The authors identify symptoms after Lyme borreliosis and anticipate the areas and research needed to improve understanding and diagnostic approaches in patients with persistent problems after Lyme borreliosis. Comment: Editorial in a prestigious scientific journal.
COBISS.SI-ID: 6947244
In a cohort study of 603 patients with multiple erythema or solitary erythema migrans, constitutive symptoms were more frequently accompanied by early disseminated than early localized disease, and the long-term outcome 12 months after treatment was comparable but not before. Conclusion: In further studies evaluating symptoms after Lyme disease, follow-up is recommended for at least 12 months after treatment. Comment: The first direct comparison of the course and outcome of European patients with early localized and disseminated cutaneous form of Lyme borreliosis.
COBISS.SI-ID: 5060780
Background. Information on larger groups of patients with acrodermatitis chronica atrophicans (ACA) is limited. Methods. The retrospective study comprised patients with ACA, diagnosed and treated at a single center. Their clinical, laboratory and microbiological characteristics were assessed; the comparison between the patients in two different time periods (1991–2003 vs. 2004–2016) was made. Results. 609 patients (399 females, 210 males; median age 64) were included. Duration of ACA until diagnosis was median 12 months. The lesions were mostly located on limbs: on lower and upper extremity in 69.3% and 46.5%, respectively. 42.5% of patients had ACA bilaterally. Constitutional and local symptoms were present in 66.2% and 21.8% of patients, respectively. Histologic findings were highly indicative of ACA in 86.5%. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, elevated protein concentration, and intrathecal synthesis of borrelial IgG antibody in 4.3%, 26.6%, and 12.0% of patients, respectively. Borreliae (predominantly Borrelia afzelii) were isolated from skin, blood, and CSF in 31.5%, 1.1%, and 1.7% of patients, respectively. Patients assessed in the later time period were older, had shorter duration of ACA, that was less frequently bilateral, less often complained of constitutional but more often of local symptoms, and had less often skin atrophy. Conclusions. ACA usually affects older women. CSF abnormalities are rare. B. afzelii proved to be the most common causative agent. In the later time period, patients with ACA had shorter duration of skin lesions, and less often constitutional symptoms and signs of skin atrophy - probably due to earlier diagnosis. Comment: The findings of this large series enabled the selection of appropriate patients with ACA for the reported project.
COBISS.SI-ID: 55194115
Demonstration of the course and outcome of patients with solitary and multiple erythema migrans. Comment: The findings of this large series allowed the selection of suitable patients with erythema migrans for the project that was completed.
COBISS.SI-ID: 5517740
Background. Several guidelines advocate the same treatment approaches for both early disseminated Lyme borreliosis, manifested as multiple erythema migrans (EM), and early localized Lyme borreliosis, manifested as solitary EM. Methods. Oral doxycycline (100 mg q12h) was compared on a non-inferiority premise with intravenous ceftriaxone (2g q24h) for 14 days in 200 adult European patients with multiple EM in an open-label alternate-treatment observational trial performed in a single-centre university hospital. Treatment outcome was assessed at 14 days and at 2, 6 and 12 months post-enrolment. Non-specific symptoms in patients and 192 control subjects without a history of Lyme borreliosis were evaluated and compared. This trial was registered at http://clinicaltrials.gov (identifier NCT01163994). Results. At the 12 month visit, 4/82 (4.9%) multiple EM patients prescribed doxycycline and 6/88 (6.8%) multiple EM patients prescribed ceftriaxone showed incomplete response manifested predominantly as post-Lyme symptoms (1.9% difference, upper limit of 95% CI 5.1%). The upper limit of 95% CI for the difference in proportion of patients with incomplete response between doxycycline and ceftriaxone groups did not exceed the predetermined non-inferiority margin of 10%. The frequency of non-specific symptoms in patients was similar to that in controls. Conclusions. The 14 day oral doxycycline was not inferior to the 14 day intravenous ceftriaxone in treatment of adult European patients with EM. Comment: The findings of this large series enabled the selection of appropriate patients with EM and MEM for the reported project.
COBISS.SI-ID: 33621209