administration, Oral; Anti-Bacterial Agents; Blotting, Western; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Erythema Chronicum Migrans; Humans; Immunoenzyme Techniques; Male; Middle Aged; Polymerase Chain Reaction; Skin; Tetracyclines; Time Factors; Travel

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Back; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Erythema Chronicum Migrans; Fever; Humans; Infusions, Intravenous; Male; Occupational Diseases

An acute Lyme carditis affects about 0.3-4% of patients with Lyme borreliosis. The acute period of the disease may be associated with critical atrioventricular conduction abnormalities (complete heart block), supraventricular and ventricular arrhythmias as well a left ventricular failure. Normally, Lyme carditis is completely reversible. Therefore the prognosis largely depends on the management of the acute complications and early antibiotic therapy. Even if the symptoms are spontaneously reversible, antibiotic therapy should be applied to prevent a chronic cardiomyopathy and other manifestations of Lyme borreliosis. We report on a 47-year old patient with acute ECG changes initially suggesting an acute coronary syndrome. However, case history and the erythema migrans indicated an acute Lyme carditis which was confirmed serologically and by myocardial biopsy later.

Topics: Anti-Bacterial Agents; Biopsy; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Echocardiography; Electrocardiography; Erythema Chronicum Migrans; Female; Follow-Up Studies; Humans; Immunohistochemistry; Lyme Disease; Middle Aged; Myocardial Infarction; Myocardium; Radiography, Thoracic; Time Factors

The aim of our analysis of causes of borreliosis in children hospitalized or ambulatory treated in the Clinic of Infectious Disease in Childhood of Medical University in Warsaw.. We observed 113 children from 6 month to 15 years old. Erythema migrans was diagnosed in 97 cases and in 3 cases was multiple erytheme migrans.. Neuroborreliosis was diagnosed in 11 children. In the treatment neuroboreliosis the ceftriaxon and cristalline penicillin was administrated.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Enzyme-Linked Immunosorbent Assay; Erythema Chronicum Migrans; Female; Humans; Infant; Lyme Neuroborreliosis; Macrolides; Penicillins; Poland; Time Factors; Treatment Outcome

A 60-years old female patient developed juxta-articular fibroid nodules and erythrocyanotic lesions of acrodermatitis chronica atrophicans after several tick bites. The woman was treated with ceftriaxon (Rocephin) 2 g daily parenterally without adverse reactions.

Topics: Acrodermatitis; Ceftriaxone; Elbow Joint; Erythema Chronicum Migrans; Female; Fibroma; Humans; Infusions, Intravenous; Knee Joint; Lyme Disease; Middle Aged; Skin; Skin Neoplasms

From 1990 through to 1997, 105 pregnant women with typical EM were investigated at the Lyme Borreliosis Outpatients' Clinic of the Department of Infectious Diseases at the University Medical Centre in Ljubljana, Slovenia. Twenty-five (23.8%) patients acquired borrelial infection during the first trimester of pregnancy; eight (7.6%) of them had noticed the skin lesion before they became pregnant. In 43 (40.6%) patients the EM appeared in the second trimester, and in 37 (35%) patients in the third trimester of pregnancy. Two (1.9%) patients received phenoxymethyl penicillin (1 million IU t.i.d.), three (2.9%) benzyl penicillin (10 million IU b.i.d.), and 100 (95.2%) ceftriaxone (2 g daily). All patients were treated for 14 days except three (2.9%) in whom the treatment with ceftriaxone was discontinued because of mild side effects. The outcome of disease was good in all 105 patients. Ninety-three (88.6%) out of 105 patients had normal pregnancies; the infants were delivered at term, were clinically healthy, and subsequently had a normal psychomotor development. In the remaining 12 (11.4%) patients an adverse outcome was observed. Two (1.9%) pregnancies ended with an abortion (one missed abortion at 9 weeks, one spontaneous abortion at 10 weeks), and six (5.7%) with preterm birth. One of the preterm babies had cardiac abnormalities and two died shortly after birth. Four (3.8%) babies born at term were found to have congenital anomalies; one had syndactyly at birth and three had urologic abnormalities which were registered at the age of 5, 7, and 10 months, respectively. A causal association with borrelial infection was not proven in any infant. For at least some unfavourable outcomes a plausible explanation not associated with Lyme borreliosis was found.

Topics: Adult; Ceftriaxone; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythema Chronicum Migrans; Female; Gestational Age; Humans; Infant; Infant, Newborn; Male; Penicillin G; Penicillin V; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Slovenia

The course of the illness and the outcome of pregnancy were investigated in a prospective study of 58 consecutively enrolled pregnant women with typical erythema migrans at the University Medical Centre of Ljubljana, Slovenia. Thirteen patients (22.4%) acquired borrelial infection in the first trimester of pregnancy, 27 (46.6%) in the second trimester, and 18 (31%) in the third trimester. All patients were treated for 14 days: 2 (3.4%) with phenoxymethylpenicillin (1 million IU thrice per day), 3 (5.2%) with benzylpenicillin (10 million units twice per day), and 53 (91.4%) with ceftriaxone (2 g daily). For 51 of the 58 women (87.9%), the pregnancies were normal and the infants were born at term, were clinically healthy, and had normal psychomotor development. Of the remaining 7 pregnancies, 1 ended with a missed abortion and 5 with preterm birth; 1 of the preterm babies had heart abnormalities. One child born at term was found to have urologic abnormalities at 7 months of age. A causal relationship between borrelial infection and fetal adverse effects has not been proven, and for at least some such cases a reasonable explanation (not associated with Lyme borreliosis) was found.

Topics: Abortion, Missed; Adolescent; Adult; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Erythema Chronicum Migrans; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Infant, Premature; Penicillin G; Penicillin V; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Prospective Studies; Urinary Tract

Clinical manifestations of Lyme disease are mainly cutaneous, neurologic, cardiac and/or located joints. Some dermatologic manifestations are more specific.. An eight year-old-girl was examined because she suffered from a nodular lesion located on the left breast areola which appeared 3 months earlier. This lesion was associated with an expanding erythematous annular lesion located on the anterior face of thorax and left axillary area, without any lymphadenopathy. The association of this cutaneous lymphocytoma and erythema chronicum migrans was suggestive of Borellia infection despite absence of previous tick bite. Serologic tests (indirect immunofluorescence) were negative, but both lesions disappeared within 2 weeks with ceftriaxone, 50 mg/kg/day.. This association is pathognomonic of Lyme disease; serologic tests may be found negative in the early stages of disease.

Topics: Breast; Breast Neoplasms; Ceftriaxone; Child; Erythema Chronicum Migrans; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lyme Disease; Nipples; Skin Neoplasms

Erythema migrans skin lesions resulting from a tick bite and infection with Borrelia burgdorferi sensu lato eventually resolve, even without antibiotic therapy. The aim of the present study was to gauge the frequency of persistence of B. burgdorferi sensu lato in such lesions. Thus, the site of a previous lesion was biopsied and cultured in 48 patients: 39 with systemic or localized symptoms/signs and nine with no symptoms. B. burgdorferi sensu lato was isolated from biopsied skin from three symptomatic patients. Cultures of other tissues and fluids were negative. By genospecies-specific polymerase chain reaction (PCR) and pulsed-field gel electrophoretic (PFGE) analysis, two isolates were classified as Borrelia afzelii. The remaining isolate was a member of an unusual group of strains that type as B. burgdorferi sensu stricto by genospecies PCR but possess an atypical PFGE profile. All three patients had a dramatic clinical response to antibiotic treatment. These findings demonstrate the capacity of viable B. burgdorferi sensu lato organisms to persist in clinically normal-appearing skin at the site of a resolved erythema migrans rash for periods ranging from 2 months to 3.5 years. This observation may provide new insight into the organisms' ability to evade the host's immune response.

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Biopsy; Blotting, Western; Borrelia; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Electrophoresis, Polyacrylamide Gel; Erythema Chronicum Migrans; Female; Genotype; Humans; Male; Middle Aged; Polymerase Chain Reaction; Skin

Cardiac manifestations are reported in 0.3%-4.0% of European patients with Borrelia burgdorferi (B.b.) infection. Usually symptoms disappear within 6 weeks. We report a case with persistent impairment of atrioventricular (AV) conduction. Diagnosis was confirmed by demonstration of IgM antibodies and increase of IgG antibody titers against B.b. in serum, by isolation of the spirochete from skin biopsy material and by the typical clinical combination of erythema migrans, Bannwarth syndrome (meningoradiculitis), and complete heart block. Despite immediate antibiotic therapy with ceftriaxone, first degree AV block and second degree block Wenckebach with atrial pacing at 100 beats/minute persisted for 2 years. We conclude, that Lyme carditis can cause long-standing or irreversible AV conduction defects despite adequate and early antimicrobial therapy.

Topics: Adult; Ceftriaxone; Chronic Disease; Diagnosis, Differential; Erythema Chronicum Migrans; Female; Heart Block; Humans; Lyme Disease