Background.The causes of post-Lyme disease symptoms are unclear. Herein, we investigated whether specific immune responses were correlated with such symptoms. Methods.The levels of 23 cytokines and chemokines, representative of innate and adaptive immune responses, were assessed in sera from 86 antibiotic-treated European patients with erythema migrans, 45 with post-Lyme symptoms and 41 without symptoms, who were evaluated prior to treatment and 2, 6, and 12 months thereafter. Results.At study entry, significant differences between groups were observed for the type 1 helper T cell (TH1)associated chemokines CXCL9 and CXCL10, which were associated with negative Borrelia cultures, and the type 17 helper T cell (TH17)associated cytokine interleukin 23 (IL-23), which was associated with positive cultures and the development of post-Lyme symptoms (P .02). Moreover, of the 41 patients with detectable IL-23 levels, 25 (61%) developed post-Lyme symptoms, and all 7 with IL-23 levels 230 ng/mL had such symptoms. Furthermore, antibody responses to the ECGF autoantigen were more common in patients with post-Lyme symptoms (P = .07) and were correlated directly with IL-23 levels (P = .02). Despite the presence of post-Lyme symptoms, all posttreatment culture results were negative, antiborrelial antibody responses declined, and there were no objective signs of disseminated disease, suggesting that spirochetal eradication had occurred with treatment in all patients. Conclusions.High TH1-associated responses correlated with more effective immune-mediated spirochetal killing, whereas high TH17-associated immune responses, often accompanied by autoantibodies, correlated with post-Lyme symptoms, providing a new paradigm for the study of postinfectious symptoms in a subset of patients with Lyme disease.
COBISS.SI-ID: 1184172
Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA) are endemic in central part of Slovenia. We tested the hypothesis that patients with erythema migrans (EM) from this region, who have leukopenia and/or thrombocytopenia (typical findings in HGA and in the initial phase of TBE but not in patients with LB) are coinfected with Anaplasma phagocytophilum and/or with TBE virus, i.e. that cytopenia is a result of concomitant HGA or the initial phase of TBE. Comparison of clinical and laboratory findings for 67 patients with EM who disclosed leukopenia/thrombocytopenia with the corresponding results in sex- and age-matched patients with EM and normal blood cell counts revealed no differences. In addition, patients with typical EM and leukopenia and/or thrombocytopenia tested negative for the presence of IgM and IgG antibodies to TBE virus by ELISA as well as for the presence of specific IgG antibodies to A. phagocytophilum antigens by IFA in acute and convalescent serum samples. Thus, none of 67 patients (95% CI: 0 to 5.3%) with typical EM (the presence of this skin lesion attests for early Lyme borreliosis and is the evidence for a recent tick bite) was found to be coinfected with A. phagocytophilum or had a recent primary infection with TBE virus. The findings in the present study indicate that in Slovenia, and probably in other European countries endemic for LB, TBE and HGA, patients with early LB are rarely coinfected with the other tick-transmitted agents.
COBISS.SI-ID: 1654700
A 49-year-old male, living in a Lyme borreliosis (LB) endemic region, noticed an erythematous skin rash about 10 days after a bite that in the next two weeks evolved to a ring-like skin lesion with diameters of 18 x 9 cm, i.e., presenting as typical erythema migrans (EM). The lesion disappeared spontaneously in five weeks, however, in the following two months the patient developed radicular pains, complete heart block that required insertion of transient heart pacemaker, and knee arthritis. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis. High levels of serum and CSF borrelial IgG antibodies and intrathecal production of the specific antibodies were ascertained, and treatment with ceftriaxone 2 g OD intravenously for 14 days was initiated. The patient regained his physical capacity, radicular chest pain and knee swelling declined and heart conduction abnormalities resolved. Pacemaker was removed during antibiotic treatment, and patient's further course was uneventful. The patient had all major manifestations of LB which could have been prevented if EM had been recognised and properly treated. However, instead of antibiotic treatment, the physician who saw the patient at the time of EM, ordered tests for the presence of borrelial antibodies, and misinterpreted negative serology as an indication against antibiotic treatment. LB is the most frequent tick-transmitted illness on the Northern hemisphere. It is caused by certain species of Lyme borreliae. In the present report epidemiology, etiology, mode of transmission, pathogenesis, clinical features, diagnosis and differential diagnosis, treatment and prevention of this emerging disease with increasing incidence are discussed. A 49-year-old male, living in a Lyme borreliosis (LB) endemic region, noticed an erythematous skin rash about 10 days after a bite that in the next two weeks evolved to a ring-like skin lesion with diameters of 18 x 9 cm, i.e., presenting as typical erythema migrans (EM). The lesion disappeared spontaneously in five weeks, however, in the following two months the patient developed radicular pains, complete heart block that required insertion of transient heart pacemaker, and knee arthritis. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis. High levels of serum and CSF borrelial IgG antibodies and intrathecal production of the specific antibodies were ascertained, and treatment with ceftriaxone 2 g OD intravenously for 14 days was initiated. The patient regained his physical capacity, radicular chest pain and knee swelling declined and heart conduction abnormalities resolved. Pacemaker was removed during antibiotic treatment, and patient's further course was uneventful. The patient had all major manifestations of LB which could have been prevented if EM had been recognised and properly treated. However, instead of antibiotic treatment, the physician who saw the patient at the time of EM, ordered tests for the presence of borrelial antibodies, and misinterpreted negative serology as an indication against antibiotic treatment. LB is the most frequent tick-transmitted illness on the Northern hemisphere. It is caused by certain species of Lyme borreliae. In the present report epidemiology, etiology, mode of transmission, pathogenesis, clinical features, diagnosis and differential diagnosis, treatment and prevention of this emerging disease with increasing incidence are discussed. A 49-year-old male, living in a Lyme borreliosis (LB) endemic region, noticed an erythematous skin rash about 10 days after a bite that in the next two weeks evolved to a ring-like skin lesion with diameters of 18 x 9 cm, i.e., presenting as typical erythema migrans (EM). The lesion disappeared spontaneously in five weeks, however, in the following two months the patient developed radicular pains, complete heart block that required insertion of transient heart pacemaker, and knee arthritis. Cerebrospinal fluid (CSF) analysis revealed lymp
COBISS.SI-ID: 1545388